[From scientific research to health policy design: the experience of iodine deficiency elimination in Peru]. / De la investigación científica al diseño de políticas de salud: la experiencia con la eliminación de la deficiencia de yodo en Perú.

Scientific research is an essential public health function, enabling recognition of problems that compromise health and facilitating solutions. Research is essential to formulate health policy at a national level. There has been significant but inconsistent overall progress, due to economic conditions in low- and middle-income countries. An example that illustrates this situation is the investigation of iodine deficiency (ID) in Peru, and the application of the results for development of a public health program. The research demonstrated persistent ID, which causes fetal brain damage and subsequent mental retardation. The use of iodinated oil to prevent and treat ID was shown to have an immediate and long-term effect, and confirmed that urinary concentration of iodine was the best indicator of iodine intake. These results were accepted by the Ministry of Health, and the National Program for the Control of Endemic Goiter and Cretinism was created in 1983, achieving virtual elimination of ID by 1995.

La investigación científica es una función esencial en salud pública; permite reconocer problemas y situaciones que comprometen la salud y la identificación de soluciones. La investigación es esencial para formulación de políticas desalud. Es imperativo para los países tener sistemas nacionales de investigación. Últimamente, ha habido un significativo avance global, pero el crecimiento no es uniforme, las condiciones son escasas en países con ingresos medianos y bajos. Una experiencia que ilustra esta situación ha sido la investigación de la deficiencia de yodo (DI) en Perú y la aplicación de resultados para la creación de un programa de salud pública. La investigación demostró persistente DI, que durante la gestación causa daño cerebral y retardo mental, que el uso de aceite yodado en la prevención y tratamiento tiene efecto inmediato y larga duración, y validó la concentración urinaria del yodo como el mejor indicador de nutrición de yodo. Estos resultados fueron tomados en cuenta por el Ministerio de Salud y en 1983 se creó el Programa Nacional de Control del Bocio y Cretinismo Endémicos, que ha logrado la eliminación virtual de la DI desde 1995.

Eliminación y prevención de la deficiencia de yodo en mujeres gestantes de Perú / Elimination and prevention of iodine deficiency in pregnant women from Peru

RESUMEN La deficiencia de yodo (DI) causa daño a través de todos los ciclos de la vida, la vulnerabilidad es mayor durante la gestación y la infancia. La yodación universal de la sal (IUS) para consumo humano es la estrategia más costo-efectiva y sostenible para su control. Perú ha logrado la eliminación sostenida de los desórdenes por deficiencia de yodo (DDI) desde 1994. Objetivo: Determinar la efectividad del programa nacional de control de los DDI y la estrategia IUS para satisfacer el mayor requerimiento de yodo y asegurar la nutrición óptima de yodo de las mujeres embarazadas de la sierra, una región con severa deficiencia natural de yodo. Material y Métodos: El estudio ha incluido a 489 mujeres embarazadas de la sierra, seleccionadas entre las asistentes a control pre natal en los centros asistenciales. En cada sujeto se verificó el consumo de sal yodada y se colectó una muestra casual de orina para el análisis de la concentración de yodo y creatinina. Resultados: Según la encuesta de admisión el 99.6 % de los hogares consumen sal yodada. La mediana global de la concentración urinaria de yodo (CUI) 209 µg/L está dentro del rango adecuado para gestantes y demuestra un estado nutricional de yodo normal. La concentración de creatinina en la orina es normal. Conclusión: Estos resultados confirman la eficiencia y el éxito del programa nacional para la eliminación sostenida de los DDI, garantizando la nutrición normal de yodo durante la gestación y, por lo tanto, previniendo el riesgo de daño cerebral de los recién nacidos cada año en la sierra.

ABSTRACT Iodine is an essential element for synthesizing thyroid hormones, it is also essential for cell metabolism and tissue development, especially in the brain. Iodine requirements are higher during pregnancy and lactation. Iodine deficiency (ID) is a widespread condition all over the world; it is frequent in Peruvian highlands and rainforest. ID causes damage in all life periods, and vulnerability for this is greater during pregnancy and infancy. Universal salt iodination (USI) for human use is the most cost-effective and sustainable strategy for controlling ID. Peru has achieved the sustained elimination of iodine deficiency disorders (IDD) since 1994. Objective. To determine the effectiveness of the national program for controlling IDDs and the USI strategy for complying with the increased iodine requirement and to assure optimal iodine nutrition in pregnant women from the Peruvian highlands, a region with severe natural iodine deficiency. Material and Methods. The study included 489 pregnant women from the highlands, who were selected from those attending prenatal assessment in healthcare centers. Iodinated salty consumption was verified in each subject and a casual urine sample was collected for measuring iodine and creatinine concentration. Results. According to the admission survey, 99.6% of household use iodinated salt. The overall mean of iodine urine concentration (IUC) was 209 µg/L, which is well within the adequate range for pregnant women, and it shows a normal iodine nutrition status. The creatinine urinary concentration was normal. Conclusion. These results confirm the efficiency and success of the national program for the sustained elimination of IDDs, assuring normal iodine nutritional supply during pregnancy; and, therefore, preventing the risk for brain damage in newborns every year in the highlands.

