RESUMO
OBJECTIVE: To investigate reports of iodine-deficiency disorder in a specific area of Haiti. METHODS: In March 2008, this cross-sectional study was performed in an area 15 miles northeast of Jacmel, Haiti, within the Chaîne de la Selle Mountains. Before arrival of the study team, an announcement was made throughout local villages soliciting volunteers to meet at a central location. Of those who arrived, participants were selected in an attempt to sample individuals from all age groups, regardless of goiter status. After providing verbal informed consent, each participant was photographed and assigned a number to be used to protect privacy. An examiner performed palpation of the thyroid gland on each participant in accordance with World Health Organization criteria. Results of palpation were classified into 3 grades: grade 0, the thyroid gland was not palpable; grade 1, the thyroid gland was palpable but not visible; and grade 2, the thyroid gland was palpable and visible while the patient was in a normal position. Casual urine samples were collected from each participant and analyzed spectrophotometrically for urinary iodine concentration. RESULTS: Eighty-eight individuals aged 2 to 72 years participated in the study. Median urinary iodine concentration was 39 microg/L. Of the 88 participants, 82 (93%) were iodine deficient (18 [20%] were severely deficient), and 45 (51%) had goiter on physical examination, including 27 with grade 1 goiters and 18 with grade 2 goiters. CONCLUSIONS: We have documented iodine deficiency with associated endemic goiter in this previously uninvestigated Haitian population, for which world health agencies currently lack definitive data. These data have potential implications for both the local area and the country as a whole where further evaluation and treatment are needed for persons at high risk for iodine-deficiency disorder.
Assuntos
Bócio Endêmico/fisiopatologia , Iodo/deficiência , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Bócio Endêmico/epidemiologia , Bócio Endêmico/urina , Haiti/epidemiologia , Humanos , Iodo/urina , Adulto JovemRESUMO
OBJECTIVE: To validate urinary iodine (I) excretion and the simplified classification of goiter by palpation, comparing them with ultrasound of the thyroid gland as the gold standard, to identify endemic goiter in pregnant women. POPULATION AND SETTING: 300 pregnant women identified in referral hospitals, in three geographic regions. METHODS: Two endocrinologists, previously trained, evaluated thyroid size by palpation and by ultrasound. Urinary iodine excretion in a sample of urine was determined. Thyroid size below the 90th centile by ultrasound was considered normal. RESULTS: Mean age of study women was 23 years old. The prevalence of low weight for gestational age was 39% and of anaemia 47%. Our sample distribution showed that 120 microg I/L was the best cut off for low urinary iodine excretion to identify endemic goiter in pregnant women (sensitivity 57% and specificity 70%, likelihood ratio of 1.4). The prevalence of goiter was 10% using ultrasound. Palpation had a sensitivity of identification goiter of 94% (95% CI 89-99%), a specificity of 80% (95% CI 75-85%), a likelihood ratio of 4.7, positive post-test probability of 36.5% and negative post-test probability of 99%. CONCLUSIONS: Low urinary iodine excretion identified up to 46% of women with goiter. This test by itself is not useful as a screening tool to identify pregnant women at risk of goiter. Identification of thyroid size by palpation was a better screening test. However, when both tests were combined in parallel, up to 100% of women with goiter were correctly identified. Our results suggest that the commonly used cut off point of 100 microg I/L to identify low urinary iodine excretion may under-estimate the prevalence of iodine deficiency disorders when used during pregnancy.
