Goiter in Brazilian modernism paintings / Bócio em pinturas da arte moderna brasileira

Objective: To evaluate Di Cavalcanti's artworks in which goiters are represented before and after the introduction of iodized salt to the Brazilian population. Methods: One hundred and thirty paintings by Di Cavalcanti from the 20's to 70's demonstrating necks were evaluated. All the paintings were observed in reproductions. The neck circumference in the paintings was measured. Since there were no standard thresholds of neck circumference, cutoffs were based on the median. Baseline characteristics of artworks were compared based on high and normal neck circumference categories using Student's t-test, Mann-Whitney-Wilcoxon test, or chi square test. Results: We analyzed 29 artworks which portray the neck of 60 women (84.5%), 8 men (11.3%) and 3 children (4.2%). The analyses of the neck circumference showed 23.3% of women (14/60), 12.5% of men (1/8), and 33.3% of children (1/3) with an abnormal profile of the neck circumference. The neck circumference ratio in 29 paintings showed that the relative sizes of the necks painted between the 1920's and 1950's (r=0.45; p=0.03), and painted between the 1960's and 70's (r= 0.54; p=0.003) have linearly decreased. The decades in which the artworks were painted explained 40.0% of the variation in size of the neck circumference (p=0.002). Conclusion: Art imitates life. Di Cavalcanti was not a physician, and probably did not have the intention to illustrate a pathological condition, although the images observed in this study should be considered as goiter or enlarged neck.

Objetivo: Avaliar as obras de Di Cavalcanti em que bócios estão representados, antes e após a introdução da iodação do sal para a população brasileira. Método: Foram avaliadas 130 pinturas de Di Cavalcanti entre os anos 1920 e 1970 demonstrando pescoços. Todas as pinturas foram observadas em reproduções. A circunferência do pescoço nas pinturas foi mensurada. Como não existia limite-padrão da circunferência do pescoço, os limites foram baseados na mediana. As características básicas das obras de arte foram comparadas por categorias da circunferência do pescoço em elevadas e normais, usando o teste t de Student, o teste de Mann-Whitney-Wilcoxon ou o teste qui-quadrado. Resultados: Analisamos 29 obras de arte que representavam o pescoço de 60 mulheres (84,5%), 8 homens (11,3%) e 3 crianças (4,2%). Ao analisar a circunferência do pescoço, 23,3% das mulheres (14/60), 12,5% dos homens (1/8) e 33,3% das crianças (1/3) demonstraram perfil anormal dela. A relação da circunferência do pescoço em 29 pinturas demonstrou que as circunferências do pescoço relativas aos pescoços pintados entre os anos 1920 e 1950 (r=0,45; p=0,03) e pintados entre os anos 1960 e 1970 (r=0,54; p=0,003) reduziram linearmente. As décadas em que as obra foram pintadas explicaram 40,0% da variação no tamanho da circunferência do pescoço (p=0,002). Conclusão: A arte imita a vida. Di Cavalcanti não era médico e, provavelmente, não tinha intenção de ilustrar uma condição patológica, embora as observações das imagens, neste estudo, tenham sido consideradas como bócio ou com aumento de volume do pescoço

Iodine nutritional status in Brazil: a meta-analysis of all studies performed in the country pinpoints to an insufficient evaluation and heterogeneity

Objectives Iodine deficiency disorder (IDD) is the result of an inadequate dietary intake of iodine, which physiological consequences are endemic goiter and thyroid dysfunction. The objective of this study was to a analyze studies that assessed the status of Brazil’s population iodine nutrition and IDD prevalence. Materials and methods Systematic review using PRISMA statement. Electronic database: PubMed, Medline, SciELO and Lilacs. Quality of studies: Newcastle-Ottawa Scale. Meta-analysis was carried out with R Core Team Statistical Software, version 3.1.0 (2014). The summary measure (WMD) and its confidence interval (CI) of 95% were calculated. The “Funnel plot” graph assessed publication bias and heterogeneity. Results Seventeen papers were eligible: pregnant women (2), school children (9), adults/elderly (4) and preschool children/infants (2). Geographic distribution: North (1), Northeast (1), Midwest (2), Southeast (13), South (3). Twenty-three thousand two hundred seventy-two subjects were evaluated between 1997 and 2013 and all have use urinary iodine (UI) measurement. However, only 7 studies could be included in meta-analysis, all from Southeast region. The overall prevalence of IDD in school children in southeast region was 15.3% (95% CI, 13-35%), however this data had an important heterogeneity, expressed by the I2 Statistic of 99.5%. Conclusion Only few studies have been performed and enrolled populations from south/southeast region of Brazil. The actual IDD prevalence analysis is complex because it was detected bias due influence of individual studies and very high heterogeneity. IDD might still be high in some areas but this remained unknown even after this meta-analysis evaluation. The generation of a national program for analysis of iodine status in all regions is urgently required. Arch Endocrinol Metab. 2015;59(1):13-22 .

