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Thyroid volumes in schoolchildren of Tehran: Comparison with European schoolchildren

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Abstract

Since the normative values of thyroid volume ultrasonography results from European schoolchildren were endorsed by the World Health Organization (WHO), few studies have addressed the limitation of the recommended References as universal normative values for thyroid volume. Our objective was to describe thyroid volume measured by ultrasonography in Tehranian schoolchildren and compare them with the WHO normative values. Cross-sectional studies were performed in 2016 schoolchildren, aged 6–15 yr, in Tehran 10 yr after distribution of iodized salt. Data were collected on age, sex, weight, height, thyroid size by palpation and ultrasonography, and urinary iodine. Age/sex and body surface area (BSA) upper limits (97th percentile) of thyroid volume were derived. The goiter prevalence was 42% by palpation, 31% grade 1 and 11% grade 2. Median urinary iodine was 21.2 μg/dl. The 97th percentiles were comparable in girls and boys of all ages. Applying the WHO thyroid volume References to the Tehranian children, they did not show any enlarged thyroid based on BSA and on age, even in 11% of children with grade 2 (visible) goiter. In the Tehranian children, the best predictors of thyroid volume were BSA, height and weight. Using linear regression, the 97th percentile of thyroid volume from Tehranian children were lower than the corresponding References from the WHO normative values. The results indicate that a thyroid volume reference based on weight alone would perform as well as the one based on BSA. In addition, until the adoption of a new applicable international reference for thyroid volume, the use of local reference in the screening of children for thyroid enlargement is recommended.

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References

  1. WHO, IUNICEF, ICCIDD. Global prevalence of iodine deficiency disorders. MDIS Working paper No. 1. WHO, Geneva, 1991

    Google Scholar 

  2. WHO, UNICEF, ICCIDD. Indicators for assessing iodine deficiency disorders and their control programs through salt iodization. WHO/NUT/94.6. WHO, Geneva, 1994.

    Google Scholar 

  3. Dunn J.T., Van der Haar F. A practical guide to the correction of iodine deficiency. International Council for Control of Iodine Deficiency Disorders/WHO, 1990.

    Google Scholar 

  4. Perez C., Scrimshaw N.S., Munoz J.A. Technique of endemic goiter surveys. In: WHO monograph series, Endemic goiter. WHO, Geneva, Vol. 44, 1960, p. 369.

    CAS  Google Scholar 

  5. Gutekunst R., Scriba P.C. Application of sonography in epidemiological studies. IDD Newsletter 1986, 2: 4–12.

    Google Scholar 

  6. Rasmussen S.N., Hjorth I. Determination of thyroid volume by ultrasonic scanning. J. Clin. Ultrasound 1974, 2: 143–147.

    Article  CAS  PubMed  Google Scholar 

  7. Hegedus L., Perrild H., Poulsen L.R., Andersen J.R., Holm B., Schnohr P., Jensen G., Hansen J.M. The determination of thyroid volume by ultrasound and in relationship to body weight, age, and sex in normal subjects. J. Clin. Endocrinol. Metab. 1983, 56: 260–263.

    Article  CAS  PubMed  Google Scholar 

  8. Gutekunst R., Martin-Teichert H. Requirements for goiter surveys and the determination of thyroid size. In: Derange F., Dunn J.T., Glinoer D. (Eds.), Iodine deficiency in Europe. A continuing concern. Plenum Press, New York, 1993, p. 109.

    Chapter  Google Scholar 

  9. Delange F., Benker G, Caron P., Eber O., Ott W., Peter F., Podoba J., Simescu M., Szybinsky Z., Vertongen F., Vitti P., Wiersinga W., Zamrazil V. Thyroid volume and urinary iodine in European schoolchildren: standardization of values for assessment of iodine deficiency. Eur. J. Endocrinol. 1997, 136: 180–187.

    Article  CAS  PubMed  Google Scholar 

  10. WHO, ICCIDD. Recommended normative values for thyroid volume in children aged 6–15 years. WHO Bulletin 1997, 75: 95–97.

    Google Scholar 

  11. Foo L.C., Zulfiqar A., Nafikudin M., Fadzil M.T., Asmah A.S.A. Local versus WHO/International Council for Control of Iodine Deficiency-recommended thyroid volume reference in the assessment of iodine deficiency disorders. Eur. J. Endocrinol. 1999, 140: 491–497.

    Article  CAS  PubMed  Google Scholar 

  12. Xu F., Sullivan K., Houston R., Zhao J., May W., Maberly G. Thyroid volumes in US and Bangladesh schoolchildren: comparison with European schoolchildren. Eur. J. Endocrinol. 1999, 140: 498–504.

    Article  CAS  PubMed  Google Scholar 

  13. Azizi F., Kimiagar M., Nafarabadi M., Yassai M. Current status of iodine deficiency disorders in the Islamic Republic of Iran. E.M.R. Health Serv. J. 1990, 8: 23–27.

    Google Scholar 

  14. Azizi F., Sarshar A., Nafarabadi M., Ghazi A., Kimiagar M., Noohi S., Rahbar N., Bahrami A., Kalantari S. Impairment of neuromotor and cognitive development in iodine-deficient schoolchildren with normal physical growth. Acta Endocrinol. 1993, 129: 501–504.

