Abstract
Background: The prevalence of goitre and urinary iodine excretion (UIE) indicate endemic iodine deficiency (ID) in a population. Previous studies have shown that Kayseri is one of the most iodine-deficient areas in Turkey. The aim of this study was to determine the prevalence of goitre, evaluate the degree of ID, its effects on thyroid functions and volume of subjects living in wide outer skirts of the old volcano Erciyes, at 1655 m and 1350 m altitudes.
Methods: UIE was determined in 209 school-age children (SAC) aged between 10 and 14 years and in 183 adults. Thyroid volume (TV) of subjects was performed used by both palpation and ultrasonography (USG). In addition, serum free tri-iodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), thyroglobulin (Tg), anti-Tg and anti thyroid peroxidase (TPO) antibody levels were measured.
Results: The prevalence of goitre according to palpation and USG among SAC was found as 50.7 and 58.4% respectively, as 65.0 and 57.9% among adults. Although mean UIC of whole subjects was 30±34 μg/l indicated moderate iodine (I) deficiency, 55.4% of the subjects’ UIE was <20 μg/l. While the serum fT3, TSH, anti-TPO, Tg levels, body mass index (BMI), TV of SAC and adults (except BMI) with goitre were higher than those of without goitre, serum fT4 and UIE were lower than those of without goitre.
Conclusions: The population living in two areas was exposed to consequences of severe and moderate ID and also endemic goitre due to geographical characteristics of the area. A plan of action including sufficient I intake of people should be planned and be implemented effectively.
Key words
central Anatolia - goiter - iodine deficiency - thyroid function - thyroid volume - urinary iodine excretion
References
1
Amoah AG, Asibey-Berko E, Ayettey OM, Addo F, Agyepong E, Lartey A, Ndanu TA.
Feasibility of thyroid ultrasonography in field studies in a developing country, Ghana.
Afr J Med Med Sci.
2004;
33
161-164
2
Aydın K, Kendirci M, Kurtoğlu S, Karaküçük Eİ, Kırış A.
Iodine and selenium deficiency in school-children in an endemic goiter area in Turkey.
J Ped Endoc Metab.
2002;
15
1027-1031
3
Azizi F, Delshad H, Mehrabi Y.
Thyroid volumes in schoolchildren of Tehran: comparison with European schoolchildren.
J Endocrinol Invest.
2001;
24
756-762
4
Bayram F, Borazan B, Torun E, Tanrıverdi F, Güven M, Erdoğan N, Muhtaroğlu S, Ünlühizarcı K, Tutuş A, Keleştimur F.
The prevalence of endemic goiter and iodine deficiency and evaluation of thyroid functions in an area of Central Anatolia.
Turkish J Endoc Metab.
2003;
1
37-43
5
Boyages SC.
Iodine deficiency disorders.
J Clin Endocrinol Metab.
1993;
77
587-591
6
Budak N, Kurtoglu S, Üstundag M.
Progress towards IDD elimination in Turkey.
IDD Newsletter.
2001;
17
13
7
Budak N, Kurtoğlu S, Bayram F, Kendirci M, Günay O, Öz L.
Iodine deficiency: important and severe public health problem in Kayseri, Central Anatolia.
J Endocrinol Invest.
2007;
, (in press)
8
Busnardo B, Nacamulli D, Frigato F, Vianello-Dri A, Vido D De, Mian C, Candiani F, Tomasella G, Zambonin L, Piccolo M, Girelli ME.
Normal values for thyroid ultrasonography, goiter prevalence and urinary iodine concentration in schoolchildren of the Veneto Region, Italy.
J Endocrinol Invest.
2003;
26
991-996
9 Delange F, Dunn JT, Glinoer D. Iodine deficiency in Europe . New York: Raven 1993: 305-309
10
Delange F.
The disorders induced by Iodine deficiency.
Thyroid.
1994;
4
107-128
11
Delange F, Hetzel B.
Iodine Deficiency Disorders.
