Iodine Nutrition and Iodine Deficiency Disorders in Greece: Signs of Improvement

Koutras, Demetrios A.; Piperingos, G. D.; Mantzos, J.; Boukis, M. A.; Karaiskos, K. S.; Hadjiioannou, Sofia

doi:10.1007/978-1-4899-1245-9_56

Cited by 8 publications

(13 citation statements)

References 13 publications

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“…Heraklion) who had a high degree of concordance, as proven in previous epidemiological studies (6,8). However, it should be noted that, in general, clinical assessment of thyroid gland size by palpation by independent observers can be misleading, as has been previously suggested (14).…”

Section: Above By Two Clinicians (Da K In Athens and M A B Inmentioning

confidence: 61%

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The predominant form of non-toxic goiter in Greece is now autoimmune thyroiditis

Doufas¹,

Mastorakos²,

Chatziioannou³

et al. 1999

European Journal of Endocrinology

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Endemic non-toxic goiter (NTG) in Greece has been attributed primarily to iodine deficiency. Thirty years ago about 60% of the prepubertal boys and girls examined in endemic goiter regions presented with NTG and among them thyroid autoimmunity was rarely detected. Although iodine supplementation has corrected this deficiency during the past 30 years, new cases of NTG still appear. To evaluate the prevalence and type of NTG and the effect of iodine supplementation on them in Greece at present, we performed two cross-sectional clinical studies and a retrospective pathology one: (i) thyroid gland volume and urinary iodine excretion (UIE) were assessed in a representative sample of 1213 schoolchildren from previously endemic and non-endemic regions; (ii) serum thyroxine, tri-iodothyronine, TSH, thyroid autoantibodies (AAB) (anti-thyroid peroxidase and anti-thyroglobulin antibodies) and UIE (in 60 patients) were measured in 300 consecutive patients with NTG from Athens and Heraklion; and (iii) we compared the prevalence of autoimmunity among fine needle aspiration smears of benign thyroid pathologies performed by the same pathologist between 1985 and 1986 (975 cases) and between 1994 and 1995 (2702 cases). We found that 12.5% of the schoolchildren examined in regions with a previous history of endemic goiter had NTG, whereas this percentage was only 1.7% in areas without such a history. In Athens (61.6%) and Heraklion (58.5%) a substantial number of NTG patients were AAB positive and biochemically hypothyroid. UIE in Athens did not differ between patients with autoimmune goiter (ATG) and simple goiter. The prevalence of autoimmune stigmata in pathology smears has increased from 5.94% (years 1985-1986) to 13.91% (years 1994-1995) (P < 0.05). We conclude that: (i) the persistence of endemic goiter in regional foci despite iodine deficiency correction suggests a possible role for a naturally occurring goitrogen; (ii) ATG is the predominant form of NTG in Greece nowadays; and (iii) the five-fold decrease in the prevalence of NTG during the past 30 years followed by the increase of ATG may support the relative character of the latter.

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Section: Above By Two Clinicians (Da K In Athens and M A B Inmentioning

confidence: 61%

“…Dietary iodine intake in Athens has almost quadrupled, reaching the optimum level of about 200 mg iodine/day (4). The urinary iodine excretion (UIE) in Athens was 45 mg/day in 1964 (3), 95 mg/g creatinine (Cr) in 1980 (5), and 208 mg/g Cr in 1991 (6). However, new cases of NTG still appear.…”

Section: Introductionmentioning

confidence: 99%

The predominant form of non-toxic goiter in Greece is now autoimmune thyroiditis

Doufas¹,

Mastorakos²,

Chatziioannou³

et al. 1999

European Journal of Endocrinology

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“…Alternatively, TSH-induced thyroid stimulation may promote the clonal selection of mutated cells, since mutant receptors retain the potential for further stimulation by TSH (26). Iodine deficiency was endemic in post-Second World War Greece, but has been corrected over the last 20 years by increased use of iodized salt and improved socioeconomic conditions (21). As a result, the prevalence of goiter has substantially decreased (22).…”

Section: Discussionmentioning

confidence: 99%

Autonomously functioning thyroid nodules in a former iodine-deficient area commonly harbor gain-of-function mutations in the thyrotropin signaling pathway

