A review of sonographic thyroid volume and iodine sufficiency in children: An Australian perspective
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SUBMITTER: Johnson A
PROVIDER: S-EPMC8411731 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The Institute of Medicine recommends that lactating women ingest 290 ?g iodide/d and a nursing infant, less than two years of age, 110 ?g/d. The World Health Organization, United Nations Children's Fund, and International Council for the Control of Iodine Deficiency Disorders recommend population maternal and infant urinary iodide concentrations ? 100 ?g/L to ensure iodide sufficiency. For breast milk, researchers have proposed an iodide concentration range of 150-180 ?g/L indicates iodide sufficiency for the mother and infant, however no national or international guidelines exist for breast milk iodine concentration. For the first time, a lactating woman and nursing infant biologically based model, from delivery to 90 days postpartum, was constructed to predict maternal and infant urinary iodide concentration, breast milk iodide concentration, the amount of iodide transferred in breast milk to the nursing infant each day and maternal and infant serum thyroid hormone kinetics. The maternal and infant models each consisted of three sub-models, iodide, thyroxine (T4), and triiodothyronine (T3). Using our model to simulate a maternal intake of 290 ?g iodide/d, the average daily amount of iodide ingested by the nursing infant, after 4 days of life, gradually increased from 50 to 101 ?g/day over 90 days postpartum. The predicted average lactating mother and infant urinary iodide concentrations were both in excess of 100 ?g/L and the predicted average breast milk iodide concentration, 157 ?g/L. The predicted serum thyroid hormones (T4, free T4 (fT4), and T3) in both the nursing infant and lactating mother were indicative of euthyroidism. The model was calibrated using serum thyroid hormone concentrations for lactating women from the United States and was successful in predicting serum T4 and fT4 levels (within a factor of two) for lactating women in other countries. T3 levels were adequately predicted. Infant serum thyroid hormone levels were adequately predicted for most data. For moderate iodide deficient conditions, where dietary iodide intake may range from 50 to 150 ?g/d for the lactating mother, the model satisfactorily described the iodide measurements, although with some variation, in urine and breast milk. Predictions of serum thyroid hormones in moderately iodide deficient lactating women (50 ?g/d) and nursing infants did not closely agree with mean reported serum thyroid hormone levels, however, predictions were usually within a factor of two. Excellent agreement between prediction and observation was obtained for a recent moderate iodide deficiency study in lactating women. Measurements included iodide levels in urine of infant and mother, iodide in breast milk, and serum thyroid hormone levels in infant and mother. A maternal iodide intake of 50 ?g/d resulted in a predicted 29-32% reduction in serum T4 and fT4 in nursing infants, however the reduced serum levels of T4 and fT4 were within most of the published reference intervals for infant. This biologically based model is an important first step at integrating the rapid changes that occur in the thyroid system of the nursing newborn in order to predict adverse outcomes from exposure to thyroid acting chemicals, drugs, radioactive materials or iodine deficiency.
| S-EPMC4773173 | biostudies-literature
Project description:Radioactive iodine (RAI) is a key component in the treatment of differentiated thyroid cancer. RAI has been recommended more selectively in recent years as guidelines evolve to reflect risks and utility in certain patient subsets. In this study we sought to evaluate the survival impact of radioactive iodine in specific thyroid cancer subgroups. Nationwide retrospective cohort study of patients using the National Cancer Database (NCDB) from 2004 to 2012 and Surveillance, Epidemiology, and End Results (SEER) database from 1992 to 2009 examining patients with differentiated thyroid cancer treated with or without RAI. Primary outcomes included all-cause mortality (NCDB and SEER), and cancer-specific mortality (SEER). Cox multivariate survival analyses were applied to each dataset, and in 135 patient subgroups based on clinical and non-clinical parameters. A total of 199,371 NCDB and 77,187 SEER patients were identified. RAI was associated with improved all-cause mortality (NCDB: RAI hazard ratio (HR) 0.55, P < 0.001; SEER: HR 0.64, P < 0.001); and cancer-specific mortality (SEER: HR 0.82, P = 0.029). Iodine therapy showed varied efficacy within each subgroup. Patients with high-risk disease experienced the greatest benefit in all-cause mortality, followed by intermediate-risk, then low-risk subgroups. Regarding cancer-specific mortality, radioactive iodine therapy was protective in high-risk patients, but did not achieve statistical significance in most intermediate-risk subgroups. Low-risk T1a subgroups demonstrated an increased likelihood of cancer-specific mortality with iodine therapy. The efficacy of RAI in patients with differentiated thyroid cancer varies by disease severity. A negative cancer-specific survival association was identified in patients with T1a disease. These findings warrant further evaluation with prospective studies.
