Purpose: Elevated iodine intake is related to a higher prevalence of subclinical hypothyroidism (SCH). We investigated the short-term effect of dietary iodine restriction on thyroid function in patients with SCH with high iodine intakes. Methods: The iodine levels in 64 SCH patients with serum TSH levels from 4.0 to 10.0 mIU/L and normal serum fT4 levels (n = 64) were assessed using 24-hour urine iodine test results and iodine intake levels calculated using a semi-quantitative food frequency questionnaire. Dietary iodine restriction was not recommended for patients with an iodine intake in the normal range (group A, n = 13), but seaweed restriction was recommended for patients with high iodine intakes (group B, n = 33). Thyroid functions and iodine levels were rechecked after three months. Another eighteen patients were prescribed thyroid hormone replacement therapy according to clinical criteria. Results: Median baseline iodine intake for the 64 patients was 290.61 ㎍/day, and median 24-hour urine iodine was 33.65 µmol/g of creatinine. The major source of dietary iodine was seaweed, which accounted for 72.2% of median baseline intake. Urine iodine and calculated iodine intake levels were positively correlated with serum TSH levels (p < 0.001 and p = 0.027, respectively), and calculated iodine intakes were significantly correlated with urine iodine levels (p = 0.001). In group B, iodine restriction significantly decreased urine iodine (p = 0.042) and TSH levels (p = 0.004), and conversion to euthyroid status was achieved in 16 of the 33 patients (48.5%). Conclusion: Iodine intake and urine iodine levels are correlated with thyroid function in SCH patients, and dietary iodine restriction can aid functional thyroid recovery in patients with elevated iodine intakes.
A low iodine diet (LID) is the recommended preparation for radioactive iodine treatment. However, the recommended duration and stringency of LID are different among each recommendation. More stringent LID is expected in Korea because Korea is a iodine-rich region. We investigated the decrement of urine iodine excretion by two-week stringent LID for remnant thyroid ablation with radioactive iodine in Korean patients with thyroid cancer, prospectively. Material and Method: From November 2006, patients who referred to our hospital for remnant ablation after total thyroidectomy were included in this study. To decrease total body iodine, our protocol included three strategies. First, we checked medication which could inhibit the radioactive iodine uptake. Second, the date of 1-131 treatment was scheduled at least 3 months later if contrast agent had been used. The last strategy was two-week stringent LID education by specialized nutritionist. Before and after two-week stringent LID, 24hr-urine iodine was analyzed respectively. 24hr-urine creatinine was also analyzed for determining more valid 24hr urine sampling subgroup. Results: Total 51 patients were finally enrolled. Average of 24hr-urine iodine excretion was significantly lowered ($787{\pm}2242\;{\rightarrow}\;85{\pm}85\;{\mu}g/d$, p=0.03) after LID and 74.4% of patients reached below the recommended urine iodine excretion level ($<100\;{\mu}g/d$). In subgroup (n=14), similar results was showed ($505{\pm}666\;{\rightarrow}\;99{\pm}116\;{\mu}g/d$, p=0.05) and 78.6% of patients met the criteria. Conclusion: Most patients could reach below the recommended urine iodine level after two-week stringent LID. Therefore, in our opinion, at least two-week stringent LID should be recommended in Korea.
The protein-bound iodine-131, the concentration of iodine-131 in blood, and the excretion rate of I-131 through urine and feces were observed in nine Korean native goats, 3 months age, following administration of $3{\mu}C$ of I-131 per kg of body weight. No signiant differences were found due to sex and castration. 1. The average protein-bound iodine-131 conversion ratio of goats was 16.7% in 24 hours. In castrated group, the lowest proteinbound iodine-131 conversion ratio was observed. 2. The average concentration of iodine-131 in bleed, increased very rapidly by 2 hours(4.75%) and rapidly decreased within 6 hours(0.73%). 3. The average excretion rate of I-131 through urine was highest in 24 hours(19.00%) and decreased rapidly within 48 hours(5.32%). 4. The average excretion ration rate of I-131 though feces was highest in 24 hours(2.55%), and decreased slowly.