La endemia bocio-cretínica en la República Argentina. Reseña cronológica breve y actualizada / La Endemic goiter in Argentina. Nowadays statistical data

Desde épocas antiguas el bocio endémico fue considerado un problema grave, por su extensión y formas clínicas acentuadas, además de su asociación con el cretinismo, también endémico, especialmente en el NOA argentino, no así en el NEA, donde no se comunicaban casos de cretinismo. Estos problemas, de origen geológico, se dan por la pobreza de yodo en ese medio y, consecuentemente en las aguas de bebida. Este problema fue postergado hasta 1965 con la realización de dos encuestas nacionales, sobre muestras probabilísticas sobre 47.619 varones de 20 años en 10 provincias y, sobre 51.768 escolares. En 1967, con suficientes datos, por la extensión de la endemia se legisló con alcance nacional, con la Ley 17.259 que fue sancionada y promulgada en 1º de mayo de 1967. La misma establecía la obligatoriedad del expendio de sal yodada, para uso alimentario humano y animal con una parte de yodo en 30.000 partes de sal, que comenzó a hacerse efectiva en 1970. Investigaciones posteriores han demostrado la efectividad de las medidas sobre la patología tiroidea...

It was known since ends of XIX century the severity of endemic goiter and chretinism, specially in the northwest zone of the country. It has been considered a geological disease because of the lack of iodine in soils and waters. In 1965 the problem was considered and the first place steps were to qualificate how extense was the disease, and two surveys; one in probabilistic samples on 47,619 males of 20 years old, in 10 provinces, and another on 51,768 schoolchildren’s. In 1967 it was decided to legislate to reach the nation with the Law 17,259 approved in May the first, 1967. Effectiveness of the measures were probed by investigations made lately...

The Association between Cobalt Deficiency and Endemic Goiter in School-Aged Children

BACKGROUND: In Iran, an iodine deficiency control program was initiated in 1989 by iodizing salt. Despite this program, goiters have remained an endemic condition in most parts of Iran. Thus, it is possible that other factors aside from iodine deficiency may contribute to endemic goiter. The aim of this study was to investigate the association between cobalt deficiency and endemic goiter in a region of Iran with a high prevalence of goiter. METHODS: A cross-sectional study was conducted among school children aged 9 to 11 years in the city of Kerman, Iran. In the first phase of the study, a multistage, proportional-to-size, cluster sampling method was used to screen 5,380 out of 29,787 students. After the screening phase, 170 students (130 goitrous and 40 nongoitrous) were randomly selected, and serum and urine specimens were obtained. We measured thyroid function, serum cobalt level, and urinary iodine excretion. Univariate and multiple logistic regression analyses were performed. RESULTS: The prevalence of grade 2 goiters was 34.8% (95% confidence interval [CI], 31.5 to 42.5), with both sexes being equally affected. The weight and body mass index of goitrous subjects was significantly lower (P<0.001) than those of nongoitrous subjects. The serum cobalt levels were lower in goitrous subjects than in nongoitrous subjects (4.4+/-2.9 microg/L vs. 6.4+/-2.7 microg/L). The urinary iodine levels were also lower in goitrous subjects than in nongoitrous subjects (198.3+/-108.3 microg/L vs. 270.2+/-91.1 microg/L). Multiple regression analysis showed that only cobalt deficiency, not iodine deficiency, significantly contributed to the presence of goiter (odds ratio, 0.78; 95% CI, 0.61 to 0.99; P=0.042). CONCLUSION: Cobalt deficiency may be an important independent predicator for goiter in endemic regions, especially areas in which goiters persist despite salt iodization programs.