| S-EPMC6994333 | biostudies-literature
Project description:BACKGROUND/OBJECTIVES: This paper aims to compare children's thyroid volume (Tvol) by age and gender in Zhejiang province in order to explore the factors influencing Tvol in this area. SUBJECTS/METHODS: This survey was a cross-sectional survey of a provincial representative sample of Zhejiang province children aged 6-12 years. The children were asked to provide a urine sample for the determination of urinary iodine concentration (UIC) and thyroid ultrasonography was performed for the determination of Tvol. RESULTS: The median (25th, 75th percentile) of UIC in children aged 6-12 years in Zhejiang province was found to be 170.0(111.2, 244.4) ?g/l. The median (25th, 75th percentile) of Tvols was found to be 3.1(2.3, 4.2) ml. There were significant differences among the different age groups on BSA (Z=-17.911, P=0.000) and Tvol (Z=-1.996, P=0.046) but not on UIC and body mass index (P>0.05). Tvol was in significant association with BSA (P=0.000) but was not associated with UIC (P>0.05). Age, gender and BSA were significant in multiple linear regression (P<0.05). CONCLUSIONS: The median UIC of children aged 6-12 years falls in the optimal iodine status as recommended by WHO/UNICEF/ICCIDD. However, urinary iodine nutritional status had little effect on the Tvol in children aged 6-12 years in Zhejiang province. Age, gender and BSA were the influencing factors of Tvol.
| S-EPMC3898111 | biostudies-literature
Project description:BackgroundRenal size is an important indicator in the diagnosis of renal diseases and urinary tract infections in children.PurposeThe purpose of this study is twofold. First, it aimed to measure the renal length and calculate the renal volume of normal Thai children using 2-dimensional ultrasonography (2D-US) and study their correlations with somatic parameters. Second, it aimed to compare the age-specific renal size of normal Thai children with the published data of their Western and Chinese counterparts.MethodsA total of 321 children (150 boys, 171 girls; age, 6-15 years) with a normal renal profile were prospectively recruited. All subjects underwent 2D-US by an experienced pediatric radiologist and the renal length, width, and depth were measured. Renal volume was calculated using the ellipsoid formula as recommended. The data were compared between the left and right kidneys, the sexes, and various somatic parameters. The age-specific renal lengths were compared using a nomogram derived from a Western cohort that is currently referred by many Thailand hospitals, while the renal volumes were compared with the published data of a Chinese cohort.ResultsNo statistically significant difference (P<0.05) was found between sexes or the right and left kidneys. The renal sizes had strong correlations with height, weight, body surface area, and age but not with body mass index. The renal length of the Thai children was moderately correlated (r=0.59) with that of the Western cohort, while the age-specific renal volume was significantly smaller (P<0.05) than that of the Chinese children.ConclusionTherefore, we concluded that the age-specific renal length and volume obtained by 2D-US would vary between children in different regions and may not be suitably used as an international standard for diagnosis, although further studies may be needed to confirm our findings.
| S-EPMC7738768 | biostudies-literature
Project description:Excessive iodine intake should be avoided in certain thyroid disorders, such as Graves' disease, Hashimoto's thyroiditis and thyroid goiter with autonomous nodules. Regarding alimentary iodine intake broad information can be found in the literature or the internet. Cure and rehabilitation therapy is used in many clinical settings, such as chronic degenerative disorders of the musculoskeletal system, rehabilitation after trauma, after treatment of malignant tumors and many others. Iodine intake with iodine-rich thermal water during cure and rehabilitation is possible and the extent depends in particular on the route of application and the duration of treatment. Information on this topic can be hardly found in the literature. This article analyses iodine-rich cure and rehabilitation treatment with iodine-rich thermal water from the point of view of the thyroid gland. The positive and possible negative effects of treatment with iodine-rich thermal water on thyroid function are elucidated. Apart from an insight into the physiology and pathophysiology of iodine metabolism, the extent of iodine intake during cure and rehabilitation treatment is presented depending on the route of application and the clinical implications for certain thyroid disorders are discussed. An overview of cure and rehabilitation centers in Austria and neighboring countries is given. In addition, an algorithm for the clinical selection of patients unsuitable for high iodine intake and who should thus avoid an iodine-rich cure or rehabilitation treatment is presented in order to assist clinicians in optimally selecting patients for cure or rehabilitation treatment with iodine-rich thermal water.
