Maternal and Fetal Thyroid Physiology.

This study was a brief review of maternal and fetal thyroid function and pathology during pregnancy.

Socio-demographic characters, distribution and transformation of iodine in soil, plant and wheat grains at District Diamer, Gilgit-Baltistan, Pakistan.

Iodine deficiency in soils and plants is a common problem in the hilly areas and has still been ignored. The aim of the current study is to investigate associated health issues, socio-economic characteristics and people's perception regarding iodine deficiency. Furthermore, a follow-up study was conducted to determine iodine and nutrients concentration in soil and crops at District Diamer, Gilgit-Baltistan, Pakistan. A descriptive and empirical analysis was examined. Most importantly, male was significantly observed as more affected for iodine deficiency than female, as contrary to the literature, socio-economic factors such as households' income and awareness (education) are reported as negative and significant contributor to reduce the iodine deficiency among the people irrespective of the gender. Majority of people (84%) heard about the iodine, but about 51.6% people argue that iodine has no effect on the human body and 56% of the respondents do not know why iodine is necessary for human. It was found that 11.5% of the community was affected from the IDD and majority of them were females. Wheat crops were the principal crop since it supplies 75% of calorific energy in an average Pakistani diet. The concentrations of iodine in soil samples range from 4.21 to 5.45 mg kg-1. The concentration of iodine in wheat crop plant sampled were considerably varied as Boner > Gais > Goher Abad with 1.12, 0.91 and 0.81 mg kg-1. respectively. Likewise, grain iodine concentration was varied as Gais > Boner > Goher Abad with 0.126, 0.102 and 0.078 mg kg-1, respectively. This study exposed that community using the cereal crops could face iodine deficiency in their diet which can cause endemic goiter among the population and control the iodine deficiency by empowering the rural community to raise the income level and providing the awareness to the people.

Epidemiology of goitre in Sri Lanka in the post-iodization era.

INTRODUCTION: Previous studies of goitre in Sri Lanka proposed the presence of a goitre belt, which was refuted subsequently. Epidemiology of goitre in the post iodization era needs re-evaluation. Objectives To describe the epidemiology of goitre in Sri Lanka. METHODS: A descriptive cross-sectional study was conducted in designated zones except in conflict areas in 2006/2007. An interviewer administered questionnaire was used and patients were evaluated clinically, biochemically and cytologically. RESULTS: Among 5200 participans 426 had goitre. Mean age was 36.3 (SD 17.3) years. Goitre was commonest in the age group 40-49 years with a female pre-ponderance. The prevalence was similar in all zones with pockets of high prevalence in each zone. Overall islandwide adjusted prevalence was 6.8% (95% CI = 6.0-7.6). CONCLUSIONS: There was no identifiable goitre belt.There were pockets of high prevalence in all zones. Goitre remains a public health issue despite universal iodization.

[From Geomorphological Research in the Canton of Aargau to European Military Pathologies. Entangling Anthropological Discourses of Crisis through the Army, 1860-1900]. / Von der Geomorphologie des Aargau zu den militärischen Pathologien Europas. Das Militär als Schnittpunkt anthropologischer Krisendiskurse, 1860-1900.

Military statistics and medical research were closely related over the 19th century. The army not only made use of these new forms of knowledge, but also provided an important institutional setting through the military medicine, which was of crucial importance to medical research in the 19th century. Besides that, Swiss military also played a crucial role in new geographical and geological research, resulting in a series of new mapping projects. This article looks on the ways, in which military context gained influence on scientific research practices in the second half of the 19th century, by analyzing the case of Heinrich Bircher's work on military recruiting statistics and the endemic goiter. New mapping projects and statistical practices were linked, transforming big parts of the country into pathological spaces. Coming from this point, the article discusses in how far the military context lead to politicizing medical discourses and, furthermore, linked them to discourses of an anthropological crisis, common in many European countries.

Status of iodine deficiency among pregnant mothers in Himachal Pradesh, India.

