RESUMO
OBJECTIVES: This study aims to investigate the population status of selenium in Colombia and other associated factors. METHODS: Cross-sectional study, in population of urban or rural origin (n=412). Main outcome measures were: median serum selenium, thyrotropin, the prevalence of and positivity of anti-thyroid peroxidase, anti-thyroglobulin, and anti-TSH receptor. RESULTS: This study found that 96.6% of the subjects had normal selenium levels, and no significant associations were found between the population median of selenium and overweight/obesity, sociodemographic variables, age, goiter, and thyroid antibody positivity. CONCLUSIONS: In Colombia, the population status of selenium is normal, and the geological characteristics may contribute to the state of selenium in this population. However, additional studies are required to evaluate the content of selenium in plants and other foods.
Assuntos
Selênio , Humanos , Adulto , Colômbia , Selênio/análise , Selênio/sangue , Selênio/deficiência , Estudos Transversais , Micronutrientes/sangue , Micronutrientes/deficiência , Pessoa de Meia-Idade , Bócio/epidemiologia , Tireotropina/sangue , Anticorpos/sangue , Plantas/química , PrevalênciaRESUMO
Objective: To assess the prevalence of goiter and iodine deficiency in indigenous pregnant women coming from five non-metropolitan areas in Colombia. Materials and methods: Descriptive cross-sectional cohort study that included pregnant women of any gestational age with no pregnancy-related conditions, seen in community health centers or in their homes. Patients with comorbidities at the time of pregnancy and those who were receiving iodine supplementation were excluded. Simple random sampling was used. The sociodemographic and obstetric characteristics, urinary iodine concentration and the presence of goiter were measured in accordance with the World Health Organization methodology. A descriptive analysis was performed. Results: Of 189 indigenous pregnant women who were candidates to enter the study, 2 declined participation, and 62 had exclusion criteria, and 125 were included in the final analysis. The mean urinary iodine concentration was 184.4 µg/L (min-max: 12.0-390.0). A total of 42 women (33.6%) had iodine deficiency (< 100 µg/L), and goiter (grade 1-2) was found in 43 (34.4%). No grade 3 or 4 goiter was identified. Conclusions: A high prevalence of goiter and iodine deficiency was found in indigenous pregnant women living in non-metropolitan areas. There is a need to assess maternal and perinatal effects and to implement nutritional interventions.
Objetivo: evaluar la prevalencia de yodo deficiencia y de bocio en mujeres indígenas gestantes de cinco áreas no metropolitanas en Colombia. Materiales y métodos: estudio de corte transversal descriptivo. Se incluyeron mujeres embarazadas de cualquier edad gestacional sin condiciones patológicas del embarazo, atendidas en los centros de salud comunitarios o en sus residencias. Se excluyeron aquellas con comorbilidades presentes al momento del embarazo y también a quienes recibían suplementos con yodo. Muestreo aleatorio simple. Se midieron las características sociodemográficas y obstétricas, la concentración de yodo en orina y la presencia de bocio de acuerdo a la metodología de la Organización Mundial de la Salud. Se realizó un análisis descriptivo. Resultados: 189 gestantes indígenas fueron candidatas a ingresar al estudio, de las cuales 2 no aceptaron participar y 62 tenían criterios de exclusión, finalmente se analizaron 125. La concentración urinaria de yodo tuvo una mediana de 184,4 µg/L (min-max: 12,0-390,0). Un total de 42 gestantes (33,6%) tenían yodo deficiencia (< 100 µg/L) y se evidenció bocio (grado 1-2) en 43 (34,4%). No se identificó bocio grados 3 o 4. Conclusiones: embarazadas indígenas residentes en áreas no metropolitanas evidenciaron alta prevalencia de bocio y yodo deficiencia. Se requiere evaluar los efectos materno-perinatales e implementar intervenciones nutricionales.
Assuntos
Bócio , Iodo , Complicações na Gravidez , Colômbia/epidemiologia , Estudos Transversais , Feminino , Bócio/epidemiologia , Humanos , Iodo/análise , Gravidez , Complicações na Gravidez/epidemiologia , Gestantes , PrevalênciaRESUMO
Hypothyroidism caused by Hashimoto's thyroiditis is the most common reason for thyroid dysfunction in children. Our objective was to analyze its impact on final stature in relation to height and pubertal stage at the time of diagnosis in children younger than 18 years with severe autoimmune hypothyroidism. Out of 79 patients, 78.5 % were girls. Those with goiter (56 %) had a better height at diagnosis than those without goiter (mean standard deviation score for height: 0.2 versus -2.42; p < 0.0001). Five girls (6.3 %) had precocious puberty. When considering the final stature of patients (n: 33), among those with short stature at the time of diagnosis, pubertal children had a significantly shorter final stature than prepubertal children (mean standard deviation score for height: -2.82 versus -1.52; p = 0.0311). The late diagnosis of severe hypothyroidism in pediatrics has a negative impact on final stature, especially in those who were pubertal patients at the time of diagnosis.
