Valores de referencia de TSH en población gestante española. ¿Podemos unificar criterios? / Reference TSH levels in Spanish pregnant women. Is it possible to unify criteria?

Introducción: Durante la gestación, se requieren rangos de referencia específicos de TSH y de tiroxina libre para la correcta valoración de la función tiroidea materna. Objetivo: Revisión de estudios sobre valores de referencia para TSH y tiroxina libre durante el primer trimestre de gestación de población española. Material y métodos: Búsqueda bibliográfica y selección de estudios que contengan rangos de referencia de TSH en el primer trimestre de gestación. Resultados: El punto de corte de TSH para definir hipotiroidismo (P97,5) varió según el inmunoanálisis utilizado. La edad gestacional, la autoinmunidad tiroidea y el estado nutricional de yodo de las poblaciones utilizadas condicionaron la variación observada en los resultados. Conclusiones: Las diferencias encontradas en los estudios revisados no permiten establecer un rango de referencia unificado para TSH. No obstante, se observa que el límite superior del rango para TSH está próximo a 4μU/mL. Sería conveniente disponer de rangos de referencia propios para cada población y específicos para cada inmunoanálisis

Introduction: Specific TSH and free thyroxine ranges are needed to adequately assess maternal thyroid function during pregnancy. Aim: The aim of this review is to review studies reporting data on references TSH and free thyroxine levels in Spanish women during the first trimester of pregnancy. Material and methods: Literature search and selection of studies providing reference TSH ranges in the first trimester of pregnancy. Results: The TSH cut-off point to define hypothyroidism (P97.5) was different depending on the immunoassay used. Gestational age, thyroid autoimmunity, and maternal iodide nutritional status can determine the variability seen in the results. Conclusions: Differences found in the studies do not allow for establishing a unified TSH reference range. However, results suggest that the TSH upper reference limit is close to 4μU/mL. Reference TSH ranges specific for each population and immunoassay during pregnancy should be defined

Reference TSH levels in Spanish pregnant women. Is it possible to unify criteria? / Valores de referencia de TSH en población gestante española. ¿Podemos unificar criterios?

INTRODUCTION: Specific TSH and free thyroxine ranges are needed to adequately assess maternal thyroid function during pregnancy. AIM: The aim of this review is to review studies reporting data on references TSH and free thyroxine levels in Spanish women during the first trimester of pregnancy. MATERIAL AND METHODS: Literature search and selection of studies providing reference TSH ranges in the first trimester of pregnancy. RESULTS: The TSH cut-off point to define hypothyroidism (P97.5) was different depending on the immunoassay used. Gestational age, thyroid autoimmunity, and maternal iodide nutritional status can determine the variability seen in the results. CONCLUSIONS: Differences found in the studies do not allow for establishing a unified TSH reference range. However, results suggest that the TSH upper reference limit is close to 4µU/mL. Reference TSH ranges specific for each population and immunoassay during pregnancy should be defined.

Estudio de correlación de los resultados histológicos con los hallazgos ecográficos en nódulos tiroideos. Clasificación TI-RADS / Acorrelation study between histological results and thyroid ultrasound findings. The TI-RADS classification

