Development of thyroid dysfunction among women with excessive iodine intake – A 3-year follow-up

ObjectivesThyroid dysfunction can be a result of excessive iodine intake, which may have adverse health consequences, particularly for women in fertile age. In 2010, we conducted a cross-sectional study among lactating women with excessive iodine intake in the Saharawi refugee camps in Algeria and found a high prevalence of thyroid dysfunction. Three years later, we conducted a follow-up study to monitor the iodine situation and explore whether thyroid dysfunction still was highly prevalent when the women no longer were post-partum. None of the women were treated for hyper- or hypothyroidism between baseline and follow-up.MethodsIn 2013, we were able to recapture 78 of the 111 women from the baseline. Thyroid hormones and antibodies were measured in serum and thyroid size was assessed by palpation. Urinary iodine concentration (UIC) and drinking water iodine concentration were measured.ResultsThe overall prevalence of thyroid dysfunction and/or positive antibodies was 34.3% and was not significantly changed from baseline. Of the non-pregnant women we reexamined, 17 had hypo- or hyperthyroidism in 2010; among these, 12 women still had abnormal thyroid function at follow-up. In addition, we found 9 new cases with marginally abnormal thyroid function. Women with thyroid dysfunction and/or positive antibodies had significantly higher BMI and thyroglobulin than women with normal thyroid function. We also found that women with high breast milk iodine concentration (BMIC) at baseline had more thyroid dysfunction at follow-up than the women with lower BMIC at baseline.ConclusionsAt follow-up, the prevalence of thyroid dysfunction was still high and had not changed during the 3 years between studies and from a postpartum period. The women still had a high iodine intake indicated by high UIC. Breast milk iodine concentration from baseline predicted thyroid dysfunction at follow-up.     

Contribution of milk to iodine intake in France

A survey based on 838, samples of milk obtained from 537 dairies covering 70 of 95 districts in France was organized to assess iodine content of milk and its contribution to total intake. Iodine levels were significantly higher in winter than in summer. Very low iodine contents (<25 μg I/kg) were found in the eastern part of the country (the Vosges, Jura, and the Alpes) and the Massif Central. During milk processing, much of the iodine is lost in the whey. The other significant sources of dietary iodine are fish and eggs. Iodized salt is sold only to households and not to industry. Even if about 20% of the iodine is lost over the first 3 mo, salt remains the main source for this trace element. It is concluded that, if iodized salt is not provided systematically for both domestic and agro-industrial use, then milk may be the most important source of iodine. This key role may explain seasonal and geographical variations in the frequencies of goiter in France.     

不同碘摄入水平对小鼠子二代鼠甲状腺功能和形态学的影响

目的研究不同碘摄入水平对小鼠子二代鼠甲状腺功能和形态学的影响。方法将断乳1个月Balb/c小鼠随机分为5组：低碘组LI、适碘组NI、5倍高碘组5HI、10倍高碘组10HI、50倍高碘组50HI。给以不同浓度碘水[〈0.25μg（LI）、1.5μg（NI）、7.5μg（5HI）、15μg（10HI）、75μg（50HI）]喂养3个月后,连续传2代。各组子二代鼠20,40日龄时处死,采用放射免疫法测定血清甲状腺激素水平,并作甲状腺形态学观察,用图文分析系统测定甲状腺滤泡的体视学参数：滤泡平均面积（SA）、滤泡腔平均面积（SB）、上皮细胞层厚度（L）和滤泡腔体积与滤泡体积之比（VA）,以期为甲状腺结构改变提供定量依据。结果 20日龄时,与NI组相比,LI组与50HI组T4明显降低;40日龄时,与NI组相比,LI组T4明显降低。形态学观察,NI组甲状腺多为中等大小滤泡,上皮细胞多为单层立方状;LI组甲状腺呈明显的滤泡增生,上皮呈柱状多为复层;50HI组甲状腺与适碘组比较,上皮细胞变扁平,腔内蓄积大量胶质。体视学参数测定：LI：L,SA均明显增大,VA明显减低;5HI组和10HI组与NI组比较各项指标之间均无统计学差异。50HI组,L明显减低,SA,SB,VA均明显增大。结论碘缺乏及高剂量碘过量均可引起子二代鼠的甲状腺功能低下。碘缺乏时子二代小鼠发生了明显的滤泡增生性甲状腺肿;高碘摄入时子二代小鼠发生了胶质蓄积性甲状腺肿,但肿大程度远不及缺碘所致的肿大。子二代小鼠对碘过量有较强耐受性,当碘摄入量为正常50倍时,才会明显影响到甲状腺的形态。     

