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Iodine deficiency a persisting problem: assessment of iodine nutrition and evaluation of thyroid nodular pathology in Portugal

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Abstract

Background

The goal of eliminating iodine deficiency (ID) by the year 2000 has still not been achieved in several countries. More than 2 billion people worldwide (over 260 million school age children) remain ID. In Europe, there are still countries, such as Portugal, without national general population data on iodine nutrition (IN). This study aims at evaluating combined complementary data of the IN of the general population through urinary iodine concentration (UIC) and the thyroid histology profile from the inland region of Beira Interior (BI), in Portugal.

Methods

UIC from a population sample of 214 volunteers (131 females and 83 males), with ages ranging from 8 to 97 years (mean 51.5 years ± SD 20.74 years), from BI was determined; the thyroid histology pattern in BI (6-year period) was evaluated; and the iodine content of the largest surface water reservoir of BI, never previously reported, was measured.

Results

Median UIC of 62.6 μg/L was measured. Over 92 % of the population had UIC less than 100 μg/L. From 279 histology reports evaluated, the incidence of the different types of thyroid nodular pathology in BI was established. There were 60 histologic diagnoses of malignancy. The observed ratio of papillary to follicular carcinoma relatively close to 1 and the fairly high percentage of anaplastic carcinomas are characteristic of ID areas.

Conclusions

The findings of this first general population study on IN from the inland region of BI, Portugal, document significant ID. This problem, with its serious public health implications, could be corrected by having affordable iodised salt widely and generally available and by promoting a proactive population attitude generated by ample public information and educational programs as to the negative consequences of ID.

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Abbreviations

ATC:

Anaplastic thyroid cancer

BI:

Beira Interior

CI:

Confidence interval

H&E:

Hematoxilin and eosine

FTC:

Follicular thyroid cancer

IC:

Iodine content

ID:

Iodine deficiency

IDD:

Iodine deficiency disorders

IN:

Iodine nutrition

PF:

Papillary to follicular

PTC:

Papillary thyroid cancer

TC:

Thyroid cancer

UIC:

Urinary iodine concentration

UK:

United Kingdom

USA:

United States of America

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Acknowledgments

The authors are grateful for the collaboration from the Portuguese Oncology Institutes of Coimbra, Oporto and Lisbon for providing all data relating to patients with thyroid nodular pathology with a residential address from the area of Beira Interior. We are grateful for the assistance of Dr. Helena Garcia of Cedap with re-evaluating some of the histologies and the clarification of their diagnoses. The authors are grateful to Águas da Covilhã for facilitating the collection of the water samples for analysis.

Authors’ contributions

JECS contributed to the design of the study, the major writing of the manuscript as well as the acquisition of most of the data; he coordinated the statistical design and the data interpretation. JLR contributed to the writing of the manuscript, the sequence alignment, as well as to its critical revision and correction. MF contributed to the elaboration and writing of the statistical analysis, as well as to the elaboration and design of table and figures, and participated in the sequence alignment critical revision and correction of the manuscript. CPF designed, performed and supervised the laboratory evaluation of urinary iodine concentration (UIC) and the iodine measurement in local water reservoir, as well as writing the sections relating to this part of the manuscript. PC performed most of the laboratory evaluation of the UIC. IMC contributed to the sequence alignment, critical revision and correction of the manuscript. MCB participated in the overall supervision and critical evaluation of the study, as well as the critical revision and correction of the study. All authors have read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal

    J. E. C. Santos, C. P. Fonseca, P. Castilho & M. C. Branco

  2. CICS-UBI Health Sciences Research Centre, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal

    J. E. C. Santos, C. P. Fonseca, P. Castilho & M. C. Branco

  3. Centro Hospitalar Cova da Beira, Covilhã, Portugal

    J. E. C. Santos & M. C. Branco

  4. Department of Biostatistics, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal

    M. Freitas

  5. CIMAGO – Centre of Investigation in Environment, Genetics and Oncobiology, Coimbra, Portugal

    I. M. Carreira

  6. Laboratory of Cytogenetics and Genomics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    I. M. Carreira

  7. Emeritus Professor of Surgery, Perleman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    J. L. Rombeau

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  1. J. E. C. Santos
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Correspondence to J. E. C. Santos.

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Conflict of interest

The authors declare that no competing financial interests exist.

Ethical approval

This study was approved by the ethics committees of the Faculty of Health Sciences of the University of Beira Interior and of Centro Hospitalar Cova da Beira (Hospitals of Covilhã and Fundão), research involving human participants being performed in accordance with ethical standards as laid down in the 1964 Declaration of Helsinki, its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Santos, J.E.C., Freitas, M., Fonseca, C.P. et al. Iodine deficiency a persisting problem: assessment of iodine nutrition and evaluation of thyroid nodular pathology in Portugal. J Endocrinol Invest 40, 185–191 (2017). https://doi.org/10.1007/s40618-016-0545-2

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  • DOI: https://doi.org/10.1007/s40618-016-0545-2

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