Endemic juvenile hypothyroidism in a severe endemic goitre area of Sudan

The impact of juvenile hypothyroidism on stature

Short stature with different alterations in the skeletal appearance usually results from juvenile hypothyroidism. The present case-control study was conducted to assess the effect of thyroid hormone deficiency on the height of young people and the prevalence of short stature in juvenile hypothyroidism. The research was conducted at the Al-Waffa Diabetic Centre between May and September 2022. The study group included 90 children with short stature, while the control group included 58 children. The statistical analysis was conducted using Minitab version 20. The results revealed that a low serum level of triiodothyronine (T3) was present in 2.2% of participants, while a low serum level of thyroxin (T4) was present in 36.7%. All subjects had elevated serum thyroid stimulating hormone (TSH). Female children had increased rates of short stature. Juvenile hypothyroidism results in various skeletal manifestations, including reduced height. Low serum thyroxin coupled with high serum thyroid stimulating hormone are common findings in juvenile hypothyroidism.

The Role of Iodine for Thyroid Function in Lactating Women and Infants

Iodine is a micronutrient needed for the production of thyroid hormones, which regulate metabolism, growth, and development. Iodine deficiency or excess may alter the thyroid hormone synthesis. The potential effects on infant development depend on the degree, timing, and duration of exposure. The iodine requirement is particularly high during infancy because of elevated thyroid hormone turnover. Breastfed infants rely on iodine provided by human milk, but the iodine concentration in breast milk is determined by the maternal iodine intake. Diets in many countries cannot provide sufficient iodine, and deficiency is prevented by iodine fortification of salt. However, the coverage of iodized salt varies between countries. Epidemiological data suggest large differences in the iodine intake in lactating women, infants, and toddlers worldwide, ranging from deficient to excessive intake. In this review, we provide an overview of the current knowledge and recent advances in the understanding of iodine nutrition and its association with thyroid function in lactating women, infants, and toddlers. We discuss risk factors for iodine malnutrition and the impact of targeted intervention strategies on these vulnerable population groups. We highlight the importance of appropriate definitions of optimal iodine nutrition and the need for more data assessing the risk of mild iodine deficiency for thyroid disorders during the first 2 years in life.

Environmental Factors Affecting Thyroid-Stimulating Hormone and Thyroid Hormone Levels

Thyroid hormones are necessary for the normal functioning of physiological systems. Therefore, knowledge of any factor (whether genetic, environmental or intrinsic) that alters the levels of thyroid-stimulating hormone (TSH) and thyroid hormones is crucial. Genetic factors contribute up to 65% of interindividual variations in TSH and thyroid hormone levels, but many environmental factors can also affect thyroid function. This review discusses studies that have analyzed the impact of environmental factors on TSH and thyroid hormone levels in healthy adults. We included lifestyle factors (smoking, alcohol consumption, diet and exercise) and pollutants (chemicals and heavy metals). Many inconsistencies in the results have been observed between studies, making it difficult to draw a general conclusion about how a particular environmental factor influences TSH and thyroid hormone levels. However, lifestyle factors that showed the clearest association with TSH and thyroid hormones were smoking, body mass index (BMI) and iodine (micronutrient taken from the diet). Smoking mainly led to a decrease in TSH levels and an increase in triiodothyronine (T3) and thyroxine (T4) levels, while BMI levels were positively correlated with TSH and free T3 levels. Excess iodine led to an increase in TSH levels and a decrease in thyroid hormone levels. Among the pollutants analyzed, most studies observed a decrease in thyroid hormone levels after exposure to perchlorate. Future studies should continue to analyze the impact of environmental factors on thyroid function as they could contribute to understanding the complex background of gene-environment interactions underlying the pathology of thyroid diseases.

