ABSTRACT
Some studies have shown the possible role of protein-energy malnutrition [PEM] in persistence of endemic goiter in iodine replenished areas. The present study was conducted to assess the association between PEM and goiter in schoolchildren of Isfahan, Iran. In a cross-sectional study using multistage cluster random-sampling, 2331 schoolchildren with age ranged from 6-13 years old with a female to male ratio of 1.60 were enrolled. Thyroid size was examined by two endocrinologists for goiter detection. Children were considered goitrous if they had palpable or visible goiters according to World Health Organization [WHO]/United Nations children's Fund/International Council for the Control of Iodine Deficiency criteria. Weight and standing height were measured using the standard tools and anthropometric indices were calculated using the WHO AnthroPlus software developed by the World Health Organization. Height-for-age Z-scores [HAZ], weight-for-age Z-scores [WAZ] and body mass index [BMI] for age were calculated for each child. Children with a HAZ, WAZ or BMI-for-age of Z-score < -2.0 were classified as stunted, underweight or thin, respectively. Blood samples were drowned to measure serum thyroid hormones. Overall, 32.9% of subjects were classified as goitrous. Weight, height, BMI, WAZ and BMI-for-age Z-score were significantly lower in children with goiter than in children who did not have goiter [P < 0.05]. The prevalence of goiter in thin children was higher than that in non-thin ones [48.4 vs. 31.6%, odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.52-2.69, P < 0.001]. Although 33.4% of non-stunted children were goitrous, 31% of stunted ones had goiter [P = 0.5]. According to the logistic regression model taking sex and age as covariates, the only significant parameter affecting palpable goiter detection was thinness [OR = 2.13, 95% CI: 1.22-3.69, P < 0.001]. In the present study, we found a high prevalence of goiter in children who were malnourished. It seems that PEM may play a role in the still high prevalence of goiter in this region
ABSTRACT
Studies in different populations have shown great variation in the prevalence of thyroid diseases in patients with type 1 diabetes mellitus [TIDM]. Our aim was to study the prevalence of thyroid disorders such as autoimmunity of thyroid [AIT], thyroid dysfunction, and goiter in children and adolescents with TIDM, compared with age- and sex-matched healthy controls in Isfahan. One hundred patients with TIDM who were referred to Isfahan Endocrine and Metabolism Research Center and 184 healthy schoolchildren matched for age and sex were included. They were examined for goiter by two endocrinologists. Thyroid function test and serum thyroid antibodies [anti-TPO Ab and anti-Tg AbJ were measured. The prevalence of subclinical hypothyroidism was high in both groups [18%]. TIDM patients had lower frequency of goiter [21% vs. 38%, P=0.001], and higher prevalence of positive AIT [22% vs. 8%, P=0.001], anti-TPO Ab positivity [19.3% vs. 5.3%, P=0.000], and anti-Tg Ab [11.1% vs. 6.4%, P=0.1] in comparison with the control group. Being positive for AIT in diabetic patients meant an odds ratio of 5 [Cl 95%: 1.5-15.6] for thyroid dysfunction. There was no association between age, sex, duration of diabetes and HbAic with serum anti-TPO Ab and anti-Tg Ab concentrations in this group. Our results demonstrated the high prevalence of AIT and thyroid dysfunction in patients with TIDM. We suggest regular thyroid function and antibody testing in these patients