La deficiencia de yodo en Cuba / Iodine deficiency in Cuba

Objetivo: caracterizar la magnitud y la severidad de la deficiencia de yodo en Cuba. Métodos: se caracterizó la magnitud y la severidad de la deficiencia de yodo en Cuba mediante la determinación de la yoduria y la prevalencia de bocio por inspección y palpación. Se realizó un estudio epidemiológico de corte transversal utilizando un muestreo complejo por conglomerados bietápico en tres estratos de selección: urbano, rural y montaña, el cual incluyó 67 municipios del país con un total de 2 101 escolares de 6 a 11 años. Resultados: se encontraron yodurias deficientes en el 6,4 por ciento de los niños evaluados a predominio del estrato de montaña. Se evidenció una ingesta excesiva de yodo en todos los estratos. La prevalencia de bocio fue de 27, 3 por ciento, considerada como endemia moderada con una mayor cifra en la montaña y sexo femenino. Los hallazgos indicaron el impacto de la yodación de la sal evaluado a través de la excreción urinaria como indicador de ingesta reciente. Conclusiones: el bocio endémico continúa siendo un problema nutricional poblacional, lo que sugiere realizar estudios de mayor profundidad para identificar las posibles relaciones causales

Objective: characterize the magnitude and severity of iodine deficiency in Cuba. Methods: characterization of the magnitude and severity of iodine deficiency in Cuba was based on determination of iodinuria and the prevalence of goitre by inspection and palpation. A cross-sectional epidemiological study was conducted using complex two-staged cluster sampling of three selected strata: urban, rural and mountainous, including 67 municipalities and a total of 2 101 school children aged 6-11. Results: deficient iodinuria was found in 6.4 percent of the children evaluated, with a predominance of the mountainous stratum. Excessive iodine intake was present in all strata. Goitre was classed as moderately endemic, with a prevalence of 27.3 percent and a predominance in the mountainous stratum and the female sex. Findings revealed the impact of salt iodization, which was evaluated through examination of urinary excretion as an indicator of recent salt intake. Conclusions: endemic goitre continues to be a nutritional problem in the population, pointing to the need to conduct more profound studies to identify possible causal relationships

Nutrición de yodo en escolares de Calama, Chile: persitencia de niveles elevados de yodo urinario / Iodine nutrition in school children of Calama city, Chile: persistence of high urinary iodine levels

Introducción: El año 2000 se determinó que la mediana de la concentración urinaria de yodo (CUI) en escolares de educación básica de Calama estaba en 2600 ug/L, valor muy elevado, el que descendió a 487 ug/L el año 2004 después de reducir los niveles oficiales de yodación de la sal de 100 ppm a 40 ppm el año 2000. Objetivo: Investigar la nutrición de yodo en escolares de Calama, 12 años después del cambio de legislación. Sujetos y métodos: 332 escolares de ambos sexos de una escuela municipal de educación básica de Calama fueron evaluados sobre la prevalencia de bocio mediante la palpación de la glándula tiroides; al 22% de los mismos (72) se les evaluó la nutrición de yodo mediante la determinación de CUI en muestras casuales de orina por espectrofotometría. Se recolectaron 58 muestras de sal de consumo humano, seleccionadas aleatoriamente en locales comerciales, comedores de la escuela y en los hogares de los escolares, para determinar su contenido de yodo por la técnica de almidón. Adicionalmente, en todos los escolares se registró peso, talla e IMC. Resultados: Se encontró una prevalencia de bocio de 8.2%, todos del grado 1. La mediana de la concentración urinaria de yodo fue 448 ug/L. La concentración de yodo en la sal fue 31,4 ± 17.8 ppm, valor dentro de los estándares oficiales establecidos en el Reglamento Sanitario de los Alimentos (RSA) del Ministerio de Salud de Chile. Comentarios y conclusiones: Los resultados muestran un leve aumento en la prevalencia de bocio y que persiste una alta CUI en escolares de Calama, probablemente debido a una excesiva ingesta de yodo, no obstante que el promedio de contenido de yodo en la sal para consumo humano estuvo dentro del rango recomendado por OMS-UNICEF-ICCIDD (20-40 ppm). Estos hallazgos plantean la necesidad de investigar otras probables fuentes de ingesta de yodo, como causa del exceso de yodo que persiste en Calama.

Introduction: In the year2000 it was determined that the median of the urinary iodine concentration (UIE) in primary school children from Calama was 2600 ug/L, a very high level which went down to 487 ugI/L in 2004, after the standards of the Food Sanitary Regulation were scaled down from 100 ppm to 40 ppm in the year 2000. Objective: To search the current iodine nutrition in school children of Calama, 12 years after the change in the legislation. Subjects and methods: 332 primary school children from Municipal School D-48 ofthe City ofCalama were assessed in relation to their prevalence of goiter determined through palpation of the thyroid gland. In 22% ofthem (72 children), UIE was determined by spectrophotometry. 58 samples ofsalt for human consumption saltwere randomly collected from local shops, school canteens and from the children's homes to determine their iodine concentration through the starch technique. In addition, the school children were measured and weighed to determine the adequacy of their height and Body Mass Index (BMI). Results: An 8.2% prevalence ofgoiter was found; all were grade 1. The iodine concentration in the salt was 31.4 ± 17.8 in the 58 samples analyzed, the average met the adequate range of the current Food Sanitary Regulation (FSR) of Health Ministry of Chile. Conclusion and comments: A non significant increase in the prevalence ofgoiter was found, the average of UIE continue being high, possible due to an excessive intake ofiodine, nevertheless average iodine concentration in the salt for human consumption is within de recommended range by WHO-UNICEF-ICCIDD (20-40 ppm). These findings prompt to search another sources of iodine intake, as an explanation of the persistent elevation of UIE in these children.

