Excessive iodine intake and thyroid dysfunction among lactating Saharawi women

ObjectivesExcessive iodine intake may lead to thyroid dysfunction, which may be particularly harmful during pregnancy and lactation. The main objective was to describe iodine status and the prevalence of thyroid dysfunction among lactating women in areas with high iodine (HI) and very high iodine (VHI) concentrations in drinking water.Design and methodsA cross-sectional survey was performed among 111 lactating women in the Saharawi refugee camps, Algeria. Breast milk iodine concentration (BMIC), urinary iodine concentration (UIC) and the iodine concentration in the most commonly consumed foods/drinks were measured. A 24-h dietary recall was used to estimate iodine intake. Thyroid hormones and antibodies were measured in serum.ResultsMedian UIC, BMIC and iodine intake across both areas was 350 μg/L, 479 μg/L and 407 μg/day, respectively. In multiple regression analyses, we discovered that being from VHI area was associated with higher UIC and BMIC. BMIC was also positively associated with iodine intake. Thyroid dysfunction and/or positive thyroid antibodies were found in 33.3% of the women, of which 18.9% had hypothyroidism and 8.1% had hyperthyroidism and 6.3% had positive antibodies with normal thyroid function. Elevated thyroid antibodies were in total found in 17.1%. We found no difference in distribution of thyroid dysfunction or positive antibodies between HI and VHI areas. BMI, BMIC and elevated thyroglobulin (Tg) predicted abnormal thyroid function tests.ConclusionsThe high prevalence of thyroid dysfunction may be caused by excessive iodine intake over several years.     

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.     

A comparison of deoxynivalenol intake and urinary deoxynivalenol in UK adults

The relationship between deoxynivalenol (DON) intake and first morning urinary DON was examined in UK adults to validate the latter as a biomarker of human exposure. DON was assessed in first morning samples collected during a period of normal diet, a wheat-restriction intervention diet, and partial wheat-restriction intervention in which bread was allowed. During the partial intervention duplicate bread portions were collected for DON analysis. During the normal diet, partial intervention and full intervention, urinary DON was detected in 198/210 (geometric mean 10.1?ng DON mg^?1 creatinine, 95% confidence interval (CI) 8.6–11.6?ng mg^?1; range nd–70.7?ng mg^?1), in 94/98 (5.9?ng mg^?1, 95% CI 4.8–7.0?ng mg^?1; range nd–28.4?ng mg^?1), and 17/40 (0.5?ng mg^?1, 95% CI 0.3–0.7?ng mg^?1; range nd–3.3?ng mg^?1) volunteers, respectively. A strong correlation between DON intake and the urinary biomarker was observed (p <0.001, adjusted r²?=?0.83) in models adjusting for age, sex and body mass index. These data demonstrate a quantitative correlation between DON exposure and urinary DON, and serve to validate the use of urinary DON as an exposure biomarker.     

Identification by nuclear magnetic resonance of iodinated lipids in the dog thyroid.

Thyroid glands were obtained from dogs on high, normal or low iodine intake. The lipids of the cells and of purified plasma membranes of these thyroids were examined by nuclear magnetic resonance spectroscopy. The presence of an iodinated methine proton peak at δ = 4.5 ppm, has been recently reported as a means for detection of iodination of 1,2-disubstituted ethylenes by Zanger and Rabinowitz (J. Org. Chem. $\text{40}$, 248, 1975). The presence of iodinated lipids in the plasma membrane, and in the cell total lipids could easily be shown in the thyroids from animals that were fed a high iodine diet. The thyroids of animals with normal iodine diets showed only trace amounts of these lipids. In the thyroids of dogs on a low iodine diet, these iodinated lipids could not be detected. Na¹³¹I fed dogs showed by thin layer chromatography the presence of iodinated phospholipids.     