El hipotiroidismo por tiroiditis de Hashimoto es la causa más frecuente de disfunción tiroidea en niños. Nuestro objetivo fue analizar el impacto en la talla final según la talla y el estadio puberal al momento del diagnóstico en menores de 18 años con hipotiroidismo grave de origen autoinmune. De los 79 pacientes, el 78,5 % fueron mujeres. Los que presentaron bocio (el 56 %) mostraron mejor talla en el diagnóstico que los que no lo tenían (puntaje de desvío estándar de media de talla: 0,2 vs. -2,42; p < 0,0001). Cinco niñas (el 6,3 %) presentaron pubertad precoz. De los pacientes con talla final (n: 33), dentro de los que presentaron talla baja al momento del diagnóstico, los púberes tuvieron una talla final significativamente menor que los prepúberes (puntaje de desvío estándar media: -2,82 vs. -1,52; p = 0,0311). El diagnóstico tardío de hipotiroidismo grave en pediatría tiene un impacto negativo en la talla final, especialmente, en los pacientes puberales al momento del diagnóstico.
Assuntos
Estatura/fisiologia , Transtornos do Crescimento/etiologia , Doença de Hashimoto/complicações , Tireoidite Autoimune/complicações , Criança , Diagnóstico Tardio , Feminino , Bócio/epidemiologia , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/etiologia , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Puberdade Precoce/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Tireoidite Autoimune/diagnóstico , Tireoidite Autoimune/etiologiaRESUMO
El hipotiroidismo subclínico (HS), elevación de tirotrofina con hormonas tiroideas normales, junto al bocio, aumentó la frecuencia en las últimas décadas. Con el objetivo de relacionar la prevalencia de bocio y HS con el consumo de agua subterránea como factor de riesgo etiológico poblacional, se analizaron 879 historias clínicas de un centro médico de Glew, en el conurbano bonaerense Sur. Se estudió la población según edad (20-60 y 12-19 años) y tipo de agua consumida (potabilizada o napa subterránea). El agua subterránea fue consumida por el 70.5% del grupo de 20 a 60 años (n = 559, 79.9% mujeres) y por el 66.3% del grupo de 12 a 19 años (n = 57, 81.4% mujeres). En el grupo de 20 a 60 años la prevalencia de HS en consumidores de agua potabilizada y subterránea fue del 1% y 57.8% (p < 0.0001) y la de bocio de 3.8% y 38.9% (p < 0.0001), respectivamente; con un riesgo atribuible al agua subterránea de 57% para HS y 35% para bocio. En el grupo de 12 a 19 años, la prevalencia de HS fue 6.9% y 52.6% (p < 0.0001) y de bocio 13.8% y 77.2% para los grupos de agua potabilizada y subterránea, (p < 0.0001) respectivamente; con un riesgo atribuible al agua subterránea de 46% para HS y 61% para bocio. El análisis fisicoquímico mostró presencia de nitratos (entre 24 y 83 mg/l) en aguas de pozos y ausencia en agua potable. La prevalencia aumentada de HS y bocio podrían deberse a la acción disruptora tiroidea de los nitratos.
Subclinical hypothyroidism (SH), elevation of the level of thyrotrophin with normal thyroid hormones, along with goiter (glandular size > 25g), increased in recent decades. In order to relate the prevalence of goiter and SH with the consumption of groundwater, as a population etiological risk factor, we analyzed 879 clinical histories from a medical center in the city of Glew in the South Buenos Aires suburbs. The population was studied according to age (20 to 60 and 12 to 19 years) and type of water consumed (potable water or groundwater). Groundwater was consumed by 70.5% of the group from 20 to 60 years old (n = 559, 79.9% women) and by 66.3% of the group from 12 to 19 years old (n = 57, 81.4% women In the group of 20 to 60 years, the prevalence of SH in potable water and groundwater users was 1% and 57.8% (p < 0.0001) and the goiter rate of 3.8% and 38.9% (p < 0.0001) respectively; with an attributable risk to groundwater of 57% for HS, and 35% for goiter In the group of 12 to 19 years, the prevalence of SH was 6.9% and 52.6% (p < 0.0001) and goiter 13.8% and 77.2% for the water and groundwater groups (p>0.0001) respectively, with an attributable risk of 46% for HS y 61% for goiter. The physicochemical analysis showed the presence of nitrates in the range of 24 to 83 mg/l in groundwater and absence in potable water. The increased prevalence of HS and goiter could be due to the thyroid disrupting action of nitrates.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Água Potável/química , Água Subterrânea/química , Doenças Transmitidas pela Água/etiologia , Bócio/etiologia , Hipotireoidismo/etiologia , Argentina/epidemiologia , Qualidade da Água , Tireotropina/sangue , Prevalência , Estudos Transversais , Fatores de Risco , Análise de Variância , Distribuição por Sexo , Distribuição por Idade , Estatísticas não Paramétricas , Doenças Transmitidas pela Água/epidemiologia , Bócio/epidemiologia , Hipotireoidismo/epidemiologia , Nitratos/análiseRESUMO
Subclinical hypothyroidism (SH), elevation of the level of thyrotrophin with normal thyroid hormones, along with goiter (glandular size > 25g), increased in recent decades. In order to relate the prevalence of goiter and SH with the consumption of groundwater, as a population etiological risk factor, we analyzed 879 clinical histories from a medical center in the city of Glew in the South Buenos Aires suburbs. The population was studied according to age (20 to 60 and 12 to 19 years) and type of water consumed (potable water or groundwater). Groundwater was consumed by 70.5% of the group from 20 to 60 years old (n = 559, 79.9% women) and by 66.3% of the group from 12 to 19 years old (n = 57, 81.4% women In the group of 20 to 60 years, the prevalence of SH in potable water and groundwater users was 1% and 57.8% (p < 0.0001) and the goiter rate of 3.8% and 38.9% (p < 0.0001) respectively; with an attributable risk to groundwater of 57% for HS, and 35% for goiter In the group of 12 to 19 years, the prevalence of SH was 6.9% and 52.6% (p < 0.0001) and goiter 13.8% and 77.2% for the water and groundwater groups (p > 0.0001) respectively, with an attributable risk of 46% for HS y 61% for goiter. The physicochemical analysis showed the presence of nitrates in the range of 24 to 83 mg/l in groundwater and absence in potable water. The increased prevalence of HS and goiter could be due to the thyroid disrupting action of nitrates.
