Iodine Deficiency Hypothyroidism Among Children in the United States - 21st Century Resurgence?

Sujatha Seetharaman MD, MPH , Sabitha Sasidharan Pillai MD , Avani Ganta MD , Kate Millington MD , Jose Bernardo Quintos MD , Lisa Swartz Topor MD, MMSc , Monica Serrano-Gonzalez MD
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Abstract

Background/Objective

Iodine deficiency hypothyroidism is an important cause of neurocognitive and motor impairment in children globally. In the United States, universal salt iodization, which began in the 1920s, led to a dramatic decline in iodine deficiency hypothyroidism. However, iodine deficiency may be reemerging due to increased consumption of noniodized salts, decreased dairy iodine concentrations, and decreased intake of iodine containing foods due to food allergies, dietary preferences such as vegan diets, or restrictive food intake disorders.

Case Report

We present a case series that challenges the existing clinical paradigm for hypothyroidism and describe 3 patients without underlying thyroid dysfunction who were diagnosed with iodine deficiency hypothyroidism over an 18-month period beginning in February 2021 in Northeastern United States. Prior studies reported 2 additional cases diagnosed in that same time frame at our clinical center.

Discussion

We report significant heterogeneity in clinical presentation: 3 patients had large goiters, 1 had a mild goiter, and 1 patient had no goiter. Biochemical tests were also variable and included a wide range of thyroid stimulating hormone elevations.

Conclusion

We suggest that a spot urine iodine concentration, combined with an elevated serum thyroglobulin level, can be an alternative to a 24-hour urinary iodine excretion for the diagnosis of iodine deficiency hypothyroidism given the clinical challenges of obtaining the latter. Thyroid function normalized in all patients with iodine supplementation.
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美国儿童缺碘甲状腺功能减退症--21 世纪的回潮?
背景/目的:碘缺乏性甲状腺功能减退症是全球儿童神经认知和运动障碍的重要病因。在美国,始于20世纪20年代的普遍食盐加碘,导致了碘缺乏症甲状腺功能减退症的急剧下降。然而,由于非碘盐摄入增加、乳制品碘浓度降低、食物过敏、饮食偏好(如纯素饮食)或限制性食物摄入障碍导致含碘食物摄入减少,碘缺乏可能再次出现。病例报告:我们提出了一个病例系列,挑战了现有的甲状腺功能减退的临床范例,并描述了3例无潜在甲状腺功能障碍的患者,从2021年2月开始,在美国东北部的18个月期间被诊断为碘缺乏性甲状腺功能减退。先前的研究报告了在我们临床中心同一时间段诊断的另外2例病例。讨论:我们报告了临床表现的显著异质性:3例患者有大甲状腺肿,1例有轻度甲状腺肿,1例无甲状腺肿。生化测试也不同,包括大范围的促甲状腺激素升高。结论:考虑到诊断缺碘性甲状腺功能减退的临床难度,我们建议尿碘浓度与血清甲状腺球蛋白水平升高相结合,可作为24小时尿碘排泄的替代方法。所有补充碘的患者甲状腺功能恢复正常。
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来源期刊
AACE Clinical Case Reports
AACE Clinical Case Reports Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
2.30
自引率
0.00%
发文量
61
审稿时长
55 days
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