| S-EPMC7593323 | biostudies-literature
Project description:The diagnosis of goiter is based on the thyroid volume measured by ultrasound in which iodine plays an important role. The purpose of this study was to evaluate the factors that affect thyroid volume and update the reference range of thyroid volume to provide a new basis for the diagnosis and treatment of goiter. A study population from mainland China was evaluated in the Thyroid disorders, Iodine status and Diabetes Epidemiological (TIDE) study. Thyroid size was measured by ultrasound, and thyroid volume was calculated. A quantile regression model was used to analyze the influence of related factors on the thyroid volume at each percentile. The median urinary iodine concentration (UIC) was 185.54 μg/l. The quantile regression model suggested that body surface area (BSA) and thyroid-stimulating hormone (TSH) were positive and negative factors for thyroid volume, respectively (p < 0.01). Excess iodine reduces the median and lower limits of thyroid volume. In iodine-sufficient areas, smoking is no longer a risk factor. The reference value range of thyroid volume stratified by sex was 3.92-19.06 ml for males and 3.1-16.17 ml for females. The maximum reference ranges for stratification by sex and BSA were 4.25-20.98 ml for men and 3.44-18.31 ml for women. The iodine nutrition level of the population in mainland China is sufficient. Iodine has the potential to alter the effect of certain factors on thyroid volume and effect is not regional. The new reference interval of adult thyroid volume based on sex and BSA has been updated, which can be used as a reliable reference for updating the diagnostic criteria of endemic goiter.
| S-EPMC10620313 | biostudies-literature
Project description:BACKGROUND AND OBJECTIVE:Adequate iodine status and normal thyroid hormone synthesis are important for optimal child development. In this study, we explored whether young children's developmental status is associated with thyroid dysfunction in an area of chronic excessive iodine exposure. METHODS:We included 298 children between 18 and 48 months of age residing in Algerian refugee camps. Early child development was measured using the Ages and Stages Questionnaires, third edition (ASQ-3), consisting of five domains: Communication, Gross Motor, Fine Motor, Problem Solving and Personal-Social. Due to poor discriminatory ability in the Gross Motor domain, the total ASQ-3 scores were calculated both including and excluding this domain. Urinary iodine concentration (UIC), thyroid hormones (TSH, FT3 and FT4), thyroid antibodies and serum thyroglobulin (Tg) were measured. RESULTS:The median UIC was 451.6 ?g/L, and approximately 72% of the children had a UIC above 300 ?g/L. Furthermore, 14% had thyroid disturbances, of whom 10% had TSH outside the reference range. Children with thyroid disturbances and TSH outside the reference ranges had lower odds of being among the 66% highest total ASQ scores, with adjusted odds ratios (95% CI) of 0.46 (0.23, 0.93) and 0.42 (0.19, 0.94), respectively. CONCLUSION:We found an association between thyroid dysfunction and poorer developmental status among children with excessive iodine intake. The high iodine intake may have caused the thyroid dysfunction and hence the delayed developmental status; however, other influential factors cannot be excluded. Optimal child development is important for a sustainable future. With iodine excess being an increasing problem globally, this subject should be further explored.
| S-EPMC5699829 | biostudies-literature
Project description:IntroductionFood allergy affects up to 10% of Australian children, and living with food allergic children can be challenging for parents. This study explored parental perceptions and knowledge as they navigate a new reality of keeping their child safe.MethodsParents of children with food allergies completed an online food allergy survey in 2015. Questions explored health knowledge, skills, and attitudes (KSAs) as well as quality of life (QoL) through the inclusion of the Food Allergy Quality of Life - Parental Burden instrument (FAQL-PB). Notification of the survey included advertisements to more than 700 randomly selected Australia-wide preschools, 44 allergy specialists, and Allergy & Anaphylaxis Australia. Responses were tabulated and analysed.ResultsOf the 400 participants who logged on, 357 commenced the survey and 318 finished. Questionnaire analysis showed that 44.1% of parents (n = 135) hesitated to use an adrenaline auto-injector and may be influenced by a classification system where symptom severity is not universally understood. While 79% would sign up to a national Anaphylaxis Registry, intention to participate in clinical trials using vaccines was disclosed by only 56%. Allergen labelling and community acceptance continue to be the most challenging aspects of managing a food allergy, and 50% of parents reported that food allergy played a role in choosing a preschool or primary school. Overall, quality of life for participants was influenced more by gender (male) and age of the child than where they lived - capital city or regional location; however, regional participants were more frustrated over lack of appreciation relating to the seriousness of food allergy (p = 0.010).ConclusionResults highlight the need for educational strategies for both the food allergy community and public, particularly in regional areas, since there is a perceived lack of appreciation as to the seriousness of food allergy. Educational resources and relevant networks are required to support parents and caregivers in the management of children with food allergy.