Assuntos
Água Potável/química , Bócio/etiologia , Água Subterrânea/química , Hipotireoidismo/etiologia , Doenças Transmitidas pela Água/etiologia , Adolescente , Adulto , Distribuição por Idade , Análise de Variância , Argentina/epidemiologia , Criança , Estudos Transversais , Feminino , Bócio/epidemiologia , Humanos , Hipotireoidismo/epidemiologia , Masculino , Pessoa de Meia-Idade , Nitratos/análise , Prevalência , Fatores de Risco , Distribuição por Sexo , Estatísticas não Paramétricas , Tireotropina/sangue , Qualidade da Água , Doenças Transmitidas pela Água/epidemiologia , Adulto JovemRESUMO
Introdução: A comida tem um papel proeminente na obtenção do iodo e uma das melhores estratégias é a iodização do sal. No Brasil, a Anvisa reduziu as doses de iodo no sal de cozinha desde 2014. Portanto, é importante avaliar a concentração urinária de iodo (CIU) em nossa população. Com base no exposto, propõe-se avaliar a CIU das gestantes, associando-a à frequência de bócio materno, aborto e peso neonatal. Métodos: Trata-se de um estudo observacional com um corte transversal composto por 37 pacientes atendidos no Serviço de Obstetrícia da Faculdade de Medicina de Barbacena e uma clínica particular em Juiz de Fora. A CIU foi verificada em 24 horas de urina. Resultados: A média de CIU foi de 213,6 µg/l de urina, com dose mínima de 29 µg/l e máxima de 437 µg/l. A glândula tireoide foi avaliada durante o exame clínico prénatal (palpação da glândula) e em 24 pacientes (38,1%) foi considerada normal. A palpação da glândula tireoide foi associada à CIU. Houve maior iodúria em gestantes com glândula não palpável (p = 0,004; T = 14,13). Não houve associação entre a CIU e história de aborto ou peso fetal ao nascimento (p > 0,05). Conclusões: Apesar de ser uma amostra pequena da população, identificamos pacientes expostas ao déficit. No entanto, a CIU não parece estar associada ao peso do recém-nascido ou a abortos, mas à dosagem de TSH e ao tamanho da glândula tireoide. Assim, a palpação da glândula tireoide poderia ser usada como uma medida indireta do CIU. (AU)
Introduction: Food has a prominent role in providing iodine and one of the best strategies is salt iodization. The Brazilian Health Regulatory Agency has reduced iodine content in table salt since 2014. Therefore, there is a need for evaluating urinary iodine concentration in our population, especially after the modified recommendations. Based on the above, we sought to assess urinary iodine concentration in pregnant women, associating it with frequency of maternal goiter, abortion and neonatal weight. Methods: This observational, cross-sectional study included 37 patients seen at the Obstetrics Service of Barbacena Medical School and a private clinic in Juiz de Fora, both in the state of Minas Gerais, Brazil. Iodine concentration was determined in 24- hour urine through chromatography. Results: The mean 24-hour urine iodine was 213.6 µg/l, with minimum and maximum measures of 29 µg/l and 437 µg/l, respectively. The thyroid gland was assessed by prenatal clinical examination (palpation of the gland). In 24 patients (38.1%) it was considered normal. Palpation of the thyroid gland was associated with 24-hour urine iodine concentration, although a higher iodine concentration was identified in pregnant women with non-palpable gland (p = 0.004; T = 14.13). There was no association between 24-hour urine iodine concentration and history of abortion or birth weight (p > 0.05). Conclusions: This study, although based on a small sample of the population, was important to identify that even in areas where iodine is considered sufficient there may be patients exposed to iodine deficit. However, urinary iodine concentration does not appear to be associated with birth weight or abortion frequency but is associated with thyroid-stimulating hormone (TSH) level and thyroid gland size, suggesting that clinical evaluation of the thyroid gland is an important element for predicting urinary iodine concentration. Thus, palpation of the thyroid gland could be used as an indirect measure of urinary iodine concentration. (AU)
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adulto , Complicações na Gravidez/epidemiologia , Peso ao Nascer , Aborto Espontâneo/epidemiologia , Bócio/epidemiologia , Iodo/deficiência , Iodo/urina , Palpação , Complicações na Gravidez/urina , Cuidado Pré-Natal , Espectrofotometria , Estudos TransversaisRESUMO
ABSTRACT Objective This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension. Subjects and methods A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter. Results The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients. Conclusion This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Refluxo Laringofaríngeo/epidemiologia , Bócio Subesternal/epidemiologia , Tireoidectomia , Estudos de Casos e Controles , Prevalência , Estudos Retrospectivos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico por imagem , Bócio/cirurgia , Bócio/complicações , Bócio/fisiopatologia , Bócio/epidemiologia , Bócio Subesternal/cirurgia , Bócio Subesternal/complicações , Bócio Subesternal/fisiopatologia , LaringoscopiaRESUMO
OBJECTIVE: This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension. SUBJECTS AND METHODS: A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter. RESULTS: The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients. CONCLUSION: This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.