Evaluación de los hábitos alimentarios relacionados con la ingesta de yodo,el estado nutricional de yodo y disfunción tiroidea en cuatro poblaciones no seleccionadas (proyecto Tirobus)

IntroductionMost of the studies on urinary iodine levels in Spain in the last decade have reported a significant improvement. A survey was undertaken together with an information campaign on the thyroid gland, the importance of iodine intake and hypothyroidism in four Spanish cities. The goals of the survey were to obtain information on consumption of iodine-containing foods, to measure urinary iodine levels and to evaluate the prevalence of thyroid dysfunction.Materials and methodsA non-preselected population attending the information campaign centers located in Barcelona, La Coruña, Malaga and Madrid was studied. A questionnaire on fish, milk and iodized salt consumption was administered. Urinary iodine levels (Pino's method) and thyrotropin (TSH) concentrations (Whatman 903^® dry paper method) were measured.ResultsA total of 872 questionnaires were completed (Madrid 40%; La Coruña 27%; Malaga 19%; and Barcelona 14%). The mean age was 51 years (SD 16); 81% were women. A total of 60.6% of interviewees reported they consumed iodized salt, 90.8% reported daily milk intake and 29.3% reported fish consumption ≥3 times per week. The mean urinary iodine concentration was 143.2 μg/L. The prevalence of high TSH levels (>4 mUI/L) was 1.3% and that of low TSH levels (<0.4 mUI/mL) was 1.2%.ConclusionsAccording to the World Health Organization criteria, the median urinary iodine concentration, both overall or by city, is indicative of optimal iodine intake. In addition to iodized salt intake, consumption of products such as milk and fish has probably contributed to these positive results. The prevalences of undiagnosed hyperthyroidism and hypothyroidism detected in this study were similar to those found in other studies.     

Correlation Between Iodine Intake and Thyroid Function in Subjects with Normal Thyroid Function

Excessive iodine intake is known to induce hypothyroidism in people who have underlying thyroid disorders. However, few studies have been performed on subjects with normal thyroid function without a history of autoimmune thyroid disease. We hypothesized that high iodine intake may cause a subtle change in thyroid function even in subjects with normal thyroid function. We analyzed 337 subjects (64 men and 273 women; mean age, 49 years) who showed normal levels of thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin antibodies (Tg-Ab) by measuring the urinary iodine excretion, free T4 (FT4), and thyroid-stimulating hormone (TSH). The results showed urinary iodine excretion had negative correlation with FT4 (γ = −0.11, p = 0.043) and showed a positive trend with TSH (γ = 0.10, p = 0.068). We found that 61.7% of subjects had circulating TPO-Ab within normal reference range. In all subjects, TPO-Ab levels were negatively correlated with FT4 (γ = −0.17, p = 0.002) and positively with TSH (γ = 0.13, p = 0.021). In conclusion, high iodine intake can negatively affect thyroid hormone levels in subjects with normal thyroid function. Population-based study will be helpful for further clarification.     

Iodine in plant-based dairy products is not sufficient in the UK: A market survey

BackgroundFollowing a well-balanced diet ensures that a person gets all the essential elements for health sustenance. However, in the United Kingdom an increasing proportion of people are transiting to become vegans who exclude animal-based products in their diets. Consequently, people may have a deficit of essential elements such as iodine which is not present in most plant-based meals, additionally iodide fortified table salt is not commonly used in the UK. Without iodine people consuming a vegan diet risk developing iodine deficiency and diseases like goiter.MethodsThe objective of this study is to determine the difference in iodine content and iodine speciation between plant-based and dairy products. More than 100 market samples of plant-based and dairy milk products were collected in Scotland, UK.ResultsIodine concentrations in dairy milk is ten times higher compared to plant-based milks. Similar differences were also apparent for butter, yogurt and cheese. A total of 20% of plant-based milk products were fortified with iodine, however these products had lower iodine concentrations compare to the equivalent dairy products. In this study we calculated that people with average diet have an iodine intake of 226 + /- 103 μg day⁻¹ from dairy products which satisfies the WHO recommended intake of adults and 90% of the recommend intake for pregnant and breast-feeding women. A diet from substituted dairy products gives only 21.8 µg day⁻¹ for the respective WHO guideline intake values, which accounts only 15% of the iodine intake for adults and 9% for pregnant and lactating women. Iodine fortified diet could increase the iodine intake to 55% or 33% of the WHO recommended daily intake respectively.ConclusionPlant-based dairy consumers are encouraged to use iodine fortified dairy products or use of iodized salt in the UK for home cooking, otherwise there are at risk to get iodine deficient.     

