Maternal Urinary Iodine Concentration during Pregnancy and Its Impact on Child Growth and Neurodevelopment: An 11-Year Follow-Up Study.

Mild-to-moderate iodine deficiency during pregnancy is prevalent worldwide, but its consequences for maternal and child health are not clear. We aimed to investigate the impact of maternal iodine intake during pregnancy on the child's growth and neurodevelopment. This study involved a cohort of 11-year-old children (n = 70) whose mothers had participated in an iodine intake survey during pregnancy. Gestational, neonatal, anthropometric, intelligence quotient (IQ), and socioeconomic parameters were analyzed according to maternal urinary iodine concentration (UIC). There was a positive linear trend of current height Z-score, full-scale IQ, verbal IQ, family income, maternal education, and a negative trend of neonatal TSH levels with increasing maternal UIC levels. However, regression analysis indicated that maternal UIC was not an independent predictor of any gestational, neonatal, or childhood development parameter. Only maternal school education was positively associated with child height and IQ. In conclusion, we did not find any evidence of a direct effect of maternal iodine intake during pregnancy on the long-term growth and neurodevelopment of children. The results suggest that socioeconomic factors are important confounding factors that affect both maternal iodine intake and child development and must be considered when investigating the association between maternal iodine intake and child outcomes.

A method to detect fulvestrant interference in estradiol in breast cancer patients.

Background: Fulvestrant resembles estradiol in its structure. Reports have been published concerning fulvestrant measured as estradiol by the immunoassays. This may induce falsely elevated estradiol results and wrongly impact medical decisions. Our aim was to confirm the interference of fulvestrant on estradiol concentration and test a method to identify the false results. Methods: Four serum samples with low estradiol levels were spiked with fulvestrant at various concentrations. Estradiol was then measured directly on serum (Dir), after a 1:5 dilution (Dil), and a ratio Dil/Dir was estimated. On the second part of the study, estradiol results (Dir, Dil and ratio Dil/Dir) from 14 women treated with fulvestrant were analysed, as well as from 14 patients not under this treatment. Results: The addition of exogenous fulvestrant to the serum samples induced a gradual rise on estradiol concentration with a mean ratio for the Dil/Dir samples of 2.1 ± 0.4 (range 1.7-2.9). Patients on fulvestrant treatment experienced a mean ratio for the Dil/Dir estradiol sample of 2.4 ± 0.4 (range 1.6-3.0). In the control group, a mean estradiol ratio Dil/Dir of 1.1 ± 0.1 was observed (range 0.8-1.3). No correlation between the number of days after fulvestrant injection and estradiol result (r = 0.531) was observed. Conclusion: Our study confirmed the interference of fulvestrant in the estradiol measurement by immunoassay. When fulvestrant was present, the estradiol ratio for Dil/Dir sample was about 2. In the control group, the ratio was around 1. The estradiol Dil/Dir ratio is a simple tool which can be used to identify fulvestrant false immunoassay estradiol results.

Iodine Intake and Related Cognitive Function Impairments in Elementary Schoolchildren.

Iodine deficiency, the most common cause of preventable mental impairment worldwide, has been linked to poorer intellectual function in several studies. However, to our knowledge, no studies have been performed in moderate iodine-deficient schoolchildren using the complete form of Wechsler Intelligence Scale for Children (WISC-III; Portuguese version). The main purpose of this study was to ascertain whether moderate iodine deficiency would affect the cognitive function of schoolchildren (7-11 years old; 3rd and 4th grades). Raven's Colored Progressive Matrices (CPM; Portuguese version) were used for measuring the intelligence quotient (IQ) of the total population (n = 256; median UIC = 66.2 µg/L), and the WISC-III was used to study two selected subgroups: one moderately iodine-deficient (n = 30) and the other with adequate iodine intake (n = 30). WISC-III was shown to be the prime instrument for cognitive function assessment among moderate iodine-deficient schoolchildren; this subgroup had a Full-Scale IQ 15.13 points lower than the adequate iodine intake subgroup, with a magnitude effect of d = 0.7 (p = 0.013). Significant differences were also registered in 6 of the 13 Verbal-Performance IQ subtests. Moderate iodine deficiency has a substantial impact on mental development and cognitive functioning of schoolchildren, with significant impairment in both Performance IQ and Verbal IQ spectrum, adversely impacting their educational performance.

Iodine Supplementation in Pregnancy in an Iodine-Deficient Region: A Cross-Sectional Survey.