Assuntos
Bócio Subesternal/epidemiologia , Refluxo Laringofaríngeo/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Bócio/complicações , Bócio/epidemiologia , Bócio/fisiopatologia , Bócio/cirurgia , Bócio Subesternal/complicações , Bócio Subesternal/fisiopatologia , Bócio Subesternal/cirurgia , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico por imagem , Laringoscopia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , TireoidectomiaRESUMO
Context: Iodine deficiency is the leading cause of preventable neurodevelopmental delay in children worldwide and a possible public health concern in Haiti. Objective: To determine the prevalence of iodine deficiency in Haitian young children and its influence by environmental factors. Design: Cross-sectional study, March through June 2015. Setting: Community churches in 3 geographical regions in Haiti. Participants: 299 healthy Haitian children aged 9 months to 6 years; one-third each enrolled in a coastal, mountainous, and urban region. Main Outcome Measures: Urinary iodide, serum thyrotropin (TSH), goiter assessment, and urinary perchlorate and thiocyanate. Results: Mean age was 3.3±1.6 years, with 51% female, median family income USD 30/week, and 16% malnutrition. Median urinary iodide levels were normal in coastal (145 µg/L, interquartile range [IQR] 97 to 241) and urban regions (187 µg/L, IQR 92 to 316), but revealed mild iodine deficiency in a mountainous region (89 µg/L, IQR 56 to 129), P < 0.0001. Grade 1 goiters were palpated in 2 children, but TSH values were normal. Urinary thiocyanate and perchlorate concentrations were not elevated. Predictors of higher urinary iodide included higher urinary thiocyanate and perchlorate, breastfeeding, and not living in a mountainous region. Conclusions: Areas of mild iodine deficiency persist in Haiti's mountainous regions. Exposure to two well-understood environmental thyroid function disruptors is limited.
Assuntos
Deficiências Nutricionais/epidemiologia , Disruptores Endócrinos/urina , Poluentes Ambientais/urina , Iodo/urina , Percloratos/urina , Tiocianatos/urina , Tireotropina/sangue , Criança , Pré-Escolar , Estudos Transversais , Deficiências Nutricionais/sangue , Deficiências Nutricionais/urina , Feminino , Bócio/diagnóstico , Bócio/epidemiologia , Haiti/epidemiologia , Humanos , Lactente , Iodo/deficiência , MasculinoRESUMO
Os aspectos epidemiológicos, clínicos e anatomopatológicos de um surto de bócio congênito em caprinos são descritos. A etiologia dessa condição foi associada à ausência de suplementação mineral com iodo para as cabras prenhes, e constituiu o fator responsável pela natimortalidade nesse surto. Clinicamente, todos os natimortos apresentaram marcado aumento de volume na região cervical ventral cranial e alopecia difusa. Na necropsia de um dos cabritos natimortos, observou-se acentuado aumento de volume simétrico de ambos os lobos da glândula tireoide, que eram firmes, compactos e vermelho-escuros. Histologicamente, as lesões eram características de bócio hiperplásico difuso e consistiam de: 1) marcada hiperplasia e hipertrofia do epitélio folicular; 2) formação de folículos tireoidianos marcadamente heterogêneos, devido principalmente à quantidade variável de coloide intraluminal; e 3) presença de vacúolos endocíticos, que representam a endocitose do coloide e demonstram a atividade da glândula tireoide.(AU)
The epidemiological, clinical, and anatomopathological aspects of an outbreak of congenital caprine goiter are described in this article. The cause of the congenital goiter and neonatal deaths was attributed to the absence of mineral supplementation with iodine to the pregnant dams. Clinically, all neonatal dead goats presented with marked swelling on the cranioventral cervical area and diffuse body alopecia. One of the dead kids was submitted to necropsy, and changes consisted of marked, symmetrical enlargement of both thyroid lobes, which were also firm, compact, and dark red. Histologically, changes were characteristic of diffuse hyperplastic goiter and consisted of: 1) marked follicular thyroid hyperplasia and hypertrophy; 2) formation of heterogeneous thyroid follicles due to the variable amounts of luminal colloid; and 3) presence of endocytic vacuoles, which represent colloid endocytosis and demonstrate activity of the thyroid gland.(AU)
Assuntos
Animais , Ruminantes , Bócio/veterinária , Bócio/epidemiologia , Bócio/diagnóstico , Anormalidades Congênitas/veterinária , Deficiência de IodoRESUMO
Os aspectos epidemiológicos, clínicos e anatomopatológicos de um surto de bócio congênito em caprinos são descritos. A etiologia dessa condição foi associada à ausência de suplementação mineral com iodo para as cabras prenhes, e constituiu o fator responsável pela natimortalidade nesse surto. Clinicamente, todos os natimortos apresentaram marcado aumento de volume na região cervical ventral cranial e alopecia difusa. Na necropsia de um dos cabritos natimortos, observou-se acentuado aumento de volume simétrico de ambos os lobos da glândula tireoide, que eram firmes, compactos e vermelho-escuros. Histologicamente, as lesões eram características de bócio hiperplásico difuso e consistiam de: 1) marcada hiperplasia e hipertrofia do epitélio folicular; 2) formação de folículos tireoidianos marcadamente heterogêneos, devido principalmente à quantidade variável de coloide intraluminal; e 3) presença de vacúolos endocíticos, que representam a endocitose do coloide e demonstram a atividade da glândula tireoide.