Iodine-rich seaweed soup has been traditionally supplied to postpartum women in Korea. This dietary habit might introduce over-intake of iodine above the recommended requirements, and might provoke postpartum thyroid dysfunction. Although the response to excess iodine intake is highly variable, goiter, hyperthyroidism, hypothyroidism, and thyroiditis could follow the daily intake of 1,500$\mu\textrm{g}$ of iodine. A few studies are available concerning iodine toxicity in Korea. The purpose of this study was to investigate the relationships between the dietary intake of iodine and thyroid function change as well as the incidence of postpartum thyroiditis. One hundred and thirty-seven postpartum women who had experienced normal deliveries were studied. Dietary intake of iodine and excretion concentration of iodine in breast milk and maternal urine were measured . Serum T$_3$, T$_4$, TSH, anti-thyroglobulin antibody, and anti-microsomal antibody were anlayzed 1 week before delivery and 1, 6, 12, and24 weeks after delivery. Iodine intake was analyzed by one-to-one interviews using 24-hr recall and a food frequncy questionnaire. The result showed that the intake of dietary iodine before delivery and 1 and24 weeks after delivery were 483$\mu\textrm{g}$/day, 3367$\mu\textrm{g}$/day, and 1069$\mu\textrm{g}$/day, respectively. The concentration of iodine in urine at the first week after delivery was 63$\mu\textrm{g}$/dL, and 23.9$\mu\textrm{g}$/dL in breast milk . The levels of serum T$_3$ and T$_4$ before delivery were 2.01ng/mL and 11.49$\mu\textrm{g}$U/dL, respectively, showing that the levels were gradually dropping to normal values after delivery. Positive serum anti-thyroglobulin antibody and anti-microsomal antibody appeared in 3 cases. After a 24 week follow-up period , 6 women(10.3%) experienced cases of postpartum thyroiditis, 5 of which were cases of hyperthyroidism and one of which was a case of hypothyroidism. These figures of postpartum thyroiditis are similar to those of other countries.
Purpose: We designed our study to evaluate the hypothesis that gastric cancer is correlated with iodine deficiency or thyroid dysfunction. Materials and Methods: We investigated the total body iodine reserve, thyroid function status and autoimmune disorder in 40 recently diagnosed gastric adenocarcinoma cases versus 80 healthy controls. The participants came from a region with high gastric cancer rate but sufficient iodine supply due to salt iodination. The investigation included urine iodine level, thyroid gland clinical and ultrasonographic examination, and thyroid function tests. Results: Goiter was detected more frequently in the case group (P=0.001); such a finding, however, was not true for lower than normal urine iodine levels. The free T3 mean level was significantly lower in the case group compared to the control group (P=0.005). Conclusions: The higher prevalence of goiter rather than low levels of urinary iodine in gastric adenocarcinoma cases suggests that goiter, perhaps due to protracted but currently adjusted iodine deficiency, is more likely to be associated with gastric adenocarcinoma compared to the existing iodine deficiency itself.
Dietary iodine intake and urinary iodide excretion were meassured from 110 patients with various thyroid hormone diseses(hypothyroidism, hyperthyroidism, simple goiter and thyroid adenoma) and 67 normal control subjects. Iodine intake was assessed on the 24-hour recall dietary data using the compiled lists of food iodine values developed from various countries. Urinary iodide concentrations of drink water samples were measured with the iodide-selective electrode. The average iodine intake of the thyroid patients was 411$\mu\textrm{g}$, which was 87% higher(p<0.05) than that of the control subjects(220$\mu\textrm{g}$). Patients with hyperthyroidism and hypothyroidism or simple goiter excreted the most(0.6442ppm) amount of iodide respectively in the urine, with the control subject in the middle(0.5229ppm). Iodide concentrations of the drinking water samples were found to be in the range of 0.0015ppm to 0.0214ppm, which seemed to vary depending on the kind(underground water vs public water) and the location.
More accurate evaluation of iodine consumption of Koreans can be made by measuring the urinary iodine excretion of people living in representative areas. The data about average iodine excretions by region, sex and age were gathered in order to suggest as a factor the criteria on the progress or prognosis of thyroid disease patients. This study was conducted on 3,000 subjects (2,000 Younggwang-gun residents and 1,000 Muan-gun residents) between July 2004 and August 2005. The data sampling was done based on stratified random sampling and the data were analyzed according to age (the subjects were divided into age groups, five years each) and sex of the subjects. Of the 3,000 subjects, a total of 1,592 people (1,174 in Younggwang-gun and 418 in Muan-gun) participated in this study, which used ISE (iodine ion selective electrode) to measure the concentration of iodine in urine. The 1,592 subjects are composed of 732 males and 860 females. The average urinary iodine excretion was $3.10{\pm}1.75mg/L$ (0.31~15.2 mg/L). The average iodine excretion of males was $3.09{\pm}1.61mg/L$ (0.42~15.2 mg/L) while it was $3.11{\pm}1.86mg/L$ (0.31~12.5 mg/L) among females, which represents no significant difference between males and females. However, the values were significantly higher than those of Europeans and Americans. There were statistically significant differences among the regions. When the data were analyzed according to age, females in their 40s were found to have a little less urinary iodine excretion and males had less and less iodine excretion as they get older. These results are deemed to have a statistically significant difference. This study was conducted on a large number of people (N=1,592) for the first time in Korea. If the data collected through this study can be regarded as the average urinary iodine excretion of Koreans, it is possible to conclude that the average iodine consumptions of Koreans are a lot more than Europeans and Americans. Thus, the effect of much iodine consumption should be studied further.
