[Experience of using phytopreparation Alba (root extract of the Potentilla alba) in complex treatment of thyroid pathology in children and adolescents].

This article presents the background for including phytopreparation Alba (root extract of the Potentilla alba) into complex treatment of thyroid pathology. The findings confirm visible reduction of size of the thyroid gland and normalizing its functions in children and adults with the thyroid gland with normal or enhanced function treated by Alba per oral.

Current status of iodine intake in Croatia--the results of 2009 survey.

In 1996, due to persistence of mild to moderate iodine deficiency, new law on obligatory salt iodination with 25 mg of potassium iodide (KI) per kg of salt was implemented in Croatia. Along with a new law, a new program for monitoring of iodine prophylaxis was implemented. Investigations of goiter and iodine intake performed in 2002, demonstrated sufficient iodine intake in Croatia with overall median of urinary iodine concentration (UIC) for schoolchildren in Croatia of 140 microg/L. In 2002, thyroid volumes (TV) measured by ultrasound in schoolchildren from all four geographic regions of Croatia were for the first time within the normal range according to ICCIDD reference values. Nowadays, Croatia is internationally recognized as iodine sufficient country. The aim of the present study was to assess current status of iodine intake in Croatia. The investigation was carried out in 2009. A total of 386 schoolchildren aged 7-10 years from all four major geographic regions of Croatia, 103 euthyroid pregnant women and 36 women of child-bearing age from Zagreb, the capital, were included in the survey. Urinary iodine concentration (UIC) was measured in all participants. Thyroid volumes were measured by ultrasound in schoolchildren from the capital of Zagreb (N = 101) and the village of Rude (N = 56). In the time period 2002-2009, the content of KI was analyzed in 384 salt samples from Croatian salt plants and samples of imported salt. An overall median UIC for schoolchildren in Croatia was 248 microg/L. Median UIC in pregnant women was 159 microg/L, with 50% of samples below and under 150 microg/L. Median UIC in women of child-bearing age was 136 microg/L. Thyroid volumes in schoolchildren were within the normal range according to the new reference values. Mean value of KI/kg of salt in samples from Croatian salt plants was 25.5 mg/kg and 24.9 mg/kg in samples of imported salt. A total of 72/384 (18.8%) of salt samples didn't corresponded to the Croatian law on obligatory salt iodination. Presented data indicate sufficient iodine intake of the Croatian population. Current medians of UIC in schoolchildren in Croatia are significantly higher than medians measured in 2002. This indicates that other potential sources of iodine are present in Croatian diet that may contribute to overall iodine intake. Due to rising medians of UIC in schoolchildren in Croatia, it is important to conduct nutrition studies to identify potential sources of "silent prophylaxis" in order to avoid iodine excess.

Tendencia de la nutrición de yodo durante las últimas décadas en escolares chilenos y sus consecuencias / Trend of iodine nutrition in recent decades and its consequences in Chilean schoolchildren

The endemic goiter, nutritional collective problem due to iodine deficience, constitutes a chronic disease with easy prevention and control, nevertheless still it constitutes a serious problem of public world health, being thought that about 650 million persons have goiter, 43 millions suffer from endemic cretinism and 1570 millions are in risk of suffering this disease for living in areas that present a deficit of iodine. Both patterns, deficit and the excess of iodine can conducted to a thyroid disease. The relation between the ingestion of iodine and the risk of disease corresponds to a U curve, where both, the low one and high ingestion of iodine it is associate to high risk of thyroid disease. To have a program of iodine supplementation, it should imply a constant vigilance of iodine nutrition to see its effect on the goiter prevalence in the population, to control his degree of fulfillment, to avoid a possible excess of ingestion of iodine it might help to correct any precocious alteration. Endemic goiter is not longer a problem in Chile. Salt iodination is in agreement with present legislation, but it is very important to have a continuous surveillance of iodine nutrition in Chile to control if salt fortification is appropiate.

Persistence of severe iodine-deficiency disorders despite universal salt iodization in an iodine-deficient area in northern India.