2005;
http://www.thyroidmanager.org/chapter 20
12 Dunn JT, Haar F. A practical guide to the correction of iodine deficiency . Netherlands: ICCIDD/UNICEF/WHO 1990: 13
13
Dunn JT, Crutchfield HE, Gutekunst R, Dunn AD.
Two simple methods for measuring iodine in urine.
Thyroid.
1993;
3
119-122
14 Dunn AD. (eds). Methods for Measuring Iodine in Urine . Netherlands: ICCIDD/UNICEF/WHO 1993: 7-10
15
Erdoğan G, Erdoğan MF, Delange F, Sav H, Güllü S, Kamel N.
Moderate to severe iodine deficiency in three endemic goiter areas from the Black Sea region and the capital of Turkey.
E J Epid.
2000;
16
1131-1134
16
Erdoğan G, Erdoğan MF, Emral R, Baştemir M, Sav H, Haznedaroğlu D, Üstündağ M, Köse R, Kamel N, Genç Y.
Iodine status and goitre prevalence in Turkey before mandatory iodization.
J Endocrinol Invest.
2002;
25
224-228
17
Gaitan E, Nelson NC, Poole GV.
Endemic goiter and endemic thyroid disorders.
World J Surg.
1991;
15
205-215
18
Gonezi J, Szabolcs G, Kovacs Z, Kakosy T, Goth M, Szilagyi G.
Ultrasonography of the thyroid gland in hospitalized, chronically geriatric patients. Tyroid volume, it is relationship to age and disease and the prevalence of diffuse and nodular goiter.
J Clin Ultrasound.
1994;
22
257-261
19
Gutekunst R, Smolarek H, Hasenpusch U.
Goitre epidemiology: Thyroid volume, iodine excretion, thyroglobulin and thyrotropin in Germany and Sweden.
Acta Endocrinol.
1986;
112
494-501
20
Hacettepe University Institute of Population Studies .
Demographic and Health Survey 2003: Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, Sağlık Bakanlığı Ana Çocuk Sağlığı ve Aile Planlaması Genel Müdürlüğü, Devlet Planlama Teşkilatı ve Avrupa Birliği. Ankara.
2004;
148
, (in Turkish)
21
Hetzel BS.
The control of iodine deficiency.
Am J Pub Health.
1993;
83
494-495
22
Kurtoğlu S, Akçakuş M, Kocaoğlu Ç, Güneş T, Budak N, Atabek ME, Karaküçük İ, Delange F.
Iodine status remain critical in mother and infant in Central Anatolia (Kayseri) of Turkey.
Eur J Nutr.
2004;
43
297-303
23
Lamberg BA.
Iodine deficiency disorders and endemic goitre.
Eur J Clin Nutr.
1993;
47
1-8
24
Lupoli G, Russo D, Fittipaldi MR, Vitale G, Napodano A, Pagliuca A, Nuzzo V, Fonderico F, Rampone E, Cascone E, Nasti A, Macchia V.
Evaluation of goiter endemia by ultrasound in schoolchildren in Val Sarmento (Italy).
J Endocrinol Invest.
1999;
22
503-507
25
Martino E, Loviselli A, Velluzzi F, Murtas ML, Carta M, Lampis M, Murru R, Mastinu Arba ML, Sica V.
Endemic goiter and thyroid function in central-southern Sardinia. Report on an extensive epidemiological survey.
J Endocrinol Invest.
1994;
17
653-657
26
Özbakır Ö, Doğukan A, Keleştimur F.
The prevalence of thyroid dysfunction among elderly subjects in an endemic goitre area of Central Anatolia.
Endocrin J.
1995;
42
713-716
27
Özkan B, Olgun H, Ceviz N, Polat P, Taysi S, Orbak Z, Koşan C.
Assessment of goiter prevalence, iodine status and thyroid functions in school-age children of rural Yusufeli district in eastern Turkey.
Turk J Pediatr.