Introducción: Existen distintas clasificaciones en ecografía tiroidea para la selección de nódulos tiroideos sospechosos de malignidad. La clasificación Thyroid Imaging Reporting and Data System (TI-RADS), descrita por Horvath en 2009, diferencia 6 categorías. Objetivos: Evaluar la sensibilidad del método TI-RADS en el diagnóstico de patología nodular tiroidea. Material y métodos: Estudio observacional retrospectivo, que incluyó a todos los pacientes sometidos a tiroidectomía en nuestro centro (n=263), desde septiembre de 2013 a diciembre de 2015. Después de la tiroidectomía, los resultados histológicos se correlacionaron con los informes de las ecografías prequirúrgicas. Resultados: De los 263 pacientes incluidos en el estudio, tras la tiroidectomía 75 (28,5%) fueron diagnosticados de cáncer de tiroides y 188 (71.5%) de patología benigna. La correlación del resultado histológico con los informes de la ecografía prequirúrgica mostró una sensibilidad inicial del 65%. Tras excluir a 15 pacientes con diagnóstico de microcarcinoma oculto, la sensibilidad se incrementó hasta el 81,6%. Posteriormente, un radiólogo que conocía el diagnóstico histológico revisó las imágenes ecográficas de los 11 pacientes falsos negativos y reclasificó a 10 de ellos como TI-RADS≥4. Este procedimiento podría haber elevado la sensibilidad hasta un 98,3%. Conclusión: Aunque la sensibilidad de la escala TI-RADS obtenida inicialmente en nuestro estudio es relativamente baja, la exclusión de los pacientes con microcarcinoma oculto permite un notable incremento de su valor. De esta manera, la utilización de la escala TI-RADS permitiría una adecuada selección de pacientes subsidiarios de punción-aspiración con aguja fina (AU)

Introduction: There are several classifications based on thyroid ultrasound for selecting suspected malignant thyroid nodules. The Thyroid Imaging Reporting and Data System (TI-RADS) classification proposed by Horvath in 2009 includes 6 categories. Objetives: To assess the sensitivity of the TI-RADS classification for diagnosing thyroid nodules. Methods: A retrospective study of all patients who underwent thyroidectomy at our hospital (n=263) from September 2013 to December 2015. After thyroidectomy, histological results were correlated to the ultrasound findings reported. Results: Of the 263 study patients, 75 (28.5%) were diagnosed with thyroid cancer and 188 (71.5%) with benign disease. Correlation of histological results with preoperative ultrasound reports showed an initial sensitivity of 65%. After excluding 15 patients diagnosed with occult microcarcinoma, sensitivity increased to 81.6%. The ultrasound images from 11 false negatives cases were then reassessed by a radiologist who knew histological diagnosis and reclassified 10 of them as TI-RADS≥4. This procedure could have increased sensitivity up to 98.3%. Conclusions: Although the sensitivity initially found in our study using the TI-RADS scale was relatively low, the value markedly improved when patients with occult microcarcinoma were excluded. Thus, use of the TI-RADS scale would allow for an adequate selection of patients amenable to fine needle aspiration of the nodule (AU)

Acorrelation study between histological results and thyroid ultrasound findings. The TI-RADS classification. / Estudio de correlación de los resultados histológicos con los hallazgos ecográficos en nódulos tiroideos. Clasificación TI-RADS.

INTRODUCTION: There are several classifications based on thyroid ultrasound for selecting suspected malignant thyroid nodules. The Thyroid Imaging Reporting and Data System (TI-RADS) classification proposed by Horvath in 2009 includes 6 categories. OBJETIVES: To assess the sensitivity of the TI-RADS classification for diagnosing thyroid nodules. METHODS: A retrospective study of all patients who underwent thyroidectomy at our hospital (n=263) from September 2013 to December 2015. After thyroidectomy, histological results were correlated to the ultrasound findings reported. RESULTS: Of the 263 study patients, 75 (28.5%) were diagnosed with thyroid cancer and 188 (71.5%) with benign disease. Correlation of histological results with preoperative ultrasound reports showed an initial sensitivity of 65%. After excluding 15 patients diagnosed with occult microcarcinoma, sensitivity increased to 81.6%. The ultrasound images from 11 false negatives cases were then reassessed by a radiologist who knew histological diagnosis and reclassified 10 of them as TI-RADS≥4. This procedure could have increased sensitivity up to 98.3%. CONCLUSIONS: Although the sensitivity initially found in our study using the TI-RADS scale was relatively low, the value markedly improved when patients with occult microcarcinoma were excluded. Thus, use of the TI-RADS scale would allow for an adequate selection of patients amenable to fine needle aspiration of the nodule.

