Zhongyan SHAN
description
Transcript of Zhongyan SHAN
10th AOTA CONGRESS
Zhongyan SHAN
Department of Endocrinology,
The First Affiliated Hospital of China Medical University
The Benefit and Concern for Universal Salt
Iodination
10th AOTA CONGRESS
• The reason for USI • The benefit about USI• The concern about USI
Content
10th AOTA CONGRESS
IDD Disorders in Developing Countries
WHO86819 Source: ACC/SCN, 1987
Distribution of Iodine Deficiency Worldwide
Iodine deficiency
10th AOTA CONGRESS
Distribution of endemic goiter in China before 1979
Ma Tai et al. People's Health Publishing House 1980
Iodine Status in China
Iodine deficiency
10th AOTA CONGRESS
Neonate
Neonatal goiterNeonatal hypothyroidism
Endemic mental retardation
Increased susceptibility of the thyroid gland to nuclear
radiation
Child and adolescent
Goiter hypothyroidism hyperthyroidism Impaired mental function Retarded physical development Increased susceptibility of thyroid gland to nuclear radiation
Adult
Goiter, with its complications
HypothyroidismImpaired mental function
Spontaneous hyperthyroidism in the elderly
Iodine-induced hyperthyroidism
Abortions Stillbirths Congenital anomalies Increased perinatal mortality Endemic cretinism Deaf mutism
Fetus
Iodine status worldwide WHO Global Database on Iodine Deficiency
Spectrum of IDD across the Life-span
10th AOTA CONGRESSM. B Zimmermann et al. Lancet 2008; 372: 1251–62.ACC/SCN State-of -the-art series nutrition policy discussion paper No 3.1988
Characteristic Features of IDD
10th AOTA CONGRESS
•Safe, feasible and highly cost-effective strategy
USI
•Iodine supplementation of foods and water for human consumption
•Iodine medications (notably oral administration of iodized oil) to directly supplement the inhabitants at risk of IDD in endemic areas.
•Active prophylaxis of domestic animals; use of iodine materials for plants or iodine deficient soils.
Others
Strategy for Iodine Supplementation
10th AOTA CONGRESS
• The reason for USI • The benefit about USI• The concern about USI
Content
10th AOTA CONGRESS
Benefit in Infant and Childhood After IS
in moderate-to-severe iodine deficient area
Prevalence of iodine deficiency decreased
Prevalence of Cretinism reduced
Mean developmental quotient increased
Infant mortality reduced
Cognition of childhood increased
Somatic growth of childhood improved
in mild-to-moderate iodine deficient area
Potential benefit during pregnancy remain unclear
10th AOTA CONGRESS
Iodine status worldwide, WHO Global Database on Iodine Deficiency, 2004
Prevalence of ID Decreased after IS
In 2003
In 2007
M. B Zimmermann et al. Lancet 2008; 372: 1251–62
In 2012
. Zimmermann M B, and Andersson M Curr Opin Endocrinol Diabetes Obes 2012, 19:382–387
There were 32 countries with ID in total 150 WHO countries.
10th AOTA CONGRESSPharoah POD et al. Lancet. 1971, 13;1(7694):308-10.Pharoah PO, Connolly KJ. Int J Epidemiol 1987, 16:68–73
In an severe iodine deficient area in Papua New Guinea Alternate families received saline (control) or iodized oil injection.
The primary outcome was the prevalence of cretinism at 4- and 10-yr follow-up
Design
at 10 yrs
1.0 1.1 1.20.050.1
Reduction of endemic cretinism
at 4 yrs
0.17(0.05-0.58)
RR(95%CI)
0.20.30.40.50.6
0.27(0.12-0.60)Results
Prevalence of Cretinism Reduced after IS
10th AOTA CONGRESSCao XY, et al. N Engl J Med 1994,331:1739–1744
Design• In a severe iodine deficient area
in western China
• Intervention was oral iodized oil at each trimester of pregnancy
• Children were divided into Untreated children: 1–3 yr of age Treated children born to treated women were followed for 2 yr.