A low iodine diet (LID) for $1{\sim}2$ weeks is recommended for patients who undergoing radioiodine remnant ablation. However, the LID educations for patients are different among centers because there is no concrete recommendation for protocol of LID. In this investigation, we compared two representative types of LID protocols performed in several centers in Korea using urine iodine to creatinine ratio (urine I/Cr). Methods: From 2006, April to June, patients referred to our center for radioiodine remnant ablation of thyroid cancer from several local hospitals which had different LID protocols were included. We divided into two groups, stringent LID for 1week and less stringent LID for 2 weeks, then measured their urine I/Cr ratio with spot urine when patients were admitted to the hospital. Results: Total 27 patients were included in this investigation (M:F=1:26; 13 in one-week stringent LID; 14 in two-week less stringent LID. Average of urine I/Cr ratio was $127.87{\pm}78.52{\mu}g/g$ in stringent LID for 1 week, and $289.75{\pm}188.24{\mu}g/g$ in less stringent LID for 2 weeks. It was significantly lower in stringent LID for 1 week group (p=0.008). The number of patients whose urine I/Cr ratios were below $100{\mu}g/g$ was 6 of 13 in stringent LID for 1 week group, and 3 of 14 in less stringent LID for 2 weeks group. Conclusion: Stringent LID for 1 week resulted in better urinary I/Cr ratio in our investigation compared with the other protocol. However it still resulted in plenty of inadequate range of I/Cr ratio, so more stringent protocol such as stringent LID for 2 weeks is expected more desirable.
Castillo, Carmen;Lustig, Nicole;Margozzini, Paula;Gomez, Andrea;Rojas, MarIa Paulina;Muzzo, Santiago;Mosso, Lorena
Endocrinology and Metabolism
/
v.33
no.4
/
pp.466-472
/
2018
Background: Thyroid dysfunction is associated with negative neonatal and obstetric outcomes. Large differences in thyroid function reference intervals exist across different populations. These differences can be explained by population-specific factors, such as iodine status. Many countries in Latin America report iodine sufficiency, but relatively few countries have published up-to-date data on iodine levels and thyroid function in the overall population, and especially in pregnant women. We evaluated the iodine status of pregnant women in Chile and determined thyroid hormone reference ranges in this population. Methods: This was a prospective observational study of healthy Chilean women at their first prenatal visit before week 14. Thyroid-stimulating hormone (TSH), total thyroxine ($T_4$), free $T_4$, antithyroid peroxidase antibody (TPOAb), and iodine levels from spot urine samples were measured. Iodine status and the reference ranges for TSH were calculated. Results: A total of 1,022 pregnant women in the first trimester were selected. Urinary iodine levels were measured in 302 randomly-selected women. The median urinary iodine concentration was $173.45{\mu}g/L$ (interquartile range, 108.11 to 249.35).The reference ranges of TSH were calculated in 670 patients selected according to the National Academy of Clinical Biochemistry guidelines. The median TSH level was $1.88{\mu}IU/mL$ (2.5th percentile: 0.13 to 97.5th percentile: 5.37). Using the reference range in the 1,022 women, the prevalence of clinical hypothyroidism was 1.76%, and that of subclinical hypothyroidism was 3.92%. TPOAb positivity was more common in women with TSH levels above $3.5{\mu}IU/mL$. Conclusion: We found adequate iodine intake and a right-shifted distribution of serum TSH levels in pregnant women in Chile. The prevalence of hypothyroidism in our sample of pregnant women was higher than has been described in the literature.
Purpose: This study was conducted to evaluate the safety of iodine intake based on ingestion levels and urinary iodine excretion of women of childbearing age (15-45 years old) using data from the 2013-2015 Korea National Health and Nutrition Examination Survey. Methods: Iodine intake was calculated using the 24 hours dietary recall method and urinary iodine excretion. The iodine nutrition database for the analysis of dietary iodine intake was constructed using the food composition database of the Rural Development Administration (RDA), the Korean Nutrition Society (KNS), the Ministries of Food and Drug Safety, China and, Japan. The World Health Organization (WHO) evaluation criteria and hazard quotient (HQ) calculated using biomonitoring equivalents (BE) were applied to evaluate the safety of the iodine intake. Results: Of the study subjects, 15.22% had a urinary iodine concentration level of less than 100 ㎍/L, which was diagnosed as deficient, and 48.16% had an excessive iodine concentration of over 300 ㎍/L. Urinary iodine concentration was 878.71 ㎍/L, iodine/creatinine was 589.00 ㎍/g, and iodine/creatinine was significantly higher at the age of 30-45 years. The dietary iodine intake was 273.47 ㎍/day, and the iodine intake calculated from the urinary iodine excretion was 1,198.10 ㎍/day. Foods with a high contribution to iodine intake were vegetables, seafood, seaweed and processed foods. The HQ was 1.665 when the urinary iodine content was > 1,000 ㎍/L. Conclusion: The results of this study implicate that the urinary iodine concentration, rather than the dietary iodine intake, is more appropriate to evaluate the iodine status under the current situation that a comprehensive iodine database for Koreans has not been established.
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