Effect of iodine supplement on iodine status and 5′-deiodinase activity in the brain of neonatal rats with iodine deficiency

The weanling Wistar rats of iodine deficiency were divided into three groups for supplementation of different levels of iodine (iodine-excessive [IE], iodine-adequate [IA], and iodine-deficient [ID]), with a control group (C). The iodine content in the thyroid was determined by epithermal neutron activation analysis. The activities of 5′-deiodinase and 5-deiodinase in the brains were assayed by determining the conversion ratios of T4 to T3 and rT3, respectively. The thyroid hormones levels in serum were also tested. The results indicated that the ID group had a goiter containing a small amount of iodine, but the IE group had a slightly swollen thyroid with rich iodine; the concentration of iodine per unit mass of thyroid was lower in group IE than in groups IA and C. The highest 5′-deiodinase and lowest 5-deiodinase activities in group ID and the lowest 5′-deiodinase activity in group IE were found. The iodine deficiency or excess resulted in a compensated hypothyroid state. The results suggest that the iodine status and the deiodinases activities would become normal for the rats of iodine deficiency if adequate iodine is supplemented soon after birth. Meanwhile, it is also critical to avoid excessive intake of iodine to reduce the risk for overcorrecting.     

Nutrición de yodo en mujeres embarazadas del área de Oviedo. ¿Es necesaria la suplementación con yodo?

Background and objectiveIn Asturias, where iodine deficiency was eradicated in school children by the year 2000, iodine deficiency persisted in pregnant women, who were recommended to use of iodine supplementation. The aim of this study was to determine the iodine nutrition of pregnant women in our area and whether or not iodine supplements are needed.Material and methodsThroughout May and June 2013 we studied the iodine nutrition and thyroid function during the first trimester of pregnancy in 173 women in the health area of Oviedo.ResultsThe median urinary iodine was 197 μg/L. Iodinated supplements were used by 47% of women, which had a yoduria median higher than those not taking iodinated supplements (247 vs. 138 μg/L; p < .001), and also a higher TSH (2.30 vs 1.94 mU/L) although not significantly different. Yoduria was also higher in women who took more than 2 servings of dairy products (median: 230 μg/L) than those who took less (median: 191 μg/L). Within the group of women who were not taking iodine supplements, those regularly using iodized salt in the kitchen (47%) had a median urinary iodine concentration of 190 μg/L indicating iodine sufficiency.ConclusionsIodinated supplements seem unnecessary nowadays in pregnant women of Oviedo who regularly take iodized salt and our recommendation in these cases should be to continue the use of iodized salt in the recommended amounts during pregnancy and consume at least two daily servings of milk or dairy products.     

碘缺乏或碘过量对小鼠子二代生长发育的影响

目的探讨碘缺乏和碘过量所致的甲状腺功能低下对小鼠子二代生长发育的影响。方法将断乳1个月Baldb／c小鼠,随机分为5组（LI,NI,5HI,10HI,50H1）。给以不同浓度碘水喂养3个月后,连续传二代。观察碘缺乏和碘过量对子二代小鼠生长发育的影响。结果20日龄时,各组子二代鼠与NI组相比,LI组与50HI组的T4明显降低;LI组的体重明显降低,50HI组体重、身长、尾长、胸腺、脾均明显降低,脑相对重量增加。40日龄时,各组子二代鼠与NI组相比,LI组T4明显降低;碘缺乏组的体重、身长、胸腺、脾、肾上腺的重量均明显降低,脑相对重量明显增加;50HI组体重、身长、尾长明显降低。结论碘缺乏,高剂量碘过量均可引起甲状腺功能低下,使子二代鼠的生长发育延迟。碘缺乏对生长发育的影响比碘过量更为明显。但小鼠对碘过量有较强的耐受性,当碘摄入量为正常的50倍时,才会影响下一代的生长发育。     

Urinary iodine and thyroid function in a population of healthy pregnant women in the North of Spain