Relationship among TNF-α, sICAM-1, and selenium in presurgical patients with abdominal aortic aneurysms

Epithermal instrumental neutron activation analysis (EINAA) has been used to determine the iodine content of many individual food materials that constitute the typical Libyan diet. The selected samples include different varieties of local and imported foods such as wheat and barley products, rice, bread, legumes such as chick peas and lentil, table salt, and commonly used spices, including thyme and fenugreek. Both conventional and anticoincidence γ-ray spectrometry techniques have been employed. Epithermal INAA in conjunction with anticoincidence counting has been found to provide the most reliable results. For quality control purposes, a number of NIST biological reference materials were analyzed. The range of daily dietary intake has been calculated as 100–180 μg of iodine per day, which is within the recommended range. Bread was identified as a significant source of iodine in the Libyan diet, as it contributed 99 μg/d.     

Iodine nutrition and breast feeding

A survey of the databanks Medline and Web of science identified studies dealing with maternal and infant iodine nutrition during breast feeding. The iodine concentration of human milk varies widely due to maternal iodine intake. Mean breast milk iodine concentrations are reported as ranging from 5.4 to 2170 μg/L (median 62 μg/L) in worldwide studies. In the few studies that compared length of lactation, gestation length, and parity number, these factors did not significantly affect milk-iodine concentrations. In studies of maternal iodine deficiency, untreated goiter had no impact on breast milk iodine when compared with controls. Iodine in human milk responds quickly to dietary iodine intake, either supplemented or consumed in natural foods. Easily absorbable iodine from foods, supplemental sources, iodine-based medication or iodine-based antiseptic solutions used during parturition, is taken up by the maternal thyroid and mammary glands through the Na⁺/I⁻ symporter system. This transmembrane carrier protein transports iodine against a high concentration gradient. Hormonal iodine in breast milk occurs mainly as T-4, but depending on maternal iodine intake, high concentrations of the inorganic form (iodide) are found. In less developed countries, where natural-food-iodine intake is low, adequate maternal iodine nutritional status depends exclusively on enforcement of food iodination. In industrialized countries, maternal iodine intake has increased as a function of increasing consumption of dairy products. The human infant is sensitive to maternal iodine nutrition during fetal development and later during breast feeding. Environmental factors, not directly related to maternal iodine intake, such as intake of selenium and organochlorine pollutants, can affect thyroid hormone homeostasis in breast-fed infants. In spite of low iodine concentrations found in milk of mothers consuming low-iodine natural foods, long lasting or even life-lasting benefits to the breast-fed infant are demonstrable.     

Effects of high potassium iodate intake on iodine metabolism and antioxidant capacity in rats

BackgroundKIO₃ and KI are the most common salt iodization agents. Coincidentally, iodine exists naturally in high-iodine drinking water in the form of iodide (I⁻) or iodate (IO₃⁻). As an oxidizing substance, IO₃⁻ should be reduced to I⁻ before it can be effectively used by the thyroid. However, there is a lack of systematic studies on the metabolic process of high dose KIO₃ in vivo.MethodsThe iodine metabolism processes in the thyroid and serum of rats after high KIO₃ intake were determined using high-performance liquid chromatography-inductively coupled plasma-mass spectrometry (HPLC/ICP–MS) and arsenic cerium catalytic spectrophotometry. The changes of redox activity in the serum, thyroid, liver, and kidneys were observed by detecting total antioxidative activity (TAA).ResultsHigh doses of IO₃⁻ were completely reduced to I⁻ in vivo within 0.5 h. The level of organic bound iodine in the serum was stable, while the organic bound iodine in the thyroid increased to a plateau after intake of high-dose KIO₃. The levels of total iodine and I⁻ in serum and thyroid increased quickly, then all decreased after reaching the maximum absorption peak, and I⁻ had two absorption peaks in serum. The thyroid blocking dose of I⁻ was 0.5 mg/kg in rat. Additionally, high KIO₃ intake did not influence the TAA in serum and other tissues.ConclusionThe body is able to reduce and utilize high doses of KIO₃ ingested through the digestive tract. The metabolism of high KIO₃ in vivo is characterized by two absorption process of I⁻ in serum and the thyroid blocking effect. Moreover, a single intake of high-dose KIO₃ does not affect TAA in vivo. The results suggest that such excess IO₃⁻ may have be reduced in the digestive tract before I⁻ enters the blood.     