Changes of the spectrum on thyroid disease after the ten-year implementation of universal salt iodization in Guangxi Zhuang Autonomous Region / 中华流行病学杂志

<p><b>OBJECTIVE</b>To reveal the relationship between iodine nutrition and the change of spectrum on thyroid diseases through comparing the different iodine environments pre- and post- the universal salt iodization(USI)campaign.</p><p><b>METHODS</b>To compare the urinary iodine concentration between 1000 normal people and 5998 patients with thyroid disease who had undergone surgical operations, from 4 major cities, including iodine deficient and rich areas of Guangxi Zhuang Autonomous Region.</p><p><b>RESULTS</b>After USI was put into practice, the urinary iodine concentration of patients with thyroid appeared higher than those of normal people(324.3 µg/L vs. 238.5 µg/L, P < 0.05). The urinary iodine concentrations of nodular goiter,Graves disease, toxic nodular goiter, thyroid papillary carcinoma and Hashimoto's thyroiditis were higher than those before the USI was taken(263.8 µg/L vs. 69.75 µg/L, 289.7 µg/L vs. 228.3 µg/L, 346.8 µg/L vs. 268.4 µg/L, 350.3 µg/L vs. 316.2 µg/L and 378.5 µg/L vs. 305.8 µg/L). The proportions of toxic nodular goiter, thyroid papillary carcinoma and Hashimoto's thyroiditis appeared as 7.59% vs. 4.80%, 5.85% vs. 4.02% and 3.88% vs. 2.46%, all higher than those before the implementation of USI, except the nodular goiter which showed a reduction (63.56% vs. 69.75%).</p><p><b>CONCLUSION</b>The spectrum of thyroid diseases appeared an obvious change in Guangxi within the last 10-year implementation of USI. However, the excessive intake of iodine might serve as a risk factor for toxic nodular goiter, thyroid papillary carcinoma and Hashimoto's thyroiditis.</p>

Analysis of urine iodine level and its influencing factors in Zhejiang from 2009 to 2011 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the iodine nutrition level of population in Zhejiang province and to analyze the relevant influencing factors from 2009 to 2011.</p><p><b>METHODS</b>From October 2009 to October 2011, a total of 19 517 subjects were recruited in this cross sectional survey, by multistage stratified cluster random sampling method. The subjects were all living over three years in Zhejiang province. The basic information and life styles were interviewed by questionnaires; and the samples of drinking water, edible salt and urines were separately collected from the subjects to test the content of iodine. In total, 16 228 subjects answered the questionnaire, and 265 samples of drinking water, 7811 samples of edible salt and 19 517 samples of urine were collected. Then, we analyzed the distribution of iodine in water, edible salt and urine samples, as well as the relevance.</p><p><b>RESULTS</b>The median (25% - 75% percentile) of water iodine was 2.42 (1.17 - 6.28) µg/L in drinking water among Zhejiang residents; while separately 2.79 (1.60 - 6.87) µg/L in city and 2.04 (1.03 - 5.29) µg/L in country side (Z = 2.07, P < 0.05). The figures turned out to be 2.17 (1.22 - 5.73) µg/L, 2.77 (1.88 - 6.87) µg/L, and 1.40 (0.77 - 5.65) µg/L, respectively, in coastal areas, coastal periphery areas and inland areas (χ(2) = 11.16, P < 0.05). The median (25% - 75% percentile) of salt iodine was 28.80 (22.93 - 32.40) mg/kg; while separately 29.00 (24.50 - 32.60) mg/kg and 28.50 (13.90 - 32.29) mg/kg in city and country side (Z = 6.32, P < 0.05). The figures turned out to be 25.19 (0.00 - 30.20) mg/kg, 29.00 (26.60 - 31.70) mg/kg and 32.40 (28.94 - 36.30) mg/kg, respectively, in coastal areas, coastal periphery areas and inland areas (χ(2) = 1581.62, P < 0.05). The coverage rate of iodized salt was 79.54% (6213/7811) in all province. The urinary iodine median was 160.74(97.20 - 247.00) µg/L, while the urinary iodine median in pregnant women was 137.99 (82.40 - 215.30) µg/L, lower than the recommended optimal levels, which was 150 - 249 µg/L. The figures turned out to be 153.45(92.00 - 237.50) µg/L in city and 168.00 (102.18 - 257.00) µg/L in country side (Z = -9.25, P < 0.05); while in coastal, coastal periphery place and inland areas, the median were separately 156.00 (94.29 - 242.80) µg/L, 150.14 (94.70 - 227.00) µg/L and 187.70 (109.00 - 276.80) µg/L (χ(2) = 194.12, P < 0.05). The analysis of relevance between urine iodine, water iodine and iodized salt showed that the urine iodine would increase as long as the iodized salt increased; and the difference had statistical significance (χ(2) = 440.88, P < 0.01). And there were no relevance between urine iodine level and the water iodine level (χ(2)cmh = 0.57, P = 0.45). The analysis of the influencing factors showed that education background (χ(2) = 14.17, P < 0.05), different styles of career (χ(2) = 16.15, P < 0.01) and diet habits (χ(2) = 108.63, P < 0.01) could influence the level of urine iodine.</p><p><b>CONCLUSION</b>Iodine was deficient in Zhejiang province. The nutrition level of iodine was fine in Zhejiang in 2009, however, the coverage rate of iodine was commonly low in coastal areas, especially the pregnant women suffered from iodine deficiency. In our study, the factors influencing the urine iodine level included iodized salt, age, education background and diet habits.</p>

