Requirements for Goiter Surveys and the Determination of Thyroid Size

Gutekunst, R.; Martin-Teichert, Hans

doi:10.1007/978-1-4899-1245-9_12

Cited by 63 publications

(62 citation statements)

References 5 publications

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“…There has been discussion in the literature regarding the appropriateness of the 1997 reference data; the WHO=ICCIDD=UNICEF median and ULN values are similar to those found in a few studies of iodine-replete children (Büurgi et al, 1999;Vitti et al, 1994), but higher than those found in a number of other studies (Foo et al, 1999;Gutekunst & Martin-Teichert, 1993;Hess & Zimmermann, 2000;Liesenkötter et al, 1997;Xu et al, 1999). Recently a set of provisional reference values has been published that are approximately 30% smaller than the 1997 values, in an effort to correct for the large systematic measurement bias shown to be apparent in the 1997 reference data (Zimmerman et al, 2001).…”

Section: Discussionmentioning

confidence: 70%

Mild iodine deficiency in a sample of New Zealand schoolchildren

2002

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Objective: To assess the iodine status of New Zealand schoolchildren. Design: A proportionate to population size school-based cluster survey was used to randomly select children from two cities. The indicators used to assess iodine status were urinary iodine, as determined in a casual urine sample, and thyroid volume, as measured by ultrasonography. A qualitative food frequency questionnaire designed to ascertain frequency of consumption over the previous 3 months of foods or food groups that are good sources of dietary iodine, including iodized salt, was administered to each child. Setting: Dunedin and Wellington, New Zealand. Participants: Three-hundred children aged 8 -10 y from 30 schools. Results: The median urinary iodine concentration of the children was 6.6 mg=dl (interquartile range, 4.5 -9.1). The percentage of children who had urinary iodine levels less than 5 mg=dl was 31.4 (95% confidence interval (CI), 24.2 -38.6). Comparison of thyroid volume with 2001 World Health Organization age=sex-specific and age=BSA-specific cut-off values resulted in a goitre prevalence of 11.3% (95% CI, 7.6 -15.1) and 12.0% (95% CI, 7.9 -16.1), respectively. Almost 30% of the children's caregivers did not use iodized salt in cooking and 51% of the children did not use iodized salt at the table.

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Section: Discussionmentioning

confidence: 70%

Mild iodine deficiency in a sample of New Zealand schoolchildren

2002

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“…Only two subjects had TSH values outside the normal range and four subjects had T 4 values below the normal range given by the manufacturer of the radioimmunassay kits. Eight men and 13 women had thyroid volumes greater than the upper limit of normal (male 25 ml; female 18 ml) reported for healthy European subjects with suf®cient iodine intake (urinary iodide excretion b150 mgag creatinine or 100 mgal in urine; Gutekunst & Martin-Teichert, 1993). Table 2 summarises correlation coef®cients for relationships between urinary iodide excretion and thyroid volume and thyroid hormones.…”

Section: Resultsmentioning

confidence: 99%

Urinary iodine and thyroid status of New Zealand residents

et al. 2001

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Objectives: The aim of this project was to assess the clinical signi®cance of our low iodine excretions in terms of thyroid hormone status and thyroid volume in an adult population in a low soil iodine area of the South Island of New Zealand. Design and setting: Two-hundred and thirty-three residents of Otago, New Zealand collected two 24 h urine samples for assessment of iodine status. Thyroid status was determined from serum total T 4 , TSH and thyroglobulin, and thyroid volumes. Relationships between urinary iodide excretion and measures of thyroid status were determined and subjects were allocated to one of three groups according to low, medium and high iodide excretion, for comparison of thyroid hormones and thyroid volumes. Results: Signi®cant correlations were found for relationships between measures of urinary iodide excretion and thyroid volume and thyroglobulin. Multiple regression analysis of data for subjects divided into three groups according to 24 h urinary iodide excretion (`60, 60 ± 90; b90 mg iodideaday) or iodideacreatinine ratio (`40; 40 ± 60; b60 mgag Cr) showed signi®cant differences in thyroid volume (P 0.029; P 0.035, respectively) and thyroglobulin (P 0.019; P 0.005, respectively) among the groups. Conclusions: The results of this study con®rm the low iodide excretions of Otago residents, and indicate that the fall in iodine status is being re¯ected in clinical measures of thyroid status, including enlarged thyroid glands and elevated thyroglobulin. Our observations suggest the possible re-emergence of mild iodine de®ciency and goitres in New Zealand. This situation is likely to worsen should iodine intakes continue to fall and continued monitoring of the situation is imperative.

