Croatia has reached iodine sufficiency.

This study was performed in 2002, 6 yr after the introduction of a new regulation on salt iodination with 25 mg KI/kg of salt. The aim of the study was to evaluate whether further significant positive results of improved iodine intake could be observed among schoolchildren in Croatia. A total of 927 schoolchildren of both sexes, aged 6-12 yr, were included in the study. In Croatia, with a population of 4,437,460 the research was implemented in four major geographical regions: the Northwestern, Slavonia, Northern Adriatic and Dalmatian regions. Investigations included randomly selected pupils from regional centers and neighboring smaller towns or villages. The results have revealed that thyroid volumes were within the normal range according to the provisional WHO/ICCIDD reference values for sonographic thyroid volume in iodine-replete school-age children, updated in 2001. A significant improvement in medians of urinary iodine excretion was detected in 2002: from 9 microg/dl in 1991 to 14.6 microg/dl in Zagreb, from 4.3 microg/dl in 1995 to 13.1 microg/dl in Split, from 9.4 microg/dl in 1997 to 14.2 microg/dl in Rijeka and from 13.4 microg/dl in 1997 to 14.7 microg/dl in Osijek. An overall median of 14.0 microg/dl of urinary iodine excretion was detected in Croatian schoolchildren. The control of salt at different levels, from production to consumption, including salt produced in all three Croatian salt plants and imported salt, revealed that Croatian salt is adequately iodized. From severe iodine deficiency before the 1950s, through mild-to-moderate iodine deficiency in the 1990s, Croatia has now reached iodine sufficiency.

[Endemic goiter in Croatia]. / Endemska gusavost u Hrvatskoj.

In the early nineties, 40 years after the introduction of iodine prophylaxis in Croatia (10 mg KI/kg salt), a nationwide study was initiated with the aim to determine the real prevalence of goiter in the country. A total of 2436 schoolchildren of both sexes, aged 7-15 years, were included in the study. Investigations were designed in a way to cover most of geographical regions in Croatia and subjects were randomly selected. The prevalence of goiter in schoolchildren was assessed by palpation and in part by ultrasonography of the neck. At the same time urinary iodine excretion was measured and potassium iodide content in salt samples was determined. The results revealed the persistence of mild endemic goiter in the inland parts of Croatia with the prevalence of 6-29% in the age group 7-11 years and 10-43% among the age group 12-15 years. The overall goiter prevalence in schoolchildren in Croatia fluctuates from 8% to 35%. The urinary iodine excretion in Zagreb varied from 1.6 to 24.4 micrograms/dL with a median of 9.0, while in 14% it was below 5 micrograms/dL. The urinary iodine excretion in Samobor varied between 0.5 and 19 micrograms/dL with a median of 7.4 micrograms/dL, while in 30% it was below 5 micrograms/dL. Examination of salt from all three salt plants in Croatia showed iodine contents between 0.0 and 12.73 mg/kg with the average value of 5.39 mg/kg. Such prevalence, most probably due to less than optimum iodine intake, is unlikely to change until potassium iodide content of salt is increased from its present level of 10 mg of KI per kg of salt, with concomitant stricter observance of legal regulations.

Current status of endemic goiter in Croatia: the results of a nationwide study (1995).

In the beginning of the nineties, 40 years after introduction of iodine prophylaxis in Croatia, on a basis of a frequent reports coming from general practitioners about the presence of a rather high prevalence of goiter among schoolchildren, a nationwide study was initiated with the aim to determine the real prevalence of goiter in the country. A total of 2856 schoolchildren of both sexes, aged 7-15 years, were included into the study. Investigations were designed in a way to cover most of geographical regions in Croatia and subjects were randomly selected. The prevalence of goiter in schoolchildren was assessed by palpation and in part by ultrasonography of the neck. At the same time urinary iodine excretion was measured and iodine content in salt samples was determined. The results have revealed the persistence of mild endemic goiter in inland parts of Croatia with the prevalence of 6-29% in the age group 7-11 years and those of 10-43% among the age group 12-15 years. The overall goiter prevalence in schoolchildren in Croatia fluctuates from 8% to 35%. Such prevalence, most probably due to less than optimum iodine intake, is unlikely to change until iodine content of the salt is increased from its present level of 10 mg of Kl per kg of salt.

Morphologic diagnosis of Hürthle cell tumors of the thyroid gland.

Despite difficulties in differential diagnosis, aspiration cytology offers unique advantages in the preoperative diagnosis of Hürthle cell (HC) tumors of the thyroid gland over immunocytochemistry and micromorphometry, which have not achieved the anticipated success in the diagnosis of HC tumors. Aspiration cytology is comparable, in terms of speed and accuracy, to microspectrometry of DNA content in HC tumors, a technique that is not convenient for routine use. Detailed morphologic analysis of 19 characteristics of the smears and of the cells revealed five parameters adding to the sensitivity, specificity and reliability of routine diagnosis: HC collection in the form of nests, marked or at least moderate anisocytosis and anisokaryosis, multinucleation and emphasized nucleoli. All five criteria are found in > 70% of HC tumors, and the rate of false positives is < 50%. The simultaneous presence of three or four of these five parameters occurred in 70-90% of HC tumors and would lead to a false-positive diagnosis of HC tumors in only 30% of cases. Routine cytologic diagnosis of HC tumors of the thyroid gland may be improved by adoption of these criteria.

[Cytologic differentiation between the autonomous and autoimmune type of diffuse hyperthyroid goiter: correlation with TSH receptor antibodies, microsomal antibodies and infiltrative ophthalmopathy]. / Pokusaj citoloske diferencijacije difuzne hipertireoidne strume na autonomni i autoimuni oblik: korelacija s TBIAb, MSA i infiltrativnom oftalmopatijom.

A group of 101 patients with diffuse hyperthyroid goiter has been studied. Sixty-seven patients showed significantly increased level of antibodies to the TSH receptor (TBIAb), 48 patients had positive microsomal antibodies (MAb) and 41 patients had infiltrative ophthalmopathy. On the basis of cytologic analysis of the whole group, the patients were divided into two groups. Group A (n = 51, autonomous form?) was characterized by follicular cell proliferation, while group B (n = 50, autoimmune form?) was characterized by lymphocyte infiltration or follicular cell proliferation with lymphocyte traces. Cytologic findings were correlated with autoimmunity markers (TBIAb, MAb, infiltrative ophthalmopathy); multiple correlation factor was 0.17. In conclusion, cytologic classification into autonomous and autoimmune hyperthyroidism form, except by microsomal antibodies, is not followed by other autoimmunity markers.