Goiter prevalence and urinary iodine status in urban and rural/mountain areas of Piedmont region

Abstract

Piedmont region was reported in the 70s as a mild iodine-deficient area with a goiter prevalence > 10%. This study aimed at characterizing the current status of iodine deficiency in Piedmont, with special attention to putative differences between urban and rural/mountain areas. A cross-sectional, observational study was performed according to the surveillance methods for iodine deficiency disorders recommended by the World Health Organization (WHO). Ultrasound local thyroid volume reference values and median urinary iodine concentration were obtained in 2178 schoolchildren aged 11-15 yr, resident in Piedmont region for more than 5 yr to assess both goiter prevalence and iodine intake. Anamnestic and anthropometric data, thyroid volume by both bimanual palpation and ultrasound were assessed, and spot urinary iodine samples were collected. The median urinary iodine concentration was 115.8 microg/l and the prevalence of goiter 3.1%, indicating this area as iodine-sufficient. Nevertheless, 39% of the schoolchild population had urinary iodine levels < 100 microg/l and 6.8% < 50 microg/l. No differences in goiter prevalence and median urinary iodine excretion were observed between urban and rural/ mountain populations. In conclusion, Piedmont is now an iodine-sufficient region. As no programs of salt iodization have been carried out in the last 30 yr, a silent iodine replacement has occurred. Despite a sufficient median urinary iodine excretion, a program of iodine prophylaxis is strongly recommended due to a large part of iodine-deficient population.

The Geographical Pattern of Thyroid Cancer Mortality Between 1980 and 2009 in Italy

“…[Bolzano and Trento] in northern Italy and Calabria in southern Italy) are in areas that in the past were known to be iodine-deficient (and thus endemic for goiter) (27)(28)(29), consistently with reports from other geographic areas (30). Residence in areas that are endemic for goiter is known to be a risk factor for TC (7).…”

“…Piemonte has been described as a moderately iodine-deficient region since the 1970s (42). However, over the years the Piemonte population has benefited from a silent iodine supplementation especially in rural/mountain areas (27,43) due to improved nutritional conditions, the presence of iodine residues remaining in milk from disinfectant agents (42) (iodophors) used in dairying, the increase in the use of industrially produced food, and to a widespread awareness among population of the risk of iodine-deficiency disorders. This has led to a condition of iodine sufficiency in this region (27,40).…”

“…However, over the years the Piemonte population has benefited from a silent iodine supplementation especially in rural/mountain areas (27,43) due to improved nutritional conditions, the presence of iodine residues remaining in milk from disinfectant agents (42) (iodophors) used in dairying, the increase in the use of industrially produced food, and to a widespread awareness among population of the risk of iodine-deficiency disorders. This has led to a condition of iodine sufficiency in this region (27,40). In contrast, recent studies on urinary iodine concentration and goiter prevalence in schoolchildren (as indicators of the severity of iodine deficiency) in some areas of southern Italy have demonstrated the persistence of a high prevalence of goiter despite improvement in urinary iodine concentration (14,15).…”

Predictors of Malignancy in Children with Thyroid Nodules

“…In spite of a mild iodine deficiency in Piedmont 46 (the region where most of our patients live), goiter prevalence decrease has been recently reported (3.1% of children). 47 Moreover, goiter nodules in iodine-deficient areas are unusual among children and young adults (prevalence, 0.5%-2.1%). 3 Therefore, although an assessment of iodine status in our study group was not performed, we believe that iodine deficiency may have had only a marginal effect on our results.…”

Long-term outcome of low-activity radioiodine administration preceded by adjuvant recombinant human TSH pretreatment in elderly subjects with multinodular goiter

“…We enrolled 49 patients over 60 years of age with a long history of MNG and symptoms of cervical compression and esthetic discomfort; in all patients, cytology after fine-needle aspiration biopsy of suspect nodules was non-malignant and neck surgery was refused or not feasible, owing to other severe concomitant diseases. All patients lived in Liguria or southern Piedmont, Italian regions where iodine prophylaxis is recommended on account of mild-to-moderate iodine deficiency [ 20 ]. The administration of anti-inflammatory steroids and beta-blockers was not contraindicated in any patients, all of whom were on these drugs when the protocol started.…”