Plant constituents and thyroid: A revision of the main phytochemicals that interfere with thyroid function

In the past few decades, there has been a lot of interest in plant constituents for their antioxidant, anti-inflammatory, anti-microbial and anti-proliferative properties. However, concerns have been raised on their potential toxic effects particularly when consumed at high dose. The anti-thyroid effects of some plant constituents have been known for some time. Indeed, epidemiological observations have shown the causal association between staple food based on brassicaceae or soybeans and the development of goiter and/or hypothyroidism. Herein, we review the main plant constituents that interfere with normal thyroid function such as cyanogenic glucosides, polyphenols, phenolic acids, and alkaloids. In detail, we summarize the in vitro and in vivo studies present in the literature, focusing on the compounds that are more abundant in foods or that are available as dietary supplements. We highlight the mechanism of action of these compounds on thyroid cells by giving a particular emphasis to the experimental studies that can be significant for human health. Furthermore, we reveal that the anti-thyroid effects of these plant constituents are clinically evident only when they are consumed in very large amounts or when their ingestion is associated with other conditions that impair thyroid function.

Knowledge, attitude, and practice of iodized salt use in Al-Riyadh and Al-Ozozab areas, Khartoum, Sudan

Iodine deficiency and subsequent iodine deficiency disorders have been a longstanding problem in many areas of the world, including Sudan, and still remains as the leading cause of preventable brain damage. According to the Sudan Household Health Survey, in 2006, the consumption of iodized salt in Sudan was 11%, only to deteriorate later on in 2011 to 9.5%. This is a descriptive cross sectional study which assesses the knowledge, attitude, and practice regarding the use of iodized salt in two socioeconomically different residential areas, Al-Riyadh and Al-Ozozab, Khartoum city, Sudan. From total of 152 participants selected from Al-Riyadh and Al-Ozozab areas (50% from each), there were 87 (57 %) females. Participants from Al-Riyadh had a higher educational and income level than those from Al-Ozozab, and better knowledge regarding the importance of regular iodized salt consumption to treat iodine deficiency (61% and 54%, respectively). However, only 39% of the participants were actually buying iodized salt. There was a significant relationship between residency and buying of iodized salt among the participants from Al-Riyadh (49%) and Al-Ozozab (30%) areas (p-value = 0.02). There was also significant association between the educational level and buying iodized salt (p-value = 0.014), but not with the income (p-value = 0.23). The consumption of potential goitrogenic foods (pearl millet or peanut butter) was high among the participants (n = 142) from Al-Riyadh and Al-Ozozab, and constituted 76% and 83%, respectively. Compulsory national salt specification needs to be established in Sudan, together with monitoring the market availability of iodized salt.

Acceptance and Impact of Millet-Based Mid-Day Meal on the Nutritional Status of Adolescent School Going Children in a Peri Urban Region of Karnataka State in India

The study assessed the potential for use of millets in mid-day school meal programs for better nutritional outcomes of children in a peri-urban region of Karnataka, India, where children conventionally consumed a fortified rice-based mid-day meal. For a three-month period, millet-based mid-day meals were fed to 1500 adolescent children at two schools, of which 136 were studied as the intervention group and were compared with 107 other children in two other schools that did not receive the intervention. The intervention design was equivalent to the parallel group, two-arm, superiority trial with a 1:1 allocation ratio. The end line allocation ratio was 1.27:1 due to attrition. It was found that there was statistically significant improvement in stunting (p = 0.000) and the body mass index (p = 0.003) in the intervention group and not in the control group (p = 0.351 and p = 0.511, respectively). The sensory evaluation revealed that all the millet-based menu items had high acceptability, with the highest scores for the following three items: finger millet idli, a steam cooked fermented savory cake; little and pearl millet bisi belle bath, a millet-lentil hot meal; and upma, a pearl and little millet-vegetable meal. These results suggest significant potential for millets to replace or supplement rice in school feeding programs for improved nutritional outcomes of children.