OBJECTIVE: The aim of the present study was to determine the impact of universal salt iodization (USI) on the prevalence of iodine deficiency in the population of an area previously known to have severe iodine deficiency in India. DESIGN: In a cross-sectional survey, a total of 2860 subjects residing in fifty-three villages of four sub-districts of Gonda District were examined for goitre and urinary iodine concentration. Free thyroxine and thyroid-stimulating hormone levels were also measured. Salt samples from households were collected for estimation of iodine content. RESULTS: A reduction in goitre prevalence was observed from 69 % reported in 1982 to 27.7 % assessed in 2007. However, 34 % of villages still had very high endemicity of goitre (goitre prevalence >30 %). Twenty-three per cent of households consumed a negligible amount (<5 ppm) and 56 % of households consumed an insufficient amount (5-15 ppm) of iodine from salt. CONCLUSIONS: Although there was an overall improvement in iodine nutrition as revealed by decreased goitre prevalence and increased median urinary iodine levels, there were several pockets of severe deficiency that require a more targeted approach. Poor coverage, the use of unpackaged crystal salt with inadequate iodine and the washing of salt before use by 90 % of rural households are the major causes of persisting iodine-deficiency disorders. This demonstrates lapses in USI implementation, lack of monitoring and the need to identify hot spots. We advocate strengthening the USI programme with a mass education component, the supply of adequately iodized salt and the implementation of complementary strategies for vulnerable groups, particularly neonates and lactating mothers.

[Alcoholization in the treatment of thyroid nodule in colloid goiter endemic region]. / Alcoolização de nódulo tiroidiano em região endêmica de bócio colóide.

Thyroid nodular disease is a common clinical disorder mainly in iodine lacking regions. This study has evaluated the effectiveness of percutaneous ethanol injection (PEI) in the treatment of single, multiple, solid, and cystic thyroid nodules of different sizes with or without glandular dysfunction, in goiter endemic region. Forty-two patients with diagnosis of colloid goiter or colloid nodular hyperplasia in fine-needle aspiration (FNA) were selected for analysis, after having been submitted to at least two PEI. Thyroid nodules were multiple (solid and or cystic) in 52.4% of the patients, single and solid or mixed in 35.7%, and single and cystic in 11.9%. The mean reduction of nodules after ethanol injection was of 58.2% in the single and of 60.8% in the cystic ones. The reduction of the whole thyroid lobe was evaluated in the multiple nodules and it reached 52.4%. The side-effects were registered only as a consequence of the application discomfort. This study points out that the percutaneous ethanol injection reaching volume mean reductions, varying from 49% to 60%, is a safe, effective, and simple method for the treatment of benign thyroid nodules.

Alcoolização de nódulo tiroidiano em região endêmica de bócio colóide / Alcoholization in the treatment of thyroid nodule in colloid goiter endemic region

A doença nodular tiroidiana é problema clínico comum, principalmente em regiões com carência de iodo. Esse estudo avaliou a eficácia da injeção percutânea de etanol (IPE) no tratamento de nódulos tiroidianos únicos, múltiplos, sólidos, císticos, de diferentes tamanhos com ou sem disfunção glandular, em região endêmica de bócio. Quarenta e dois pacientes com diagnóstico de bócio colóide ou hiperplasia nodular colóide, na punção biópsia aspirativa por agulha fina (PBAAF), foram selecionados para análise após terem sido submetidos a pelo menos duas IPEs. Os nódulos tiroidianos eram múltiplos (sólidos e ou císticos) em 52,4 por cento dos pacientes, únicos e sólidos ou mistos em 35,7 por cento e únicos e císticos em 11,9 por cento. A redução média dos nódulos após injeção de etanol foi de 58,2 por cento para os únicos e 60,8 por cento nos císticos. Nos nódulos múltiplos, avaliou-se a redução de todo o lobo tiroidiano, alcançando 52,4 por cento de redução. Os efeitos colaterais registrados foram decorrentes apenas do desconforto na aplicação. Este estudo indica que a injeção percutânea de etanol (IPE), alcançando reduções médias de volume que variam de 49 a 60 por cento, é método seguro, eficaz e simples para o tratamento de nódulos tiroidianos benignos.

