Thyroid, Diet, and Alternative Approaches.

BACKGROUND: Increasingly, patients are asking their physicians about the benefits of dietary and alternative approaches to manage their diseases, including thyroid disease. We seek to review the evidence behind several of the vitamins, minerals, complementary medicines, and elimination diets that patients are most commonly using for the treatment of thyroid disorders. SUMMARY: Several trace elements are essential to normal thyroid function, and their supplementation has been studied in various capacities. Iodine supplementation has been implemented on national scales through universal salt iodization with great success in preventing severe thyroid disease, but can conversely cause thyroid disorders when given in excess. Selenium and zinc supplementation has been found to be beneficial in specific populations with otherwise limited generalizability. Other minerals, such as vitamin B12, low-dose naltrexone, and ashwagandha root extract, have little to no evidence of any impact on thyroid disorders. Avoidance of gluten and dairy has positive impacts only in patients with concomitant sensitivities to those substances, likely by improving absorption of levothyroxine. Avoidance of cruciferous vegetables and soy has little proven benefit in patients with thyroid disorders. CONCLUSION: While many patients are seeking to avoid conventional therapy and instead turn to alternative and dietary approaches to thyroid disease management, many of the most popular approaches have no proven benefit or have not been well studied. It is our responsibility to educate our patients about the evidence for or against benefit, potential harms, or dearth of knowledge behind these strategies.

Role of Dietary Supplements in Thyroid Diseases.

BACKGROUND: Thyroid hormones play a vital role in regulating our body's metabolism. Two important thyroid hormones released from the thyroid gland are tri-iodothyronine (T3) and tetra-iodothyronine (T4). Thyroid-stimulating hormone and thyroid regulating hormone control the T3 and T4 levels in our body. Increased TSH levels indicate hypothyroidism and decreased TSH levels indicate hyperthyroidism. Iodine is a crucial nutrient for the synthesis of thyroid hormones and is mostly obtained from our diet. Other essential nutrients for the thyroid hormones formation include selenium, iron, vitamin D, vitamin B12, etc. Dietary changes in these nutrients can result in alterations in thyroid function and structure. Although normally, the hormonal diseases cannot be cured, but we can improve their signs and symptoms using suitable dietary supplements. OBJECTIVE: The aim of the study was to thoroughly analyze the various benefits and risks associated with the use of dietary supplements for the prevention and treatment of various thyroid disorders, like hypothyroidism, as seen in Hashimoto's thyroiditis; hyperthyroidism, as seen in Graves' disease; sick euthyroidism and subclinical hypothyroidism. METHODS: Literature was searched using the search terms "dietary supplements+thyroid diseases" on Pubmed, Google Scholar, Scopus, Cochrane Library, and other search engines, and data were collected from 1967 to November, 2021, including research inputs from the authors. The literature was thoroughly searched, and deep knowledge was acquired on this topic, which was then sequentially organized and summarized using suitable tables and figures. CONCLUSION: After analyzing various studies on this topic, we arrived at the conclusion that although there are various claimed and observed health benefits of dietary supplements in the prevention and treatment of various thyroid disorders, still several studies have shown too many risks to be associated with the use of dietary supplements, and people using these products should be aware of these risks in order to use them very judiciously for the improvement of their thyroid status.

Specialist thyroid package 1 (PS1) in outpatient endocrine care [Pakiet specjalistyczny dotyczacy tarczycy (PS1) w ambulatoryjnej opiece endokrynologicznej].

The article presents the assumptions of a new specialist thyroid package (PS1) in outpatient specialist care in the field of endocrinology, which was introduced by the National Health Fund (NFZ - Narodowy Fundusz Zdrowia) from January 2020. It became an impulse to characterize the current problems affecting specialist care in the field of endocrinology, search for their potential causes and propose strategies that are intended to contribute to increasing the efficiency of the system.

Nutraceuticals in Thyroidology: A Review of in Vitro, and in Vivo Animal Studies.

Nutraceuticals are defined as a food, or parts of a food, that provide medical or health benefits, including the prevention of different pathological conditions, and thyroid diseases, or the treatment of them. Nutraceuticals have a place in complementary medicines, being positioned in an area among food, food supplements, and pharmaceuticals. The market of certain nutraceuticals such as thyroid supplements has been growing in the last years. In addition, iodine is a fundamental micronutrient for thyroid function, but also other dietary components can have a key role in clinical thyroidology. Here, we have summarized the in vitro, and in vivo animal studies present in literature, focusing on the commonest nutraceuticals generally encountered in the clinical practice (such as carnitine, flavonoids, melatonin, omega-3, resveratrol, selenium, vitamins, zinc, and inositol), highlighting conflicting results. These experimental studies are expected to improve clinicians' knowledge about the main supplements being used, in order to clarify the potential risks or side effects and support patients in their use.