Assuntos
Bócio Endêmico/patologia , Iodo/urina , Complicações na Gravidez/patologia , Glândula Tireoide/patologia , Adulto , Feminino , Bócio Endêmico/diagnóstico por imagem , Bócio Endêmico/urina , Humanos , Programas de Rastreamento , Palpação/métodos , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/urina , Fatores de Risco , Sensibilidade e Especificidade , Glândula Tireoide/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodosRESUMO
Para valorar la ingesta diaria de iodo se midió la ioduria en 134 escolares de ambos sexos, de 5 - 14 años, de Luján de Cuyo (Mendoza). Los mismos fueron categorizados: a) según la existencia o no de bocio por palpación de 2 observadores; b) según el nivel socioeconómico y c) según la marca comercial de sal consumida. Las muestras provenían de un grupo examinado de 700 escolares. No hubo diferencias significativas en sexo, edad, peso o estatura entre los grupos mencionados. Se recolectaron m-uestras de escolares bociosos en mayor proporción que de normales. La ioduria media de los escolares sin bocio fue significativamente mayor que la de los bociosos, (p < 0,005). La prevalencia de bocio disminuyó en los escolares con ioduria de > 150 mug/24 h (p < 0,05). Los niveles de ioduria de escolares de distinto nivel socioeconómico fueron semejantes (p = 0,56). No se encontraron diferencias significativas entre consumidores de las dos marcas comerciales de sal más comunes (p = 0,07). Aunque los valores medios de ioduria en la población evaluada son aceptables, la amplia variabilidad observada sugiere la implementación de mejores medidas de control y de información a la población y, tal vez, la suplementación de iodo discriminada para optimizar la iodoprofilaxis.
Assuntos
Pré-Escolar , Feminino , Humanos , Adolescente , Criança , Bócio Endêmico/urina , Iodo/urina , Cloreto de Sódio na Dieta/efeitos adversos , Distribuição de Qui-Quadrado , Incidência , Classe Social , Fatores Socioeconômicos , Cloreto de Sódio na Dieta/classificação , Glândula Tireoide/químicaRESUMO
Para valorar la ingesta diaria de iodo se midió la ioduria en 134 escolares de ambos sexos, de 5 - 14 años, de Luján de Cuyo (Mendoza). Los mismos fueron categorizados: a) según la existencia o no de bocio por palpación de 2 observadores; b) según el nivel socioeconómico y c) según la marca comercial de sal consumida. Las muestras provenían de un grupo examinado de 700 escolares. No hubo diferencias significativas en sexo, edad, peso o estatura entre los grupos mencionados. Se recolectaron m-uestras de escolares bociosos en mayor proporción que de normales. La ioduria media de los escolares sin bocio fue significativamente mayor que la de los bociosos, (p < 0,005). La prevalencia de bocio disminuyó en los escolares con ioduria de > 150 mug/24 h (p < 0,05). Los niveles de ioduria de escolares de distinto nivel socioeconómico fueron semejantes (p = 0,56). No se encontraron diferencias significativas entre consumidores de las dos marcas comerciales de sal más comunes (p = 0,07). Aunque los valores medios de ioduria en la población evaluada son aceptables, la amplia variabilidad observada sugiere la implementación de mejores medidas de control y de información a la población y, tal vez, la suplementación de iodo discriminada para optimizar la iodoprofilaxis. (AU)
Assuntos
Pré-Escolar , Feminino , Humanos , Estudo Comparativo , Adolescente , Criança , Bócio Endêmico/urina , Iodo/urina , Cloreto de Sódio na Dieta/efeitos adversos , Cloreto de Sódio na Dieta/classificação , Glândula Tireoide/química , Fatores Socioeconômicos , Classe Social , Distribuição de Qui-Quadrado , IncidênciaRESUMO
In order to evaluate iodine daily intake in 5-14 year-old school children urinary iodine excretion was measured in morning urinary samples of 134 school children. This value was corrected to microgram/ 24 h according to Jolin and Escobar del Rey's formula. Thyroid size was evaluated by two expert examiners following WHO criteria. Coincidence between both examiners was indispensable to establish goiter diagnosis. We evaluated urinary samples of 134 school children (117 normal and 17 goitrous). Urinary iodine excretion mean values were significantly different between Normal: 140.04 +/- 86.28 micrograms/24 h and Goitrous: 98.24 +/- 47.91 micrograms 24 h; p < 0.005). Goiter prevalence was found to diminish significantly when urinary iodine excretion was greater than 150 micrograms/24 h (p < 0.05). Similar mean urinary iodine excretion was observed in different socioeconomic groups. No significant differences were detected in the evaluation of two most common salt trademark consumer groups. In conclusion 1) iodoprophylaxis efficacy was assessed by urinary iodine excretion, a valid means to estimate iodine intake. Acceptable mean levels of iodine intake were found in the group under study, but the individual variability was important; 2) goitrous schoolchildren showed an iodine intake lower than normal and 3) the important variability observed in the evaluated data, the assessed relation between goiter and lower iodine intake, and the high frequency of insufficient iodine intake should justify a better control of iodoprophylaxis and a more widespread information dissemination among the population and perhaps iodine supplements in specific groups.