A model of radioiodine transfer to goat milk incorporating the influence of stable iodine

Previously reported models for radioiodine in ruminants cannot account for the effect of variations in stable iodine intake including large countermeasure doses of stable iodine on the transfer of radioiodine to goat milk. A metabolically based model of radioiodine transfer in goats has been parameterised using new experimental data on the effect of countermeasure doses of stable iodine on radioiodine transfer to milk. To account for the effect of dietary stable iodine levels, the model represents the transfer of iodine from the extracellular fluid to milk with Michaelis-Menten kinetics. The model shows good agreement with the experimental data, and the estimated parameters compare favourably with values which can be estimated from the literature. The parameterised model accounts for 95% of the variation in the observed data for milk, faeces, urine and thyroid (n=199). The model has been used to predict the effects of variation in stable iodine intake and the extent of consequent chemical contamination of milk by stable iodine. The time taken for radio-iodine to reach peak concentrations in milk following a deposition event is predicted to vary significantly (ca. 2 days) over a range of expected stable iodine intakes. Doses of stable iodine sufficient to reduce the radioiodine transfer to milk will result in stable iodine concentrations in milk greatly in excess of internationally advised limits. Therefore, we recommend that stable iodine supplementation not be used as a countermeasure to reduce radioiodine transfer to milk. Indeed, model predictions suggest that reductions in stable iodine intake would be a more effective countermeasure. However, this is unlikely to be feasible since the short physical half-life of ¹³¹I may not allow adequate time to implement changes in feed manufacture. The model described in this paper is freely available in ModelMaker 3.0 format (http://www.notingham.ac.uk/environmental-modelling/). Received: 16 August 1999 / Accepted in revised form: 15 November 1999     

Tg in Adults as a Sensitive Biomarker of Iodine Status: A 5-Year Follow up Population Study in Different Levels of Iodine Intake Regions

This study was to evaluate the usefulness of serum thymoglobulin (Tg) in adults to assess iodine status through a 5-year cohort study which was conducted in three regions with different levels of iodine intake: mild deficiency, more than adequate, and excess, from 1999 to 2004 in China. A total of 3099 subjects over 14 years old with normal serum levels of Tg in 1999 were eligible, of whom 2448 were followed in 2004. Serum levels of thyroid hormones and thyroid autoantibodies as well as urine iodine were measured, and B-mode ultrasonography of the thyroid was performed. A general linear model was performed to determine the determinant factors of serum Tg. Among subjects with mildly deficient iodine intake, those with more than adequate intake, and those with excessive intake, the baseline levels of serum Tg were substantially different (7.5μg/L, 5.9μg/L, and 6.8μg/L respectively, P<0.01), which were associated with age, sex, the rate of positive TgAb, abnormal thyroid volume, abnormal TSH, and positive personal history of thyroid diseases. The data from 1856 subjects with normal range of thyroid parameters but no personal history of thyroid diseases were analyzed to clarify the effect of iodine intake on Tg. Among these three regions, the serum Tg levels were substantially different in both 1999 and 2004, with a similar pattern for increased Tg (ΔTg) (3.1μg/L, 2.5μg/L and 3.5μg/L respectively, P<0.01). The general linear model analysis revealed that age, Tg, and baseline TSH levels were the determinants of ΔTg besides iodine intake. In conclusion, serum Tg in adults, resulting from a time-accumulative effect of iodine exposure, is a useful biomarker of regional iodine intake.     

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.     

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.     

Naturally occurring radionuclides in food and drinking water from a thorium-rich area

This paper focuses on a survey of uranium and thorium decay chain radionuclides in food and drinking water from the thorium-rich (monazite-bearing) region of Buena, which is located in the state of Rio de Janeiro, Brazil. The radionuclide concentration values in the food and drinking water from Buena reached values higher than 100-fold the international reference values. The daily intake of radionuclides by the local population is similar to that of another high background radiation area in Brazil, but the intake is higher than that of residents from a normal background radiation area. Approximately 58?% of the food consumed by Buena inhabitants is produced locally. Based on that figure, locally produced food and the dilution of total radionuclides in the diet of residents caused by food importation are both highly relevant to a population’s intake of radionuclides. The concentration values for ²¹⁰Pb and the radium isotopes in drinking water from Buena are among the highest values to be reported in the literature. ²²⁸Ra is the most important radionuclide ingested with both food and water among the inhabitants of Buena.     