Carta respuesta: cribado de la enfermedad tiroidea en el embarazo / Reply letter: screening for thyroid disease in pregnancy

No disponible

Análisis coste-efectividad del cribado universal de la enfermedad tiroidea en mujeres embarazadas en España / Cost-effectiveness analysis of universal screening for thyroid disease in pregnant women in Spain

OBJETIVO: Evaluar la relación coste-efectividad del cribado universal para la enfermedad tiroidea en mujeres embarazadas frente al cribado selectivo y no realizar cribado. METODOLOGÍA: Modelo analítico de decisión para embarazo y periodo posparto que compara los años de vida ajustados por la calidad (AVAC) obtenidos gracias a la realización de un cribado universal frente al cribado de alto riesgo y no realizar cribado. Se consideraron las probabilidades de los ensayos aleatorios controlados para los resultados obstétricos adversos. Se utilizó un modelo de Markov para valorar el período de vida tras el primer año después del parto y considerar la posible progresión a hipotiroidismo clínico. Los principales supuestos del modelo, así como el uso de recursos fueron evaluados por expertos clínicos. Se consideraron únicamente los costes sanitarios directos. RESULTADOS: Realizar un cribado universal produce 0,011 AVAC más que el cribado selectivo y 0,014 AVAC más que la alternativa de no realizar cribado. Los costes totales directos por paciente fueron de 5.786 Euros para el cribado universal, 5.791 Euros para cribado por riesgo y de 5.781 Euros sin cribado. El paso del cribado selectivo por riesgo al cribado universal puede ahorrar 2.653.854 Euros al sistema sanitario español. CONCLUSIONES: El cribado universal de enfermedad tiroidea durante el primer trimestre de gestación es una estrategia dominante frente al cribado selectivo y coste-efectiva con respecto al no cribado (ratio coste-efectividad incremental de 374 Euros por AVAC), que permite además diagnosticar y tratar casos de hipotiroidismo clínico y subclínico que podrían no ser detectados al cribar solo mujeres con alto riesgo

OBJECTIVE: To assess the cost-effectiveness of universal screening for thyroid disease in pregnant women in Spain as compared to high risk screening and no screening. METHODOLOGY: A decision-analytic model comparing the incremental cost per quality-adjusted life year (QALY) of universal screening versus high risk screening and versus no screening. was used for the pregnancy and postpartum period. Probabilities from randomized controlled trials were considered for adverse obstetrical outcomes. A Markov model was used to assess the lifetime period after the first postpartum year and account for development of overt hypothyroidism. The main assumptions in the model and use of resources were assessed by local clinical experts. The analysis considered direct healthcare costs only. RESULTS: Universal screening gained .011 QALYs over high risk screening and .014 QALYS over no screening. Total direct costs per patient were 5,786 Euros for universal screening, 5,791 Euros for high risk screening, and 5,781 Euros for no screening. Universal screening was dominant compared to risk-based screening and a very cost-effective alternative as compared to no screening. Use of universal screening instead of high risk screening would result in 2,653,854 Euros annual savings for the Spanish National Health System. CONCLUSIONS: Universal screening for thyroid disease in pregnant women in the first trimester is dominant in Spain as compared to risk-based screening, and is cost-effective as compared to no screening (incremental cost-effectiveness ratio of 374 Euros per QALY). Moreover, it allows diagnosing and treating cases of clinical and subclinical hypothyroidism that may not be detected when only high-risk women are screened

[Cost-effectiveness analysis of universal screening for thyroid disease in pregnant women in Spain]. / Análisis coste-efectividad del cribado universal de la enfermedad tiroidea en mujeres embarazadas en España