Assessment of iodine status using dried blood spot thyroglobulin: development of reference material and establishment of an international reference range in iodine-sufficient children.

CONTEXT: Thyroglobulin (Tg) may be a valuable indicator of improving thyroid function in children after salt iodization. A recently developed Tg assay for use on dried whole blood spots (DBS) makes sampling practical, even in remote areas. OBJECTIVE: The study aim was to develop a reference standard for DBS-Tg, establish an international reference range for DBS-Tg in iodine-sufficient children, and test the standardized DBS-Tg assay in an intervention trial. DESIGN, PARTICIPANTS, AND INTERVENTIONS: Serum Tg reference material of the European Community Bureau of Reference (CRM-457) was adapted for DBS and its stability tested over 1 yr. DBS-Tg was determined in an international sample of 5- to 14-yr-old children (n = 700) who were euthyroid, anti-Tg antibody negative, and residing in areas of long-term iodine sufficiency. In a 10-month trial in iodine-deficient children, DBS-Tg and other indicators of iodine status were measured before and after introduction of iodized salt. RESULTS: Stability of the CRM-457 Tg reference standard on DBS over 1 yr of storage at -20 and -50 C was acceptable. In the international sample of children, the third and 97th percentiles of DBS-Tg were 4 and 40 microg/liter, respectively. In the intervention, before introduction of iodized salt, median DBS-Tg was 49 microg/liter, and more than two thirds of children had DBS-Tg values greater than 40 microg/liter. After 5 and 10 months of iodized salt use, median DBS-Tg decreased to 13 and 8 microg/liter, respectively, and only 7 and 3% of children, respectively, had values greater than 40 microg/liter. DBS-Tg correlated well at baseline and 5 months with urinary iodine and thyroid volume. CONCLUSIONS: The availability of reference material and an international reference range facilitates the use of DBS-Tg for monitoring of iodine nutrition in school-age children.

New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group Report.

BACKGROUND: Goiter prevalence in school-age children is an indicator of the severity of iodine deficiency disorders (IDDs) in a population. In areas of mild-to-moderate IDDs, measurement of thyroid volume (Tvol) by ultrasound is preferable to palpation for grading goiter, but interpretation requires reference criteria from iodine-sufficient children. OBJECTIVE: The study aim was to establish international reference values for Tvol by ultrasound in 6-12-y-old children that could be used to define goiter in the context of IDD monitoring. DESIGN: Tvol was measured by ultrasound in 6-12-y-old children living in areas of long-term iodine sufficiency in North and South America, central Europe, the eastern Mediterranean, Africa, and the western Pacific. Measurements were made by 2 experienced examiners using validated techniques. Data were log transformed, used to calculate percentiles on the basis of the Gaussian distribution, and then transformed back to the linear scale. Age- and body surface area (BSA)-specific 97th percentiles for Tvol were calculated for boys and girls. RESULTS: The sample included 3529 children evenly divided between boys and girls at each year ( +/- SD age: 9.3 +/- 1.9 y). The range of median urinary iodine concentrations for the 6 study sites was 118-288 micro g/L. There were significant differences in age- and BSA-adjusted mean Tvols between sites, which suggests that population-specific references in countries with long-standing iodine sufficiency may be more accurate than is a single international reference. However, overall differences in age- and BSA-adjusted Tvols between sites were modest relative to the population and measurement variability, which supports the use of a single, site-independent set of references. CONCLUSION: These new international reference values for Tvol by ultrasound can be used for goiter screening in the context of IDD monitoring.

Iodine nutrition improves in Latin America.