Hipertiroidismo y captaciones de yodo bajas en una paciente con enfermedad de Graves

Thyrotoxicosis factitia is defined as thyrotoxicosis resulting from exogenous ingestion of thyroid hormone, usually in patients with a psychiatric disorder. Diagnosis can be difficult and this entity should be suspected in patients with high free tiroxine (T4) concentrations, low or suppressed thyroglobulin concentrations, normal urinary iodide excretion and low or suppressed ¹³¹I uptake. To establish the differential diagnosis, thyrotoxicosis factitia must be distinguished from several diseases with low ¹³¹I uptake, such as Graves’ disease, subacute thyroiditis, hyperthyroidism due to excessive iodine intake, struma ovarii and metastasis from thyroid cancer. Treatment is based on b-blockers to reduce symptoms and avoid iatrogeny. We present a case of thyrotoxicosis factitia treated in our outpatient clinic.     

Geographical and seasonal variation in iodine content of cow’s milk in the UK and consequences for the consumer´s supply

BackgroundDairy products provide a crucial source of dietary iodine for the majority of the UK population, contributing approximately 30–40 % of daily intake. Fluctuations in the iodine content of purchased milk both seasonally and annually implies potential fragility of iodine supply likely through fluctuating supplementation practices in cow herds. We set out to establish the level of national variation in herds and identify factors which might impact milk iodine content.MethodsMilk samples were obtained from 98 herds across the UK via the National Milk Laboratories in August and December 2016. Iodine concentration of samples was measured using ICP-MS. Milk samples and feed intake data were additionally taken from 22 cows from the University of Nottingham (UON) dairy herd.ResultsThere was considerable variation in milk iodine content from < 0.012 (Limit of Detection) to 1558 μg L⁻¹, with a summer median of 197 μg L⁻¹ and winter median 297 μg L⁻¹. Overall, winter values were higher than summer counterparts (P < 0.001) and this held true for samples taken from the North West (P = 0.002) and South West (P = 0.006) but not for other regions studied. Data from the UON herd showed a negative relationship between iodine content and milk yield (P = 0.03) and we found that milk iodine content varied considerably despite apparently similar iodine intakes.ConclusionsRegional differences in milk iodine concentration between summer and winter suggests that feeding practices are far from uniform across the country. The negative association observed between iodine concentration and milk yield in UON samples, suggests that reduced summer values may be influenced by dilution in addition to seasonal differences in concentrate feed provision.     

Quantification of Food Intake in Drosophila

Measurement of food intake in the fruit fly Drosophila melanogaster is often necessary for studies of behaviour, nutrition and drug administration. There is no reliable and agreed method for measuring food intake of flies in undisturbed, steady state, and normal culture conditions. We report such a method, based on measurement of feeding frequency by proboscis-extension, validated by short-term measurements of food dye intake. We used the method to demonstrate that (a) female flies feed more frequently than males, (b) flies feed more often when housed in larger groups and (c) fly feeding varies at different times of the day. We also show that alterations in food intake are not induced by dietary restriction or by a null mutation of the fly insulin receptor substrate chico. In contrast, mutation of takeout increases food intake by increasing feeding frequency while mutation of ovo^D increases food intake by increasing the volume of food consumed per proboscis-extension. This approach provides a practical and reliable method for quantification of food intake in Drosophila under normal, undisturbed culture conditions.     

The Normal Thyroidal Uptake of Iodine

The range of values for the 24-hour thyroidal accumulation of radioactive iodine in euthyroid persons varies with geographic location. In the San Bernardino Valley region of Southern California the “normal range” is 6 percent to 33 percent in euthyroid subjects. This is lower than in studies from other areas of the United States. The urinary iodide excretion and the absolute iodine uptake of the thyroid are higher than in studies from many other areas of the United States, pointing to iodine abundance as the reason for this difference. The geographic variation and the possibility of changing dietary iodine intake of normal persons point to the necessity of current and local determinations of the “normal range” of the thyroidal uptake of radioiodine if the results of this thyroid function test are to be properly interpreted.