OBJECTIVE: To assess the cost-effectiveness of universal screening for thyroid disease in pregnant women in Spain as compared to high risk screening and no screening. METHODOLOGY: A decision-analytic model comparing the incremental cost per quality-adjusted life year (QALY) of universal screening versus high risk screening and versus no screening. was used for the pregnancy and postpartum period. Probabilities from randomized controlled trials were considered for adverse obstetrical outcomes. A Markov model was used to assess the lifetime period after the first postpartum year and account for development of overt hypothyroidism. The main assumptions in the model and use of resources were assessed by local clinical experts. The analysis considered direct healthcare costs only. RESULTS: Universal screening gained .011 QALYs over high risk screening and .014 QALYS over no screening. Total direct costs per patient were €5,786 for universal screening, €5,791 for high risk screening, and €5,781 for no screening. Universal screening was dominant compared to risk-based screening and a very cost-effective alternative as compared to no screening. Use of universal screening instead of high risk screening would result in €2,653,854 annual savings for the Spanish National Health System. CONCLUSIONS: Universal screening for thyroid disease in pregnant women in the first trimester is dominant in Spain as compared to risk-based screening, and is cost-effective as compared to no screening (incremental cost-effectiveness ratio of €374 per QALY). Moreover, it allows diagnosing and treating cases of clinical and subclinical hypothyroidism that may not be detected when only high-risk women are screened.

Valores de referencia de tirotropina durante la gestación / Tirotropine reference intervals during pregnancy

El hipotiroidismo materno clínico y el subclínico tienen consecuencias graves tanto para la madre como para el feto. Debido a la compleja fisiología de la función tiroidea durante el embarazo, debería realizarse la evaluación hormonal según valores de referencia para cada trimestre de gestación y para cada zona y con las técnicas propias de cada laboratorio. Si no se dispone en el laboratorio de estos valores de referencia trimestrales propios, se recomiendan los siguientes valores de referencia de tirotropina: primer trimestre < 2,5 mUI/L; segundo y tercer trimestres < 3,0 mUI/L(AU)

Overt and subclinical maternal hypothyroidism is known to have serious adverse effects for both mother and fetus. Given the complex physiology of thyroid function during pregnancy, hormone assessment should be performed according to reference values for each gestational trimester and generated locally in each reference laboratory. If trimester-specific references intervals are not available in the laboratory, the following reference ranges of tirotropine are recommended: first trimester < 2,5 mUI/L; second and third trimesters < 3,0 mUI/L(AU)

Estudio de cohorte retrospectivo de pacientes diagnosticados de cáncer de tiroides del área suroeste de Madrid. Factores pronósticos en el cáncer diferenciado de tiroides / No disponible

Objetivos Análisis de las características clínicas e histopatológicas de los pacientes con cáncer de tiroides en el área suroeste de Madrid e identificación de los factores de mal pronóstico en el subgrupo de carcinoma diferenciado de tiroides (CDT) del epitelio folicular. Pacientes y métodos .Estudio retrospectivo de una cohorte de cáncer de tiroides de nuestro hospital entre 1998-2009. Las variables clínicas, quirúrgicas e histopatológicas significativas se incluyeron en modelos de regresión de Cox y logística para la identificación de factores pronósticos de muerte, recidiva y persistencia de enfermedad. Resultados Se incluyeron 150 pacientes con mediana de edad 49 años y mediana de seguimiento de 5,4 años. Los subtipos histológicos fueron: carcinoma papilar (86%), carcinoma folicular (6,6%), carcinoma medular (4%), carcinoma pobremente diferenciado (2,7%) y carcinoma anaplásico (0,7%).Al final del estudio: 68% curación, 3,3% muertos (mortalidad por cáncer tiroideo 1,3%), 1,3% pérdida de seguimiento, 6,7% con enfermedad bioquímica persistente, 2,7% con enfermedad clínica persistente y 18% pendiente de evaluación. El mejor modelo pronóstico para recidiva de CDT fue el estadiaje TNM (estadio ii-iv frente a i: HR 5,9, 95% IC 1,3-26,6) y para persistencia de enfermedad o muerte el estadiaje clínico de la ETA (alto riesgo frente a bajo/muy bajo riesgo: OR 9,2, 95% IC 2,6-33,2)Conclusiones En nuestro estudio la mortalidad y persistencia clínica de enfermedad fueron bajas. La clasificación de pacientes con CDT según estadiaje de la ETA fue un buen factor predictor de enfermedad persistente o muerte (AU)