Decision-Analytic Modeling Studies in Prevention and Treatment of Iodine Deficiency and Thyroid Disorders: A Systematic Overview.

Background: Prevention and treatment of iodine deficiency-related diseases remain an important public health challenge. Iodine deficiency can have severe health consequences, such as cretinism, goiter, or other thyroid disorders, and it has economic implications. Our aim was to give an overview of studies applying decision-analytic modeling to evaluate the effectiveness and/or cost-effectiveness of iodine deficiency-related prevention strategies or treatments related to thyroid disorders. Methods: We performed a systematic literature search in PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Database), Tuft's Cost-Effectiveness Analysis Registry, and National Health System Economic Evaluation Database (NHS EED) to identify studies published between 1985 and 2018 comparing different prevention or treatment strategies for iodine deficiency and thyroid disorders by applying a mathematical decision-analytic model. Studies were required to evaluate patient-relevant health outcomes (e.g., remaining life years, quality-adjusted life years [QALYs]). Results: Overall, we found 3950 studies. After removal of duplicates, abstract/title, and full-text screening, 17 studies were included. Eleven studies evaluated screening programs (mainly newborns and pregnant women), five studies focused on treatment approaches (Graves' disease, toxic thyroid adenoma), and one study was about primary prevention (consequences of iodine supplementation on offspring). Most of the studies were conducted within the U.S. health care context (n = 7). Seven studies were based on a Markov state-transition model, nine studies on a decision tree model, and in one study, an initial decision tree and a long-term Markov state-transition model were combined. The analytic time horizon ranged from 1 year to lifetime. QALYs were evaluated as health outcome measure in 15 of the included studies. In all studies, a cost-effectiveness analysis was performed. None of the models reported a formal model validation. In most cases, the authors of the modeling studies concluded that screening is potentially cost-effective or even cost-saving. The recommendations for treatment approaches were rather heterogeneous and depending on the specific research question, population, and setting. Conclusions: Overall, we predominantly identified decision-analytic modeling studies evaluating specific screening programs or treatment approaches; however, there was no model evaluating primary prevention programs on a population basis. Conclusions deriving from these studies, for example, that prevention is cost-saving, need to be carefully interpreted as they rely on many assumptions.

Nutraceutical Supplements in the Thyroid Setting: Health Benefits beyond Basic Nutrition.

In recent years, there has been a growing interest in nutraceuticals, which may be considered as an efficient, preventive, and therapeutic tool in facing different pathological conditions, including thyroid diseases. Although iodine remains the major nutrient required for the functioning of the thyroid gland, other dietary components play important roles in clinical thyroidology-these include selenium, l-carnitine, myo-inositol, melatonin, and resveratrol-some of which have antioxidant properties. The main concern regarding the appropriate and effective use of nutraceuticals in prevention and treatment is due to the lack of clinical data supporting their efficacy. Another limitation is the discrepancy between the concentration claimed by the label and the real concentration. This paper provides a detailed critical review on the health benefits, beyond basic nutrition, of some popular nutraceutical supplements, with a special focus on their effects on thyroid pathophysiology and aims to distinguish between the truths and myths surrounding the clinical use of such nutraceuticals.

Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the "SERENA study", a randomized, double-blind, placebo-controlled trial.

PURPOSE: Selenium is frequently in nutraceuticals for pregnancy, given its role on fertility and thyroid metabolism. However, most evidence rise from non-controlled studies. We aimed to evaluate the protective effect of selenium against thyroid autoimmunity during and after pregnancy. METHODS: A multicenter, randomized, double-blind, placebo-controlled trial was performed and promoted by the Young Italian Endocrinologists Group (EnGioI)-Italian Society of Endocrinology. Forty-five women with thyroiditis in pregnancy were enrolled and randomly assigned to L-selenomethionine (L-Se-Met) 83 mcg/day or placebo (PLB) and evaluated at 10 ± 2 (T1), 36 ± 2 weeks of gestation (T2) and 6 months after delivery (postpartum, PP). RESULTS: We measured a significant reduction of autoantibodies after pregnancy in L-Se-Met group [at PP: TgAb 19.86 (11.59-52.60), p < 0.01; TPOAb 255.00 (79.00-292.00), p < 0.01], and an antibodies titer's rebound in PLB group (TgAb 151.03 ± 182.9, p < 0.01; TPOAb 441.28 ± 512.18, p < 0.01). A significant increase in selenemia was measured in L-Se-Met group at T2 (91.33 ± 25.49; p < 0.01) and PP (93.55 ± 23.53; p = 0.02). Two miscarriage occurred in PLB. No differences were found in thyroid volume, echogenicity, quality of life, maternal/fetal complications. CONCLUSIONS: SERENA study demonstrated a beneficial effect of L-Se-Met supplementation on autoantibody titer during pregnancy and on postpartum thyroiditis recurrence.