Georgopoulos

Sykiotis

Sgourou

et al. 2003

European Journal of Endocrinology

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Background: Somatic activating mutations of the thyrotropin (thyroid-stimulating hormone (TSH)) receptor (TSHR) and G as protein have been detected in solitary toxic adenomas and toxic multinodular goiters, but their role in the pathogenesis of autonomous nodules is debated. The frequency of mutations is highly variable among populations and is inversely proportional to iodine intake. Design and patients: We screened 28 clinically and histologically heterogeneous autonomous nodules from 24 Greek patients for the presence of TSHR and G as mutations. Results: By direct sequencing of genomic DNA, we detected 11 somatic heterozygous gain-of-function mutations in TSHR and one in G as . Forty-three percent (12 of 28) of all nodules and 57% (four of seven) of solitary toxic adenomas harbored an activating mutation. Typical adenomas and hyperplastic nodules did not differ in mutation frequency. Substitutions I568T and T632I were detected in both histological types of nodules. Conclusions: Our findings indicate that activating somatic mutations in the TSH signaling pathway are frequent in autonomous nodules in Greece. This may be due to earlier exposure of the population to iodine deficiency, which was corrected in Greece only over the past two decades. Gain-of-function mutations are shared by nodules with varying histological and clinical presentations. Thus, they may represent a common molecular mechanism underlying the pathogenesis of non-autoimmune thyroid autonomy.

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“…The following parameters were recorded: sex, age at diagnosis, year of diagnosis, histology, prefecture of birthplace, birthplace categorization (village/city), prefecture of residence, residence categorization (village/city) and categorization of birthplace and residence as an iodine-deficient area or not. The characterization of an area as iodine-deficient or not was based on earlier studies conducted in Greece [6][7][8][9][10] . In this study we did not take into account the patients treatment modalities and disease course due to a paucity of consistently collected data.…”

Section: Methodsmentioning

confidence: 99%

Differentiated thyroid cancer in Greece: 1963-2000. Relation to demographic and environmental factors

Ilias¹,

Alevizaki²,

Lakka-Papadodima³

et al. 2002

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Thyroid cancer (TC) is a relatively rare neoplasia, accounting for 0.35%-0.38% of total deaths due to cancer in Greece. Environmental/nutritional factors are considered to play a role in its pathogenesis. The aim of this retrospective review of patients histories from three of the largest specialized centers in southern Greece, from 1963 to 2000, was to assess associations of differentiated TC (DTC) with demographic and environmental factors. The total number of DTC cases was 610 (119 men or 19.5%, and 491 women or 80.5%), of which 442 cases (72%) were papillary DTCs (pure papillary type: 54.5% and mixed papillary-follicular type: 45.5%), 90 cases (15%) were of the pure follicular type, while 78 cases (13%) were classified as suspicious lesions, requiring follow-up, but not definitively carcinomas. The mean age (±SD) at diagnosis for all groups was 42.3±1.3 years. Fifty percent of the patients were living in Athens at the time of diagnosis. The diagnosis was delayed in patients living in villages compared to those living in cities (mean age ±SD): 43.7±14.1 years and 40.9±13.8 years, respectively; p<0.05, t-test). Patients who were born in iodine-sufficient areas (n=162/193, 84%; X 2 =5.09, P=0.02) had papillary carcinoma more frequently compared to patients who were born in previously iodine-deficient areas (n=159/214, 74%). During the observation period (19632000) there appeared to be three different trends in the incidence of newly diagnosed cases: a random variation during the first nine years and a steady increase during the second two decades (starting before the Chernobyl nuclear accident) followed by a significant decline during the last few years. We suggest that the observed variations in the incidence of DTC could be related to the availability of diagnostic tools as well as to increased awareness.

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Iodine Nutrition and Iodine Deficiency Disorders in Greece: Signs of Improvement

Cited by 8 publications

References 13 publications

The predominant form of non-toxic goiter in Greece is now autoimmune thyroiditis

The predominant form of non-toxic goiter in Greece is now autoimmune thyroiditis

Autonomously functioning thyroid nodules in a former iodine-deficient area commonly harbor gain-of-function mutations in the thyrotropin signaling pathway

Differentiated thyroid cancer in Greece: 1963-2000. Relation to demographic and environmental factors

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