Iodine deficiency has been a public health problem in most Latin American countries. Massive programs of salt iodization have achieved great progress toward its elimination but no consistent monitoring has been applied. We used the ThyroMobil model to visit 163 sites in 13 countries and assess randomly selected schoolchildren of both genders 6-12 years of age. The median urinary iodine concentration (8208 samples) varied from 72 to 540 microg/L. One national median was below the recommended range of 100-200 microg/L; five were 100-200 microg/L, and seven were higher than 200 microg/L, including three greter than 300 microg/L. Urinary iodine concentration correlated with the iodine content of salt in all countries. Median values of thyroid volume were within the normal range for age in all countries, but the goiter prevalence varied markedly from 3.1% to 25.0% because of scatter. The median iodine content of salt from local markets (2734 samples) varied from 5.9 parts per million (ppm) to 78 ppm and was greater than 15 ppm in 83.1% of all samples. Only seven countries had higher than 15 ppm iodine in 80% of the samples, and only three had greater than 15 ppm in at least 90%. Iodized salt was available at retail level in all countries but its median iodine content was within the recommended range (20-40 ppm) in only five. This study, the first to apply a standardized assessment strategy to recent iodine nutrition in Latin America, documents a remarkable success in the elimination of iodine deficiency by iodized salt in all but 1 of the 13 countries. Some iodine excess occurs, but side effects have not been reported so far, and two countries have already decreased their legal levels of salt iodization and improved the quality control of iodized salt, in part because of our results. The present work should be followed by regular monitoring of iodine nutrition and thyroid function, especially in the countries presently exposed to iodine excess.

[Iodine content of cattle milk from mountain and coast from Perú]. / Contenido de yodo en leche de vacuno procedente de la Sierra y Costa del Perú.

With the objective to establish the cause-effect relationship between a geological area and the iodine content in cattle milk, and to estimate the contribution of milk consumption to the dietary iodine intake, the iodine content in cattle milk from the sierra and the coastal regions of Perú was determined. Milk samples were collected of cows from the three main productive zones of Perú, 62 in Cajamarca, 42 in Arequipa, both in the sierra, and 27 in Lima at the coast. The measurement of iodine was made by the method of Zak, based on the Sandell- Kolthoff reaction. The median values obtained were 24 microg/L in Cajamarca, 34 microg/L in Arequipa, and 170 microg/L in Lima. The median value in the sierra, 26 microg/L, was significantly lower than the one found in the coast. Moreover, while in the former 81% of individual values were below 50 microg/L, in the latter, on the contrary, 77% were above 80 microg/L. These results confirm that the iodine content in cattle milk is related to ecological factors. At the same time, they demonstrate that the iodine content in milk from the sierra is six times lower than in milk from the coast, and also that its consumption does not contribute significantly to satisfy the human physiological requirements of iodine in that zone.

Thyroglobulin is a sensitive measure of both deficient and excess iodine intakes in children and indicates no adverse effects on thyroid function in the UIC range of 100-299 µg/L: a UNICEF/ICCIDD study group report.

CONTEXT: The median urinary iodine concentration (UIC) is a biomarker of iodine intake. According to the World Health Organization, a median UIC in the range 100-199 µg/L indicates adequate and 200-299 µg/L more than adequate intake. Thyroglobulin (Tg) may be a promising functional biomarker of both iodine deficiency and excess. OBJECTIVES: Using a standardized dried blood spots-Tg assay in children, we evaluated the Tg response to both low- and high-iodine intake and estimated the population cutoff point for iodine deficiency or excess. Also, we compared thyroid functions within the UIC ranges of 100-199 vs 200-299 µg/L. DESIGN AND SETTING: We conducted a cross-sectional study in primary schools in 12 countries. SUBJECTS: SUBJECTS were 6 to 12 years old (n = 2512). MAIN OUTCOME MEASURES: We measured UIC, TSH, total T4, Tg, and thyroid antibodies. RESULTS: Over a range of iodine intakes from severely deficient to excessive, Tg concentrations showed a clear U-shaped curve. Compared with iodine-sufficient children, there was a significantly higher prevalence of elevated Tg values in children with iodine deficiency (UIC <100 µg/L) and iodine excess (UIC >300 µg/L). There was no significant change in the prevalence of elevated Tg, TSH, T4, or thyroid antibodies comparing children within the UIC ranges of 100-199 vs 200-299 µg/L. CONCLUSIONS: In school-aged children, 1) Tg is a sensitive indicator of both low and excess iodine intake; 2) a median Tg of <13 µg/L and/or <3% of Tg values >40 µg/L indicates iodine sufficiency in the population; 3) the acceptable range of median UIC in monitoring iodized salt programs could be widened to a single category of sufficient iodine intake from 100 to 299 µg/L.