The impact of mandatory iodine fortification and supplementation on pregnant and lactating women in Australia.

BACKGROUND AND OBJECTIVES: In Australia, two public health measures were introduced between 2009 and 2010 to reduce iodine deficiency. However there has been a shortage of information regarding their effectiveness and the ongoing prevalence of iodine deficiency in Australia. The primary aim of this study was to assess the extent to which these public health measures have reduced rates of iodine deficiency among pregnant and lactating women. METHODS AND STUDY DESIGN: A review was conducted to identify all studies published since January 2010 that quantitatively measured the iodine status of pregnant and/or lactating women in Australia. RESULTS: We found 25 publications, of which seven were included in this review after our exclusion criteria were applied. Of the seven included publications, three demonstrated the pregnant and lactating women in their studies to be iodine replete (median urinary iodine concentrations (MUIC) greater than 150 µg/L, or a breast milk iodine concentration (BMIC) of greater than 100 µg/L). The remaining four publications found MUIC of pregnant and lactating women to be below the 150 µg/L threshold, in the mild-to-moderate iodine deficiency category. Only two studies, documented iodine sufficiency among pregnant and lactating women in the absence of iodine supplementation. CONCLUSIONS: Many pregnant and lactating women in Australia remain at least mildly iodine deficient. Antenatal iodine supplementation was the factor most consistently associated with an adequate iodine status. Larger, more representative studies or sentinel studies with a National coordination are needed to understand the differences in iodine status that exist across the country.

Monitoring the effects of iodine prophylaxis in the adult population of southern Italy with deficient and sufficient iodine intake levels: a cross-sectional, epidemiological study.

I prophylaxis is the most effective strategy to eradicate I deficiency disorders, but it has been shown to affect the thyroid disease pattern. In this study, we assessed the frequency of thyroid disorders in an adult population living in two areas of southern Italy after implementing I prophylaxis. To this aim, a cross-sectional, population-based study including 489 subjects from an I-deficient rural and an I-sufficient urban area of southern Italy was conducted. Thyroid ultrasound was performed on all participants, and urine and blood samples were collected from each subject. The levels of thyroid-stimulating hormone (TSH), thyroglobulin (TgAb) and thyroperoxidase antibodies (TPOAb), urinary I excretion (UIE), and thyroid volume and echogenicity were evaluated. We found that the median UIE was higher in the urban than in the rural area (P=0·004), whereas the prevalence of subjects affected by goitre was higher in the rural compared with the urban area (P=0·003). Positive TgAb rather than TPOAb were more frequent in subjects from the urban area compared with the rural area (P=0·009). The hypoechoic pattern at thyroid ultrasound (HT-US) was similar between the two areas, but TgAb were significantly higher (P=0·01) in HT-US subjects from the urban area. The frequency of elevated TSH did not differ between the two screened populations, and no changes were found for TgAb positivity in subjects with high TSH in the urban compared with the rural area. Our findings support that the small risks of I supplementation are far outweighed by the substantial benefits of correcting I deficiency, although continued monitoring of populations is necessary.

A new insight on the role of zinc in the regulation of altered thyroid functions during lithium treatment.