OBJECTIVE: Iodine is an essential micronutrient needed for the production of thyroid hormones. Pregnant mothers who are deficient in iodine provide less iodine to the fetal thyroid. This results in low production of thyroid hormones by the fetal thyroid, thereby leading to compromised mental and physical development of the fetus. The current study aimed to assess the current status of iodine nutrition among pregnant mothers in Himachal Pradesh, India, a known endemic region for iodine deficiency. DESIGN: Three districts, namely Kangra, Kullu and Solan, were selected. SETTING: In each district, thirty clusters (villages) were identified by utilizing the population-proportional-to-size cluster sampling methodology. In each cluster, seventeen pregnant mothers attending the antenatal clinics were included. SUBJECTS: A total of 1711 pregnant mothers (647 from Kangra, 551 from Kullu and 513 from Solan) were studied. Clinical examination of the thyroid of each pregnant mother was conducted. Spot urine samples were collected from ten pregnant mothers in each cluster. Similarly, salt samples were collected from eleven pregnant mothers in each cluster. RESULTS: Total goitre rate was 42·2 % (Kangra), 42·0 % (Kullu) and 19·9 % (Solan). The median urinary iodine concentration was 200 µg/l (Kangra), 149 µg/l (Kullu) and 130 µg/l (Solan). The percentage of pregnant mothers consuming adequately iodized salt (iodine content of 15 ppm and more) was found to be 68·3 % (Kangra), 60·3 % (Kullu) and 48·5 % (Solan). CONCLUSION: Pregnant mothers in Kullu and Solan districts had iodine deficiency as indicated by a median urinary iodine concentration less than 150 µg/l.

Bioavailability of iodine in the UK-Peak District environment and its human bioaccessibility: an assessment of the causes of historical goitre in this area.

Iodine is an essential micronutrient for human health. Its deficiency causes a number of functional and developmental abnormalities such as goitre. The limestone region of Derbyshire, UK was goitre-endemic until it declined from the 1930s and the reason for this has escaped a conclusive explanation. The present study investigates the cause(s) of goitre in the UK-Peak District area through an assessment of iodine in terms of its environmental mobility, bioavailability, uptake into the food chain and human bioaccessibility. The goitre-endemic limestone area is compared with the background millstone grit area of the UK-Peak District. The findings of this study show that 'total' environmental iodine is not linked to goitre in the limestone area, but the governing factors include iodine mobility, bioavailability and bioaccessibility. Compared with the millstone grit area, higher soil pH and calcium content of the limestone area restrict iodine mobility in this area, also soil organic carbon in the limestone area is influential in binding the iodine to the soil. Higher calcium content in the limestone area is an important factor in terms of strongly fixing the iodine to the soil. Higher iodine bioaccessibility in the millstone grit than the limestone area suggests that its oral bioaccessibility is restricted in the limestone area. Iodine taken up by plant roots is transported freely into the aerial plant parts in the millstone grit area unlike the limestone area, thus providing higher iodine into the human food chain in the millstone grit area through grazing animals unlike the goitre-prevalent limestone area.

Selenium deficiency a factor in endemic goiter persistence in sub-Saharan Africa.

BACKGROUND: Goiter is still common in Uganda, despite the present iodized salt coverage of at least 95%. Where there is endemic goiter after adequate iodine supplementation, selenium deficiency could be a factor for the continued occurrence of goiter. The objectives of the present study, therefore, were to determine the serum selenium levels among goitrous patients and nongoitrous controls and to determine the association between goiter and selenium levels among these patients. METHODS: The investigation was designed as a case control study in which 92 subjects were enrolled, 46 cases and 46 controls of similar age and sex distribution. Subjects were interviewed and examined. Blood samples were taken and selenium concentrations were determined by electrothermal atomic absorption spectrometry. RESULTS: The overall mean serum selenium levels were 77.25 µg/l (SD 16.78) for the goiter patients and 95.50 µg/l (24.47) for the nongoiter controls. The difference between goitrous and nongoitrous populations was statistically significant (p=0.0001). Selenium levels above 102.8 µg/l had a statistically significant protective effect against goiter with adjusted odds ratio 0.3 (0.13-0.69); p=0.005. Other factors, such as age, main food constituent, and use of iodized salt, had no association with goiter. CONCLUSIONS: There were significant differences between selenium levels among goitrous patients and nongoitrous controls. High selenium levels seem to have a protective effect against goiter. Selenium supplementation as a preventive strategy is worth further exploration.

Are pregnant women in New Zealand iodine deficient? A cross-sectional survey.

