Examination of iodine status in the German population: an example for methodological pitfalls of the current approach of iodine status assessment

Johner, Simone A.; Thamm, Michael; Schmitz, Roma; Remer, Thomas

doi:10.1007/s00394-015-0941-y

Cited by 53 publications

(27 citation statements)

References 28 publications

(32 reference statements)

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“…However, in regions with iodine deficiency, the indication for scintigraphy should be independent of the TSH level as stated by the guidelines for clinical practice for the diagnosis and management of thyroid nodules of the American Association of Clinical Endocrinologists, the Associazione Medici Endocrinologi, and the European Thyroid Association (39). This recommendation takes into account that the prevalence of hyperthyroidism and, thus, a suppressed TSH concentration, in patients with HTNs depends on the iodine supply, which is still suboptimal in several European countries, including Germany (1). Two studies from Germany reported that most HTNs are found in patients with a TSH level within the reference range (32,33).…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of thyroid nodules is high, especially in iodine-deficient countries. Germany is a country with a long history of iodine deficiency; even today, the iodine supply is considered suboptimal (1). In general, the prevalence of thyroid nodules in adults without previously diagnosed thyroid disorders was estimated at up to 59%, with a higher prevalence in the older population (2,3).…”

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confidence: 99%

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Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions

et al. 2018

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Thyroid nodules are a common finding, especially in iodine-deficient regions. Ultrasonographic scoring systems such as Thyroid Imaging Reporting And Data System (TIRADS) are helpful in differentiating between benign and malignant thyroid nodules by offering a risk stratification model. Depending on the constellation or number of suspicious ultrasound features, a fine needle biopsy (FNB) is recommended. However, none of the previously published TIRADS considered the functional status of the nodules. Hyperfunctioning thyroid nodules (HTN) were presumed to exclude malignancy with a very high negative predictive value. Particularly in regions where the iodine supply is lower, the majority of HTN are seen in patients with normal TSH levels. Therefore, thyroid scintigraphy is essential for the detection of HTN. We investigated whether TIRADS identifies HTN as non-suspicious. We evaluated 615 HTN (23.2±10.0 mm at maximum diameter in 582 patients ( = 442 female, 57.7±13.2 years, and = 140 male, 60.1 ±12.7 years) detected byTc Pertechnetate or Iodine scintigraphy. Prior to evaluating the scintigraphic appearance, all nodules were analyzed prospectively with sonography, using the TIRADS model referenced in Kwak et al., wherein fine needle biopsy is recommended for TIRADS 4A or higher. We also investigated two subgroups, 42 nodules with available histology as well as 117 patients with subclinical or overt hyperthyroidism. Whereas 15.9% of the nodules were classified as TIRADS 3 or lower and <0.1% as TIRADS 5, most of the nodules were classified as TIRADS 4A (29.3%), 4B (29.3%), and 4C (24.9%), respectively. Altogether, more than 80% of the autonomous thyroid nodules were classified as TIRADS 4A or higher which would result in a recommendation of fine needle biopsy. Focusing on those 117 HTN that were already associated with hyperthyroid laboratory values, the rates were similar: 81.2% were categorized as TIRADS 4A or higher (4A: 33.3%, 4B: 29.9%, 4C:17.1%, 5: 0.9%). In the subgroup of patients who underwent thyroid surgery, all nodules were benign, confirming the known NPV of HTN with regard to malignancy exclusion. Integration of thyroid scintigraphy into the TIRADS model is essential to prevent unnecessary FNB and thyroid surgery.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions

et al. 2018

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“…Even in industrialized nations, I malnutrition is still a widespread problem ( Andersson et al, 2012). For instance, in Germany about 30% of the population does not reach the estimated I requirements ( Johner et al, 2016), in spite of ongoing I prophylaxis measures, e.g. , the use of iodized table salt in households, common in this country since several decades.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing the efficacy of iodine foliar sprays used for biofortifying butterhead lettuce (Lactuca sativa)

Lawson

Daum

Czauderna

et al. 2016

J. Plant Nutr. Soil Sci.

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Iodine biofortification of butterhead lettuce (Lactuca sativa) via foliar sprays was investigated in field trials, focusing on assessing the influence of the time and application method. The iodine (I) concentrations in the edible plant parts increased when potassium iodide (KI) and potassium iodate (KIO3) solutions were sprayed at doses up to 0.25 kg I ha−1 on different dates close to harvest. Crop yield and marketable quality were not significantly affected by I treatments. A greater efficacy of KI was frequently observed and probably related to its lower point of deliquescence and smaller anion size in comparison with KIO3. KI sprays on butterhead lettuce at different times of the day resulted in a higher I enrichment when applied at 11:00 and 15:00 h. The diurnal variation in I uptake may reflect the impact of fluctuating climatic conditions at the time of application. Iodine treatments at different application dates near harvest led to an increasing I concentration in the vegetable produce that could be related to the rising shoot fresh mass and leaf area. When KI and KIO3 were sprayed simultaneously with commercial calcium fertilizers, fungicides or insecticides, I accumulation in butterhead lettuce was not negatively affected or in some cases even significantly enhanced. The results show that foliar sprays of KI and KIO3 are an effective method to biofortify butterhead lettuce with I and this approach may easily be implemented as a routine method in commercial cultivation.

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“…31,32 Dependent on urine volume, simple iodine concentration measurements can be highly variable. In a very recent paper on iodine status of the German population, 33 it could be clearly shown that despite completely different median iodine concentrations in children and adults (117 vs 62 μg/l, measured in several thousands spot urines), both populations had a very similar median estimated iodine intake (calculated by creatinine scaling) when standardized to body surface area (107 vs 103 μg per day per 1.73 m 2 ). Without the creatinine scaling, which transforms the hydration-dependent concentration measurements to a (hydration-independent) 24-h excretion level, an obviously highly misleading conclusion would have been drawn, namely that in Germany, children are iodine sufficient while adults are mildly or borderline moderate iodine deficient (according to the criteria of the World Health Organization).…”

Section: Discussionmentioning

confidence: 94%

Urinary 24-h creatinine excretion in adults and its use as a simple tool for the estimation of daily urinary analyte excretion from analyte/creatinine ratios in populations

2015

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The present mean values of 24-h creatinine excretion are suggested as a useful tool to derive realistic hydration-status-independent average 24-h excretion rates from urinary analyte/creatinine ratios. We propose to apply these creatinine reference means routinely in biomarker-based studies aiming at characterizing the nutrient or metabolite status of adult populations by simply measuring metabolite/creatinine ratios in spot urines.

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Examination of iodine status in the German population: an example for methodological pitfalls of the current approach of iodine status assessment

Cited by 53 publications

References 28 publications

Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions

Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions

Factors influencing the efficacy of iodine foliar sprays used for biofortifying butterhead lettuce (Lactuca sativa)

Urinary 24-h creatinine excretion in adults and its use as a simple tool for the estimation of daily urinary analyte excretion from analyte/creatinine ratios in populations

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