BACKGROUND: Lithium salts are widely used for the treatment of mental disorders but cause thyroid dysfunctions while zinc is an essential trace element and is required for a broad range of biological activities. The present study was designed to explore the potential of zinc in regulating 131I biokinetics and thyroid functions following lithium therapy. METHODS: To carry out the investigations, 40 female sprague dawley rats weighing 110-140g were segregated into four groups viz. Group I animals served as untreated controls, group II animals were given lithium (Li2CO31.1 g/kg diet), group III animals were supplemented with zinc (227 mg ZnSO4/L drinking water) and animals in group IV were given a combined treatment of lithium and zinc. The treatments were given for durations of 1, 2 and 4 months. RESULTS: Following intraperitoneal administration of 0.37 MBq carrier- free-131I, a significant depression in the thyroidal 131I uptake both at 2 and 24 hrs was observed following lithium treatment for all the durations which however was brought to within normal levels following zinc supplementation. Lithium treatment caused a significant elevation in the thyroidal biological half lives of 131I which was appreciably attenuated following 2 and 4 months of zinc supplementation. Lithium administration for 2 and 4 months significantly decreased serum T3 and T4 levels which however were increased following zinc supplementation. Lithium treatment for 4 months caused a significant decrease in the thyroidal activities of Na+ K+ ATPase and monoamine oxidase which were brought to near normal levels by zinc. Further, lithium treatment for 4 months raised thyroidal levels of lipid peroxidation and catalase which however were normalized by zinc supplementation. On the contrary, thyroidal levels of reduced glutathione and glutathione S transferase decreased significantly following 2 and 4 months of lithium treatment but were significantly increased following zinc treatment. CONCLUSIONS: The present study concludes that zinc supplementation is helpful in attenuating the adverse effects caused by lithium on thyroid functions and can effectively regulate the biokinetics of 131I.

Neonatal Thyroid-Stimulating Hormone Screening as a Monitoring Tool for Iodine Deficiency in Turkey.

OBJECTIVE: Thyroid-stimulating hormone (TSH) level in neonates is recommended as an indicator for presence of iodine deficiency (ID) at a population level and as a monitoring tool in programs of iodine supplementation. The purpose of this study, based on data from the National Newborn Screening Program (NNSP) for congenital hypothyroidism (CH) in 2014, was to analyze neonatal TSH levels to predict the current status of iodine nutrition in Turkey. METHODS: According to screening methodology, heel-prick blood samples of newborns were collected on filter paper cards usually on day 3-5 after birth (or shortly before discharge). Results of samples collected >48 h after birth were analyzed. The degree of severity of ID was assessed by using the epidemiologic criteria of the World Health Organization (WHO). Elevated TSH levels (>5 mIU/L) were processed and classified according to province, region, birth season, and sampling time. RESULTS: A total of 1,298531 newborns were registered in the NNSP for the CH database. Of those, 1,270311 newborns had screening results collected >48 h after birth and were included in the statistical analyses. The national prevalence of elevated TSH was 7.2%. While the Gaziantep sub-region had the highest TSH elevation rate (15.9%), the Tekirdag sub-region had the lowest rate (4.0%; p<0.001). Seasonal variations were also significant, and the elevated TSH prevalence rate was highest in winter (7.4%; p<0.001). CONCLUSION: National CH screening results suggest that Turkey may still be mildly iodine deficient. Nationwide studies should be performed for direct assessment and monitoring of iodine status in vulnerable populations to confirm accuracy of our results.

Effect of selenium supplementation via Brazil nut (Bertholletia excelsa, HBK) on thyroid hormones levels in hemodialysis patients: a pilot study / Efecto de la suplementación de selenio a través de la nuez de Brasil (bertholletia excelsa, HBK) en los niveles de hormonas tiroideas en pacientes de hemodiálisis: un estudio piloto

Background: thyroid function depends on trace mineral selenium (Se), being at the active center of the iodothyronine deiodinase that catalyzes the conversion of the thyroxine (T4) to the active form of thyroid hormone, triiodothyronine (T3). Hemodialysis (HD) patients have reduced T3 levels partly due to impaired hormonal conversion that can be related to Se deficiency, a common feature in these patients. This study evaluated the effect of Brazil nuts (richest Se source) on thyroid hormone levels in HD patients. Methods: we performed an uncontrolled intervention with 40 HD patients (53.3 ± 16.1 yrs, dialysis vintage 62.0 (8.0 - 207.0) months) that received one nut (≈5g, average 58.1 mg Se/g) per day for three months. Se plasma levels were determined by atomic absorption spectrophotometry with hydride generation and, serum T3, free T4 (FT4), TSH as well as glutathione peroxidase (GPx) activity were measured by ELISA. Results: all patients were Se deficient and presented low T3 levels at baseline. After intervention, Se plasma levels (from 17.6 ± 11.6 to 153.4 ± 86.1 μg/L), GPx activity (from 33.7 ± 5.9 to 41.4 ± 11.2 nmol/min/mL), T3 (from 27.3 ± 8.8 to 50.2 ± 4.8ng/dL) and FT4 levels (0.87 ± 0.2 to 0.98 ± 0.4 ng/dL) were significantly increased (p < 0.05), while TSH levels were reduced (from 2.17 ± 1.3 to 1.96 ± 1.1 uUI/mL), but not significantly. Conclusion: in conclusion, increasing Se levels via Brazil nut supplementation was associated with improvement in thyroid hormone levels in HD patients, although the amount of Se given was not able to restore T3 to normal levels (AU)