Epidemiological Assessment of Goiter.

Research Question: 1. What is the magnitude of problem of Goiter? 2. What is the level of iodised salt consumed by school children at school & home? Objectives: 1. To find out incidence of Goiter. 2. To find out level of iodised salt consumed by school children at school & home. Study Design: Cross-sectional study. Settings: School & houseto- house survey of urban & rural area of Raichur district. Participant: School children & general population of both sexes. Sample size: 45173. Statistical analysis: Proportion & Chi-squared test. Results: Total population covered 45173 in five talukas. Males were 23463 & females 21730, adult population 16404, children more than 15 yrs were 28769 & school population was 24984. School boys were 14269 & girls 10715. Highest prevalence of goiter found in Raichur taluka i.e. 5.68% and lowest in Lingsur taluka i.e. 0.86%. Over all prevalence of Goiter among surveyed villages is found to be 3.19 % (1439 cases). Higher prevalence has been reported among females in age group of 10- 14 yrs 5.25% & 15-19 yrs 4.66% compared to other age groups of village population. School children in Raichur district revealed the prevalence of Goiter 3.66%. Conclusion: Prevalence of Goiter among surveyed villages is found to be 3.19 % (1439 cases), which is less compared to the National figures. The people are consuming the iodated salt and ban on non-iodated salt may be effectively implemented in study region.

frequency of malignancy in nodular goiter - a single center study

To find out the frequency of malignancy in nodular goiters. A total of 204 cases were studied in the department of ENT and Head and Neck surgery, Hayatabad Medical Complex, Peshawar. The duration of this descriptive study was from June 1, 2008 to May 31, 2010. After taking informed consent, a detailed history was obtained. Clinical and laboratory investigations were carried out as an aid to diagnosis and determine the patients' fitness for surgery. Patients with nodular goiters were categorized into two categories i.e., Solitary thyroid nodule and multinodular goiter. Surgically resected thyroid specimens were examined histopathologically. The data was analyzed using SPSS 16.0 for windows to determine the frequency of malignancy in nodular goiter. Ages of the patients ranged from 17 to 84 years with a mean age of 37 +/- 12.48 years. The male to female ratio was 1:3:5. 18.14% cases presented as solitary thyroid nodules [STN] and 81.86% as multinodular goiters [MNG]. Out of the total 83.82% cases were benign and 16.18% cases were malignant. The prevalence of malignancy in multinodular goiter was 14.37% and in the solitary thyroid nodules as 24.32%. Papillary carcinoma was the commonest malignancy followed by follicular carcinoma. The prevalence of cancer is significant in nodular goiters and these malignant tumours are usually of the papillary type. Solitary thyroid nodules have more chances of being malignant than multinodular goiter

Antecedentes, diagnóstico, repercusión y prevención del déficit de yodo en la salud humana / Backgrounds, diagnosis, repercussion and prevention of iodine deficits in human health

