title: Persistence of goitre in the post-iodization phase: micronutrient deficiency or thyroid autoimmunity?
abstract: OBJECTIVE
  Despite years of salt iodization, goitre continues to be a major public health problem worldwide. We examined the prevalence of goitre in the post-iodization phase and the relationship of goitre with micronutrient status and thyroid autoimmunity in school children of Chandigarh, north India.
  
  
  METHODS
  Two phase study; in the first phase, 2148 children of 6 to 16 yr were screened for goitre by two independent observers as per the WHO grading system. In the second phase, a case-control study, 191 children with goitre and 165 children without goitre were compared with respect to urinary iodine, iodine content of salt, serum levels of T3, T4, TSH, anti-TPO (thyroid peroxidase) antibody, haemoglobin, ferritin and selenium.
  
  
  RESULTS
  Prevalence of goitre in the studied subjects was 15.1 per cent (13.9% in 6 to 12 yr and 17.7% in 13 to 16 yr age group, P = 0.03). Median urinary iodine excretion in both the groups was sufficient and comparable (137 and 130 μg/l). 3.2 per cent children with goitre and 2.4 per cent without goitre had hypothyroidism (subclinical and clinical) and only one child with goitre had subclinical hyperthyroidism. Nine (4.9%) children in the goitre group and 3 (1.9%) in control group had anti-TPO antibody positivity. The median serum selenium levels were not different in both the groups (181.9 and 193.5 μg/l). Seventy one (37.4%) of the goitrous children had anaemia (haemoglobin <12 g/dl) as compared to 41 (24.8%) of the control group (P < 0.01). More number of goitrous children (39, 20.6%) were depleted of tissue iron stores (serum ferritin <12 μg/l) as compared to controls (11, 6.4%; P < 0.001). Serum ferritin level negatively correlated with the presence of goitre (r = -0.22, P = 0.008) and had an OR of 2.8 (CI 1.20-6.37, P = 0.017).
  
  
  CONCLUSIONS
  There was a high prevalence of goitre in young children despite iodine repletion and low thyroid autoimmunity. The concurrent iron deficiency correlated with the presence of goiter. However, the cause and effect relationship between iron deficiency state and goitre requires further elucidation.
authors.affiliation: Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Sambit
authors.initials: S
authors.lastname: Das
authors.forename: Anil
authors.initials: A
authors.lastname: Bhansali
authors.forename: Pinaki
authors.initials: P
authors.lastname: Dutta
authors.forename: Arun
authors.initials: A
authors.lastname: Aggarwal
authors.forename: M P
authors.initials: MP
authors.lastname: Bansal
authors.forename: Dinesh
authors.initials: D
authors.lastname: Garg
authors.forename: Muthuswamy
authors.initials: M
authors.lastname: Ravikiran
authors.forename: Rama
authors.initials: R
authors.lastname: Walia
authors.forename: Vimal
authors.initials: V
authors.lastname: Upreti
authors.forename: Santosh
authors.initials: S
authors.lastname: Ramakrishnan
authors.forename: Naresh
authors.initials: N
authors.lastname: Sachdeva
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Bhadada
mesh_terms: D000293:Adolescent; D015551:Autoimmunity / Q000276:immunology*; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006043:Goiter, Endemic / Q000178:diet therapy* / Q000453:epidemiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D007455:Iodine / Q000008:administration & dosage / Q000378:metabolism*; D008297:Male; D018977:Micronutrients / Q000172:deficiency*; D009752:Nutritional Status; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*; D013961:Thyroid Gland / Q000276:immunology*; D013963:Thyroid Hormones / Q000378:metabolism
chemical_list: D018977:Micronutrients; D017673:Sodium Chloride, Dietary; D013963:Thyroid Hormones; C034024:iodized salt; D007455:Iodine