ETIOLOGICAL PROFILE OF GOITER AND CORRELATION BETWEEN IODINE NUTRITIONAL STATUS WITH AUTOIMMUNE THYROIDITIS IN CHILDREN
Abstract
Despite years of salt iodization,
goiter continues to be a major public
health problem worldwide. Iodine intake
has a marked influence on the incidence
and prevalence of thyroid abnormalities
in a population and excess iodine exposure
was reported to be associated with
autoimmune thyroiditis (AIT) and thyroid
dysfunction. Measurement of urinary iodine
excretion (UIE) reflects a persons
iodine nutritional status and WHO recommend
it to be used as the primary impact
indicator for monitoring salt iodisation
programme.AIM a. To evaluate for possible
etiologies of goiter in children using a
standard approach and b. To assess iodine
nutrition and to correlate iodine nutritional
status with autoimmune thyroiditis
in children.MATERIALS AND METHODSDESIGN
Descriptive studySTUDY
PERIOD January 2010 to May
2011,STUDY POPULATION All children
with goiter during the study period between
age group 6-12 yrs, attending the
pediatric endocrinology outpatient department
of our institute.
Children with proven congenital hypothyroidism
were excluded from the
study.MANOUVERE 59 Children with goiter
were enrolled in the study. All 59 children
were subjected to blood tests for T4,
TSH, thyroid microsomal, antithyroglobulin
antibody titres and Fine needle aspiration
(FNAC). Urinary iodine excretion (UIE) was
estimated in spot urine samples. RESULTS
Among the various etiologies of goiter,
autoimmune thyroiditis 42(71.2) was the
commonest, followed by euthyroid goiter
13(22) and iodine deficiency 4(6.8) being
the least. mild IDD was present only in 4
(6.8) children, 11 (18.6) had adequate iodine
nutrition 17 (28.8) had UIE above normal
requirements and 27(45.8) children
had UIE more than 300ugL. The levels of
urinary iodine were significantly higher in
children with autoimmune thyroiditis compared
with euthyroid goiter (316.9586.124
vs.167.94 58.72, p0.001).CONCLUSION In
any child presenting with goiter complete
work up is necessary, so as to decide upon
a rational treatment. A possible link between
increased iodine intake and autoimmune
thyroiditis was found in our study.
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Pandav CS, et al. A review of tracking
progress towards elimination of iodine
deficiency disorders in Tamil Nadu, India.
Indian J Public Health. 2010 Jul-
Sep; 54(3):120-125
Kapil U, Singh P. Current status of
urinary iodine excretion levels in 116
districts of India. J Trop Pediatr 2004;
: 245-247.
Kapil U, Singh P, Pathak P. Current
status of iodine nutrition and iodine content
of salt in Andhra Pradesh. Indian
Pediatr 2004; 41: 165-169.
WHO/UNICEF/ICCIDD (2001). Assessment
of Iodine Deficiency Disorders
and Monitoring their Elimination.
Geneva: world health organization.
WHO Document WHO/NHD/01.1 2001.
WHO/UNICEF/ICCIDD (1994) Indicators
for assessing Iodine Deficiency
Disorders and their control through salt
iodization. Geneva: world health organization.
WHO Document WHO/
NUT/94.6.
Orell SR, Philips J. 1997. The thyroid.
Fine needle biopsy and cytological diagnosis
of thyroid lesions, Ed 1. Basel:
Karger; 66–72.
Marwaha RK, Tandon N, Gupta N,
Karak AK, Verma K, Kochupillai N. Residual
goiter in the post iodization
phase: iodine status, thiocyanate exposure
and autoimmunity. Clin Endocrinol
; 59:672–681.
Marwaha RK, Garg MK, Nijhavan
VS . Prevalence of chronic lymphocytic
thyroiditis in adolescent girls. J Assoc
Phys India.1998; 46:606–608.
Mäenpää J, Raatikka M, Räsänen J,
Taskinen E, Wager O. Natural course of
juvenile autoimmune thyroiditis. J Pediatr
; 107:898–904.
Seal AJ,Creeke PI,Gnat D,Abdalla
F,Mirghani Z Excess dietary iodine intake
in long term african refugees.public
health nutr.2006; 9:35-39.
Dayan CM, Daniels GH. Chronic
autoimmune thyroiditis. N Engl J Med
; 335: 99-107.
Gopalakrishnan S. Singh SP, Prasad
WR, Jain SK, Ambardar VK, Sankar R.
Prevalence of goiter and autoimmune
thyroiditis in schoolchildren in Delhi, India,
after two decades of salt iodisation.
J Pediatr Endocrinol Metab 2006; 19:
-893.
Teng W, Shan Z, Teng X, Guan H, Li
Y, Teng D, et al. Effect of iodine intake
on thyroid diseases in China. N Engl J
Med 2006; 354: 2783-2793.
Kahaly GJ, Dienes HP, Beyer J,
Hommel G. Iodide induces thyroid autoimmunity
in patients with endemic goiter:
a randomized, double-blind, placebo
-controlled trial. Eur J Endocrinol 1998;
: 290 297
Guan H, Shan Z, Teng X, Li Y, Teng
D, Jin Y, et al. Influence of iodine on the
reference interval of TSH and the optimal
interval of TSH: results of a followup
study in areas with different iodine
intakes. Clin Endocrinol (Oxf) 2008; 69;
-141.
Laurberg P, Jogerson T, Perrild H,
Ovensen L, Knudsen N, Pedersen IB,
Rasmussen LB, Carle A, Vejbjerg P .
The Danish investigation on iodine
intake and thyroid disease, DanThyr:
status and perspectives. Eur J Endocrinol
; 115: 219-228.
El May MV, Zekri S, Boubaker s,
Ladgham A, El May A. Chronic iodine
overload and apoptosis in cold nodules
from endemic multinodular goiters.
Arch Inst Pasteur Tunis2005; 82:
-74
Rasooly L, Burek CL, Rose NR
Iodine induced autoimmune thyroiditis
in NOD-H-2h4 mice. Clin Immunol
Immunopathol 1996;81:287-292
Li M, Liu DR, Qu CY, Zhang PY,
Qian Q, Zhang C, Jia QZ, Wang HX,
EastmanCJ, Boyages SC Endemic
goiter in central China caused by excessive
iodine intake. Lancet 2 1987;
-259
Zhang N, Tong YJ, Shan ZY,
TengWP. Effect of chronic mild and
moderate iodine excess on thyroid
anti-oxidative ability of iodine deficiency
and non-iodine deficiency Wistar
rats. Zhonghua Yi Xue Za Zhi
; 86:1274-1278.
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