La glándula tiroidea tiene 2 particularidades: al examen físico está al alcance de la mano del médico, y su función se relaciona con un oligoelemento, el yodo, que tiene una relevante importancia en el metabolismo de nuestro organismo. Su deficiencia favorecería la aparición de enfermedades conocidas como desórdenes por déficit de yodo, que tienen un impacto negativo en la vida de hombres y mujeres, de animales y de plantas. Desde el punto de vista clínico está considerada como la mayor causa de daño cerebral en niños, hipotiroidismo y bocio en el adulto, todas prevenibles, y en dependencia de la voluntad conjunta de organismos y organizaciones nacionales e internacionales, es posible de erradicar con una práctica sencilla como el consumo de la sal yodada. Los métodos diagnósticos utilizados para evaluar su deficiencia son de extraordinaria utilidad en la práctica clínica. En la actualidad la utilización de la ecografía como método coadyuvante para realizar la mensuración de la glándula tiroides y definir el bocio en zonas de suficiencia de yodo, como la nuestra, sería de gran utilidad por su mayor especificidad y sensibilidad. El objetivo de nuestro trabajo es ofrecer una panorámica general de la importancia de las funciones del yodo en el organismo y su relación con la glándula tiroides, sus métodos diagnósticos, el impacto, la repercusión y la prevención de los desórdenes por déficit de yodo en la salud humana, así como la aplicación de nuestro programa nacional de yodación de la sal(AU)

Thyroid gland has two particular features: the manual physical examination is easy and its function is related to oligoelement, the iodine having a relevant significance in the metabolism of our organism. Its deficiency will favor the appearance of diseases known as disorders due to iodine deficit with a negative impact on life of men and women, of animals and of plants. From the clinical point of view it is considered as the leading cause of brain damage in children, hypothyroidism and goitre in the adult, all are preventable and in dependence of the together will of national and international organisms and institutions it is possible to eradicate it with a simple practice, eg iodized salt. The diagnostic methods used to assess its deficiency are very useful in the clinical practice. Nowadays, the use of echography as an assisting method to carry out the mensuration of the thyroid gland and to define the goitre in zones of iodine sufficiency like ours, will be very useful due its high level of specificity and sensitivity. The aim of present paper is to offer a general panorama of the significance of iodine functions in the organism and its relation to the thyroid gland, its diagnostic methods, the impact, the repercussion and the prevention of disorders due to iodine deficit in human health, as well as the implementation of our national program of salt iodization(AU)

Tendencia de la nutrición de yodo durante las últimas décadas en escolares chilenos y sus consecuencias / Trend of iodine nutrition in recent decades and its consequences in Chilean schoolchildren

The endemic goiter, nutritional collective problem due to iodine deficience, constitutes a chronic disease with easy prevention and control, nevertheless still it constitutes a serious problem of public world health, being thought that about 650 million persons have goiter, 43 millions suffer from endemic cretinism and 1570 millions are in risk of suffering this disease for living in areas that present a deficit of iodine. Both patterns, deficit and the excess of iodine can conducted to a thyroid disease. The relation between the ingestion of iodine and the risk of disease corresponds to a U curve, where both, the low one and high ingestion of iodine it is associate to high risk of thyroid disease. To have a program of iodine supplementation, it should imply a constant vigilance of iodine nutrition to see its effect on the goiter prevalence in the population, to control his degree of fulfillment, to avoid a possible excess of ingestion of iodine it might help to correct any precocious alteration. Endemic goiter is not longer a problem in Chile. Salt iodination is in agreement with present legislation, but it is very important to have a continuous surveillance of iodine nutrition in Chile to control if salt fortification is appropiate.

Teores de iodo em sal fortificado para o consumo humano / Iodine contents in fortified salt for human consumption

No Brasil, como em muitos países, é obrigatória a fortificação de sal de cozinha com iodo a fim de evitar graves distúrbios de saúde causados pela deficiência de iodo no organismo. A Resolução RDC nº 130(26/5/2003) estabelece que o sal adequado para o consumo humano deve conter entre 20 e 60 miligramas de iodo para cada quilograma de produto. Distúrbios de deficiência de iodo (DDI) podem ser causados pela carência ou pelo excesso de iodo. Neste trabalho foram avaliados os teores de iodo em 31 amostras de sal coletadas em estabelecimentos comerciais da região de Campinas-SP. A determinação do teor de iodo foi efetuada em triplicata aplicando-se a titulação iodométrica no Centro de Laboratório Regional –Instituto Adolfo Lutz de Campinas III. Do total de amostras, 10% estavam não conformes com a legislação vigente. No entanto, foi observada melhora gradativa no procedimento de iodação do sal no período estudado, uma vez que houve diminuição da porcentagem de amostras não conformes em relação aos dados anteriores: 20% em 2008; 11% em 2009 e 0% em 2010. A variação dos teores de iodo nas amostras de sal foi evidenciada em produtos de mesma marca e de lotes diferentes.