BackgroundIodine is an essential trace element for the synthesis of thyroid hormones, which are keys in maternal metabolism during pregnancy as well as in neurological development during fetal and postnatal life. This was a prospective study on iodine status and thyroid function in women during pregnancy in the Basque country to assess whether there was any relationship among maternal urinary iodine, maternal thyroid function and thyrotropin (TSH) in newborns, and to explore any difference in women experiencing miscarriages.MethodsWe analyzed TSH, free T₄ (FT₄), free T₃ (FT₃), thyroid peroxidase antibody (TPO-Ab) titers in serum and urinary iodine concentrations (UIC) in 2104 women in the first trimester of pregnancy and in 1322 of them in their second trimester. We obtained neonatal TSH levels in 1868 cases.ResultsIn the first (T1) and second trimesters (T2), the median UICs were 88.5 μg/L and 140 μg/L, respectively. No relationship was found between UIC and FT₄, or maternal and neonatal TSH. In T1 and T2, 9.7% and 7.5% of women were TPO-Ab positive, respectively. The total miscarriage rate was 10%. The percentage of miscarriages in healthy women was 8.9%, lower than in women with overt hypothyroidism (21.2%; p < 0.001) and than in women with subclinical hypothyroidism (15.6%; p < 0.025). The miscarriage rate was not higher in TPO-Ab-positive women.ConclusionsIn this study most women had iodine deficiency during pregnancy. Neonatal TSH is not correlated with maternal UIC during pregnancy. Pregnant women with hypothyroidism have a higher rate of miscarriages.     

Ingesta de yodo durante el embarazo: efectos en la función tiroidea materna y neonatal

IntroductionRecent studies in Spain have shown an inadequate iodine intake in a significant proportion of pregnant women. Pregnancy increases thyroid hormone requirements, and adequate iodine intake is therefore needed.Material and methodsOne hundred and forty-seven women in their third trimester (week 37) of pregnancy provided a blood sample and a 24-hour urine sample to test serum and urine iodine levels and completed a food frequency questionnaire to assess iodine intake during pregnancy. Serum TSH levels were measured in the babies born to the 140 mothers in the postpartum group.ResultsOnly 10.9% of pregnant women consumed more than 250 μg iodine daily, and 24.4% of them consumed less than 100 μg daily. Mean free T4 levels were 9.37 pmol/L, and 74 women (54.41%) had levels below the hypothyroxinemia threshold. TSH levels were normal in 135 newborns (96.4%), while 5 (3.6%) had levels higher than 5 μU/mL.     

大连地区分泌型与非分泌型母亲母乳菌群结构的差异

目的 探讨大连地区分泌型和非分泌型母亲哺乳期间母乳菌群的主要差异。 方法 于大连市妇幼保健院纳入42名志愿者产妇,收集其产后第6天的母乳样本。提取母乳样本DNA,并对包含rs601338和rs1047781单核酸位点多态性(SNP)的片段用聚合酶链式反应(polymerase chain reaction,PCR)检测并加以测序,以检测受试母亲岩藻糖基转移酶2基因(FUT2)的类型。采用16S rRNA高通量测序法对不同母乳样本中微生物的多样性进行分析,并且对不同母乳样本中的微生物丰度及类型展开探讨。 结果 母亲分泌型分布情况分析:42名志愿者中,36名母亲是分泌型,6名母亲是非分泌型。母乳菌群多样性分析:分泌型与非分泌型组母亲母乳菌群比较,发现反映组内差异的Alpha多样性指数(包括Ace、Chao1以及Shannon等)在2组间差异无统计学意义;通过使用主坐标分析,发现分泌型组和非分泌型组的距离相对较远,母乳菌群组内菌群结构类似,组间差异性较显著,说明母乳中的蛋白核心岩藻糖基化水平可明显改变母乳中菌群结构。乳汁菌群物种构成分析:从门水平分析,变形菌门与厚壁菌门为主要优势菌;从属水平分析,2组母乳菌群中的双歧杆菌属丰度差异较显著。相关性分析:分泌型母乳的菌群中相关基因的表达更强,说明分泌型母乳对菌群基因的表达有促进作用。 结论 母乳菌群构成在一定程度上受到母体FUT2基因类型,即母亲分泌型和非分泌型的影响。     

