Evaluation of goiter using ultrasound criteria: a survey in a middle schoolchildren population of a mountain area in Central Italy

Shift of Reference Values for Thyroid Volume by Ultrasound in 8- to 13-Year-Olds with Sufficient Iodine Intake in China

BACKGROUND

The iodine nutritional status of the Chinese population has been greatly improved in recent years. Therefore, the reference values for thyroid volume (Tvol) in children with sufficient iodine intake need to be updated. The study aimed to update the reference values for Tvol in children with sufficient iodine intake in order to define goiter in the context of sustained iodine sufficiency.

METHODS

A cross-sectional study was conducted in children with sufficient iodine intake in China. Twice-repeated 24-hour urine samples were collected from each child to estimate habitual daily iodine intake. Serum thyroid function tests were measured. Tvol was assessed by ultrasound. From the sample of euthyroid children with sufficient iodine intakes, the 50th and 97th percentiles for Tvol by age and body surface area (BSA) were calculated using quantile regression.

RESULTS

A total of 679 children aged 8-13 years with sufficient iodine intake (188 μg/day [145-235 μg/day]) were included in the analysis. The mean Tvol of the children was 4.1 ± 1.6 mL, and no differences were found between boys and girls in any age or BSA group. Quantile regression models demonstrated that BSA was a strong positive predictor of Tvol (p < 0.0001), while age only had a significant effect on median Tvol (p = 0.013). Sex was not a significant predictor of Tvol in children.

CONCLUSIONS

The reference values for Tvol in Chinese children have been updated. This study indicates that the upper limit of (97th percentile) Tvol was dependent on BSA, while the median Tvol was determined by both age and BSA.

Normative Data of Thyroid Volume-Ultrasonographic Evaluation of 422 Subjects Aged 0-55 Years

OBJECTIVE

To establish local normative data of thyroid volume assessed by ultrasonography in subjects aged 0-55 years living in İstanbul, Turkey.

METHODS

Subjects without any known history of thyroid disease, of major surgery and/or chronic disease were enrolled in the study and evaluated by physical examination and thyroid ultrasonography. Thyroid gland and isthmus at usual location, each lateral lobe volume with three dimensions, ectopic thyroid tissue and echogenicity of the gland were assessed.

RESULTS

Initially, 494 subjects were enrolled in the study. Subjects showing heterogeneous thyroid parenchyma (n=21) and/or nodule (n=51) in ultrasonography were excluded. Final analysis covered 422 subjects (216 males, 206 females). Thyroid volume was found to significantly correlate with height, weight, age and body surface area (r=0.661, r=0.712, r=0.772 and r=0.779, respectively; p<0.0001 for all). These correlations were even stronger in subjects younger than 18 years (r=0.758, r=0.800, r=0.815 and r=0.802, respectively; p<0.0001 for all).

CONCLUSION

The study provides updated reference norms for thyroid volume in Turkish subjects which can be used in the diagnosis and follow-up of patients with thyroid diseases.

Effects of prophylaxis with iodised salt in an area of endemic goitre in north-eastern Sicily

In developed countries, the use of iodised salt represents the best prophylaxis of endemic goitre in areas exposed to iodine deficiency. In the present study we re-evaluated goitre prevalence and iodine intake 10 years after the introduction of iodised salt in an area of goitre endemia in north-eastern Sicily (Italy), and we compared these results with those obtained in previous surveys. Three centres with known moderate goitre endemia (Bronte, Nicosia, and Gagliano) and three other smaller ones with severe goitre endemia (Sperlinga, Villadoro, and Maniace) were studied. We surveyed 697 schoolchildren. Goitre prevalence was assessed by thyroid palpation and by a thyroid ultrasound scan. Iodine urinary excretion was also measured. Iodised salt consumption was 44% of total salt consumption. Goitre prevalence assessed by thyroid palpation was significantly decreased in all towns studied compared to previous surveys. However, the persistence of a mild goitre endemia was observed in some small rural centres (5.8% in Sperlinga/Villadoro, and 11.4% in Maniace). Goitre prevalence evaluated by thyroid ultrasound scan was greater than 5% in all centres of the endemic area and was always greater than that assessed by thyroid palpation. Iodine urinary excretion was above 100 microg/l in all localities studied. In conclusion, our studies indicate a progressive reduction in goitre prevalence over a period of about 30 years in schoolchildren in a well-characterised endemic area in northeastern Sicily. The decrease in goitre prevalence was associated with a significant increase in urinary iodine excretion. However, it may be speculated that iodine deficiency is the pre-eminent, but not the exclusive cause of goitre endemia in this area.

Prevalence of post-partum thyroiditis in Liguria (Italy): an observational study

BACKGROUND

Post-partum thyroiditis (PPT) is an autoimmune disorder occurring within the first year following delivery. A variable prevalence has been reported in different surveys. We prospectively evaluated PPT prevalence and outcome in a cohort of pregnant women living in a well-defined geographic area.

AIM

A subset from a group of healthy women consecutively evaluated for thyroid function and thyroid autoimmunity during pregnancy, referring to the same obstetric unit, were followed up at 4-6 months and 1 yr after delivery.

MATERIALS/SUBJECTS AND METHODS

Follow-up for PPT was performed in 258 pregnant women. Control data were obtained in a comparable group of healthy non-pregnant women. Free T3 (fT3), free T4 (fT4), TSH thyroglobulin/thyroid peroxidase autoantibodies (TgAb/TPOAb), and urinary iodine excretion were measured.

RESULTS

Autoantibody positivity was observed in 9.3% of pregnant, similar to control women. Forty-three out of 59 autoantibody-positive women were followed up; 23 showed PPT at the first control, 18 had hypothyroidism at 1 yr (5 had not shown PPT at the first control). Among 215 out of 584 autoantibody-negative women followed up, 27 developed PPT (15 of them without thyroid autoantibodies); 16 developed thyroid autoantibodies without PPT. After 1 yr, 9 women had hypothyroidism: only 1 of them was autoantibody-negative at the former control. Urinary iodine was increased in several pregnant women.

CONCLUSIONS

An overall PPT prevalence of about 18% may be estimated. PPT was also observed in autoantibody- negative women. Differences with other surveys may be related to both study protocol and characteristics of the population studied.

Fine needle aspiration cytology of thyroid nodules: conventional vs thin layer technique

OBJECTIVE

Liquid-based cytology using the thin layer technique has recently been introduced in thyroid fine needle aspiration cytology together with or in substitution of direct smears, but its usefulness is still controversial and relatively few studies have been published in this field. The aim of the present study was to compare the results obtained from conventional smears with those from thin layer smears.

DESIGN

In 3875 thyroid nodules, a double cytologic sampling was taken in randomized order, to prepare conventional or thin layer smears.

MAIN OUTCOME

The diagnoses agreed in 2934 (75.7%) cases and disagreed in 941 (24.3%). The analysis of discordant data showed there were fewer non-diagnostic cases in the thin layer smears (377 vs 541, p<0.001) whereas in conventional smears there were more cases positive for carcinoma (27 vs 4, p<0.001). The cytohistologic correlation was available for 194 cases and showed that conventional smears had a greater capacity for revealing carcinomas (44 vs 31). Finally, diagnoses based on conventional smears were more sensitive than thin layer smears (93.6% vs 65.9%) whereas specificity was constant.

CONCLUSIONS

From our experience, the conventional smear offers a greater possibility of diagnosis when suspecting malignancy or diagnosing malignancy cases, whereas thin layer smears significantly reduce the number of non-diagnostic cases. For this reason, we suggest combining the two techniques in routine cytologic diagnosis.