De la investigación científica al diseño de políticas de salud: la experiencia con la eliminación de la deficiencia de yodo en Perú / From scientific research to health policy design: the experience of iodine deficiency elimination in Peru

RESUMEN La investigación científica es una función esencial en salud pública; permite reconocer problemas y situaciones que comprometen la salud y la identificación de soluciones. La investigación es esencial para formulación de políticas desalud. Es imperativo para los países tener sistemas nacionales de investigación. Últimamente, ha habido un significativo avance global, pero el crecimiento no es uniforme, las condiciones son escasas en países con ingresos medianos y bajos. Una experiencia que ilustra esta situación ha sido la investigación de la deficiencia de yodo (DI) en Perú y la aplicación de resultados para la creación de un programa de salud pública. La investigación demostró persistente DI, que durante la gestación causa daño cerebral y retardo mental, que el uso de aceite yodado en la prevención y tratamiento tiene efecto inmediato y larga duración, y validó la concentración urinaria del yodo como el mejor indicador de nutrición de yodo. Estos resultados fueron tomados en cuenta por el Ministerio de Salud y en 1983 se creó el Programa Nacional de Control del Bocio y Cretinismo Endémicos, que ha logrado la eliminación virtual de la DI desde 1995.

ABSTRACT Scientific research is an essential public health function, enabling recognition of problems that compromise health and facilitating solutions. Research is essential to formulate health policy at a national level. There has been significant but inconsistent overall progress, due to economic conditions in low- and middle-income countries. An example that illustrates this situation is the investigation of iodine deficiency (ID) in Peru, and the application of the results for development of a public health program. The research demonstrated persistent ID, which causes fetal brain damage and subsequent mental retardation. The use of iodinated oil to prevent and treat ID was shown to have an immediate and long-term effect, and confirmed that urinary concentration of iodine was the best indicator of iodine intake. These results were accepted by the Ministry of Health, and the National Program for the Control of Endemic Goiter and Cretinism was created in 1983, achieving virtual elimination of ID by 1995.

Diabetes gestacional, hipotiroidismo y concentración urinaria de yodo en embarazadas. Yodurias en escolares en Paraguay: Exceso de yodo en la sal y riesgo de hiper e hipotiroidismo / Gestational diabetes, hypothyroidism and iodine urinary concentration in pregnant women. Urinary iodine in schoolage children in Paraguay: Iodine excess in salt and hyper and hypothyroidism risk

The main inclicator of iodine nutritional status of salt for human con-sumption is the urinary concentration of iodine, which is useful in monitoring universal levels in salt. Paraguay has suffered deficiency in salt with highprevalence of goiter in thepopulation reaching48.6%. In 2000, results of the ThyroidMobileproject in Latin America showed a goiter prevalence of 17% but 79.6% of the consumed iodized salt was adequate in paraguayan households (more than 15 ppm of iodine). The average values of iodine urinary concentration in 4487 scholars was 437 µg/L, 30% of the average value was between the ideal of 100 to 199 µg/L and 46.1% were above 300 mg/L, with risk of excess iodine. Urinary concentration of iodine during pregnancy was measure for the first time in Paraguay in 200 women; the average was 484 µg/L but diabetes and hypothyroidism during pregnancy was observe in 50% of them. Objective: Determine iodine concentration in urine of the school population in 17 departments of the country and measure the levels of iodine in urine in 200 pregnant women from 15-37 years of age and their levels of glycaemia, and thyroid TSH. Methods: During the years, 2006 and 2007 were evaluated 4487 school randomized, in a probabilistic sample, 3198 in rural areas and 1,289 in urban areas; casual urine samples was collected to determine iodine content. The urinary concentration of iodine in two hundredpregnant women, concentration of iodine in salt, and levels of glycaemia and TSH were also included in the present study All candidates agreed with the informed consent under the ethics rules. Results: These data showed by comparing the levels of iodine in urine concentration in more than adequate and excessive level but this last was markedly elevated (93.8%). The median level greater than 300 µg/L was observed in 100% of the 4,487 urine samples, while the median urinary iodine levels of300-500 µg/L was 91.3% and above 500 was 9.7%. These levels showed the risk of developing thyroid autoimmune diseases. In 200 pregnancy women the average of urine concentration of iodine was 498 pcg/L, subclinical and clinical hypothyroidism and gestational diabetes was 50% of both. Conclu-sion: To obtain normal median urinary iodine levels is necessary to decrease the amount of iodine in salt. The main recommendation is to insist on adequate monitoring of iodized salt consumption. Also continue surveillance and monitoring in sentinel sites reporting the importance of adequate iodine intake of the population especially in pregnant women that also need to be warm about the diabetes during pregnancy but also a regimen is necessary to keep them within the normal levels of glycemia. The subclinical hypothyroidism has been also studied in the same patients.