• The main outcomes: neurological examination head circumference Development quotient
Iodine Supplementation Reduced Cretinism in Severe Iodine Deficient Areas
treated in T1 Treated in T2 Treated in T3 or after birth
02468
10
2 2
9
Prevalence of neurological abnormalities
Developmental Quotient Increased after IS
treated children untreated children 65
70
75
80
85
90
9590
75
Developmental quotient at 2yr
10th AOTA CONGRESS
• A placebo-controlled, double-blind, 6-month intervention trial
• Moderately iodine-deficient area in Albania
• 10- to 12-yr-old children (n= 310) were randomized
• Receive either 400 mg of iodine as oral iodized oil or placebo.
• Children were given a serial of seven cognitive and motor tests
• Median UI in the treated group was 172μ g/liter at 24 wks
• Mean T4 increased approximately 40% compared with placebo
Zimmermann MB, et al.Am J Clin Nutr2006 83:108–114
Cognition at School Age Improved After IS
10th AOTA CONGRESSZimmermann MB, et al.Am J Clin Nutr2006 83:108–114
1.0 1.5 2.0 2.5 3.00.5
Cognitive Improvement
Ravens matrices
4.7(3.8-5.8)
2.8(1.6-4.0)
3.5
RR(95%CI)
4.0 4.5 5.0 5.5 6.0
Rapid target marking
Symbol search
2.8(1.9-3.6)
Rapid naming
4.5(2.3-6.6)
cognitive impairment
Cognition at School Age Improved After IS
10th AOTA CONGRESS DeLong GR, et al. Lancet, 1997, 350:771–773.
58.247.4
106.2
28.7 19.1
57.3
0
20
40
60
80
100
120
Rong Ru Tusal a Bakechi
Before
After
• In three areas of severe iodine deficiency in Xinjiang, China• Potassium iodate for women of childbearing age over a 2- to 4-wk period • Observe neonatal and infant mortality in the following 2–3 yr.
the
infa
nt m
orta
lity
rate
(/
1000
birt
hs)
The odds of neonatal death were reduced by 65% in iodine treated groups
Infant Mortality Reduced after IS
10th AOTA CONGRESS
• Aim: to determine whether iodine repletion improves growth in school-age children
• Design: Three prospective, double-blind intervention studies in severely, moderately , and mildly iodine-deficient areas.
• Intervention: receiving either 400mg of oral iodized oil or placebo for 6 months
Zimmermann MB, et al. J Clin Endocrinol Metab 2007, 92:437–442
Somatic Growth of Childhood Improved After IS
10th AOTA CONGRESS
Height-for-age z-score Weight-for-age z-score
Zimmermann MB, et al. J Clin Endocrinol Metab 2007, 92:437–442
Somatic Growth of Childhood Improved After IS
10th AOTA CONGRESS
Author UI Time Number Amount Main Results
Romano(1991)Italy
31–37μg/L
T1 SI N=17Con N=18
120-180μg iodizedsalt
In controls, a 16% increase in TV. Treatment had no effect on maternal TSH
Pedersen (1993)Denmark
55μg/L
G17 to term
SI N=28Con N=26
200μg KI Maternal TV increased 16% in the treated group vs. 30% in controls. Maternal Tg and TSH were lower in the treated group.
Glinoer(1995)Belgium
36μg/L
G14 to-term
SI N=36Con N=36
100μg KI The treated women had smaller TV, and lower TSH and Tg , compared with controls.
TV: thyroid volume
Controlled Studies in Mild-to-Moderate ID
10th AOTA CONGRESS
Author UI Time Number Amount Main Results
Liesenkotteer(1996)Germany
53 g/g Cr
G11 to term
SI N=38Con N=70
300μg KI Treatment had no significant effect on maternal TSH, T3, T4, TV, or Tg.
Antonangeli(2002)Italy
74g/g Cr
G18–26 to G29–33 wk.
SI-1 N=32SI-2 N=35
200μg KI50μg KI
no differences in maternal FT4, FT3, TSH, Tg, or TV between groups.