| S-EPMC7578552 | biostudies-literature
Project description:Background and purposeThere is no useful guide or study related to the differentiation of asymptomatic diffuse thyroid disease from normal thyroid by using thyroid US. This study was prospectively designed to evaluate the efficacy of the use of real-time thyroid sonography as performed by an experienced radiologist for the identification of asymptomatic DTD.Materials and methodsFrom January 2008 to December 2008, 2267 patients underwent thyroid sonography in our hospital by 1 radiologist. Each patient's thyroid was prospectively classified as being in 1 of 4 of the following diagnostic categories on the basis of the sonographic features as determined with the use of real-time sonography: suggestive for DTD, suspicious for DTD, indeterminate, and no evidence of DTD. We calculated the diagnostic efficacy of the sonographic classifications compared with the pathology results.ResultsSonographic classifications for DTD in 340 patients who underwent thyroid surgery because of thyroid malignancy or other causes included the following: suggestive for DTD (n = 32), suspicious for DTD (n = 39), indeterminate (n = 18), and no evidence of DTD (n = 251). On the pathology, HT (n = 33), chronic lymphocytic thyroiditis (n = 27), diffuse hyperplasia (n = 2), and NTP (n = 278) were identified. There were true-positive cases (n = 50), true-negative cases (n = 244), false-positive cases (n = 21), and false-negative cases (n = 7). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for a diagnosis of asymptomatic DTD were 87.7%, 92.1%, 70.4%, 97.2%and 91.3%, respectively.ConclusionsThe present sonographic classification based on real-time sonography of the thyroid is a useful tool for differentiating asymptomatic DTD from normal thyroid.
| S-EPMC7964008 | biostudies-literature
Project description:ContextNodular goiter is common worldwide, but there is still debate over the medical treatment.ObjectiveThe objective of the study was the measurement of the effect of a treatment with (nonsuppressive) T(4), iodine, or a combination of both compared with placebo on volume of thyroid nodules and thyroid.DesignThis was a multicenter, randomized, double-blind trial in patients with nodular goiter in Germany [LISA (Levothyroxin und Iodid in der Strumatherapie Als Mono-oder Kombinationstherapie) trial].SettingThe study was conducted in outpatient clinics in university hospitals and regional hospitals and private practices.ParticipantsOne thousand twenty-four consecutively screened and centrally randomized euthyroid patients aged 18-65 yr with one or more thyroid nodules (minimal diameter 10 mm) participated in the study.InterventionIntervention included placebo, iodine (I), T(4), or T(4)+I for 1 yr. T(4) doses were adapted for a TSH target range of 0.2-0.8 mU/liter.Outcome measuresThe primary end point was percent volume reduction of all nodules measured by ultrasound, and the main secondary end point was a change in goiter volume.ResultsNodule volume reductions were -17.3% [95% confidence interval (CI) -24.8/-9.0%, P < 0.001] in the T(4)+I group, -7.3% (95% CI -15.0/+1.2%, P = 0.201) in the T(4) group, and -4.0% (95% CI -11.4/+4.2%, P = 0.328) in the I group as compared with placebo. In direct comparison, the T(4)+I therapy was significantly superior to T(4) (P = 0.018) or I (P = 0.003). Thyroid volume reductions were -7.9% (95% CI -11.8/-3.9%, P < 0.001), -5.2% (95% CI -8.7/-1.6%, P = 0.024) and -2.5% (95% CI -6.2/+1.4%, P = 0.207), respectively. The T(4)+I therapy was significantly superior to I (P = 0.034) but not to T(4) (P = 0.190).ConclusionIn a region with a sufficient iodine supply, a 1-yr therapy with a combination of I and T(4) with incomplete suppression of thyrotropin reduced thyroid nodule volume further than either component alone or placebo.
| S-EPMC3206705 | biostudies-literature