Objectives To analyze the clinical and histopathological features of patients with thyroid cancer in the southwest Madrid area and to identify poor prognostic factors in the subgroup with differentiated thyroid carcinoma (DTC) of the follicular epitelium. Patients and methods A retrospective cohort study of patients diagnosed with thyroid cancer at our hospital from 1998 to 2009. Significant clinical, surgical, and histopathological variables were included in Cox proportional hazard and logistic regression models to identify baseline factors predicting for death, recurrence, and persistent disease in DTC. Results A total of 150 patients with a median age of 49 years and a median follow-up of 5.4 years were enrolled. Histological subtypes were: papillary carcinoma (86%), follicular carcinoma (6.6%), medullary carcinoma (4%), poorly differentiated carcinoma (2.7%), and anaplastic carcinoma (0.7%). At the end of the study, 68% of patients were cured, 3.3% had died (disease-specific mortality, 1.3%), 1.3% were lost to follow-up, 6.7% had persistent biochemical disease, and 2.7% persistent clinical disease, while 18% of patients were pending assessment. The best prognostic model for DTC recurrence was TNM staging (stage II-IV vs. I: HR 5.9, 95% CI 1.3-26.6), while the best model for persistent disease or death was ETA clinical staging (high risk vs. low or very low risk: OR 9.2, 95% CI 2.6-33.2).Conclusions In our study, disease-specific mortality and persistent clinical disease were low. Classification of DTC patients based on ETA staging after initial treatment was a good predictor of persistent disease or death (AU)

[A retrospective cohort study of patients diagnosed of thyroid cancer in the southwest Madrid area. Predictive factors in differentiated thyroid cancer]. / Estudio de cohorte retrospectivo de pacientes diagnosticados de cáncer de tiroides del área suroeste de Madrid. Factores pronósticos en el cáncer diferenciado de tiroides.

OBJECTIVES: To analyze the clinical and histopathological features of patients with thyroid cancer in the southwest Madrid area and to identify poor prognostic factors in the subgroup with differentiated thyroid carcinoma (DTC) of the follicular epitelium. PATIENTS AND METHODS: A retrospective cohort study of patients diagnosed with thyroid cancer at our hospital from 1998 to 2009. Significant clinical, surgical, and histopathological variables were included in Cox proportional hazard and logistic regression models to identify baseline factors predicting for death, recurrence, and persistent disease in DTC. RESULTS: A total of 150 patients with a median age of 49 years and a median follow-up of 5.4 years were enrolled. Histological subtypes were: papillary carcinoma (86%), follicular carcinoma (6.6%), medullary carcinoma (4%), poorly differentiated carcinoma (2.7%), and anaplastic carcinoma (0.7%). At the end of the study, 68% of patients were cured, 3.3% had died (disease-specific mortality, 1.3%), 1.3% were lost to follow-up, 6.7% had persistent biochemical disease, and 2.7% persistent clinical disease, while 18% of patients were pending assessment. The best prognostic model for DTC recurrence was TNM staging (stage II-IV vs. I: HR 5.9, 95% CI 1.3-26.6), while the best model for persistent disease or death was ETA clinical staging (high risk vs. low or very low risk: OR 9.2, 95% CI 2.6-33.2). CONCLUSIONS: In our study, disease-specific mortality and persistent clinical disease were low. Classification of DTC patients based on ETA staging after initial treatment was a good predictor of persistent disease or death.