Thyroid nodular disease is a common clinical disorder mainly in iodine lacking regions. This study has evaluated the effectiveness of percutaneous ethanol injection (PEI) in the treatment of single, multiple, solid, and cystic thyroid nodules of different sizes with or without glandular dysfunction, in goiter endemic region. Forty-two patients with diagnosis of colloid goiter or colloid nodular hyperplasia in fine-needle aspiration (FNA) were selected for analysis, after having been submitted to at least two PEI. Thyroid nodules were multiple (solid and or cystic) in 52.4 percent of the patients, single and solid or mixed in 35.7 percent, and single and cystic in 11.9 percent. The mean reduction of nodules after ethanol injection was of 58.2 percent in the single and of 60.8 percent in the cystic ones. The reduction of the whole thyroid lobe was evaluated in the multiple nodules and it reached 52.4 percent. The side-effects were registered only as a consequence of the application discomfort. This study points out that the percutaneous ethanol injection reaching volume mean reductions, varying from 49 percent to 60 percent, is a safe, effective, and simple method for the treatment of benign thyroid nodules.

Treatment of iodine deficiency in school-age children increases insulin-like growth factor (IGF)-I and IGF binding protein-3 concentrations and improves somatic growth.

CONTEXT: Iodine deficiency in utero impairs fetal growth, but the relationship between iodine deficiency and postnatal growth is less clear. OBJECTIVE: The objective of the study was to determine whether iodine repletion improves somatic growth in iodine-deficient children and investigate the role of IGF-I and IGF binding protein (IGFBP)-3 in this effect. DESIGN, PARTICIPANTS, AND INTERVENTIONS: Three prospective, double-blind intervention studies were done: 1) in a 10-month study, severely iodine-deficient, 7- to 10-yr-old Moroccan children (n = 71) were provided iodized salt and compared with children not using iodized salt; 2) in a 6-month study, moderately iodine-deficient, 10- to 12-yr-old Albanian children (n = 310) were given 400 mg iodine as oral iodized oil or placebo; 3) in a 6-month study, mildly iodine-deficient 5- to 14-yr-old South African children (n = 188) were given two doses of 200 mg iodine as oral iodized oil or placebo. At baseline and follow-up, height, weight, urinary iodine (UI), total T4 (TT4), TSH, and IGF-I were measured; in Albania and South Africa, IGFBP-3 was also measured. RESULTS: In all three studies, iodine treatment increased median UI to more than 100 microg/liter, whereas median UI in the controls remained unchanged. In South Africa, iodine repletion modestly increased IGF-I but did not have a significant effect on IGFBP-3, TT4, or growth. In Albania and Morocco, iodine repletion significantly increased TT4, IGF-I, IGFBP-3, weight-for-age z scores, and height-for-age z scores. CONCLUSION: This is the first controlled study to clearly demonstrate that iodine repletion in school-age children increases IGF-I and IGFBP-3 concentrations and improves somatic growth.

[Effect of chronic mild and moderate iodine excess on thyroid anti-oxidative ability of iodine deficiency and non-iodine deficiency Wistar rats].