    CAS  PubMed  Google Scholar 

  15. Azizi F., Kalani H., Kimiagar M., Sarshar A., Nafarabadi M., Rahbar N., Noohi S., Mohajer M., Yassai M. Physical, neuromotor and intellectual impairment in non-cretinous schoolchildren with iodine deficiency. Int. J. Vit. Nutr. Res. 1995; 65: 199–205.

    CAS  Google Scholar 

  16. Azizi F. Success in prevention of iodine deficiency disorder in Iran. Ir. J. Nucl. Med. 1995. 3: 1–3.

    Google Scholar 

  17. Salarkia N., Zakeri H., Soheilikhah S., Gharavi Nori A., Kimiagar M., Azizi F. Determination of thyroid size by palpation and ultrasonography and assessment of urinary iodine excretion in inhabitants of Tehran City. Proceedings of the Fourth International Congress on Endocrine Disorders, November 20–22, 1966, Tehran, I.R. Iran, Abstract 04.

    Google Scholar 

  18. Hedayati M., Mirmiran P., Sheikholeslam R., Azizi F. In search of optimal criteria for monitoring iodine sufficiency. Proceedings of the Fifth International Congress of Endocrine Disorders, September 6–9, 1999, Tehran, I.R. Iran, Abstract 077.

    Google Scholar 

  19. DuBois D., DuBois E.F. Clinical calorimetry: a formula to estimate the approximate surface area if height and weight be known. Arch. Intern. Med. 1916, 17: 863.

    Article  CAS  Google Scholar 

  20. Brunn J., Block U., Ruf J., Bos I., Kunze W.P., Scriba P.C. Volumetrie der Schildrüsenlappen mittels real-time sonographie. Dtsch. Med. Wochenschr. 1981, 106: 1338–1340.

    Article  CAS  PubMed  Google Scholar 

  21. Sandell E.B., Kolthoff I.M. Micro determination of iodine by a catalytic method. Mikrochemica Acta 1937, 1: 9–25.

    Article  CAS  Google Scholar 

  22. Neter J., Wassermann W., Whimore G.A. Applied statistics, ed. 3. Allyn & Bacon Inc., Boston, 1988.

    Google Scholar 

  23. Hamill W.P., Drizd T.A., Johnson C.L., Reed R.B., Roche A.F., Moore W.M. Physical growth: National Center for Health Statistics percentiles. Am. J. Clin. Nutr. 1979, 32: 607–729.

    CAS  PubMed  Google Scholar 

  24. Aghini-Lombardi F., Antonangeli L., Pinchera A., Leoli F., Rago T., Bartolomei A.M., Vitti P. Effect of iodized salt on thyroid volume of children living in an area previously characterized by moderate iodine deficiency. J. Clin. Endocrinol. Metab. 1997, 82: 1136–1139.

    CAS  PubMed  Google Scholar 

  25. Vitti P., Martino E., Aghini-Lombardi F., Rago T., Antonangeli L., Maccherini D., Nanni P., Lovi-selli A. Thyroid volume by ultrasound in children as a tool for the assessment of mild iodine deficiency. J. Clin. Endocrinol. Metab. 1994, 79: 600–603.

    CAS  PubMed  Google Scholar 

  26. Gutekunst R., Smolarek H., Hasenpusch U., Stubbe P., Friedrich H.J., Wood W.G., Scriba P.C. Goiter epidemiology: thyroid volume, iodine excretion, thyroglobulin and thyrotropin in Germany and Sweden. Acta Endocrinol. 1986, 112: 494–501.

    CAS  PubMed  Google Scholar 

  27. Ivarsson S.A., Persson P.H., Ericsson U.B. Thyroid gland volume as measured by ultrasono-graphy in healthy children and adolescents in a non-iodine deficient area. Acta Paediatr. Scand. 1986, 78: 633–634.

    Article  Google Scholar 

  28. Liesenkotter K.P., Kiebler A., Stach B., Willgerodt H., Gruters A. Small thyroid volumes and normal iodine excretion in Berlin schoolchildren indicate full normalization of iodine supply. Exp. Clin. Endocrinol. Diabetes 1997, 105: 46–50.

    Article  PubMed  Google Scholar 

  29. Langer P., Tajtakova M., Bohov P., Klimes I. Possible role of genetic factors in thyroid growth rate and in the assessment of upper limit of normal thyroid volume in iodine-replete adolescents. Thyroid 1999, 9: 557–562.

    Article  CAS  PubMed  Google Scholar 

  30. Delange F. What do we call a goiter. Eur. J. Endocrinol. 1999, 140: 486–488.

    Article  CAS  PubMed  Google Scholar 

  31. Ueda D. Normal volume of the thyroid gland in children. J. Clin. Ultrasound 1990, 18: 455–462.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Fereidoun Azizi.

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Azizi, F., Delshad, H. & Mehrabi, Y. Thyroid volumes in schoolchildren of Tehran: Comparison with European schoolchildren. J Endocrinol Invest 24, 756–762 (2001). https://doi.org/10.1007/BF03343924

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