Consequences of iodine deficiency and excess in pregnant women: an overview of current knowns and unknowns

Severe iodine deficiency during development results in maternal and fetal hypothyroidism and associated serious adverse health effects, including cretinism and growth retardation. Universal salt iodization is the first-line strategy for the elimination of severe iodine deficiency. Iodine supplementation is recommended for vulnerable groups in severely iodine-deficient regions where salt iodization is infeasible or insufficient. A recent clinical trial has informed best practices for iodine supplementation of severely iodine-deficient lactating mothers. Because of successful programs of universal salt iodization in formerly severely iodine-deficient regions around the world, public health concern has shifted toward mild to moderate iodine deficiency, which remains prevalent in many regions, especially among pregnant women. Observational studies have shown associations between both mild maternal iodine deficiency and mild maternal thyroid hypofunction and decreased child cognition. Iodine supplementation has been shown to improve indexes of maternal thyroid function, even in marginally iodine-deficient areas. However, no data are yet available from randomized controlled trials in regions of mild to moderate iodine insufficiency on the relation between maternal iodine supplementation and neurobehavioral development in the offspring; thus, the long-term benefits and safety of such supplementation are uncertain. Although it is clear that excessive iodine intake can cause alterations in thyroid function in susceptible individuals, safe upper limits for iodine intake in pregnancy have not been well defined. Well-designed, prospective, randomized controlled trials that examine the effects of iodine supplementation on maternal thyroid function and infant neurobehavioral development in mildly to moderately iodine-deficient pregnant women are urgently needed. In addition, clinical data on the effects of iodine excess in pregnant and lactating women are needed to inform current recommendations for safe upper limits on chronic iodine ingestion in general and on iodine supplementation in particular.

Endemic goitre in the Sudan despite long-standing programmes for the control of iodine deficiency disorders

OBJECTIVE

To describe the status of iodine deficiency disorders (IDDs) in the Sudan more than 25 years after the initiation of IDD control programmes and to explore the causes of endemic goitre in the country.

METHODS

Testing for IDDs was carried out in 6083 schoolchildren 6 to 12 years of age from the capital cities of nine states in different areas of the country using the three indicators recommended by the World Health Organization: the prevalence of goitre, laboratory measurements of urinary iodine concentration in casual urine samples and serum thyroglobulin (Tg) levels. Serum levels of thyroxine (T4), triiodothyronine (T3) and thyroid-stimulating hormone (TSH), as well as urinary secretion of thiocyanate, which can affect the transport of iodine into thyrocytes, were also measured.

FINDINGS

The prevalence of goitre in the different samples ranged from 12.2% to 77.7% and was 38.8% overall. The overall median urinary iodine concentration was 6.55 μg/dl, with the lowest median value having been found in Kosti city (2.7 μg/dl), situated in the centre of the country, and the highest (46.4 μg/dl) in Port Sudan, on the Red Sea coast. The highest mean serum Tg level (66.98 ng/ml) was found in Kosti city, which also had the highest prevalence of goitre.

CONCLUSION

IDDs still constitute a public health problem throughout urban areas in the Sudan and iodine deficiency appears to be the main etiological factor involved.

Nutritional Epidemiology and Thyroid Hormone Metabolism

Severe iodine deficiency was the main cause of endemic goiter and cretinism. Most of the previously iodine-deficient areas are now supplemented, mainly with iodized salt. The geographical distribution of severe endemic areas has been progressively reduced, and at present, approximately 200 million people living in remote places are still at risk of severe iodine deficiency. International public health programs should be focused first on reaching these populations, and second on auditing and monitoring the operational work of supplementation programs. This second point is essential to prevent iodine-induced hyperthyroidism or interruptions of iodine supplement distribution, which could be catastrophic for the fetus and the young infant. Echography brings a complementary tool to clinical assessment of goiter by palpation. Inductively coupled plasma-mass spectrometry brings at least a definitive gold standard for iodine measurement and thyroid hormone measurement. Thiocyanate overload has been clearly documented as a goitrogen in Central Africa, and when associated with selenium deficiency, it may be included as risk factor for endemic myxedematous cretinism. Variable exposure to different environmental risk factors is likely the explanation of the variable distribution of two types of endemic cretinism (neurological and myxedematous), and the clinical overlap of the pathogeny of both syndromes is more important than previously described. It is possible that Kashin-Beck osteoarthropathy is another evanescent endemic disease that will disappear with the correction of iodine deficiency.