OBJECTIVE: To investigate the effects of chronic mild and moderate iodine excess on thyroid oxidative injury and anti-oxidative ability of iodine deficiency and non-iodine deficiency Wistar rats. METHODS: Four-week-old Wistar rats were fed with iodine deficient diet for three months to make iodine deficient goiter models, then divided randomly into three groups: iodine deficient control group (Group IDC) fed with double distilled water, iodine-supplement group I (Group IS I) fed with potassium iodate solutions with the iodine concentrations of 100 microg/L, and iodine-supplement group II (Group IS II), fed with potassium iodate solution with the iodine concentrations of 330 microg/L. Another four-week-old Wistar rats were fed with normal diet for three months, and then divided randomly into three groups: normal control group (NC) fed with double distilled water, iodine-excess group I (IEI) fed with potassium iodate solution with the iodine concentration of 300 microg/L, and iodine-excess group II (Group IEII), fed with potassium iodate solution with the iodine concentration of 660 microg/L. 1, 2, 4, 8, and 24 weeks after treatment samples of urine were collected to detect the median urine iodine (MUI), samples of plasma were collected from the hearts of 8-14 rats from each group and then rats were killed. Their thyroid glands were taken out to measure the wet weight and made into homogenate. Biochemical method was used to measure the activities of glutathione-peroxidase (GSH-P(X)) and superoxide dismutase (SOD) as well as the contents of malonyldialdehyde (MDA) and H2O2 in the homogenates of thyroid glands. RESULTS: The GSH-P(X) activity 2 weeks after treatment of Group IS II was significantly lower than that of Group IDC (P < 0.05), and the GSH-P(X) activity 4 weeks after treatment of Group IS I was significantly lower than that of Group IDC (P < 0.001). The activities of GSH-P(X) 4, 8, and 24 weeks after treatment of Groups IS I and IS II were all lower than those of Group C at the same time points significantly (P < 0.001, < 0.01, and < 0.05 respectively). The activities of SOD were decreased gradually in Groups IS I and IS II and were significantly lower than those of Group IDC since 8 weeks after treatment (P < 0.001 or < 0.05). The SOD activities in thyroid glands of Groups IEI and IEII since 8 weeks after treatment decreased significantly in comparison with Group NC (all P < 0.01 or < 0.001). The contents of H2O2 in thyroid glands of Groups IS I and IS II were significantly lower than those of Group IDC at different time points (P < 0.001, < 0.01, or < 0.05), and were significantly lower than those of Group NC 8 and 24 weeks after treatment (P < 0.001 or < 0.01). The contents of MDA in thyroid glands since 2 weeks after treatment of Group IEI were all significantly lower than those of Group IDC at the same time points (all P < 0.05), and the content of MDA in thyroid glands since 1 week after treatment of Groups IS II were all significantly lower than those of Group IDC at the same time points (all P < 0.05). CONCLUSION: Supplementation of 100 microg/L and 330 microg/L iodine on iodine deficiency Wistar rats may alleviate the oxidative injury but weaken the anti-oxidative protection of thyroid. The anti-oxidative protection of thyroid glands of non-iodine deficiency Wistar rats may also be weakened by supplementation of 300 microg/L and 660 microg/L iodine.

[Ways of enhancing mentality in schoolchildren from an iodine-deficiency region].

Mentality was studied in 537 schoolchildren aged 7-8, 10-11, and 15-16 years who lived in an iodine-deficiency region. Its low level was found in 71% of the children. A comprehensive program was worked out and used to enhance the schoolchildren's mentality in iodine deficiency. It included the use of Iodomarine in a dose of 100 microg/day, lectures for and discussions with the children and their parents, dissemination of information materials on iodine deficiency and sequels. The program was implemented in the study group during an academic year. After prophylaxis, the sizes of the thyroid became normal in 21% of the children in the study group. There was a reduction in the number of patients with decreased attention, memory, and thinking from 49.8 to 20.7%, from 38.7 to 22.5%, and from 23.2 to 15.1%, respectively. Anxiety grade decreased in 14.7% of the pupils. A more beneficial effect was observed in junior-form pupils. The obtained results made it possible to define the informative indices of decreased mentality in schoolchildren due to iodine deficiency.

Chronic iodine overload and apoptosis in cold nodules from endemic multinodular goiters.

As apoptosis and necrosis are known to exist during experimental goiter development and involution, we studied them in ten Tunisian multinodular endemic goiters, five of them having received a chronic excess of iodine during six months. Apoptotic thyrocyte nuclei have been counted on hematoxylin-eosin stained semi-thin sections. Using immunoperoxidase on paraffin sections, bcl-2 and bax immunoreactivities have been evidenced, and CD34 positive microvessels counted; ultra-thin sections have also been observed. After six months of iodine overload, apoptotic thyrocytes were ten times more numerous; CD34 positive endothelial cells were diminished by one half bcl-2 immunoreactivity disappeared in thyrocytes and a bax one appeared in thyroid follicular and endothelial cells. Presence of numerous apoptotic follicular and endothelial cells was confirmed using electron microscopy. Chronic iodine excess induces apoptosis and necrosis of thyroid follicular and endothelial cells, leading to thyroglobulin accumulation in connective tissue.

[Iodine deficiency disorder persistance after introduction of iodized salt in a previously endemic goiter area]. / Persistencia de un trastorno por déficit de yodo tras la introducción de sal yodada en un área con antecedentes de bocio endémico.