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“…Brunn et al (12) state that the potential contribution of the thyroid isthmus to total gland volume should be ignored. However, others recommend that if the isthmus is .1 cm (whether this is width and/or depth is not specified), its volume should be included (13,14).…”

Section: Discussionmentioning

confidence: 99%

Toward a consensus on reference values for thyroid volume in iodine-replete schoolchildren: results of a workshop on inter-observer and inter-equipment variation in sonographic measurement of thyroid volume

Zimmermann

Molinari

Spehl

et al. 2001

European Journal of Endocrinology

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Objective: Interpretation of thyroid ultrasonography for assessing goiter prevalence requires valid reference criteria from iodine-sufficient populations. Reports have suggested the current reference criteria for thyroid volume (T vol ) of WHO/ICCIDD (International Council for the Control of Iodine Deficiency Disorders) may be too high. Our objective was to determine if inter-observer and/or interequipment variability contributes to the disagreement in sonographic T vol in children reported from iodine-sufficient areas. Design: A 2-day workshop in which four experienced ultrasound examiners from around Europe measured T vol in 45 6±12-year-old Swiss schoolchildren using four different portable ultrasound machines. One of the participating examiners (observer A) had generated the T vol data in European children that are the basis for the WHO/ICCIDD reference criteria. Methods: Sonographic T vol was measured in each child by all four examiners on all four machines. Six hundred and eighty-four examinations were completed, with examiners having no knowledge of one another's results. Inter-observer and inter-equipment variation was calculated. Results: Mean inter-equipment variation in T vol was 15.2% (95% CI: 14.1, 16.3%). There were no significant differences in T vol between equipment P 0X51X For all observers, the mean interobserver variation in T vol was 25.6% (95% CI: 23.9, 27.2%). At all ages and all body surface areas, there was a large systematic measurement bias (+30% volume) between the mean T vol of observer A and the mean T vol of observers B, C and D. Reanalysis using data from observers B, C and D reduced the mean inter-observer variation in T vol to 13.3% (95% CI: 11.9, 14.7%). A correction factor for the systematic difference of operator A for the P50 and P97 of T vol was estimated using analysis of covariance. When applied to the WHO/ICCIDD reference data, it sharply reduced the discrepancy between the WHO/ICCIDD criteria and those from other iodine-sufficient children around the world. Conclusions: Inter-equipment error contributes minimally to reported differences in sonographic T vol . Even among experienced examiners, inter-observer variation in sonographic T vol in children can be high, and probably contributes to the current disagreement on normative values in iodine-sufficient children. A systematic bias at least partially explains why the WHO/ICCIDD reference data differ from those reported from other iodine-sufficient children around the world. The findings argue strongly for the standardization of methods used for sonographic measurement of T vol in children.

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Requirements for Goiter Surveys and the Determination of Thyroid Size

Cited by 63 publications

References 5 publications

Mild iodine deficiency in a sample of New Zealand schoolchildren

Mild iodine deficiency in a sample of New Zealand schoolchildren

Urinary iodine and thyroid status of New Zealand residents

Toward a consensus on reference values for thyroid volume in iodine-replete schoolchildren: results of a workshop on inter-observer and inter-equipment variation in sonographic measurement of thyroid volume

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