Selenium and iodine supplementation of rural Tibetan children affected by Kashin-Beck osteoarthropathy

BACKGROUND

Kashin-Beck disease is an osteoarthropathy endemic in selenium- and iodine-deficient areas around Lhasa, Tibet.

OBJECTIVE

We assessed the efficacy of selenium supplementation on disease progression.

DESIGN

A double-blind, randomized controlled trial of selenium supplementation was carried out in 324 children aged 5-15 y who had Kashin-Beck disease. Two hundred eighty children received iodized oil before being randomly assigned to receive selenium or placebo, and a control group of 44 subjects was not supplemented at all. Clinical and radiologic signs, selenium status, urinary iodine, and thyroid function were evaluated at baseline and at 12 mo.

RESULTS

The frequencies of joint pain, decreased joint mobility, and radiologic abnormalities were not significantly different between the 3 groups at 12 mo. Height-for-age z scores increased significantly in the subjects who received placebo and iodine or selenium and iodine. In contrast, unsupplemented control subjects did not recover from growth retardation. Serum selenium concentrations at 12 mo were within the reference range and were significantly greater in the selenium-iodine group than in the placebo-iodine group. Serum thyroid hormone concentrations were within the reference ranges after the administration of iodine, and these values were not significantly affected by selenium supplementation.

CONCLUSIONS

The results of this study do not rule out the possibility that selenium may help to prevent the occurrence of Kashin-Beck disease. However, selenium supplementation had no effect on established Kashin-Beck disease, growth, or thyroid function once iodine deficiency was corrected. These results suggest that iodine, but not selenium, deficiency should be corrected in Tibetan children with Kashin-Beck disease.

Thyroid function in the newborn in relation to maternal thyroid status during labour in a mild iodine deficiency endemic area in Sudan

OBJECTIVES

Data on neonatal and maternal thyroid function during labour in a mild iodine deficiency endemic area are lacking. The current study focuses on elucidating the thyroid function during labour, in a group of pregnant women who live in an area of mild iodine deficiency in Sudan compared to that observed in their corresponding newborns.

MEASUREMENTS

Serum concentrations of TSH, thyroglobulin (Tg), triiodothyronine (T3) and free thyroxine (FT4) were investigated during labour in a group of mothers and their neonates residing in an area with mild iodine deficiency in Sudan (n = 76 mother-newborn pairs).

DESIGN

Maternal blood samples were taken on two occasions: first, during the third trimester of pregnancy (weeks 32-39); and, second, just before delivery. Cord blood samples were obtained by a doctor or a trained midwife during delivery.