Severe iodine deficiency in pregnancy can result in cretinism. There is growing concern that less severe iodine deficiency may also affect fetal growth and development. A handful of prior small New Zealand studies focussed on pregnant women living in Dunedin. This study utilised biochemical, clinical and dietary indices to assess iodine status of 170 women living throughout New Zealand. The median urinary iodine concentration (UIC) of the women was 38 µg/L, well below the 150 µg/L cut-off value that indicates adequate iodine status; 7% of women had goitre. Not surprisingly, iodine intake was also low at 48 µg/day. The majority of women had TSH and FT4 concentrations within pregnant reference ranges, suggesting that despite the low UIC observed in these women, thyroid hormone production appeared unaffected.

Residual goiter in Semirom; iodine status and thiocyanate overload do not play a role.

This study was performed to investigate the role of thiocyanate overload in the etiology of endemic goiter in schoolchildren of Semirom, Iran. A total of 1828 schoolchildren were selected by multi-stage random sampling. Urinary iodine concentration (UIC) and urinary thiocyanate (USCN) were measured in a group of these children. The median UIC was 18.5 microg/dl. The mean +/- SD of USCN in goitrous and nongoitrous subjects did not differ significantly (0.75 +/- 0.78 mg/dl vs. 0.63 +/- 0.40 mg/dl; p = 0.30). Finally, we concluded that neither iodine deficiency nor thiocyanate overload contributed to the high prevalence of goiter in Semirom. The role of other goitrogenic factors should be investigated in this region.

Is Gippsland environmentally iodine deficient? Water iodine concentrations in the Gippsland region of Victoria, Australia.

OBJECTIVE: This paper provides evidence of environmental iodine deficiency in the Gippsland region. DESIGN: Quantitative study; water samples were collected from 18 water treatment plants and four rain water tanks across Gippsland and water iodine concentrations were measured. SETTING: Gippsland region of Victoria, Australia. MAIN OUTCOME MEASURES: This paper reports on the iodine concentration of drinking water from sources across Gippsland and examines the contribution of iodine from water to the Gippsland diet. This study also briefly examines the relationship between the concentration of iodine in water and distance from the sea. The cut-off value for water iodine concentrations considered to be indicative of environmental iodine deficiency is <2 µg L(-1) . RESULTS: The mean iodine concentration of water from 18 Gippsland water treatment plants was 0.38 µg L(-1) and would therefore make negligible difference to the dietary intake of iodine. This finding also falls well below the suggested dietary intake of iodine from water estimated by the 22nd Australian Total Diet Study. Our study found no linear relationship between the water iodine concentration and distance from the sea. CONCLUSION: As Gippsland has environmental iodine deficiency there is a greater probability that people living in this region are at higher risk of dietary iodine deficiency than those living in environmentally iodine sufficient regions. Populations living in areas known to have environmental iodine deficiency should be monitored regularly to ensure that problems of iodine deficiency, especially amongst the most vulnerable, are addressed promptly.

Insulin-like growth factor-1 and zinc status of goitrous primary-school children in Arak, Islamic Republic of Iran.

Despite a successful national salt iodinization programme, endemic goitre still persists in Iranian children. In a cross-sectional study in Arak the prevalence of goitre was 5.2% in a sample of 6520 primary-school children. Subsamples of 193 children with goitre and 151 healthy children were assessed for urinary iodine excretion, thyroid hormone profile, insulin-like growth factor-1 (ICF-1) and serum zinc. The mean urinary iodine levels of goitrous children and healthy children were 17.4 microg/dL and 15.3 microg/dL respectively, suggesting that iodine consumption was adequate. No significant differences were found between goitrous and healthy schoolchildren in mean levels of urinary iodine, serum IGF-1 or serum zinc. Other factors need be evaluated to, explain the residual prevalence of goitre.

The role of thyroid autoantibodies in the etiology of endemic goiter in schoolchildren of Isfahan, Iran.