Persistence of goitre in the post-iodization phase: micronutrient deficiency or thyroid autoimmunity.

Background & objectives: Despite years of salt iodization, goitre continues to be a major public health problem worldwide. We examined the prevalence of goitre in the post-iodization phase and the relationship of goitre with micronutrient status and thyroid autoimmunity in school children of Chandigarh, north India. Methods: Two phase study; in the first phase, 2148 children of 6 to 16 yr were screened for goitre by two independent observers as per the WHO grading system. In the second phase, a case-control study, 191 children with goitre and 165 children without goitre were compared with respect to urinary iodine, iodine content of salt, serum levels of T3, T4, TSH, anti-TPO (thyroid peroxidase) antibody, haemoglobin, ferritin and selenium. Results: Prevalence of goitre in the studied subjects was 15.1 per cent (13.9% in 6 to 12 yr and 17.7% in 13 to 16 yr age group, P= 0.03). Median urinary iodine excretion in both the groups was sufficient and comparable (137 and 130 µg/l). 3.2 per cent children with goitre and 2.4 per cent without goitre had hypothyroidism (subclinical and clinical) and only one child with goitre had subclinical hyperthyroidism. Nine (4.9%) children in the goitre group and 3 (1.9%) in control group had anti-TPO antibody positivity. The median serum selenium levels were not different in both the groups (181.9 and 193.5 µg/l). Seventy one (37.4%) of the goitrous children had anaemia (haemoglobin <12 g/dl) as compared to 41 (24.8%) of the control group (P <0.01). More number of goitrous children (39, 20.6%) were depleted of tissue iron stores (serum ferritin <12 µg/l) as compared to controls (11, 6.4%; P<0.001). Serum ferritin level negatively correlated with the presence of goitre (r = - 0.22, P =0.008) and had an OR of 2.8 (CI 1.20 - 6.37, P =0.017). Interpretation & conclusions: There was a high prevalence of goitre in young children despite iodine repletion and low thyroid autoimmunity. The concurrent iron deficiency correlated with the presence of goiter. However, the cause and effect relationship between iron deficiency state and goitre requires further elucidation.

Endemic goitre in the Sudan despite long-standing programmes for the control of iodine deficiency disorders

Objective To describe the status of iodine deficiency disorders (IDDs) in the Sudan more than 25 years after the initiation of IDD control programmes and to explore the causes of endemic goitre in the country.Methods Testing for IDDs was carried out in 6083 schoolchildren 6 to 12 years of age from the capital cities of nine states in different areas of the country using the three indicators recommended by the World Health Organization: the prevalence of goitre, laboratory measurements of urinary iodine concentration in casual urine samples and serum thyroglobulin (Tg) levels. Serum levels of thyroxine (T4), triiodothyronine (T3) and thyroid-stimulating hormone (TSH), as well as urinary secretion of thiocyanate, which can affect the transport of iodine into thyrocytes, were also measured.Findings The prevalence of goitre in the different samples ranged from 12.2% to 77.7% and was 38.8% overall. The overall median urinary iodine concentration was 6.55 µg/dl, with the lowest median value having been found in Kosti city (2.7µg/dl), situated in the centre of the country, and the highest (46.4 µg/dl) in Port Sudan, on the Red Sea coast. The highest mean serum Tg level (66.98 ng/ml) was found in Kosti city, which also had the highest prevalence of goitre.Conclusion IDDs still constitute a public health problem throughout urban areas in the Sudan and iodine deficiency appears to be the main etiological factor involved

Concomitância de bócio coloide com outras doenças tireoidianas: coincidência ou influência de fatores ambientais e individuais? / Colloid goitre concomitant with other thyroid diseases: coincidence or influence of environmental factors and individual?