RESULTS

The median concentrations (and interquartile ranges) of neonatal TSH, Tg, T3 and FT4 were 6.8 (4.7-12.4) mU/l, 61 (40.2-98.2) microg/l, 0.9 (0.8-1.2) nmol/l and 14.2 (13.4-15.9) pmol/l, respectively. The corresponding levels for the mothers during labour were 2.3 (1.9-3.2) mU/l, 33 (15.0-56.8) microg/l, 2.6 (2.0-2.9) nmol/l and 11.4 (10.3-13.3) pmol/l, respectively. The median neonatal serum concentrations of TSH, Tg and FT4 were significantly higher than the corresponding maternal levels (P < 0.0001, P < 0.0001, P < 0.0001, respectively). In contrast, the median maternal serum concentration of T3 was significantly higher than that of the neonates (P < 0.0001). When the different neonatal thyroid parameters were compared with each other, significant correlations were observed between TSH and FT4 (r = 0.4, P = 0.001); Tg and T3 (r = -0.3, P = 0.04) and Tg and FT4 (r = 0.5, P = 0.0001). Women with Tg concentrations above 20 microg/l showed a higher median TSH concentration and lower median FT4 concentration than those with Tg concentrations below 20 microg/l (P < 0.001, P < 0.001, respectively). Nevertheless, the thyroid function of neonates born of mothers with elevated Tg was similar to that of neonates born of mothers with low Tg levels. No significant changes had occurred in the thyroid function parameters between the third trimester of pregnancy and during the time of labour. The thyroid function indicators of the babies born by vaginal delivery did not differ significantly from those of the babies born by Caesarian section.

CONCLUSIONS

The study suggests that, in areas with mild iodine deficiency, neonates may be at the limit of decompensation as evidenced by their enhanced TSH and Tg levels as well as increased T4 compared to their mothers. This finding must not create a false sense of well-being and points rather to the urgency of iodine supplementation of mothers even in areas with mild iodine deficiency, as in this part of Sudan. The mode of delivery, whether by spontaneous vaginal delivery or Caesarian section, did not seem to affect the thyroid function of the newborn.

Traditional pharmacology and medicine in Africa. Ethnopharmacological themes in sub-Saharan art objects and utensils

Drawing from the general description that ethnopharmacology studies the human use of crude drugs and poisons in a traditional context, ethnopharmacological themes in native art can be defined as themes visualizing different features of traditional medicines and poisons, such as natural sources, methods of preparation, containers, usage and implements, target diseases and effects. This review documents that native African art objects and utensils are a goldmine of such ethnopharmacological themes by focusing on the following subjects: (a) objects related to the use of medicines (sources as well as tools for their collection, preparation and keeping); (b) objects related to the use of poisons (e.g. for ordeals, hunting and fishing); (c) objects related to the use of psychotropic agents (e.g. alcoholic beverages, kola nuts, smoking and snuffing materials); (d) pathological representations (e.g. treponematoses, leprosy, smallpox, swollen abdomen, scrotal enlargement, goiter and distorted faces); and (e) portrayals of certain types of treatment (e.g. topical instillations, perinatal care, and surgery). To avoid the impression that ethnopharmacology has little else to offer than armchair amusement, an epilogue outlines the medical relevance of this interdisciplinary science for Western and African societies.

Iodine nutrition in Sudan: determination of thyroid-stimulating hormone in filter paper blood samples

In this study we examined the technique of measuring thyroid-stimulating hormone (TSH) on filter paper blood samples for use in evaluating the iodine nutrition status of newborns and adults living in iodine-deficient areas. Filter paper blood samples were obtained between the 5th and 7th day after birth from 103, 43 and 103 term newborns living in Khartoum (mild iodine deficiency), Kosti (moderate iodine deficiency) and Darfur (severe iodine deficiency), respectively. TSH was measured with a commercial assay and the levels were compared with those obtained with the same method in 1147 samples from term Swedish newborns, obtained on the 3rd to the 5th day of life. The mean (95% confidence interval) TSH levels of the three Sudanese groups and the Swedish group were 7.1 (4.8-9.4), 8.3 (6.6-10.1), 11.9 (0.9-22.9) and 4.51 (3.8-5.3) mU l-1, respectively. The mean TSH for all three Sudanese groups was higher than the Swedish mean (p < 0.001). TSH levels determined in filter paper blood samples from adults living in an iodine-deficient area showed a correlation (p < 0.001; r = 0.55) to levels in corresponding serum samples (range 0.52-14.1 mU l-1, median 3.4 mU l-1). No significant correlation was found, however, between blood spot levels and serum levels within the reference range (< 5 mU l-1). A modification of the commercial procedure consisting in using three instead of two monoclonal antibodies did not sufficiently improve the assay for measurements of TSH within the reference range. Thus, there is a need to develop the filter paper technique further to make it a useful test for monitoring iodine deficiency in populations expected to have TSH levels close to the reference range. In the examination of neonates, however, with their birth-induced surge of TSH, the current assay promises to be a convenient tool for discovering iodine deficiency within a community.