Introducción: la función tiroidea depende de minerales traza de selenio (Se), que está en el centro activo de la deiodinasa yodotironina, que cataliza la conversión de la tiroxina (T4) a la forma activa de la hormona tiroidea, triyodotironina (T3). Hemodiálisis (HD) de los pacientes ha reducido los niveles de T3 de los pacientes, debido en parte a la conversión hormonal alterada que puede estar relacionada con la deficiencia de Se, una característica común en estos pacientes. Este estudio evaluó el efecto de las nueces de Brasil (la más rica fuente de Se) en los niveles de hormonas tiroideas en pacientes en HD. Métodos: se realizó una intervención no controlada con 40 pacientes en HD (53,3 ± 16,1 años, diálisis vendimia 62,0 (8,0 - 207,0 meses)), que recibieron una nuez (≈ 5, promedio 58,1 mg Se/g) por día durante tres meses. Determinaron los niveles plasmáticos de Se por espectrofotometría de absorción atómica con generación de hidruros y los niveles de T3, T4 libre (FT4), TSH en suero, así como la actividad de la glutatión peroxidasa (GPx) por ELISA. Resultados: todos los pacientes tenían niveles bajos de Se y T3 al inicio del estudio. Después de la intervención, los niveles plasmáticos de Se (de 17,6 ± 11,6 a 153,4 ± 86,1 mg/L), actividad GPx (de 33,7 ± 5,9 a 41,4 ± 11,2 nmol/min/ml), T3 (de 27,3 ± 8,8 a 50,2 ± 4,8 ng/dL) y T4L (0,87 ± 0,2 a 0,98 ± 0,4 ng/dL) se incrementaron significativamente (p <0,05), mientras que los niveles de TSH se redujeron (de 2,17 ± 1,3 a 1,96 ± 1,1 IUU/ml), pero no de forma significativa. Conclusión: en conclusión, el aumento de los niveles de Se vía suplementación con nuez brasileña se asocia con una mejoría en los niveles de hormonas tiroideas en pacientes en HD, aunque la cantidad de Se dada no fue capaz de restablecer la T3 a los niveles normales (AU)

The effect of Greek herbal tea consumption on thyroid cancer: a case-control study.

BACKGROUND: Although in the last decade several studies have addressed the protective role of black and green tea on several diseases, including cancer, there are only few and controversial studies on the effect of tea on benign and malignant thyroid diseases. METHODS: An age and gender group matched case-control study conducted in Athens, Greece, was designed. 113 Greek patients with histologically confirmed thyroid cancer and 286 patients with benign thyroid diseases along with 138 healthy controls were interviewed with a pre-structured questionnaire in person by trained interviewers. RESULTS: An inverse association between chamomile tea consumption and benign/malignant thyroid diseases was found (P < 0.001). The odds of chamomile tea consumption, two to six times a week, after controlling for age, gender and BMI, were 0.30 (95% CI: 0.10-0.89) and 0.26 (95% CI: 0.12-0.5) for developing thyroid cancer and benign thyroid diseases, respectively when compared with not consumption. The duration of consumption was also inversely associated with the diseases. Thirty years of consumption significantly reduced the risk of thyroid cancer and benign thyroid diseases development by almost 80%. Similar, although weaker protective association, was found for sage and mountain tea. Adjustment for smoking, alcohol and coffee consumption did not alter the results. CONCLUSIONS: Our findings suggest for the first time that drinking herbal teas, especially chamomile, protects from thyroid cancer as well as other benign thyroid diseases.

Nutrición de yodo en mujeres embarazadas del área de Oviedo. ¿Es necesaria la suplementación con yodo? / Iodine nutrition in pregnant women from Oviedo area. Is iodine supplementation necessary?