JUSTIFICATIVA E OBJETIVOS: Considera-se que aproximadamente um terço da população mundial vive em áreas deficientes de iodo, sendo que 4% a 5% desta têm problemas relacionados à carência, particularmente atraso no desenvolvimento pôndero estatural e redução da capacidade de trabalho. Em virtude da grande prevalência do bócio coloide e sua relação com a deficiência de iodo, o objetivo deste estudo foi determinar se há relação de bócio coloide com outras disfunções tireoidianas. MÉTODO: Analisaram-se retrospectivamente prontuários e laudos de exames anatomopatológicos de 256 pacientes submetidos à tireoidectomias no Serviço de Cirurgia de Cabeça e Pescoço do Centro Médico Samaritano de Goiânia, no período janeiro de 2004 a dezembro de 2006. RESULTADOS: A amostra apresentava 156 diagnósticos de bócio coloide no qual um era bócio difuso (0,6%), 119 eram multinodulares (76,3%) e 36 uninodulares (23,1%). Em associação, encontrou-se alta frequência de tireoidite linfocítica 75 (47,4%) como segundo diagnóstico, seguido de bócio adenomatoso uninodular 25 (15,8%) e bócio adenomatoso multinodular 16 (10,5%). Quando analisados separadamente, os bócios uninodulares frequentemente se associaram ao bócio adenomatoso uninodular 16 (42,9%) e os bócios multinodulares à tireoidite linfocítica 79 (66,7%). CONCLUSÃO: O estudo determinou prevalência elevada de bócio coloide em 156 pacientes (60,7%), com significante associação à tireoidite linfocítica em 75 (47,4%), carcinoma folicular 16 (10,5%), carcinoma papilar e carcinoma com células de Hürthle 8 (5,3%). Os resultados corroboraram com a literatura em relação às prevalências anatomopatológicas, porém não se encontra estudos da associação de bócio coloide com demais doenças, alertando-se para a necessidade de maior atenção à provável associação.

BACKGROUND AND OBJECTIVES: It is considered that approximately one third of the world population lives in iodine deficient areas, and 4% to 5% that have problems related to the shortage, particularly developmental delay ponder stature and reduced work capacity. Given the high prevalence of goiter colloid and its relationship to iodine deficiency, the aim of this study was to determine whether the same relationship with other thyroid disorders. METHOD: A retrospective medical records and reports of pathological examinations of 256 patients undergoing thyroidectomy at the Department of Surgery of Head and Neck Samaritan Medical Center of Goiania, in the period January 2004 to December 2006. RESULTS: The sample had 156 diagnoses of colloid goiter in which was a diffuse goiter (0.6%), 119 were multinodular (76.3%) and 36 uninodular (23.1%). In combination, we found high frequency of lymphocytic thyroiditis in 75 (47.4%) as a second diagnosis, followed by adenomatous goiter uninodular 25 (15.8%) and multinodular goiter 16 (10.5%). When analyzed separately, the uninodular goiter was often associated with adenomatous goiter uninodular 16 (42.9%) multinodular goiters and lymphocytic thyroiditis 79 (66.7%). CONCLUSION: The study found high prevalence of goiter colloid in 156 patients (60.7%) with significant association with lymphocytic thyroiditis in 75 (47.4%), follicular carcinoma 16 (10.5%), papillary carcinoma and Hürthle cell carcinoma 8 (5.3%). The results corroborate with the literature regarding the prevalence pathological, although in association studies of colloid goiter with other diseases, alerting to the need for greater attention to the possible association.

Carcinoma folicular de tiroides mínimamente invasivo en edad pediátrica / Minimally invasive follicular thyroid carcinoma in pediatric age

Los carcinomas de la glándula tiroides son poco usuales en edad pediátrica, pero su presencia ha aumentado durante los últimos años; posiblemente, debido al incremento en la irradiación de la cabeza, cuello y mediastino. Entre estas neoplasias, el carcinoma papilar es el más habitual, y los carcinomas foliculares verdaderos son, por el contrario, bastante raros y se asocian al bocio endémico, a alteraciones genéticas y al incremento de los niveles de TSH. Sus características morfológicas son particulares y ayudan a su diagnóstico, el cual ha sido redefinido recientemente. Describiremos el caso de una adolescente de 13 años con carcinoma folicular de tiroides mínimamente invasivo, con nódulo tiroideo hipocaptante en el polo inferior del lóbulo izquierdo, de 6 meses de evolución. La punción aspiración con aguja fina demostró una lesión de células foliculares sospechosa de neoplasia. Se realizó lobectomía tiroidea, con reporte de carcinoma folicular mínimamente invasivo.

Thyroid carcinomas are rare during childhood and adolescence. They have increased recently probably due to a higher frequency radiation over the head, neck and mediastinum. The papillary carcinoma is the most common and true follicular carcinoma is far less common. Follicular thyroid carcinoma is associated with endemic goiter, genetic disorders, and increased TSH levels. Its morphological characteristics are peculiar and have been recently redefined, thus helping the diagnosis. A minimally invasive follicular thyroid carcinoma in 13 years old girl is described, presenting a hypocaptant thyroid nodule in the left lobe lower pole. The fine needle aspiration biopsy revealed a follicular cell lesion suspicious of malignancy. Thyroid lobectomy was performed reporting minimally invasive follicular carcinoma.