The epidemiological, clinical, and anatomopathological aspects of an outbreak of congenital caprine goiter are described in this article. The cause of the congenital goiter and neonatal deaths was attributed to the absence of mineral supplementation with iodine to the pregnant dams. Clinically, all neonatal dead goats presented with marked swelling on the cranioventral cervical area and diffuse body alopecia. One of the dead kids was submitted to necropsy, and changes consisted of marked, symmetrical enlargement of both thyroid lobes, which were also firm, compact, and dark red. Histologically, changes were characteristic of diffuse hyperplastic goiter and consisted of: 1) marked follicular thyroid hyperplasia and hypertrophy; 2) formation of heterogeneous thyroid follicles due to the variable amounts of luminal colloid; and 3) presence of endocytic vacuoles, which represent colloid endocytosis and demonstrate activity of the thyroid gland.
Assuntos
Animais , Anormalidades Congênitas/veterinária , Bócio/diagnóstico , Bócio/epidemiologia , Bócio/veterinária , Deficiência de Iodo , RuminantesRESUMO
OBJECTIVES: To assess the effectiveness of the Sustainable Elimination of Iodine Deficiency Program through determination of urinary iodine and goiter prevalence. MATERIALS AND METHODS: A cross-sectional study was conducted in Cuban school children aged 6 to 11 years old in 2011-2012. A stratified multistage sample was used in which the levels of iodine excretion in urine (urinary iodine) and the presence of goiter were determined. RESULTS: The median urinary iodine was 176.3 µg/L; 7.6% of the students showed some deficiency of iodine, only 2.2% were below 50 µg/L (severe deficiency), and 15.3% had urinary iodine above 300 µg/L. The percentage of school children with optimal iodine nutrition was 43.5%, this category showed a significantly higher frequency (p=0.03) in the mountain areas (52.5%). Goiter prevalence was 17.6% which corresponds to a mild endemic. However, in the mountain area the prevalence was 32.6% (severe endemic). CONCLUSIONS: The comprehensive analysis of the impact of iodine deficiency control measures assessed by urinary iodine excretion and goiter prevalence reflects that it is no longer a population health problem in urban and rural areas of Cuba, attributable to a proper process of salt iodization. Nevertheless, high goiter prevalence is still observed in the mountain area of Cuba.
Assuntos
Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/prevenção & controle , Bócio/epidemiologia , Iodo/deficiência , Criança , Estudos Transversais , Cuba/epidemiologia , Feminino , Humanos , Iodo/urina , Masculino , Programas Nacionais de Saúde , Prevalência , Avaliação de Programas e Projetos de Saúde , Saúde da População Rural , Saúde da População UrbanaRESUMO
Objetivos: Evaluar la efectividad del “Programa de Eliminación Sostenible de Deficiencia de Yodo” mediante determinación de yoduria y prevalencia de bocio. Materiales y métodos. Se realizó un estudio transversal en el cual se incluyó a la población escolar cubana de 6 a 11 años que cursaba estudios en el periodo 2011-2012. Se empleó un muestreo estratificado polietápico. En el cual se determinaron los niveles de excreción de yodo en la orina (yoduria) y la presencia de bocio. Resultados. La mediana de yoduria fue de 176,3 µg/L; el 7,6% de los escolares presentaron alguna deficiencia de yodo, solo el 2,2% estaba por debajo de 50 µg/L (deficiencia severa) y el 15,3% tenía yodurias por encima de 300 µg/L. El porcentaje de escolares con nutrición óptima de yodo fue de 43,5%, esta categoría presentó una frecuencia significativamente mayor ( p=0,03) en el estrato montaña (52,5%). La prevalencia de bocio encontrada fue de 17,6%, que corresponde a una endemia ligera. Sin embargo, en el estrato montaña se encontró una prevalencia de 32,6 % (endemia severa). Conclusiones. El análisis integral del impacto de las acciones de control de la deficiencia de yodo evaluado a través de la excreción urinaria de yodo y la prevalencia de bocio refleja que ha dejado de ser un problema de salud poblacional en los estratos urbano y rural de Cuba, atribuible a un adecuado proceso de yodación de la sal. Sin embargo, aún se observa una alta prevalencia de bocio en la zona de montaña de Cuba.