INTRODUCCIÓN Y OBJETIVO: En Asturias, donde la deficiencia de yodo fue erradicada en los escolares en el año 2000, persistía una deficiencia de yodo en las mujeres embarazadas, por lo que se les recomendaba la utilización de suplementos yodados. El objetivo de este estudio es conocer la nutrición de yodo de las mujeres embarazadas de nuestra área y la necesidad o no de suplementos yodados. MATERIAL Y MÉTODOS: Durante mayo y junio de 2013 hemos estudiado la nutrición de yodo y la función tiroidea en el primer trimestre del embarazo de 173 mujeres del área sanitaria de Oviedo. RESULTADOS: La mediana de la yoduria fue 197 μg/L. Tomaban suplementos yodados el 47% de las mujeres, con una mediana de yoduria superior a la de las que no tomaban suplementos yodados (247 vs 138 μg/L; <0,001) y también una TSH superior (2,30 vs 1,94 mU/L), aunque no significativamente diferente. La yoduria fue también superior en las mujeres que tomaban más de 2 raciones de productos lácteos (mediana: 230 μg/L) que en aquellas que tomaban menos de 2 raciones (mediana: 191 μg/L). Dentro del grupo de mujeres que no tomaban suplementos yodados, aquellas que utilizaban habitualmente sal yodada en la cocina (47%), tenían una mediana de yoduria de 190 μg/L, indicativa de suficiencia de yodo. CONCLUSIÓN: En la actualidad los suplementos yodados serían innecesarios en las mujeres embarazadas de nuestra entorno que consumen de forma habitual sal yodada y la recomendación en estos casos debería ser la de continuar utilizando la sal yodada en la cantidad recomendada en la gestación, así como consumir al menos dos raciones diarias de leche o productos lácteos

BACKGROUND AND OBJECTIVE: In Asturias, where iodine deficiency was eradicated in school children by the year 2000, iodine deficiency persisted in pregnant women, who were recommended to use of iodine supplementation. The aim of this study was to determine the iodine nutrition of pregnant women in our area and whether or not iodine supplements are needed. MATERIAL AND METHODS: Throughout May and June 2013 we studied the iodine nutrition and thyroid function during the first trimester of pregnancy in 173 women in the health area of Oviedo. RESULTS: The median urinary iodine was 197 μg/L. Iodinated supplements were used by 47% of women, which had a yoduria median higher than those not taking iodinated supplements (247 vs. 138 μg/L; p < .001), and also a higher TSH (2.30 vs 1.94 mU/L) although not significantly different. Yoduria was also higher in women who took more than 2 servings of dairy products (median: 230 μg/L) than those who took less (median: 191 μg/L). Within the group of women who were not taking iodine supplements, those regularly using iodized salt in the kitchen (47%) had a median urinary iodine concentration of 190 μg/L indicating iodine sufficiency. CONCLUSIONS: Iodinated supplements seem unnecessary nowadays in pregnant women of Oviedo who regularly take iodized salt and our recommendation in these cases should be to continue the use of iodized salt in the recommended amounts during pregnancy and consume at least two daily servings of milk or dairy products

Iodine nutritional status after the implementation of the new iodized salt concentration standard in Zhejiang Province, China.

BACKGROUND: Iodine deficiencies were prevalent in China until the introduction of universal salt iodization (USI) in 1995. In 2012, the standard salt iodine concentration was adjusted to 20-30 mg/kg. The success of USI for the control of iodine deficiency disorders requires monitoring its effect at a population level. METHODS: Two cross sectional surveys of a representative sample of children aged 8-10 years in Zhejiang Province were carried out in 2011 and 2013. Data on participants' socio-demographic characteristics were collected from the children using a structured questionnaire. Spot urine samples were collected and delivered to local Center for Disease Control and Prevention laboratory for measuring urinary iodine concentration. In 2011, out of 420 selected children aged 8-10 years, 391 were recorded and provided urine samples. In 2013, out of 1560 selected children aged 8-10 years, 1556 were recorded and provided urine samples. RESULTS: The median urinary iodine concentration of subjects in the 2013 survey was 174.3 µg/L, significantly lower than that of 2011(p = 0.000). The median urinary iodine concentration of subjects living in urban and rural areas in the 2013 survey was 169.0 µg/L, and 186.1 µg/L respectively, significantly lower than that of 2011 only for subjects living in urban areas (p = 0.000). There were no significant differences for subjects living in rural areas in the survey in 2011 and in 2013 (p = 0.086). CONCLUSIONS: At the time the new local iodization policy put forward, iodine nutrition was generally adequate in both urban and rural areas, suggesting that the new policy for adjusting the standard salt iodine concentration is effective. Our data also indicate that the reason people living in urban areas had a lower urinary iodine concentration than people in rural areas may be due to their preference for using non-iodized salt in the last 2 or 3 years. Maintaining USI at an appropriate level is an important part of preventing iodine deficiency disorders and should always be based on regular monitoring and comparison of urinary iodine concentration by province.