Evaluación de los hábitos alimentarios relacionados con la ingesta de yodo, el estado nutricional de yodo y disfunción tiroidea en cuatro poblaciones no seleccionadas (proyecto Tirobus) / Assessment of dietary habits related to iodine intake and iodine concentration and thyroid dysfunction in a non-preselected population in Spain (the Thyrobus Project)

Introducción La mayoría de los últimos estudios realizados en España sobre el estado nutricional de yodo muestran una significativa mejoría. Con motivo de una campaña de información sobre la glándula tiroides, la importancia del yodo y el hipotiroidismo, efectuada en 4 ciudades de España, se realizó un estudio para conocer el consumo de alimentos ricos en yodo, la yoduria y la prevalencia de disfunciones tiroideas. Material y métodos Población no seleccionada que acudió a los centros de información de la campaña realizada en Barcelona, A Coruña, Málaga y Madrid. Se realizó una encuesta sobre el consumo de pescado, leche y sal yodada. Se analizó la yoduria (método Pino) y la tirotropina (TSH) (muestra recogida en papel absorbente Whatman-903®).Resultados Se realizaron 872 encuestas (el 40% en Madrid, el 27% en A Coruña, el 19% en Málaga y el 14% en Barcelona). La edad media de la población encuestada era de 51 años (DE: 16) siendo el 81% mujeres. Afirmaba consumir sal yodada el 60,6%; el 90,8% consumía leche diariamente y el 29,3% consumía pescado 3 veces o más por semana. La mediana de yoduria fue de 143,2μg/l. La prevalencia de TSH elevada (>4mUI/l) fue del 1,3% y de TSH baja (<0,4mUI/l) fue del 1,2%.ConclusionesLa mediana de la yoduria global o por ciudades es indicativa de una nutrición óptima de yodo (según criterios de la Organización Mundial de la Salud). Probablemente, productos como la leche y el pescado, además de la sal yodada, pueden haber influido en estos resultados. La prevalencia de hipertiroidismo e hipotiroidismo no conocido detectada es similar a la descrita en otros estudios (AU)

Introduction Most of the studies on urinary iodine levels in Spain in the last decade have reported a significant improvement. A survey was undertaken together with an information campaign on the thyroid gland, the importance of iodine intake and hypothyroidism in four Spanish cities. The goals of the survey were to obtain information on consumption of iodine-containing foods, to measure urinary iodine levels and to evaluate the prevalence of thyroid dysfunction. Materials and methods A non-preselected population attending the information campaign centers located in Barcelona, La Coruña, Malaga and Madrid was studied. A questionnaire on fish, milk and iodized salt consumption was administered. Urinary iodine levels (Pino's method) and thyrotropin (TSH) concentrations (Whatman 903® dry paper method) were measured. Results A total of 872 questionnaires were completed (Madrid 40%; La Coruña 27%; Malaga 19%; and Barcelona 14%). The mean age was 51 years (SD 16); 81% were women. A total of 60.6% of interviewees reported they consumed iodized salt, 90.8% reported daily milk intake and 29.3% reported fish consumption ≥3 times per week. The mean urinary iodine concentration was 143.2μg/L. The prevalence of high TSH levels (>4mUI/L) was 1.3% and that of low TSH levels (<0.4mUI/mL) was 1.2%.Conclusions According to the World Health Organization criteria, the median urinary iodine concentration, both overall or by city, is indicative of optimal iodine intake. In addition to iodized salt intake, consumption of products such as milk and fish has probably contributed to these positive results. The prevalences of undiagnosed hyperthyroidism and hypothyroidism detected in this study were similar to those found in other studies (AU)

Déficit de yodo en una población de mujeres embarazadas pertenecientes a un área con leve deficiencia de yodo / Iodine deficiency in pregnant women from a mildly iodine-deficient area