Objectives: To assess the effectiveness of the Sustainable Elimination of Iodine Deficiency Program through determination of urinary iodine and goiter prevalence. Materials and methods. A cross-sectional study was conducted in Cuban school children aged 6 to 11 years old in 2011-2012. A stratified multistage sample was used in which the levels of iodine excretion in urine (urinary iodine) and the presence of goiter were determined. Results. The median urinary iodine was 176.3 µg/L; 7.6% of the students showed some deficiency of iodine, only 2.2% were below 50 µg/L (severe deficiency), and 15.3% had urinary iodine above 300 µg/L. The percentage of school children with optimal iodine nutrition was 43.5%, this category showed a significantly higher frequency (p=0.03) in the mountain areas (52.5%). Goiter prevalence was 17.6% which corresponds to a mild endemic. However, in the mountain area the prevalence was 32.6% (severe endemic). Conclusions. The comprehensive analysis of the impact of iodine deficiency control measures assessed by urinary iodine excretion and goiter prevalence reflects that it is no longer a population health problem in urban and rural areas of Cuba, attributable to a proper process of salt iodization. Nevertheless, high goiter prevalence is still observed in the mountain area of Cuba.
Assuntos
Criança , Feminino , Humanos , Masculino , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/prevenção & controle , Bócio/epidemiologia , Iodo/deficiência , Estudos Transversais , Cuba/epidemiologia , Iodo/urina , Programas Nacionais de Saúde , Prevalência , Avaliação de Programas e Projetos de Saúde , Saúde da População Rural , Saúde da População UrbanaRESUMO
OBJECTIVES: To evaluate the prevalence of goiter and nodular disease in patients with class III obesity, and to correlate results with serum leptin levels and insulin resistance (IR) parameters. SUBJECTS AND METHODS: A cross-sectional study was performed to assess thyroid ultrasound (US) patterns, HOMA-IR, serum leptin, and TSH levels in obese patients and controls. RESULTS: Thyroid volume was positively correlated with body mass index (BMI) (r = 0.240, p = 0.039) and with HOMA-IR (r = 0.329; p < 0.01). Thyroid US patterns were similar between groups. However, when data from the male group was considered, greater thyroid volume was detected in the obese group compared with controls (10.8 vs. 8.5 cm³; p = 0.04). Also, nodules were more frequently detected (67% vs. 18%), as were nodules requiring FNAB (33.3% vs. 0%, p ≥ 0.05-0.09), in this group. CONCLUSION: Although IR did not correlate directly with the presence of nodules, the results support the hypothesis of a direct association between insulin resistance and thyroid volume.
Assuntos
Bócio/epidemiologia , Resistência à Insulina , Obesidade Mórbida/complicações , Nódulo da Glândula Tireoide/epidemiologia , Adulto , Estudos de Casos e Controles , Estudos Transversais , Bócio/diagnóstico , Homeostase , Humanos , Leptina/sangue , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Prevalência , Nódulo da Glândula Tireoide/diagnóstico , Tireotropina/sangueRESUMO
OBJECTIVES: To evaluate the prevalence of goiter and nodular disease in patients with class III obesity, and to correlate results with serum leptin levels and insulin resistance (IR) parameters. SUBJECTS AND METHODS: A cross-sectional study was performed to assess thyroid ultrasound (US) patterns, HOMA-IR, serum leptin, and TSH levels in obese patients and controls. RESULTS: Thyroid volume was positively correlated with body mass index (BMI) (r = 0.240, p = 0.039) and with HOMA-IR (r = 0.329; p < 0.01). Thyroid US patterns were similar between groups. However, when data from the male group was considered, greater thyroid volume was detected in the obese group compared with controls (10.8 vs. 8.5 cm³; p = 0.04). Also, nodules were more frequently detected (67% vs. 18%), as were nodules requiring FNAB (33.3% vs. 0%, p ≥ 0.05-0.09), in this group. CONCLUSION: Although IR did not correlate directly with the presence of nodules, the results support the hypothesis of a direct association between insulin resistance and thyroid volume.
OBJETIVOS: Avaliar a prevalência de bócio e doença nodular tireoidiana em pacientes com obesidade grau III e correlacionar os resultados com os níveis de leptina e parâmetros de resistência à ação da insulina (RI). SUJEITOS E MÉTODOS: Estudo seccional foi desenvolvido realizando ultrassonografia (US) tireoidiana e níveis séricos de HOMA-IR e TSH nos pacientes obesos e nos controles. RESULTADOS: Volume tireoidiano foi positivamente correlacionado com índice de massa corporal (IMC) (r = 0,240, p = 0,039) e com HOMA (r = 0,329; p < 0,01). Volume tireoidiano e prevalência de doença nodular tireoidiana foram similares entre os grupos. Quando avaliado o subgrupo masculino, maiores volumes tireoidianos foram detectados no grupo dos obesos comparados aos controles (10,8 vs. 8,5 cm³; p = 0,04), nódulos foram mais frequentes (67% vs. 18%), assim como nódulos com indicação de punção (33,3% vs. 0%, p ≥ 0,05-0,09). CONCLUSÃO: Embora RI não se correlacione diretamente com a presença de nódulos, os resultados suportam a hipótese da direta associação entre resistência à ação da insulina e volume tireoidiano.