Iodine deficiency is a common problem in pregnant women and may have implications for maternal and child health. Iodine supplementation during pregnancy has been recommended by several scientific societies. We undertook a cross-sectional survey to assess the efficacy of these recommendations in a European iodine-deficient region. Urinary iodine concentrations (UIC) were determined in pregnant women before (n = 203) and after (n = 136) the implementation of guidelines for iodine supplementation in pregnancy. Iodine supplementation (200 µg/day) reduced the proportion of pregnant women with severe iodine deficiency (37.4% to 18.0%, p = 0.0002). The median UIC increased from 67.6 µg/L to 106.8 µg/L but remained below the recommended target level (>150 µg/L) for pregnant women. In conclusion, iodine supplementation in pregnant women improved iodine status in this iodine-deficient region but was insufficient to achieve recommended iodine levels in pregnancy. Additional measures, such as the adjustment of the dose or timing of supplementation, or universal salt iodization, may be needed.

Parathyroid carcinoma: Single centre experience.

OBJECTIVE: Parathyroid Carcinoma is a rare malignant neoplasm, accounting for less than 1% of primary hyperparathyroidism cases. Parathyroid carcinomas are characterized by markedly elevated levels of PTH, severe hypercalcemia and established target organ damage. The authors report the experience of a single centre regarding the management and outcome of patients with parathyroid carcinomas and revise relevant literature. DESIGN: Retrospective review of all patients with parathyroid carcinoma evaluated at a tertiary oncologic centre from 1991 until 2021. RESULTS: Seventeen patients were identified (10 males), with a mean age at diagnosis of 53 ± 16 years and a median follow-up of 16.5 years. Most patients presented with hypercalcemia (n = 15), with a mean serum calcium concentration of 13.5 mg/dl (9.6-16.5) and mean PTH of 1173 pg/ml (276-2500). Hyperparathyroidism-mediated organ damage was observed in most patients (n = 16), with predominant renal (n = 12) and skeletal (n = 9) complications. En bloc surgical resection was performed in nine patients. Three patients underwent adjuvant radiotherapy. Recurrence was observed in 8 cases (47.1%) after a median of 24 months following surgery and no independent predictors of recurrence were identified. The overall survival and disease specific survival at 5-year was 88% and 94%, respectively. CDC73 mutations were present in 38.5% of analysed patients and one patient was diagnosed with MEN1. CONCLUSION: Parathyroid carcinoma is associated with a significant rate of recurrence and limited effective treatment beyond initial complete surgical resection. Therefore, preoperatively high index of suspicion is paramount to optimize patient care. This is, to our knowledge, the largest Portuguese cohort published so far.

Efficacy of a Salt Iodization Program on Iodine Status and Intakes in Schoolchildren of São Miguel Island, Azores, Portugal.

INTRODUCTION: Iodine is an essential micronutrient and its deficiency can severely impact children's development. In 2012, the Thyroid Study Group of the Portuguese Society of Endocrinology, Diabetes and Metabolism discovered that the median urinary iodine concentration (mUIC) level in schoolchildren of São Miguel was far too low at 70.9 µg/L. In response, the government implemented a salt iodization program to help normalize levels. This investigation evaluated the efficacy of such an approach. METHODS: Urinary iodine concentration (UIC) was evaluated in 362 schoolchildren from São Miguel using the fast colorimetric method. RESULTS: mUIC was 106.7 µg/L, significantly higher than that observed in 2012 (p < 0.001). Over half (55.5%) of the schoolchildren had a UIC >100 µg/L versus 23.0% in 2012 (p < 0.001). 9.4% of schoolchildren had a UIC <50 µg/L, significantly lower than the 30.6% reported in 2012 (p < 0.001). DISCUSSION/CONCLUSION: Five years after the implementation of the government salt iodization program, the mUIC increased from 70.9 to 106.7 µg/L. This study confirms the efficacy of the adopted measures in schoolchildren population.

[Iodine intake in Portuguese school children]. / Aporte do Iodo nas Crianças das Escolas em Portugal.

OBJECTIVE: The aim of the present study was to evaluate iodine intake in portuguese school children in order to inform health authorities of eventual measures to be implemented. INTRODUCTION: Iodine is the key element for thyroid hormone synthesis and its deficiency even mild, as found in other European countries, may have deleterious effects in pregnancy resulting in cognitive problems of offsprings. In Portugal there are no recent data on iodine intake in schoolchildren. POPULATION AND METHODS: 3680 children aged 6-12 years of both sexes, from 78 different schools were studied. Iodine intake was evaluated trough urine iodine (UI) determinations using a colorimetic method. RESULTS: The global median UI value was 105.5 µg/L; the percentage of children with UI <100 µg/L was 47.1%, corresponding to 41% of the studied schools. The percentage of values <50 µg/L was 11.8%. The male gender, the south region of the country and the distribution of milk in school were significantly linked with a higher iodine elimination. DISCUSSION: Our global results point to a borderline/ mildly insufficient iodine intake in the portuguese school population. However 47% of the children had UI under 100 µg /L. The comparison of our results with the available data from 30 years ago, point to a considerable improvement, due to silent prophylaxis. Male gender, geographical area and milk distribution influenced positively iodine intake.The importance of milk has been referred in numerous papers. CONCLUSIONS: The study of UI in the Portuguese school population points to a borderline iodine intake. However, in 47% of children iodine intake was inadequate. Compared with data from the eighties, a considerable increase in iodine elimination was found. Taking into account the potencial deleterious effects of inadequate iodine intake, a global prophylaxis with salt iodization has to be considered.

