title: Endemic goiter in pregnant women: utility of the simplified classification of thyroid size by palpation and urinary iodine as screening tests.
abstract: OBJECTIVE
  To validate urinary iodine (I) excretion and the simplified classification of goiter by palpation, comparing them with ultrasound of the thyroid gland as the gold standard, to identify endemic goiter in pregnant women.
  
  
  METHODS
  300 pregnant women identified in referral hospitals, in three geographic regions.
  
  
  METHODS
  Two endocrinologists, previously trained, evaluated thyroid size by palpation and by ultrasound. Urinary iodine excretion in a sample of urine was determined. Thyroid size below the 90th centile by ultrasound was considered normal.
  
  
  RESULTS
  Mean age of study women was 23 years old. The prevalence of low weight for gestational age was 39% and of anaemia 47%. Our sample distribution showed that 120 microg I/L was the best cut off for low urinary iodine excretion to identify endemic goiter in pregnant women (sensitivity 57% and specificity 70%, likelihood ratio of 1.4). The prevalence of goiter was 10% using ultrasound. Palpation had a sensitivity of identification goiter of 94% (95% CI 89-99%), a specificity of 80% (95% CI 75-85%), a likelihood ratio of 4.7, positive post-test probability of 36.5% and negative post-test probability of 99%.
  
  
  CONCLUSIONS
  Low urinary iodine excretion identified up to 46% of women with goiter. This test by itself is not useful as a screening tool to identify pregnant women at risk of goiter. Identification of thyroid size by palpation was a better screening test. However, when both tests were combined in parallel, up to 100% of women with goiter were correctly identified. Our results suggest that the commonly used cut off point of 100 microg I/L to identify low urinary iodine excretion may under-estimate the prevalence of iodine deficiency disorders when used during pregnancy.
authors.affiliation: Unidad de Investigación en Epidemiologi;a de la Nutrición, División de Investigación Epidemiológica y en Servicios de Salud, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, DF, Mexico.
authors.forename: Rutila
authors.initials: R
authors.lastname: Castañeda
authors.forename: Diana
authors.initials: D
authors.lastname: Lechuga
authors.forename: Rosa Isela
authors.initials: RI
authors.lastname: Ramos
authors.forename: Clementina
authors.initials: C
authors.lastname: Magos
authors.forename: Maribel
authors.initials: M
authors.lastname: Orozco
authors.forename: Homero
authors.initials: H
authors.lastname: Martínez
mesh_terms: D000328:Adult; D005260:Female; D006043:Goiter, Endemic / Q000000981:diagnostic imaging / Q000473:pathology* / Q000652:urine; D006801:Humans; D007455:Iodine / Q000652:urine*; D008403:Mass Screening; D010173:Palpation / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000652:urine; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology*; D016216:Ultrasonography, Prenatal / Q000379:methods
chemical_list: D007455:Iodine