OBJECTIVE: Correction of iodine deficiency diminishes the incidence of toxic nodular goitre. The aim of this study was to assess the etiology of thyrotoxicosis in two areas with different goitre prevalence in Galicia, fifteen years after the institutional campaign of salt iodination. Results of the present survey are compared with those from a study performed ten years ago. METHODS: Two hundred and two thyrotoxic patients attended in La Coruña (coastal zone) and Lugo (inland zone) from January 2000 to May 2002 were included. Clinical and exploratory data were recorded. Thyroid hormones, thyroid-directed antibodies and thyroid stimulating immunoglobulin (TSI) were measured. A thyroid 99m technetium or 123 iodine scintigram was performed. RESULTS: In the whole group 58.6% of the cases were diagnosed of nodular goitre, 30.3% of Graves disease, 7.1% of iodine induced thyrotoxicosis and 3.5% of subacute thyroiditis. In coastal zone these percentages were 52.2, 37.0, 5.4 and 4.3%, respectively. In the inland area, 64.2% nodular goitre, 24.5% Graves disease, 8.5% iodine induced thyrotoxicosis and 2.8% subacute thyroiditis. The most frequent diagnosis in both the whole group and in each area was toxic multinodular goitre. CONCLUSIONS: In some areas of Spain, toxic nodular goitre continues to be the most frequent cause of thyrotoxicosis. It is necessary to insist on implementation and monitoring of iodine supplementation programs.

[Diagnosis and treatment of benign goiter]. / Struma durch Jodmangel. So kriegen Sie den Kropf wieder klein.

Although the German population is now appreciably better supplied with iodine, this is still not adequate in all regions and in all situations, e.g. during pregnancy and breast feeding. As a result, more than 20 million Germans have an iodine-deficiency goiter that requires treatment. Investigation of a goiter is effected with sonography and the determination of serum TSH. If the results indicate euthyroid diffuse goiter, medical treatment should be initiated. In recent years, the combination of thyroid hormone and iodine has proved particularly effective. In contrast to monotherapy with levothyroxine goiter recurrence after discontinuation of treatment is less common, and the combination is usually tolerated better.

Predictive factors for recurrence after thyroid lobectomy for unilateral non-toxic goiter in an endemic area: results of a multivariate analysis.

BACKGROUND: The aim of the study was to identify the factors that are predictive of recurrence after thyroid lobectomy for unilateral non-toxic thyroid goiter in an endemic region through a multivariate analysis. METHODS: Two hundred sixty-eight consecutive patients who underwent thyroid lobectomy and who were evaluated by the same endocrinologist were included. Univariate and multivariate analysis analyzed the relationship between sex, age, preoperative thyroid-stimulating hormone, duration of disease, duration of levothyroxine (LT4) preoperative therapy, cytologic results, histologic results, resected thyroid weight, numbers and diameters of thyroid nodules, morphologic alterations of the remnant lobe, follow-up length, postoperative LT4 therapy, ultrasonographic evidence of recurrence, and reoperation. RESULTS: The incidence of recurrence was 33.9% (91/268 patients) after a mean follow-up time of 79.9 months (range, 12-251 months), female sex ( P = .016), multiple nodules ( P = .017), and lack of postoperative LT4 therapy ( P = .0009) were predictive factors of recurrence. Reoperation was performed in 20 patients (7.4%); factors that were predictive of reoperation were the presence of multiple nodules ( P = .008), resected thyroid weight ( P = .00006), and lack of postoperative hormonal therapy ( P = .0005). CONCLUSIONS: Thyroid lobectomy for unilateral non-toxic goiter, when combined with suppressive or substitutive thyroxin therapy, resulted in a low rate of recurrence and reoperation in an endemic area.

[Trends of mental and somatic diseases during therapy of endemic goiter]. / Dinamika psikhicheskikh i vegetativnykh narushenii na fone lecheniia endemicheskogo zoba.

The trend of mental and somatic diseases was studied in 70 patients with epidemic goiter (EG) treated with L-thyroxine or iodides during 1-5-year follow-up. Borderline mental disorders (diminished memory and attention, emotional and intellectual disorders) were found to be stable in these patients. The most delicate functions of the brain, such as the capacity for analysis and synthesis, are particularly vulnerable. Irrespective of the age of a patient, his/her educational level, occupation, the size of goiter, concrete rather than abstract logic thinking are prevalent in patients with EG. Drug treatment of EG only improves the patients' health status, but fails to eliminate evolving mental disorders even if the sizes of the thyroid can be brought to the normal values, the use of L-thyroxine is more effective that that of iodides.