TV: thyroid volume
Controlled Studies in Mild-to-Moderate ID
10th AOTA CONGRESS
mild-to-moderate iodine deficiency: 37-70μg/L
After iodine supplementation of 150~300μg/d
• UI concentration increased
• Maternal thyroid volume decreased
• Neonatal thyroid volume decreased
• No effect on maternal FT4, FT3, TSH, and Tg
• No long-term follow-up data
Zimmermann M: Thyroid, 2007, 17: 829-835
potential benefit of iodine supplementation in mild-to-moderate iodine deficiency during pregnancy remain unclear
Controlled Studies in Mild-to-Moderate ID
A Summary
10th AOTA CONGRESS
In adults, iodine supplementation can
change the subtype of thyroid cancer
decrease the risk of diffuse goiter
Benefit about USI in Adulthood
10th AOTA CONGRESS
Time SIC
(mg/kg)UIC
(μg/L) TGR(%)
palpationTGR(%)
B ultrasound
Rate of qualified
iodized salt
1995 16.2 164 20.4 - 39.9
1997 37.0 330 10.9 9.6 81.1
1999 42.3 306 8.8 8.0 88.9
2002 31.4 241 5.8 5.1 88.9
2005 30.8 246 5.0 4.0 90.2
Prevalence of Thyroid Goiter in ChinaBefore and After USI (1995–2005)
10th AOTA CONGRESS
Type of Thyroid cancer
Iodinedeficiency
Iodinesufficiency
Undifferentiated thyroid cancer
follicular thyroid cancer
papillary thyroid cancer
Changes of Type of Thyroid Cancer after USI
10th AOTA CONGRESS
Content
• The reason for USI • The benefit about USI• The concern about USI
10th AOTA CONGRESS
Recommendation by the U.S. National Academy of Sciences
Jean Vanderpas. Annu. Rev. Nutr. 2006. 26:293–322
Recommended Dietary Allowance and Upper Limit of Iodine Intake (μg/d)
10th AOTA CONGRESSLaurberg P et al: Thyroid 2001,11(5):457
Iodine Intake Level
Thyr
oid
Dis
ease
U-Shaped Curve between Iodine Intake and Thyroid Diseases
10th AOTA CONGRESSWHO, UNICEF,ICCIDD, 2007. Geneva: WHO
Criteria for Assessing Iodine Nutrition Based on Median of urinary iodine concentrations
In school-aged children
10th AOTA CONGRESSWHO, UNICEF, ICCIDD 2001 A guide for programme managers. WHO publ., Geneva.
Optimal Iodine Nutrition and Corresponding Iodine Intake
10th AOTA CONGRESSP LaurbergBest. Practice & Research Clinical Endocrinology & Metabolism 24 (2010) 13–27
Spectrum of Disorders Depends on UIC
MUI
10th AOTA CONGRESS
18
4
0.9
3.8
0
4
8
12
16
20
38ug/ L 150ug/ L
Overt Hypo Sub Hypo
Pre
vale
nce
(%)]
*:compared with another area,P<0.05
Denmark n=523 the elderlyMUI
Laurberg: J Clin Endocrinol Meatb, 1998,83:765. Szabolcs, Clin Endocrinol,97,47:87.
10.4
7.6
1.50.8
4.2
23.9
0
5
10
15
20
25
72ug/ gCr 100ug/ gCr 513ug/ gCr
Overt Hypo Sub Hypo
*
*#
#
*:compatred with other two areas,P<0.05#:Compared with area with the lowest UI,P<0.05
Hungary n=346 the
elderly
Pre
vale
nce
(%)]
Prevalence of Hypothyroidism Increased after USI
*
*
10th AOTA CONGRESSP Laurberg, Best Practice & Research Clinical Endocrinology & Metabolism 24 (2010) 13–27
Incidence of Hypothyroidism Increase after USI
Aalborg
10th AOTA CONGRESS
90
30
2.8
7.4
0
10
20
30
40
50
60
70
80
90
100
0
1
2
3
4
5
6
7
8
SIC Incidence of hyperthyroidism
pp
m
/100
,000
10
20
1.64
1
1.36
1
0
5
10
15
20
25
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
SIC Overt Hyper Sub Hyper
pp
m %
Zimbabwe , 1995 Austria , 1998
Lancet 1995, 346:1563
Eur J
Nucl Med 1998, 25:367
Incidence of Hyperthyroidism Increased after USI
10th AOTA CONGRESSP Laurberg, Best Practice & Research Clinical Endocrinology & Metabolism 24 (2010) 13–27
Types of hyperthyroidism in populations with different iodine intake levels
Iodine intake level50-60 μg/day
Iodine intake level250-350 μg/day
10th AOTA CONGRESS
Prevalence of AIT in Poland Prevalence of Thyroid Cancer in Australia
Thyroid, 1997, 7: 733-741.