BACKGROUND: Eleven years after the initiation of universal salt iodization program in Iran, the prevalence of goiter is still high in some areas. AIM: To investigate the role of thyroid autoimmunity in the etiology of residual goiter in schoolchildren of Isfahan, Iran. MATERIAL AND METHODS: In a cross-sectional study, 2331 schoolchildren were selected by multi-stage random cluster sampling. Thyroid size was estimated in each child by inspection and palpation. Urinary iodine concentration (UIC), serum anti-thyroperoxidase antibody (anti-TPO Ab), and anti-thyroglobulin antibody (Anti-Tg Ab) were measured. RESULTS: Overall, 32.9% of children had goiter. The median UIC was 1955.5 microg/dl. There was significant difference in prevalence of positive anti-TPO Ab in goitrous (grade 2) and non-goitrous children (9.7 vs 3.7%, p= 0.02). Goitrous children had higher prevalence of positive anti-Tg Ab than non-goitrous ones (15.1 vs 3.1%, p<0.001). CONCLUSIONS: According to the present study, goiter is still a public health problem in this region. This study suggests that thyroid autoimmunity is among the contributors of goiter persistence after elimination of iodine deficiency in Isfahan.

Vitamin A status does not contribute to the residual goiter in schoolchildren of Isfahan, an iodine replenished area.

Two thousand three hundred and thirty-one schoolchildren were selected by multi-stage random sampling. The thyroid size was estimated by inspection and palpation. The urinary iodine concentration and serum retinol (SR) were measured in 454 and 468 schoolchildren, respectively. Overall, 32.9% of 2,331 children had goiter. The median urinary iodine concentration was 195.5 microg/l. The mean+/-standard deviation of SR in goitrous and non-goitrous children was 34.84+/-7.28 microg/dl and 33.73+/-7.87 microg/dl, respectively (P=0.14). There was no child with vitamin A deficiency (SR <20 microg/dl) in both the goitrous and non-goitrous groups. The prevalence of subjects with low vitamin A status (SR <30 microg/dl) in the goitrous and non-goitrous groups was 27.7% and 33.3%, respectively (P=0.21). In conclusion, the present study reveals that vitamin A deficiency and low vitamin A status are not among the contributing factors of goiter persistence in the studied area, and the role of other responsible factors should be investigated.

Iodine: deficiency and therapeutic considerations.

Iodine deficiency is generally recognized as the most commonly preventable cause of mental retardation and the most common cause of endocrinopathy (goiter and primary hypothyroidism). Iodine deficiency becomes particularly critical in pregnancy due to the consequences for neurological damage during fetal development as well as during lactation. The safety of therapeutic doses of iodine above the established safe upper limit of 1 mg is evident in the lack of toxicity in the Japanese population that consumes 25 times the median intake of iodine consumption in the United States. Japan's population suffers no demonstrable increased incidence of autoimmune thyroiditis or hypothyroidism. Studies using 3.0- to 6.0-mg doses to effectively treat fibrocystic breast disease may reveal an important role for iodine in maintaining normal breast tissue architecture and function. Iodine may also have important antioxidant functions in breast tissue and other tissues that concentrate iodine via the sodium iodide symporter.

Dietary supplies of iodine & thiocyanate in the aetiology of endemic goitre in Imphal East district of Manipur, north east India.

BACKGROUND & OBJECTIVE: The present investigation was undertaken to study the iodine nutritional status of school children of Imphal east district in Manipur where endemic goitre persists during post-salt iodization phase along with the investigation of the factors responsible for the occurrence of goitre endemicity. METHODS: A total of 1,286 children (6-12 yr) were clinically examined for goitre from study areas of Imphal east district. A total of 160 urine samples were collected and analyzed to measure urinary iodine and thiocyanate levels. Iodine content was measured in 140 salt samples and 16 drinking water samples. RESULTS: Overall goitre prevalence was about 30 per cent (grade 1-24.7%; grade 2-5.3%) and median urinary iodine level was 17.25 microg/dl. The mean urinary thiocyanate level was 1.073 +/- 0.39 mg/dl. Iodine/thiocyanate ratio (microg/mg) was in the ranges from 15.65 to 22.34. The mean iodine content in drinking water samples was 2.92 +/- 1.75 microg/l and 97.8 per cent of edible salts had iodine level above 15 ppm at the consumption point. INTERPRETATION & CONCLUSION: Our findings showed that in spite of no biochemical iodine deficiency, iodine deficiency disorders (IDD) is a serious public health problem in Imphal east district of Manipur. The consumption pattern of certain plant foods containing thiocyanate (or its precursors) was relatively high that interfere with thyroid hormone synthesis resulting in the excretion of more iodine. Thus, the existing dietary supplies of thiocyanate in relation to iodine may be a possible aetiological factor for the persistence of endemic goitre in the study region during post salt iodization period.