[Comparative analysis of the efficacy of iodine prophylaxis in pregnant women living in endemic goiter areas]. / Sravnitel'nyi analiz éffektivnosti metodov iodnoi profilaktiki u beremennykh v usloviiakh zobnoi éndemii.

AIM: To assess efficacy of different methods of iodine prophylaxis in pregnant women living in conditions of goiter endemia. MATERIAL AND METHODS: Standard clinical, laboratory and device tests for iodine deficiency according to WHO criteria were made in 156 pregnant women living in the territory affected by goiter endemia. Of them, 121 examinees had no thyroid pathology, 35 ones had diffuse euthyroid goiter. All of them received different kinds of iodine prophylaxis. RESULTS: The occurrence of neonatal TTH values over 5 iU/l in neonates born by mothers free of thyroid pathology on potassium iodide prophylaxis when pregnant was 9.1%. This is much lower than in conventional iodine prophylaxis--17.24% (p < 0.01). A comparative analysis of the efficacy of potassium iodide-200 in pregnant women with diffuse euthyroid goiter and its combination with L-thyroxine has shown that by the effect on lessening frequency of neonatal TTH over 5 iU/l the above schemes do not differ significantly, thyroid reduction is more prominent in pregnant women on thyroxine with potassium iodide. CONCLUSION: The index of neonatal TTH is an objective criterium to control efficacy of different methods of iodine prophylaxis in pregnancy.

[The use of antioxidants in children with diffuse endemic goiter]. / Primenenie antioksidantov u detei s diffuznym éndemicheskim zobom.

Activity of lipid peroxidation and antioxidation activity was investigated in 33 children with endemic goiter in 13 children with chronic autoimmune thyroiditis bu the method of chemiluminescation of blood. The control group was consisted of 20 healthy children. Disbalance in the system "Lipid peroxidation-antioxidation activity" (LP-AOA) was revealed in 72% of children with endemic goiter and in 92% of children with chronic autoimmune thyroiditis. Vegetable antioxidant "Neonivit" and vitamin "Aevit" were used to used to correct the changes LP-AOA system in children with endemic goiter. The effect was received in 70% of cases that allows recommending these antioxidants in the complex treatment of endemic goiter.

Development of a dried whole-blood spot thyroglobulin assay and its evaluation as an indicator of thyroid status in goitrous children receiving iodized salt.

BACKGROUND: Serum thyroglobulin appears to be a sensitive marker of thyroid dysfunction in endemic goiter. However, its value as an indicator of thyroid status in children after the introduction of iodized salt has not been tested. OBJECTIVE: The objective was to optimize and validate a thyroglobulin assay on dried whole blood spots and to evaluate thyroglobulin as an indicator of thyroid response to iodized salt. DESIGN: A standardized, commercially available, sandwich fluoroimmunometric serum thyroglobulin assay was adapted for use on blood spots and validated in Swiss children. In a 1-y prospective study in 377 goitrous Moroccan children aged 6-15 y, the assay was used to measure thyroglobulin before and after the introduction of iodized salt. Urinary iodine, thyroid volume, thyrotropin, and thyroxine were measured, and regression was done with thyroglobulin as the dependent variable. RESULTS: Correlation between the blood spot and serum assays was excellent (r = 0.98). The SD of the difference between the blood spot and serum assays was 3.8 micro g/L; the median CVs for the blood spot assay in controls and samples were 6.3% and 14.4%, respectively. Median thyroglobulin was 24.5 (range: 0-328.8) micro g/L at baseline and fell significantly after the introduction of iodized salt to 6.2 (0-83.1) and 4.4 (0-47.1) micro g/L at 5 and 12 mo, respectively (P < 0.0001). Regression of urinary iodine and thyroid volume on thyroglobulin was highly significant at baseline and at 5 mo (P < 0.001). CONCLUSION: Thyroglobulin, measured in dried whole blood spots, may be a valuable indicator of improving thyroid function in children after supplementation with iodized salt.