Objetivo: Los estudios realizados en España proponen que la ingesta de yodo de las mujeres embarazadas está por debajo de los requerimientos nutricionales. Con este estudio se pretende conocer el estado nutricional de yodo en una población de mujeres embarazadas de Madrid. Pacientes y método: Estudio prospectivo de una cohorte de 112 mujeres gestantes con enfermedad endocrina entre enero y septiembre de 2004. Resultados: La yoduria fue 101,5 (60,25-176,75) µg/l. Sólo el 30,4% de las mujeres mostraban suficiencia de yodo (yoduria > 160 µg/l). La tirotropina fue 2,1 (1,12-2,95) µU/ml; la tiroxina libre, 0,87 (0,77-1) ng/dl; los anticuerpos antitiroglobulina y los anticuerpos antiperoxidasa, positivos en el 5,4 y el 19,6% respectivamente. En el análisis bivariable, el consumo de sal yodada se asoció con la suficiencia de yodo (odds ratio [OR] = 3,6; intervalo de confianza [IC] del 95%, 1,45-8,93). El 41,3% de las consumidoras de sal yodada presentaron yodurias > 160 µg/l, frente al 16,3% de las no consumidoras (p = 0,004). No hubo asociación entre suficiencia de yodo y antecedentes familiares de enfermedad tiroidea, bocio, tratamiento con levotiroxina, tirotropina, tiroxina libre, anticuerpos antitiroglobulina ni anticuerpos antiperoxidasa. En el análisis multivariable, la OR ajustada del consumo de sal yodada sobre la suficiencia nutricional de yodo fue 3,92 (1,46-10,53; p = 0,008). Conclusiones: En esta muestra, el 69,6% de las gestantes presentaron yodurias < 160 µg/l. El consumo de sal yodada se asoció a suficiencia de yodo. En esta cohorte no encontramos asociación de suficiencia de yodo con positividad de anticuerpos antitiroglobulina y anticuerpos antiperoxidasa ni con concentraciones de tirotropina y tiroxina libre

Objective: Studies performed in Spain suggest that iodine intake in pregnant women is below nutritional requirements. This study was designed to determine the degree of iodine nutrition during pregnancy in women from Madrid. Patients and method: A prospective study of 112 pregnant women with endocrinological disorders was performed between January 2004 and September 2004. Results: The urinary iodine level was 101.5 µg/l (60.25-176.75). Only 30.4% of the women showed adequate urinary iodine levels (higher than 160 µg/l). Serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) concentrations were 2.1 µU/ml (1.12-2.95) and 0.87 µg/dl (0.77-1), respectively. Antithyroglobulin (TgAb) and antiperoxidase (TPOAb) antibody values were positive in 5.4% and 19.6%, respectively. In the bivariate analysis, iodized salt intake was associated with iodine sufficiency (OR = 3.6; 95% CI, 1.45-8.93). A total of 41.3% of women with iodized salt intake had urinary iodine levels higher than 160 µg/l compared with 16.3% of those not consuming iodized salt (p = 0.004). No association was found between iodine sufficiency and a family history of thyroid disease, the presence of goiter, levothyroxine treatment, TSH, FT3, FT4, TPOAb or TgAb. In the multivariate analysis, the adjusted OR for the association between intake of iodized salt and iodine sufficiency was 3.92 (1.46-10.53; p = 0.008). Conclusions: In this sample, 69.6% of the pregnant women showed urinary iodine levels lower than 160 µg/l. Intake of iodized salt was associated with iodine sufficiency. We found no correlation between urinary iodine levels and TSH, FT4, FT3, or antibody positivity

Consumo de sal yodada en pacientes de consultas de endocrinología de tres áreas sanitarias de la Comunidad de Madrid / Iodized salt intake in patients attending endocrinology outpatient clinics in three health areas of the Autonomous Community of Madrid