Euro J Endocrinol,2002,146:19-26.
Prevalence of AIT and Thyroid Cancer after USI
1. 50%
5. 70%
0%
1%
2%
3%
4%
5%
6%
Before USI After USI
P=0.03 7. 80
3. 07
0
2
4
6
8
10
Before USI After USI
/ 10( 万)P=0.04
10th AOTA CONGRESS
From 1995 to 2005
241 246
330 306
164
0
100
200
300
400
1995 1996 1997 1999 2001 2002 2005 Year
MUI(ug/L)
Excessive
More than Adequate
Adequate
Deficient
241 246
MU
I(m
cg/L
)
330306
165
USI Salt iodine was adjusted
Iodine Nutrition of Population in China
10th AOTA CONGRESS
Date Subject Contents population
1999 IITD-1 3 rural communities with MUI 84μg/L, 243 μg/L and 651 μg/L.
3,761
2004 IITD-2 IITD-1 follow-up ( 5 years) 3,018
2007 IITD-3 2 rural communities with MUI 145 μg/L and 261μg/L
3,813
2010 IITD-4 6 cities with more than adequate iodine intake and 4 cities with adequate iodine intake
15,181
2002 PPT Screening pregnant women and followed-up for 12 months
610
IITD: iodine-induced thyroid diseases; PPT: postpartum thyroiditis;
Epidemiologic Studies about Iodine and Thyroid Diseases in China
10th AOTA CONGRESS Teng WP, Shan ZY, et al: New Engl J Med 354: 2783-2793
IITD-1, IITD-2
10th AOTA CONGRESS
Zhangwu
PanshanHuanghua
• Three communities with iodine- :
– Mild deficiency (84μg/L)
– More than adequacy (243μg/L)
– Excess (614μg/L)
Study Design
• Baseline study in 1999 and follow-up in 2004
• To obtain prevalence and incidence of thyroid
diseases and an association with iodine intake
IITD-1, IITD-2
Teng WP, Shan ZY, et al: New Engl J Med 354: 2783-2793
10th AOTA CONGRESS
1.6
3.7
2
3.9
1.2 1.1
0
0.8
1.6
2.4
3.2
4
4.8
Prev
alen
ce ra
te[%
]
*:Compared with Panshan and Zhangwu, P<0.05
*
Overt hyperthyroidism
Subclinical hyperthyroidism
Panshan 103μg/L Zhangwu 375μg/L Huanghua 615μg/L
HYPERTHYROIDISM, Prevalence
IITD-1, IITD-2
10th AOTA CONGRESS
1.36 1.36
0.94
1.97
0.811.04
0
0.5
1
1.5
2
Overthyperthyroidism
Subclinical hyperthyroidism
Cum
ulati
ve in
cide
nce[
%]
HYPERTHYROIDISM, Incidence
IITD-1, IITD-2
Panshan 103μg/L Zhangwu 375μg/L Huanghua 615μg/L
10th AOTA CONGRESS
0.27
0.910.95
2.9
2.05
5.96
0
1
2
3
4
5
6
Clinical hypothyroidism Subclinical hypothyroidism
Pre
vale
nce
(%)
Panshan103μg/L Zhangwu375μg/L Huanghua615μg/L
*
*
#
#
*: Compared with Panshan, P<0.05#: Compared with Panshan and Zhangwu, P<0.05
HYPOTHYROIDISM, Prevalence
6.1
2.9
0.9
2.0
0.90.3
IITD-1, IITD-2
Teng WP, Shan ZY, et al: New Engl J Med 354: 2783-2793
10th AOTA CONGRESS
0.23 0.23
0.47
2.6
0.44
2.89
0
0.5
1
1.5
2
2.5
3
Clinical hypothyroidism Subclinical hypothyroidism
1999
-200
4 C
umul
ativ
e In
cide
nce(
%)