Suplementación de yodo en la gestación y lactancia / Iodine supplementation in pregnancy and lactation

El beneficio de la suplementación con yodo durante la gestación en las áreas con deficiencia grave de yodo está bien establecido. En el año 2004 la Organización Mundial de la Salud incluyó a España entre los países con adecuada ingesta de yodo y varios estudios recientes confirman que la ingesta de yodo es suficiente en la población española. Los profesionales españoles, sin embargo, se han encontrado con recomendaciones contradictorias, lo que ha generado confusión e incertidumbre en la práctica a seguir en cuanto a la suplementación de yodo a la mujer gestante o en periodo de lactancia. A los clínicos e investigadores les preocupa que las situaciones de déficit de yodo leve o moderado puedan relacionarse con un peor desarrollo de los niños, pero la suplementación rutinaria de yodo en la gestación no está exenta de riesgo. PrevInfad considera que, al tratarse de una medida profiláctica que afecta a dos individuos -madre e hijo- y que se aplica al conjunto de una población sana, debe primar el principio de precaución y que no existen pruebas de calidad suficiente para determinar el balance entre los beneficios y los riesgos de la suplementación farmacológica de yodo durante la gestación y la lactancia, por lo que sugiere que no se realice esta intervención (AU)

The benefits of Iodine supplementation in Iodine-deficient areas are well established. The World Health Organization included Spain among the countries with an adequate Iodine intake in 2004 and some recent research papers confirm that Iodine intake is adequate in the Spanish population. Nevertheless, Spanish health professionals have been faced with contradictory recommendations, producing confusion and uncertainty in clinical practice referring to Iodine supplementation in pregnancy and breastfeeding mothers. Clinicians and researchers are concerned that mild or moderate Iodine deficiency could be related to underdevelopment in children, but routine Iodine supplementation in pregnancy is not risk free. The working group PrevInfad (Prevention in Childhood and Adolescence) considers that being a preventive intervention that applies to the total healthy population, the precaution principle must be prioritized, and that there is no evidence on the balance risk-benefit in the pharmacological Iodine supplementation during pregnancy and breastfeeding. For these reasons they suggest not making this intervention

Suplementación con yodo durante el embarazo y la lactancia. Toma de posición del Grupo de Trabajo de Trastornos relacionados con la Deficiencia de Yodo y Disfunción Tiroidea de la Sociedad Española de Endocrinología y Nutrición / Iodine supplementation during pregnancy and lactation. Position statement of the working group on disorders related to iodine deficiency and thyroid dysfunction of the Spanish Society of Endocrinology and Nutrition

La deficiencia de yodo grave y moderada durante el embarazo y la lactancia afecta a la función tiroidea de la madre y del neonato, así como al desarrollo neuropsicológico del niño. Estudios realizados en España confirman que la mayoría de las mujeres se encuentran en yododeficiencia durante la gestación y la lactancia. Las mujeres embarazadas, las que amamantan a sus hijos y las que planifican su gestación deberían recibir suplementos de yodo

Severe and mild iodine deficiency during pregnancy and lactation affects thyroid function of the mother and neonate as well as the infant's neuropsychological development. Studies performed in Spain confirm that most women are iodine deficient during pregnancy and lactation. Pregnant and breast feeding women and women planning to become pregnant should take iodine supplements

Thyroid dysfunction in thalassaemic patients: ferritin as a prognostic marker and combined iron chelators as an ideal therapy.