El principal indicador del impacto de la yodación de la sal de consumo humano es la concentración urinaria de yodo la cual es útil en el monitoreo de la sal. En la encuesta del año 1988 realizada en el Paraguay, se alcanzó una prevalencia de bocio de 48,6% en la población escolar con un déficit de yodo en la sal, pero el año 2000 en el estudio del proyecto de Tiroides Móvil, se redujo por el método ecográfico a 17%. Ese mismo año la mediana de los niveles urinarios en niños escolares de 6-12 años fue 258 µg/L, considerando que 30% se encontraba entre el valor ideal de 100 a 199 µg/L y 46,1% sobre 300 µg/L, implicando un riesgo de exceso de yodo en dicha población con las posibles consecuencias de aparición tanto de hipo como de hipertiroidismo. El 93% presentó exceso de yodo en la sal y la mediana urinaria fue 437 ug/ mL. Un grupo de embarazadas han sido estudiadas en el Hospital San Pablo por primera vez en el Paraguay para la determinación de la yoduria, yodo en sal, diabetes gestacional, hipotiroidismo en el embarazo y sus valores antropométricos resultando un hipotiroidismo subclínico del 50% y diabetes gestacional del 50%. Objetivo: Determinar las yodurias en la población escolar de 6-12 años pre púber de ambos sexos en 17 departamentos del país y en una submuestra en embarazadas y también niveles de glicemia en el embarazo en un hospital de Asunción. Sujetos y Métodos: En el periodo del 2006-2007 fueron evaluados 4.487 escolares randomizados, en una muestra probabilística, 3.198 en el área rural y 1.289 en el área urbana con muestras en orina casual. El año 2015, doscientas embarazadas fueron estudiadas con muestras de glicemia en ayunas y 2 horas post prandial, dosaje de TSH, yodo en sal de 100 gramos de la sal de consumo en sus hogares y de orina para ver la concentración de yodo en sal y urinaria de yodo. Todos los candidatos fueron estudiados bajo consentimiento autorizado y de acuerdo a normas éticas. Resultados: Al comparar los niveles de yodo en orina en el nivel más que adecuado y el excesivo de la yoduria se vió que éste último nivel estaba marcadamente elevado (93.8%), que la mediana de los niveles mayores a 300 ug/L era del 100% del total de las 4.487 muestras de orina, mientras que la mediana de los niveles de yoduria entre 300-500 µg/L fue de 91,3% y por encima de 500 fue 9.7% lo cual implicó el riesgo de desarrollar enfermedades tiroideas autoinmunes. Las embarazadas presentaron una mediana urinaria de yodo 484 µg/L, diabetes gestacional e hipotiroidismo subclínico en 50%. Conclusión: Para normalizar los niveles de yoduria, es necesario disminuir la cantidad de yodo en la sal. La recomendación es insistir en el monitoreo de la adecuada yodación de las sales de consumo familiar y continuar con la vigilancia y el monitoreo constante en sitios centinelas divulgando la importancia de la adecuada ingesta de yodo a la población. Un régimen dietético a las embarazadas es necesario implementar en el primer trimestre del embarazo.

Latin American thyroid society recommendations for the management of thyroid nodules.

Several guidelines on diagnosis and treatment of thyroid nodules and cancer have recently been published. However, recommended practices are not always appropriate to different settings or countries. The aim of this consensus was to develop Clinical Guidelines for evaluation and management of patients with thyroid nodules applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society involved with research and management of thyroid nodules and cancer from different medical centers in Latin America. The consensus was produced based on the expert opinion of the panel with use of principles of evidence-based medicine. Following a group meeting, a first draft based on the expert opinion of the panel was elaborated and later circulated among panel members for further revision. After revision, this document was submitted to all LATS members for commentaries and considerations and finally revised and refined by the authors. The final recommendations represent state of the art on management of thyroid nodules applied to all Latin American countries.

Recommendations of the Latin American Thyroid Society on diagnosis and management of differentiated thyroid cancer.

The aims of these recommendations were to develop clinical guidelines for evaluation and management of patients with differentiated thyroid cancer applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society (LATS) involved with research and management of thyroid cancer from different medical centers in Latin America. The recommendations were produced on the basis of the expert opinion of the panel with use of principles of Evidence-Based Medicine. Following a group meeting, a first draft based on evidences and the expert opinions of the panel was elaborated and, later, circulated among panel members, for further revision. After, this document was submitted to the LATS members, for commentaries and considerations, and, finally, revised and refined by the authors. The final recommendations presented in this paper represent the state of the art on management of differentiated thyroid cancer applied to all Latin American countries.