Assuntos
Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Bócio/epidemiologia , Resistência à Insulina , Obesidade Mórbida/complicações , Nódulo da Glândula Tireoide/epidemiologia , Estudos de Casos e Controles , Estudos Transversais , Bócio/diagnóstico , Homeostase , Leptina/sangue , Obesidade Mórbida/sangue , Prevalência , Nódulo da Glândula Tireoide/diagnóstico , Tireotropina/sangueRESUMO
Resistance to thyroid hormone (RTH) is characterized by elevated levels of thyroid hormones, normal or slightly increased TSH levels respondent to TRH, resistance to thyroid hormone administration, and variable clinical expression. To describe the diverse clinical and biochemical findings of six children from five unrelated families with molecular diagnosis of RTH (0.5-12.7 years) and their follow-up (3-20 years). All RTH patients and 4 affected parents' harbored mutations in exons 9 or 10 of the thyroid receptor ß gene: p.M313T (de novo), pN331D, p.L341P, p.L346F, and p.P453L. At consultation 5/6 had goiter, 4/6 tachycardia, and 3/5 learning disabilities. Median hormone levels were: T(4) 257.4 nmol/l (NR: 77.2-180.2); FreeT(4) 39.9 pmol/(NR:10.3-28.3); T(3) 4.28 nmol/l (NR:1.23-3.39) TSH 2.8 mUI/l (NR: 0.5-5) always responsive to TRH. TSH levels remained detectable after supraphysiologic T(3) administration while SHBG levels showed a paradoxical decrease in 4/6. Thyroid antibodies, initially present in two subjects, became positive in other two during follow-up. All patients grew normally and presented variable symptoms that were treated according to need. Two patients developed psychiatric disorders. Only one of the four affected parents exhibited clinical signs of RTH (tachycardia and depression). Parent's thyroid profile showed similar TSH and T(3) levels but lower T(4) and FT(4) than their children. RTH has a distinctive biochemical profile with highly variable clinical manifestations and outcomes. Its recognition and molecular characterization avoid misleading diagnosis. Treatment has to be instituted according to each subject's own clinical requirements.
Assuntos
Bócio/epidemiologia , Mutação/genética , Receptores dos Hormônios Tireóideos/genética , Taquicardia/epidemiologia , Síndrome da Resistência aos Hormônios Tireóideos/complicações , Síndrome da Resistência aos Hormônios Tireóideos/genética , Hormônios Tireóideos/sangue , Adolescente , Criança , Pré-Escolar , Depressão/epidemiologia , Feminino , Seguimentos , Humanos , Lactente , Deficiências da Aprendizagem/epidemiologia , Masculino , Linhagem , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Síndrome da Resistência aos Hormônios Tireóideos/diagnóstico , Adulto JovemRESUMO
INTRODUCTION: Changes in the prevalence of papillary thyroid carcinoma (PTC) have been reported in institutions and national cancer registries. OBJECTIVE: To describe time trends in benign and malignant thyroid diseases in a national endocrine referral center. MATERIALS AND METHODS: Systematic review and classification of consecutive specimens with slides/paraffin blocks in surgical pathology archives (January 1990 to December 2009). Institutional registries, size, type of surgery and number of inclusion blocks were recorded. Patients whose registries were granted before January 1990 without nodules, but treated after twelve months for a suspicious thyroid lesion, were included. These patients in a passive follow-up permitted incidence density calculations. Cases were grouped by quinquennium. RESULTS: Institutional registers were conceded to 103,961 persons worthy of attention, and 1,269 were submitted to thyroidectomies (1.2%). One hundred twenty four patients none treated for thyroid diseases before 1990, developed thyroid nodules after 1991. The incidence density for goiter was 0.05 person/year and for PTC 0.04 person/year in that group. In all series woman to man relation was 9:1 with a mean age of 45 years. Total or near total thyroidectomies were performed in 60% patients and benign diseases were diagnosed in 732 (52%) cases. Thyroid surgeries increased since 2005 (p=0.03) with a rise in goiter prevalence (0.25, 0.31, 0.35, 0.38, p for trend 0.0005), without significant increase in PTC prevalence (0.41, 0.43, 0.35, 0.40, p for trend 0.71) in thyroidectomies. CONCLUSIONS: Goiter as the only finding in thyroid specimens increased 52% in the last 20 years. PTC prevalence is steady with a higher number of tumors<3 cm.
Assuntos
Carcinoma Papilar/epidemiologia , Bócio/epidemiologia , Doenças da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/epidemiologia , Tireoidectomia/estatística & dados numéricos , Adenocarcinoma Folicular/epidemiologia , Adenocarcinoma Folicular/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Criança , Feminino , Seguimentos , Bócio/cirurgia , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Morbidade/tendências , Prevalência , Encaminhamento e Consulta , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/cirurgia , Carga Tumoral , Adulto JovemRESUMO
OBJECTIVE: To determine the prevalence of iodine deficiency, its causes and its association with intelligence quotient (IQ) in Mexican schoolchildren. DESIGN: Cross-sectional analytical study, in which determinations of thyroid gland size, urinary iodine excretion, IQ, iron nutritional status, physical anthropometry, family consumption of goitrogenic foods, type/origin and iodine saturation of salt consumed at home and coliform organisms in drinking water were performed, and the association of each variable with IQ scores was evaluated by multiple regression analyses. SETTING: Municipality of Cuauhtémoc, in Colima, Mexico (altitude: 600-2700 m above sea level). Sea salt is extracted manually nearby and often used for human consumption. Goitre remains present in the region despite over half a century of mandatory salt iodination in the country. SUBJECTS: Three hundred and three children, similar proportions of boys and girls, mean age 9.3 years, randomly selected from 19 public elementary schools. RESULTS: Overall goitre rate was 21.4%; low urinary iodine excretion was found in 19.5% of the children, high urinary iodine excretion in 32.0%. IQ scores were transformed into percentile values, with the following categorisation: < or = P5 (low IQ), 48.5%; > P5 to < or = P25 (below average), 24.2%; > P25 to < P75 (average), 18.8%; > or = P75 to < P95 (above average), 3.6%; > or = P95 (high IQ), 4.9%. Ninety-two per cent of the population used iodinated salt, but deficient iodine saturation (<50 ppm) was found in 86.8% of salt samples. The main goitrogenic foods consumed were peanuts (by 31.5% of the sample), cabbage (30.1%), broccoli (27.7%) and cauliflower (25.7%). Median counts of coliform organisms (colony-forming units/100 ml of drinking water) were: 207.5 (well water), 151 (cisterns), 52 (private homes), 25 (elementary schools) and 12 (kindergartens). Moderate iodine deficiency was associated (P < 0.05) with a 4.26 times higher risk of low IQ. CONCLUSIONS: There is a perturbing negative impact of these findings on human capital acquisition for the region and the country. More attention is needed to ensure effective salt iodination processes, particularly in regions where goitrogens may contribute to the negative effects of iodine deficiency on the intellectual development of children.