OBJECTIVE: Endocrine complications characterised patients with ß thalassaemia (ßT). In particular, thyroid dysfunction occurs frequently in ßT major, but its long-term natural history is poorly understood. DESIGN: A total of 72 ßT patients were followed for 8 years. The incidence of thyreopathies, defined as the primary study endpoint, was assessed. The aim of this study was to analyse the prognostic role of ferritin for thyreopathies in patients with major and intermedia ßT. The power of different iron chelators to treat iron overload and to prevent or reverse thyreopathies was also assessed. METHODS: Patients were treated with chelators with different chelation strategies during the study. Receiver operating characteristics analysis was employed to calculate the area under the curve for serum ferritin to find the best cutoff values capable of identifying thyroid dysfunction in thalassaemic patients. Kaplan-Meier curves were generated to assess incidence of thyreopathy. Adjusted risk estimates for thyreopathy were calculated using univariate followed by multivariate Cox proportional hazard regression analysis. RESULTS: PATIENTS WITH THYROID DYSFUNCTION WERE CHARACTERISED BY HIGHER FERRITIN WHEN COMPARED WITH PATIENTS WITHOUT THYREOPATHIES (1500 (8722336) VS 513 (370698) G/L; P0.0001). PATIENTS WITH FERRITIN VALUES ABOVE 1800G/L EXPERIENCED A SIGNIFICANTLY FASTER EVOLUTION TO ENDPOINT (LOG-RANK ((2)): 7.7; P=0.005). Ferritin predicted high risk of thyroid dysfunction independently of confounding factors (hazard ratio: 1.20; P<0.0001). The intensification of chelation therapy led to an amelioration of thyroid function. CONCLUSIONS: Ferritin represents a prognostic marker for ßT patients and a predictive factor for progression to thyroid dysfunction. Intensive chelation therapy allows the prevention and reversibility of thyroid complications.

Thyroxine and triiodothyronine content in commercially available thyroid health supplements.

BACKGROUND: As defined by the Dietary Supplement Health and Education Act 1997, such substances as herbs and dietary supplements fall under general Food and Drug Administration supervision but have not been closely regulated to date. We examined the thyroid hormone content in readily available dietary health supplements marketed for "thyroid support." METHODS: Ten commercially available thyroid dietary supplements were purchased. Thyroid supplements were dissolved in 10 mL of acetonitrile and water with 0.1% trifloroacetic acid and analyzed using high-performance liquid chromatography for the presence of both thyroxine (T4) and triiodothyronine (T3) using levothyroxine and liothyronine as a positive controls and standards. RESULTS: The amount of T4 and T3 was measured separately for each supplement sample. Nine out of 10 supplements revealed a detectable amount of T3 (1.3-25.4 µg/tablet) and 5 of 10 contained T4 (5.77-22.9 µg/tablet). Taken at the recommended dose, 5 supplements delivered T3 quantities of greater than 10 µg/day, and 4 delivered T4 quantities ranging from 8.57 to 91.6 µg/day. CONCLUSIONS: The majority of dietary thyroid supplements studied contained clinically relevant amounts of T4 and T3, some of which exceeded common treatment doses for hypothyroidism. These amounts of thyroid hormone, found in easily accessible dietary supplements, potentially expose patients to the risk of alterations in thyroid levels even to the point of developing iatrogenic thyrotoxicosis. The current study results emphasize the importance of patient and provider education regarding the use of dietary supplements and highlight the need for greater regulation of these products, which hold potential danger to public health.

Thyroid function in pregnant women: iodine deficiency after iodine enrichment program.

OBJECTIVE: Significant changes in thyroid function occur during pregnancy which can complicate the interpretation of thyroid function tests. Therefore, normative gestational related reference ranges for thyroid hormones tests are required. The aim of this study was to determine the reference ranges for free triiodothyronine (FT3), free thyroxin (FT4) and thyroid stimulating hormone (TSH) in Iranian pregnant women. METHODS: This study was a cross-sectional observational study conducted in the Obstetrics and Gynecology department, Akbarabadi University Hospital. A single blood sample from 584 pregnant women was analyzed for thyroid function. Serum levels of TSH, FT4, FT3, total T4 (TT4), T3 resin uptake (T3RU) and anti-thyroid peroxidase antibody (TPO Ab) were measured. Urinary iodine was determined in some cases. Reference intervals based on 2.5th and 97.5th percentiles were calculated. RESULTS: The composition of reference population comprising 584 women included 162 in first trimester and 422 in the third trimester. The 2.5th and 97.5th percentiles values were used to determine the reference ranges for FT3, FT4, TT4, T3RU and TSH. These values were T3 1.4 and 2.9 pmol/L, FT4 7.1 and 18 pmol/L, TT4 7.2 and 13.5 µg/dL and TSH 0.5 and 3.9 µg/L, respectively. The level of urinary iodine in 80.5% of the subjects was less than normal. CONCLUSIONS: Serum levels of thyroid hormones are different in Iranian population that could be due to racial differences or differences in iodine intake.