[Prolactin and the laboratory]. / Prolactina e o laboratório.

Up to 95% of adult serum prolactin is monomeric prolactin with a molecular weight of 23 kDa. Macroprolactin is a prolactin-antibody complex of molecular weight greater than 100 kDa and constitutes less than 1% of circulating prolactin. In some cases, hyperprolactinemia is the result of elevated macroprolactin levels, misleading the medical approach to the patient. This may involve inappropriate and unnecessary imaging investigations and treatment, either medical or surgical. The screening of macroprolactin in all the hyperprolactinemic patients could be useful and necessary. Presently is facilitated by a simple and rapid laboratory test such as the polyethyleneglycol precipitation. Besides the macroprolactin, the hook effect is another laboratorial pitfall in the diagnosis of the hyperprolactinemia. It is characterized by the finding of falsely low levels of serum prolactin in patients with very high prolactin levels and big prolactinomas. The hook effect should be excluded in patients with prolactin levels less than 200 ng/mL and macroadenomas. It is identified by re-measuring the prolactin level after performing a serum dilution. In this article, we focus these two pitfalls in the laboratorial diagnosis of the hyperprolactinemia, remembering that they could occur and interfere with a correct approach of the patient.

In vitro assays to test the interference of anti-thyroglobulin antibodies on thyroglobulin measurement.

OBJECTIVE: To assess the interference of anti-thyroglobulin antibodies (TgAb) on serum thyroglobulin (Tg) measurement by in vitro experiments. Design Re-evaluation of Tg concentration after dilution with different TgAb-positive sera. On a first step, dilutions of the same Tg with different TgAb sera were performed and on a second step, different Tgs were diluted with the same TgAb serum. METHODS: Tg measurements were performed using an immunometric (IMA) chemiluminescence assay. TgAb measurements were performed using two methods: immunoflurimetric assay (UNICAP 100) and IMA chemiluminescent assay (IMMULITE 2000). RESULTS: Dilution of a known concentration of Tg with different TgAb-positive sera resulted in a variation of the final concentration of Tg ranging from -24 to -79%. A weak correlation was observed between the TgAb concentration and the percentage of the Tg deviation. Dilution of different Tgs with the same TgAb-positive serum illustrated how the same TgAb positive serum may determine a high interference or a neutral effect. CONCLUSIONS: Present results suggest that the interference on Tg measurement observed in the presence of TgAb may result not only from the anti-thyroglobulin antibodies, but also from the thyroglobulin itself.

A practical method for the detection of macroprolactinaemia using ultrafiltration.

OBJECTIVE: The aim of this study was to evaluate a method for the estimation of the percentage of big-big prolactin (bb-PRL) in serum, based on centrifugal ultrafiltration (UF) and to be used for the detection of macroprolactinaemia. DESIGN: Serum samples were submitted to gel filtration chromatography (GFC), UF and precipitation with polyethylene glycol (PEG). PATIENTS: Serum samples obtained from 13 patients with macroprolactinaemia (Group 1) and from 15 hyperprolactinaemic patients without macroprolactinaemia (Group 2) were studied by the three methods. MEASUREMENTS: PRL was measured in serum, fractions from GFC, filtrate and retentate obtained after UF (this last measurement was used only to study the 'recovery' of PRL after UF and was not necessary for clinical purposes), and supernatant obtained after PEG precipitation. The calculation of the percentage of bb-PRL, by UF, was made using a simple algorithm. RESULTS: In Group 1 the percentages (mean and SD) of bb-PRL as determined by GFC, UF and PEG were, respectively, 73 +/- 16, 83 +/- 5.3 and 78 +/- 7.0. In Group 2, the percentages of bb-PRL were, in the same order as above, 4.3 +/- 8.2, 16 +/- 19 and 3.7 +/- 11. The difference of the means between Groups 1 and 2 was highly significant (P << 0.001) for all the three methods. In Group 1 the percentages of bb-PRL were widely scattered when measured by GFC but closely clustered when measured by either UF or PEG. The opposite occurred in Group 2. CONCLUSIONS: The centrifugal ultrafiltration method for the detection of macroprolactinaemia is simple, inexpensive, requires only two prolactin assays and yields the same results as the polyethylene glycol precipitation method.