青岛地区某医院12年甲状腺癌发病模式变迁

目的:探讨青岛地区某医院12年甲状腺癌的发病趋势和病理类型分布。方法:回顾性分析2001-2012年于青岛大学附属医院行手术切除的甲状腺癌患者的发病年龄、性别比例、手术数量以及病理类型构成比的变化。结果:12年来手术治疗甲状腺癌2421例,其中乳头状癌(PTC)占94.13%,滤泡状癌(FTC)占3.02%,髓样癌(MTC)占2.15%,未分化癌(ATC)占0.70%。甲状腺癌手术数量呈逐年递增趋势,尤以近4年升高显著,其病理类型以PTC为主,构成比例由79.63%上升至97.47%。四类甲状腺癌均以女性多见(男女比例1:1.38-1:4.37)。甲状腺癌的平均确诊年龄为46.80岁,PTC最低(46.48岁),ATC最高(64.25岁)。结论:青岛地区甲状腺癌发病数量呈逐年递增趋势,PTC是最常见的病理类型,其构成比例上升明显,其他类型相对下降。PTC的发病可能与高碘有关。     

碘过量大鼠仔鼠垂体促甲状腺激素细胞的组织学研究

目的探讨不同剂量碘过量对大鼠20日龄仔鼠垂体促甲状腺激素细胞的形态学影响。方法将断乳1个月的Wistar大鼠,雌雄各半,随机分为4组：NI组、10HI组、50HI组、100HI组。饲养3个月的雌雄大鼠1：1合笼交配产生仔鼠,断乳后的仔鼠喂养同上述大鼠。测定20日龄仔鼠垂体TSH细胞的体密度和面数密度。结果100HI组仔鼠垂体TSH细胞的体密度高于NI组,10HI、50HI与NI组相比无差异,各碘过量组的面数密度与NI组相比也无差别。结论大剂量碘过量可造成大鼠仔鼠乖体TSH细胞分泌颗粒蓄积,细胞体积增大。     

Utilisation of iodine from different sources in pigs

Balance experiments have demonstrated that growing pigs fed a ration consisting of wheat, barley, extracted soya meal, dicalciumphosphate, and iodine‐free feeding salt utilised 48.8% of the received iodine.

The tested supplementary iodine sources included potassium iodide (KI), ethylenediamine dihydroiodide (EDDI), iodine humate (HUI) prepared from iodine acid (HIO₃), and the product P containing 0.004% iodine in an oil base (P). The amount of the supplemented iodine was in all cases 1 mg per 1 kg feed.

The utilisation of iodine from the supplements reached 93.6, 92.6, 90.7, and 67.9% for KI, EDDI, P, and HUI, respectively. The values were significantly higher compared with controls (P < 0.01). Compared with KI and EDDI, the utilisation of iodine from HUI was significantly lower (P < 0.01). The lower availability of iodine from HUI was probably due to the high binding capacity of humate.

The amount of urinary iodine excreted by control pigs receiving in the non‐supplemented ration 147.5 μg iodine per day, was 40.3 μg per day (27.3%). In the pigs receiving in the supplemented ration 1647.5 μg iodine per day, the amount of urinary iodine reached 734.9 to 805.0 μg per day (44.6 to 48.9%). The corresponding values of faecal excretion were 75.6 μg iodine per day (51.2%) for the control pigs and 106.2 to 121.1 μg iodine per day (6.45 to 7.35%) for the pigs fed the supplemented rations. A high amount of 528.6 μg iodine per day (32.1%) was excreted in the faeces by pigs of the group HUI.     

Safe Range of Iodine Intake Levels: A Comparative Study of Thyroid Diseases in Three Women Population Cohorts with Slightly Different Iodine Intake Levels

Iodine excess may lead to thyroid diseases. Our previous 5-year prospective survey showed that the prevalence and incidence of hypothyroidism or autoimmune thyroiditis increased with iodine intake. The aim of the present study was to investigate the optimal range of iodine intake by comparing the prevalence of thyroid diseases in three areas with slightly different levels of iodine intake. In 2005, 778 unselected women subjects from three areas with different iodine intake levels were enrolled. Levels of serum thyroid hormones, thyroid autoantibodies, and urinary iodine were measured, and thyroid B ultrasounds were performed. Among the subjects with mildly deficient iodine intake, those with adequate intake, and those with more than adequate intake, the prevalence of clinical and subclinical hypothyroidism was 0, 1.13, and 2.84%, respectively (P = 0.014); that of thyroid goiter was 24.88, 5.65, and 11.37%, respectively (P < 0.001); that of serum thyrotropin values was1.01, 1.25, and 1.39 mIU/l, respectively; and that of serum thyrotropin/thyroglobulin ratio was 7.98, 6.84, and 5.11, respectively (P < 0.001). In conclusion, median urinary iodine 100~200 μg/l may reflect the safe range of iodine intake levels. Serum thyrotropin/thyroglobulin ratio might be a better index of evaluating iodine status.