High-nitrate levels in drinking water may be a risk factor for thyroid dysfunction in children and pregnant women living in rural Bulgarian areas.

Nitrate inhibits the accumulation of iodide in thyroid gland. The aim of present study was to evaluate the influence of this ion on the iodine status of two risk population groups. Subjects of study were pregnant women and children aged between 3 and 6 years from two villages in Bulgaria with high- and low-nitrate levels in drinking water. The relative risk of thyroid disorders for the pregnant women living in the village with high-nitrate levels in drinking water expressed as an odds ratio was 5.294 (95% confidence intervals 1.003-27.939; P=0.0454) and was considered as significant. Statistically significant differences were found between the goiter rate in exposed and non-exposed pregnant women. The relative risk of thyroid dysfunction for the children exposed to a high-nitrate level, expressed as an odds ratio was 2.333 (95% confidence intervals 0.8491-6.412; P=0.1396) and was considered as not significant; the goiter prevalence in the exposed children was also not statistically different. The results of the study confirmed the role of high-nitrate level in drinking water as a risk factor for thyroid dysfunction in vulnerable population groups.

Endemic goiter in Semirom; there is no difference in vitamin A status between goitrous and nongoitrous children.

BACKGROUND: Despite long-standing iodine supplementation in Iran, the prevalence of goiter remains high in some areas. This suggests other nutritional deficiencies may be considered as responsible factors for goiter persistence. In the present study we investigated the possible role of vitamin A deficiency (VAD) and low vitamin A status in the etiology of endemic goiter in Semirom, Iran. MATERIALS AND METHODS: In this cross-sectional study, 1,828 students from 108 primary schools of urban and rural areas of Semirom were selected by multistage random cluster sampling. Thyroid size was estimated in each child by inspection and palpation. Urinary iodine concentration (UIC) and serum retinol (SR) were measured. RESULTS: Overall, 36.7% of schoolchildren had goiter. The median UIC was 18.5 microg/dL. The mean+/-SD of SR in goitrous and nongoitrous children was 38.84+/- 10.98 and 39.17+/-10.85 microg/dL respectively (p=0.82). There were two children with VAD (SR less than 20 microg/dL); one in the goitrous and one in the nongoitrous group. The prevalence of subjects with low vitamin A status (SR less than 30 microg/dL) in the goitrous and nongoitrous groups was 26.2 and 21.5% respectively (p=0.42). CONCLUSION: Goiter is still a public health problem in this region. Iodine deficiency, VAD or low vitamin A status is not among the contributors of goiter persistence in schoolchildren of Semirom. The role of other micronutrient deficiencies or goitrogens should be investigated.

Endemic goiter and iodine deficiency status among Guinea-Bissau school-age children.

BACKGROUND/OBJECTIVES: Iodine deficiency disorders are estimated to affect 25% of all school-age children around the world. Current policies concerning iodine deficiency disorders in many countries are not based on robust or recent national data. Our objective was to evaluate the current status of iodine nutrition in Guinea-Bissau (West Africa). SUBJECT/METHODS: A cross-sectional survey including 299 school-age children, aged 6-14 years old, from four distinct regions of Guinea-Bissau across a coast-hinterland gradient (Bolama, Bissau, Cambaju-Bafatá, and Gabú) was performed. Several iodine deficiency disorders indicators were used: total goiter rate, median urinary iodine concentration (UIC) and regional iodine content in household salt and drinking water samples. Data on the total goiter rate were obtained by thyroid ultrasound. RESULTS: Goiter was found in 73.5% (CI 95%, 68.5-78.2%) of the school-age children. We observed a median urinary iodine concentration of 110 mcg/l, with 7.3% of the studied population presenting urinary iodine concentration < 50 mcg/l. Only 12.5% of the household salt samples revealed iodine content ≥ 15 mg/kg. Median well water iodine concentration was 11.7 mcg/l. CONCLUSIONS: Guinea-Bissau presents high rates of goiter in school-age children despite satisfactory median urinary iodine concentration population levels. Salt and drinking water iodine median content cannot explain these findings. Further studies following the progress in iodine deficiency status and the presence of potential goitrogens in diet of this vulnerable population are in needed.