Nutrición de yodo en escolares de Calama, Chile: persitencia de niveles elevados de yodo urinario / Iodine nutrition in school children of Calama city, Chile: persistence of high urinary iodine levels

Introducción: El año 2000 se determinó que la mediana de la concentración urinaria de yodo (CUI) en escolares de educación básica de Calama estaba en 2600 ug/L, valor muy elevado, el que descendió a 487 ug/L el año 2004 después de reducir los niveles oficiales de yodación de la sal de 100 ppm a 40 ppm el año 2000. Objetivo: Investigar la nutrición de yodo en escolares de Calama, 12 años después del cambio de legislación. Sujetos y métodos: 332 escolares de ambos sexos de una escuela municipal de educación básica de Calama fueron evaluados sobre la prevalencia de bocio mediante la palpación de la glándula tiroides; al 22% de los mismos (72) se les evaluó la nutrición de yodo mediante la determinación de CUI en muestras casuales de orina por espectrofotometría. Se recolectaron 58 muestras de sal de consumo humano, seleccionadas aleatoriamente en locales comerciales, comedores de la escuela y en los hogares de los escolares, para determinar su contenido de yodo por la técnica de almidón. Adicionalmente, en todos los escolares se registró peso, talla e IMC. Resultados: Se encontró una prevalencia de bocio de 8.2%, todos del grado 1. La mediana de la concentración urinaria de yodo fue 448 ug/L. La concentración de yodo en la sal fue 31,4 ± 17.8 ppm, valor dentro de los estándares oficiales establecidos en el Reglamento Sanitario de los Alimentos (RSA) del Ministerio de Salud de Chile. Comentarios y conclusiones: Los resultados muestran un leve aumento en la prevalencia de bocio y que persiste una alta CUI en escolares de Calama, probablemente debido a una excesiva ingesta de yodo, no obstante que el promedio de contenido de yodo en la sal para consumo humano estuvo dentro del rango recomendado por OMS-UNICEF-ICCIDD (20-40 ppm). Estos hallazgos plantean la necesidad de investigar otras probables fuentes de ingesta de yodo, como causa del exceso de yodo que persiste en Calama.

Introduction: In the year2000 it was determined that the median of the urinary iodine concentration (UIE) in primary school children from Calama was 2600 ug/L, a very high level which went down to 487 ugI/L in 2004, after the standards of the Food Sanitary Regulation were scaled down from 100 ppm to 40 ppm in the year 2000. Objective: To search the current iodine nutrition in school children of Calama, 12 years after the change in the legislation. Subjects and methods: 332 primary school children from Municipal School D-48 ofthe City ofCalama were assessed in relation to their prevalence of goiter determined through palpation of the thyroid gland. In 22% ofthem (72 children), UIE was determined by spectrophotometry. 58 samples ofsalt for human consumption saltwere randomly collected from local shops, school canteens and from the children's homes to determine their iodine concentration through the starch technique. In addition, the school children were measured and weighed to determine the adequacy of their height and Body Mass Index (BMI). Results: An 8.2% prevalence ofgoiter was found; all were grade 1. The iodine concentration in the salt was 31.4 ± 17.8 in the 58 samples analyzed, the average met the adequate range of the current Food Sanitary Regulation (FSR) of Health Ministry of Chile. Conclusion and comments: A non significant increase in the prevalence ofgoiter was found, the average of UIE continue being high, possible due to an excessive intake ofiodine, nevertheless average iodine concentration in the salt for human consumption is within de recommended range by WHO-UNICEF-ICCIDD (20-40 ppm). These findings prompt to search another sources of iodine intake, as an explanation of the persistent elevation of UIE in these children.

Recommendations of the Latin American Thyroid Society on diagnosis and management of differentiated thyroid cancer / Recomendações da Sociedade Latino-Americana de Tireoide para diagnóstico e manejo do carcinoma diferenciado de tireoide

The aims of these recommendations were to develop clinical guidelines for evaluation and management of patients with differentiated thyroid cancer applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society (LATS) involved with research and management of thyroid cancer from different medical centers in Latin America. The recommendations were produced on the basis of the expert opinion of the panel with use of principles of Evidence-Based Medicine. Following a group meeting, a first draft based on evidences and the expert opinions of the panel was elaborated and, later, circulated among panel members, for further revision. After, this document was submitted to the LATS members, for commentaries and considerations, and, finally, revised and refined by the authors. The final recommendations presented in this paper represent the state of the art on management of differentiated thyroid cancer applied to all Latin American countries.