Introducción: Estudios previos muestran que el consumo de sal yodada en diferentes grupos de población española es inferior al recomendado por la Organización Mundial de la Salud para lograr la erradicación de la deficiencia de yodo. El objetivo de este estudio es conocer el consumo de sal yodada en pacientes de consultas de endocrinología de la Comunidad de Madrid. Pacientes y métodos: Se estudió a 2.683 pacientes atendidos en consultas de endocrinología de 3 áreas sanitarias y en una consulta de atención primaria de la Comunidad de Madrid. Se midieron las siguientes variables: consumo de sal yodada, sexo, edad, edad fértil en mujeres, centro sanitario, presencia y tipo de patología tiroidea y contraindicación para consumo de sal yodada. Por razones económicas y organizativas no se evaluaron otras variables, como el estado nutricional de yodo mediante determinación de yoduria o el tipo de sal presente en los hogares de la población encuestada, variables que podrían haber aportado datos más objetivos y confirmatorios del consumo real de sal yodada que los obtenidos exclusivamente de las respuestas dadas por los individuos encuestados. Tras el análisis estadístico bivariado se procedió a la inclusión de las variables independientes en un modelo de regresión logística binaria, siendo la variable dependiente dicotómica el consumo de sal yodada. Resultados: Un 44,6% de los pacientes refirió consumir sal yodada. Su consumo en mujeres en edad fértil y en pacientes con patología tiroidea en la que está contraindicado el uso de sal yodada fue similar al resto de los pacientes. El consumo de sal yodada fue significativamente mayor en mujeres (odds ratio [OR]: 1,47; intervalo de confianza [IC] del 95%: 1,21-1,8) pacientes con patología tiroidea (OR: 1,22, IC del 95%: 1,02-1,44) y pacientes atendidos en consultas de endocrinología (OR: 1,43; IC del 95%: 1,08-1,9). Conclusiones: Menos de la mitad de los pacientes estudiados consume sal yodada, mostrando un nivel de información inadecuado sobre los beneficios para la salud del consumo de sal yodada. Se plantea la necesidad de la realización de campañas institucionales informativas periódicas sobre la importancia de la deficiencia de yodo, que promuevan la generalización del consumo de sal yodada en toda la población española

Introduction: Several previous studies have shown that iodized salt intake in different groups of the Spanish population is lower than that recommended by the World Health Organization to eradicate iodine deficiency. The aim of the present study was to determine iodized salt intake in patients attending endocrinology outpatient clinics in the Autonomous Community of Madrid. Patients and methods: We evaluated 2.683 patients attending endocrinology outpatient clinics in three health areas and one primary care center in the Autonomous Community of Madrid. The following variables were collected: iodized salt intake, sex, age, fertile age in women, health center, presence and type of thyroid disease, and contraindication for iodized salt intake. For economic and management reasons, we did not evaluate other variables such as nutritional iodine status through determination of urinary iodine excretion or the type of salt present in the homes of the population surveyed, which could have provided more objective and confirmatory results on real iodized salt intake than those exclusively obtained from the answers given by the population surveyed. A bivariate statistical analysis was performed and the independent variables were included in a binary logistic regression model with iodized salt intake as the dependent dichotomic variable. Results: A total of 44.6% of the patients reported iodized salt consumption. The intake of iodized salt in women of fertile age and in patients with a diagnosis of thyroid disease contraindicating iodized salt intake was similar to that observed in the remaining patients. The use of iodized salt was significantly higher in women (odds ratio [OR]: 1.47; 95% confidence interval [CI]: 1.21-1.8), patients with thyroid disease (OR: 1.22; 95% CI: 1.02-1.44), and patients attending endocrinology outpatient clinics (OR: 1.43; 95% CI: 1.08-1.9). Conclusions: Less than 50% of the patients consumed iodized salt, revealing that information on the health benefits of iodized salt intake is inadequate. Periodic institutional information campaigns on the importance of iodine deficiency should be implemented to promote widespread iodized salt intake among all sectors of the Spanish population