Assuntos
Bócio/epidemiologia , Inteligência/efeitos dos fármacos , Inteligência/fisiologia , Iodo/administração & dosagem , Iodo/deficiência , Cloreto de Sódio na Dieta , Adolescente , Antropometria , Criança , Fenômenos Fisiológicos da Nutrição Infantil/fisiologia , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Bócio/terapia , Humanos , Iodo/normas , Iodo/uso terapêutico , Iodo/urina , Masculino , México/epidemiologia , Necessidades Nutricionais , Estado Nutricional/fisiologia , Prevalência , Análise de Regressão , Cloreto de Sódio na Dieta/administração & dosagem , Cloreto de Sódio na Dieta/normas , Cloreto de Sódio na Dieta/uso terapêutico , Glândula Tireoide/anatomia & histologia , Glândula Tireoide/efeitos dos fármacos , Glândula Tireoide/fisiologia , Microbiologia da ÁguaRESUMO
We have conducted a longitudinal epidemiologic study among pregnant women from three cities in northern Chile: Taltal with 114 microg/L, Chañaral with 6 microg/L, and Antofagasta with 0.5 microg/L perchlorate in the public drinking water. We tested the hypothesis that long-term exposure to perchlorate at these levels may cause a situation analogous to iodine deficiency, thus causing increases in thyrotropin (TSH) and thyroglobulin (Tg) levels and decreased levels of free thyroxine (FT4), in either the mother during the early stages of gestation or the neonate at birth, or in the fetus cause growth retardation. We found no increases in Tg or TSH and no decreases in FT4 among either the women during early pregnancy (16.1 +/- 4.1 weeks), late pregnancy (32.4 +/- 3.0 weeks), or the neonates at birth related to perchlorate in drinking water. Neonatal birth weight, length, and head circumference were not different among the three cities and were consistent with current U.S. norms. Therefore, perchlorate in drinking water at 114 microg/L did not cause changes in neonatal thyroid function or fetal growth retardation. Median urinary iodine among the entire cohort was 269 microg/L, intermediate between that of pregnant women in the United States at National Health and Nutrition Examination Survey (NHANES) I and at NHANES III and consistent with current World Health Organization (WHO) recommendations. Median breast milk iodine was not decreased in the cities with detectable perchlorate. Analysis of maternal urinary perchlorate excretion indicates an additional dietary source of perchlorate.
Assuntos
Exposição Ambiental , Recém-Nascido/fisiologia , Percloratos/efeitos adversos , Gravidez/fisiologia , Doenças da Glândula Tireoide/induzido quimicamente , Doenças da Glândula Tireoide/epidemiologia , Glândula Tireoide/fisiologia , Abastecimento de Água/análise , Adulto , Antropometria , Peso ao Nascer , Cesárea/estatística & dados numéricos , Chile/epidemiologia , Feminino , Bócio/epidemiologia , Inquéritos Epidemiológicos , Humanos , Iodetos/urina , Estudos Longitudinais , Masculino , Leite Humano/química , Selênio/sangue , Inquéritos e Questionários , Testes de Função Tireóidea , Glândula Tireoide/fisiopatologia , Hormônios Tireóideos/sangueRESUMO
This paper adds iodine data to the nutritional survey recently published in the Eur J Clin Nutr (2004;58:532-540) to identify growth retardation and micronutrient deficiencies among Tarahumara children from five selected indigenous boarding schools in Mexico. Total goiter rate (TGR) (n=384), urinary iodine concentrations (UI) (n = 100), and iodine content of salt were measured. Overall, TGR was 7.0% (grade 1 = 6.8%, grade 2 = 0.2%). The median UI of the group was 125 microg/l, while the median UI across the schools ranged from 92.0-156.5 microg/l, with 32 and 6% of the children having UI between 50-99 microg/l and 20-49 microg/l, respectively. The iodine content in all the salt packages checked at the schools was above 25 parts per million. Based on TGR and UI, there is a marginal iodine deficiency in this sample of children, probably due to an insufficient iodine intake. These results add to existing evidence that iodine deficiency still constitutes a public health problem in certain populations living in the mountainous regions in Mexico.