Estas recomendações tiveram por objetivo o desenvolvimento de diretrizes para avaliação e manejo de pacientes com câncer diferenciado da tiroide em países latino-americanos. Um painel composto por 13 membros da Sociedade Latino-Americana de Tireoide (SLAT) - que estavam envolvidos em pesquisas, e eram peritos no cuidado do paciente com câncer da tiroide e provenientes de diferentes centros médicos latino-americanos - utilizou os princípios da Medicina Baseada em Evidências para produzir esse consenso. Após uma primeira reunião, um texto inicial foi elaborado, baseado em evidências e opiniões dos especialistas do painel e, posteriormente, circulado entre os membros do painel, para revisão. Após a revisão, o documento foi enviado aos membros da SLAT para comentários e considerações e, finalmente, revisado e refinado pelos autores. As recomendações finais aqui apresentadas demonstram o estado da arte no manejo do câncer diferenciado da tireoide aplicadas aos países latino-americanos.

Latin American Thyroid Society recommendations for the management of thyroid nodules / Recomendações da Sociedade Latino-Americana de Tireoide no manejo de nódulos tireoideos

Several guidelines on diagnosis and treatment of thyroid nodules and cancer have recently been published. However, recommended practices are not always appropriate to different settings or countries. The aim of this consensus was to develop Clinical Guidelines for evaluation and management of patients with thyroid nodules applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society involved with research and management of thyroid nodules and cancer from different medical centers in Latin America. The consensus was produced based on the expert opinion of the panel with use of principles of evidence-based medicine. Following a group meeting, a first draft based on the expert opinion of the panel was elaborated and later circulated among panel members for further revision. After revision, this document was submitted to all LATS members for commentaries and considerations and finally revised and refined by the authors. The final recommendations represent state of the art on management of thyroid nodules applied to all Latin American countries.

Vários consensos têm sido publicados acerca do diagnóstico e do tratamento de nódulos e câncer da tireoide. Entretanto, as recentes recomendações nem sempre são apropriadas para diferentes regiões ou países. O objetivo deste trabalho foi oferecer uma série de recomendações para a avaliação e conduta de pacientes portadores de nódulos tireoideos aplicáveis a todos os países da América Latina. O trabalho foi realizado por um comitê composto por 13 membros da Sociedade Latino-Americana de Tireoide envolvidos com pesquisa e manejo de pacientes portadores de nódulos e carcinoma diferenciado da tireoide, de diferentes centros médicos da América Latina. As recomendações foram estabelecidas, após consenso, utilizando as opiniões especializadas de cada membro e os princípios da medicina baseada em evidência. Após a primeira reunião do grupo, um primeiro documento foi elaborado e encaminhado a todos os membros para revisão. Posteriormente, o documento foi enviado aos membros da Sociedade Latino-Americana de Tireoide para avaliação, sugestões e comentários. A versão final, elaborada após refinada revisão de todos os autores, representa o estado da arte no diagnóstico e na conduta de nódulos tireoideos, aplicáveis a todos os países da América Latina.

Contenido de yodo en leche de vacuno procedente de la sierra y costa del Perú / Iodine content of cattle milk from two milksheds in Perú

Con la finalidad de establecer la relación causa-efecto entre área geológica y contenido de yodo en la leche de vacuno y estimar la contribución del consumo de leche a la ingesta de yodo, en la presente investigación se ha determinado el contenido de yodo en leche de vacuno procedente de la sierra y costa de Perú. Se obtuvieron muestras de leche de tres principales zonas productoras, 62 en Cajamarca, 44 en Arequipa, ambos departamentos de la Sierra, y 27 muestras en el Departamento de Lima en la Costa. La determinación cuantitativa de yodo se realizó por el método de Zak modificado, basado en la relación de Sandell-Kolthoff. Las medianas obtenidas fueron 24 µg/L en Cajamarca, 34 µg/L en Arequipa y 170 µg/L en Lima. El valor de la mediana corespondiente a la sierra, 26 µg/L, fue significativamente más baja que el corespondiente a la Costa; además mientras en la primera el 81 por ciento de los valores individuales estuvieron por debajo de 50 µg/L, en la segunda, contrariante, el 77 por ciento estuvieron sobre 80 µg/L. Estos resultados confirman que el contenido de yodo en leche de la sierra es 6 veces menor que en la costa y que su consumo contribuye significativamente a satisfacer las necesidades fisiológicas de yodo de los pobladores de dicha zona