Goiter prevalence in children immigrating from an endemic goiter area in Ethiopia to Israel

A survey study was performed to assess the prevalence of goiter and thyroid dysfunction in a population of 534 Ethiopian children, one year after arrival in Israel. The overall prevalence of goiter was 43.6%. Children in the age group 1-2 years had the lowest prevalence of goiter (6.7%). A progressive increase in goiter prevalence and size with age was observed, with peak occurrence around puberty for both boys (56.7%) and girls (72.2%). Serum FT4 levels were elevated in 4 children; elevated serum TSH levels (above 4.5 mIU/l) were found in 11 children, all of them had normal FT4 levels. Thus the prevalence of hypothyroidism and hyperthyroidism was 2% and 0.8%, respectively, with an even distribution across the various age groups. All the children were clinically normal. The high prevalence of goiter in this group of Ethiopian children with the low frequency of hypothyroidism may be attributed to the combined effects of food goitrogens and iodine deficiency prevailing in Ethiopia. The standard Israeli diet seems to be adequate in respect to iodine requirements, and no iodine enrichment is needed for children immigrating from Ethiopia.

The disorders induced by iodine deficiency

This paper reviews present knowledge on the etiology, pathophysiology, complications, prevention, and therapy of the disorders induced by iodine deficiency. The recommended dietary allowances of iodine are 100 micrograms/day for adults and adolescents, 60-100 micrograms/day for children aged 1 to 10 years, and 35-40 micrograms/day in infants aged less than 1 year. When the physiological requirements of iodine are not met in a given population, a series of functional and developmental abnormalities occur including thyroid function abnormalities and, when iodine deficiency is severe, endemic goiter and cretinism, endemic mental retardation, decreased fertility rate, increased perinatal death, and infant mortality. These complications, which constitute a hindrance to the development of the affected populations, are grouped under the general heading of iodine deficiency disorders (IDD). At least one billion people are at risk of IDD. Iodine deficiency, therefore, constitutes one of the most common preventable causes of mental deficiency in the world today. Most of the affected populations live in mountainous areas in preindustrialized countries, but 50 to 100 million people are still at risk in Europe. The most important target groups to the effects of iodine deficiency from a public health point of view are pregnant mothers, fetuses, neonates, and young infants because the main complication of IDD, i.e., brain damage resulting in irreversible mental retardation, is the consequence of thyroid failure occurring during pregnancy, fetal, and early postnatal life. The main cause of endemic goiter and cretinism is an insufficient dietary supply of iodine. The additional role of naturally occurring goitrogens has been documented in the case of certain foods (milk, cassava, millet, nuts) and bacterial and chemical water pollutants. The mechanism by which the thyroid gland adapts to an insufficient iodine supply is to increase the trapping of iodide as well as the subsequent steps of the intrathyroidal metabolism of iodine leading to preferential synthesis and secretion of triiodotyronine (T3). They are triggered and maintained by increased secretion of TSH, which is ultimately responsible for the development of goiter. The acceleration of the main steps of iodine kinetics and the degree of hyperstimulation by TSH are much more marked in the pediatric age groups, including neonates, than in adults, and the development of goiter appears as an unfavorable side effect in the process of adaptation to iodine deficiency during growth. The most serious complication of iodine deficiency is endemic cretinism, a syndrome characterized by irreversible mental retardation together with either a predominant neurological syndrome or predominant hypothyroidism, or a combination of both syndromes.(ABSTRACT TRUNCATED AT 400 WORDS)