Assuntos
Bócio Endêmico/urina , Iodo/urina , Cloreto de Sódio na Dieta , Adolescente , Criança , Pré-Escolar , Feminino , Bócio Endêmico/epidemiologia , Humanos , Incidência , Masculino , Classe Social , Fatores Socioeconômicos , Glândula Tireoide/químicaRESUMO
An epidemiological survey on goiter was conducted in Buenos Aires, on 3882 schoolchildren, a randomized sample of 160,026 children of public schools, before establishing prophylactic measures in 1968. With an estimated error of 5% the result was 14.8% of goiter prevalence. This figure qualified Buenos Aires as an endemic area and was, therefore, included in the National Programme to Combat Endemic Goiter, through iodized salt (proportion 1:30,000 of salt). Schools were qualified according to their social level in high, middle and low; the prevalence of goiter was 6.8%, 12.2% and 26.4%, respectively. The prevalence was also higher in older ages. In 1986, using the same randomized sample, a second survey was conducted, after 18 years of prophylaxis. Goiter prevalence was 8.5%. Goiter in the low social class was about the same as in the middle class. In randomized samples of 49 urines, iodine concentration was determined yielding an average of 139.6 micrograms/g creatinine (median 120.9 micrograms/g creatinine). Urinary iodine level in 14 children with goiter was 146.1 micrograms/g creatinine and in 12 without goiter was 171.4 micrograms/g. There was no statistical difference between these three groups. Variations in radioiodine uptake, urinary iodine, plasma inorganic iodine levels, and water iodine are discussed.
Assuntos
Bócio Endêmico/epidemiologia , Adolescente , Fatores Etários , Argentina/epidemiologia , Criança , Creatinina/urina , Feminino , Bócio Endêmico/prevenção & controle , Bócio Endêmico/urina , Humanos , Iodo/administração & dosagem , Iodo/urina , Masculino , Análise de Regressão , Estudos de Amostragem , Fatores Sexuais , Fatores Socioeconômicos , Sódio na Dieta/administração & dosagem , População UrbanaAssuntos
Bócio Endêmico/urina , Iodo/urina , Adolescente , Adulto , Argentina , Criança , Pré-Escolar , Dieta , Feminino , Bócio Endêmico/prevenção & controle , Humanos , Iodo/administração & dosagem , Masculino , Pessoa de Meia-IdadeRESUMO
This paper reports on recent epidemiological observations in western Colombia, which further demonstrate the presence of naturally-occurring goitrogens contaminating water supplies in areas where goitre persists despite prolonged and continuous iodine supplementation. 'Prospective' and 'cross-sectional' studies in 41 localities where the populations have been on a uniform and adequate iodine supplementation for the last 10-20 years indicate that, in the endemia of western Colombia, environmental factors other than nutritional iodine deficiency are responsible for differences in goitre prevalence. Further epidemiological studies to determine the causal factors for the persistence of the endemia established a correlation between the sources of drinking water and goitre prevalence rates. Organic compounds containing sulfur with marked thionamide-like antithyroid activity were isolated from water supplying endemic goitre districts, and results are presented supporting the hypothesis that sedimentary rocks rich in organic matter are the main source of water-borne goitrogens. Bacteriological investigations showed that the presence of Klebsiella pneumoniae in drinking water and bacterial concentration were related significantly with goitre prevalence only in the presence of other variables, particularly the presence of sedimentary rocks. In the light of these epidemiological observations and experimental studies it may be concluded that, at present, endemic goitre in western Colombia is not due to nutritional iodine deficiency, but that water supplies are contaminated with sulfur-bearing organic compounds with thionamide-like antithyroid activity most probably deriving from sedimentary rocks rich in organic matter and that these compounds are the main factor underlying the endemia.