Prevalencia de bocio endemico por el metodo ecografico, determinación de yodurias y yodo en sal en escolares del Paraguay / Prevalence of endemic goiter with the ultrasonographic method, determination of orinary iodine and dosage of iodine content of salt in school of Paraguay

Paraguay, país mediterráneo ubicado en el corazón de America del Sur, con una superficie de 406.542 Km2 y con una población de 5,8 millones de habitantes importa toda la sal que consume de países cercanos como la Argentina, Brasil y Chile. En el presente estudio observacional, de tipo descriptivo utiliza el método ecográfico para determinar el tamaño y las características de la glándula tiroides, se examinaron 1034 escolares de ambos sexos de 13 distritos del país y fue realizado durante 3 meses del año 2000. Los lugares elegidos tenían antecedentes de bajo consumo de sal yodada con valores de yoduria por debajo de 50 æg/L, como también la medición de la yoduria por el método de trinitrito , el tenor de yodo en sal y la relación talla/peso de los escolares estudiados. El 82.9 por ciento del volumen tiroideo de los escolares resultó dentro de los limites normales. Se detectó un volumen tiroideo aumentado en el 17.1 por ciento de los niños según la edad y sexo y en 22 por ciento según la superficie corporal. Nódulos tiroideos se observaron en 5 niños y sólo1 niño tenía antecedentes de haber tenido cirugía tiroidea. El 53 por ciento de los distritos presentaron medias urinarias de yodo por encima de 200 æg/dL con un promedio de 301.3 æg/dL. El 40 por ciento de los distritos presentaron yodurias óptimas (entre 100 y 199 æg/dlL) con una media de 145 æg/dL. Solo el 7 por ciento presentó una media urinaria de yodo bajo 100 æg/dL. El estudio demostró una mejoría en la yodación de la sal de consumo humano al compararlo con los realizados en 1988 en el Paraguay,sin embargo,existen riesgos de producir en la población tirotoxicosis y enfermedades tiroideas autoinmunes por el porcentaje de yodo en la sal en aumento, por lo que se recomienda un seguimiento y control con los ajustes necesarios de los niveles de yodación.

Prevalencia y características del bocio endemico en la población escolar de Urubamba-Cuzco / Prevalence and characteristic of the endemic goiter in scholl population un Urubamba-Cuzco

Se ha realizado una encuesta para determinar la prevalencia de bocio endémico en la población de la provincia de Urubamba, Departamento del Cuzco, zona tradicionalmente carente de iodo, con la finalidad de establecer la eficacia de las medidas profilácticas empleadas. De 3,936 niños examinados, 80% de la población escolar total de Urubamba, 2,260 correspondieron al sexo masculino (57.4%) y 1,676 al sexo femenino (42.6%) cuyas edades fluctuaron entre 3 a 20 años, 86.3% estuvo comprendido entre 7 y 18 años. Se aplicaron los criterios de la OMS para la evaluación del tamaño de la glándula tiroidea. Se encontró una prevalencia general de bocio de 39.7% correspondiendo 40.6% al sexo femenino y 38.9% al masculino. La distribución por distritos en orden decreciente fue: Maras, 50.9%, Ollantaytambo 42.7%, Huayllabamba 39.6%, Chinchero 38.9%, Yucay 37.7%, Urubamba distrito 34.4% y Macchu Pichu 6.8%. La distribución por edades y sexos mostró cifras semejantes hasta los 10 años, edad a partir de la cual se nota una prevalencia progresivamente mayor en las mujeres que se hace más notable en el grupo etario de 15 a 20 años. El 31.9% correspondió a un bocio grado OB, en tanto que el bocio grado I se presentó en el 7.3% y bocio grado II en el 0.40%. No se encontraron bocios de grado III. En los distritos de Maras, y Ollantaytambo se encontraron las mayores cifras de bocio grado I, 10.4% y 12.6% respectivamente. La baja excreción urinaria de iodo demostró que el bocio en esta población está vinculada a una severa deficiencia de este elemento, debido al consumo de sal no iodada, proveniente principalmente de las salinas de Maras, debido a su menor costo en relación a la sal iodada distribuida por EMSAL. El examen de las curvas de crecimiento muestra que esta población presenta signos de desnutrición significativa que podría estar en relación a la deficiencia de iodo y a otros factores nutricionales que aún no han sido explorados. Los resultados anteriores demuestran que las normas y políticas para la erradiación del bocio han sido eficaces en esta región, determinando la persistência de una alta prevalencia de esta endema con las serias secuelas que indicen en el desarrollo social y económico de esta región