2004;
46
16-21
28
Panunzi C, Manca Bitti ML, Paolo A Di, Fabbrini R, Valle D, Spadoni GL, Del Duca E, Guglielmi R, Valente M, Finocchi A, Vitale S, Dituri F, Valenti M, Bauzulli N, Olivieri A, Gilardi E, D'Archivio M, Sorcini M, Boscherini B.
Goiter prevalance and urinary excretion of iodine in a sample of school age children in the city of Rome.
Ann Ist Super Sanita.
1998;
34
409-412
29
Peterson S, Sanga A, Eklof H, Bunga B, Taube A, Gebre-Medhin M, Rosling H.
Classification of thyroid size by palpation and ultrasonography in field surveys.
Lancet.
2000;
355
106-110
30
Rago T, Chiovato L, Aghini-Lombardi F, Grasso L, Pinchera A, Vitti P.
Non-palpable thyroid nodules in a borderline iodine-sufficient area: detection by ultrasonography and follow-up.
J Endocrinol Inves.
2001;
24
770-776
31
Sebotsa ML, Dannhauser A, Jooste PL, Joubert G.
Prevalence of goitre and urinary iodine status of primary-school children in Lesotho.
Bull World Health Organ.
2003;
81
28-34
32
Simsek E, Safak A, Yavuz O, Aras S, Dogan S, Kocabay K.
Sensitivity of iodine deficiency indicators and iodine status in Turkey.
J Pediatr Endocrinol Metab.
2003;
16
197-202
33
Smyth PP, Darke C, Parkes AB, Smith DF, John R, Hetherton AM, Lazarus JH.
Assessment of goiter in an area of endemic iodine deficiency.
Thyroid.
1999;
9
895-901
34
Takalo RM, Makarainen HP, Kaarina Jaakkola R.
Thyroid gland volume and echo structure in 13-year-old children in northern Finland.
Acta Endocrinol.
1991;
124
238-244
35
Temple V, Mapira P, Adeniyi K, Sims P.
Iodine deficiency in Papua New Guinea (sub-clinical iodine deficiency and salt iodization in the highlands of Papua New Guinea).
J Public Health (Oxf).
2005;
27
45-48
36
Ueda D.
Normal volume of the thyroid gland in children.
J Clin Ultrasound.
1990;
18
455-462
37 Urgancıoğlu İ, Hatemi H. Endemic goitre in Turkey . İstanbul. Cerrahpaşa School of Medicine 1988 (in Turkish)
38
Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, Grimley Evans J, Hasan DM, Rodgers H, Tunbridge F.
The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey.
Clin Endocrinol (Oxf).
1995;
43
55-68
39 World Health Organization: .World Health Report. 1995-Bridging the Gaps . Geneva. WHO 1995
40 WHO .Assessment of Iodine Deficiency Disorders and Monitoring their Elimination (A guide for programme managers) (Second Edition) . World Health Organization 2001 42 http://www.sph.emory.edu/pamm/idd/whomanual/wholedoc.pdf
41
Zimmermann M, Saad A, Hess S, Torresani T, Chaouki N.
Throid ultrasound compared with World Health Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions of mild and severe iodine deficiency.
Eur J Endocrinol.
2000;
143
727-731
42
Zimmermann MB, Bridson J, Bozo M, Grimci L, Selimaj V, Tanner MS.
Severe iodine deficiency in southern Albania.
Int J Vitam Nutr Res.
2003;
73
347-350
43
Zini M, Poluzzi V, Bertani A, Portioli I, Cavalchi B, Valcavi R.
Epidemiologic investigation on the prevalence of goiter and urinary excretion of iodine in the school population of the province of Reggio Emilia.
Ann Ist Super Sanita.
1998;
34
383-387
Correspondence
Prof. Dr. F. Bayram
Department of Endocrinology and Metabolism
Erciyes University
Medical School
38039 Kayseri
Turkey
Telefon: +90/352/437 49 01219 07
eMail: fbayram@kaynet.net