Panshan103μg/L Zhangwu375μg/L Huanghua615μg/L
*: Compared with Panshan, P<0.05
HYPOTHYROIDISM, Incidence
**
2.92.6
0.20.30.5
0.2
IITD-1, IITD-2
Teng WP, Shan ZY, et al: New Engl J Med 354: 2783-2793
10th AOTA CONGRESS
19.5
13.6
5.1
0
5
10
15
20
Panshan
Zhangwu
Huanghua
Prev
alen
ce ra
t (%
)
3.7 3.5 2.5
0
5
10
15
20
Panshan
Zhangwu
Huanghua
Diffuse goiter Nodular goiter
#
*
*
*:Compared with Huanghua,P<0.05#: Compared with Huanghua and Panshan,P<0.05
THYROID GOITER, Prevalence
IITD-1, IITD-2
10th AOTA CONGRESS
7.08
4.46.9
0
2.5
5
7.5
10
Panshan
Zhangwu
HuanghuaIn
cide
nce
rate
(‰/y
ear)
5.01
2.410.85
0
2.5
5
7.5
10
Panshan
Zhangwu
Huanghua
Diffuse goiter Nodular goiter
*
* *
*:Compared with Zhangwu,P<0.05*:Compared with Huanghua,P<0.05#: Compared with Huanghua and Zhangwu,P<0.05
#*
THYROID GOITER, Incidence
IITD-1, IITD-2
10th AOTA CONGRESSTeng XC, Shan ZY, Teng WP: Euro J Endocrinol, 2011,164: 943-950
IITD-3
10th AOTA CONGRESS
Study Design
• Two communities with iodine- :
– Adequate (145μg/L)
– More than adequate (261μg/L)
A cross-sectional study in 2007
Compare difference of thyroid diseases between adequate iodine intake and more than adequate iodine intake
Rongxing
Chengshan
Teng XC, Shan ZY, Teng WP: Euro J Endocrinol, 2011,164: 943-950
IITD-3
10th AOTA CONGRESSTeng XC, Shan ZY, Teng WP: Euro J Endocrinol, 2011,164: 943-950
Characteristics of Two Communities
IITD-3
10th AOTA CONGRESS
0.16
1.99 2.15
0.42
4.935.35
0
2
4
6
Clinicalhypothyroidism
Subclinicalhypothyroidism
Clinical andsubclinical
Pre
vale
nce(
%)
Chengshan145μg/L Rongxing261μg/L
*
##
#: Compared with Chengshan, P<0.01 *: Compared with Chengshan, P<0.05
HYPOTHYROIDISM prevalence
Teng XC, Shan ZY, Teng WP: Euro J Endocrinol, 2011,164: 943-950
IITD-3
10th AOTA CONGRESS
ANTI-THYROID ANTIBODIES prevalence
8.47.93
10.69 10.32
0
3
6
9
12
TPOAb TgAb
Pre
vale
nce(
%)
Chengshan145μg/L Rongxing261μg/L
*
*: Compared with Chengshan, P<0.05
*
Teng XC, Shan ZY, Teng WP: Euro J Endocrinol, 2011,164: 943-950
IITD-3
10th AOTA CONGRESS
National Cooperation Group of IITD-4 Study
Weiping Teng Lulu Chen Chao Liu
Binyin Shi Lixin Shi Zhongyan Shan
Nanwei Tong Shu Wang Jianping Weng
Xiaoping Xing Jiajun Zhao
A survey of iodine status and thyroid diseases in ten cities in China
IITD-4
10th AOTA CONGRESS
Distribution of Samples – 10 Cities
Chengdu
Guangzhou
Shanghai
Jinan
Nanjing
Beijing
Guiyang
Xi’an
Shenyang
Wuhan
IITD-4
10th AOTA CONGRESS
City nGender(M: F)
Average of Age Range of Age
Beijing 1539 1: 1.9 47.3±13.4 20-88
Chengdu 1500 1: 1.2 45.8±15.2 15-82
Guangzhou 1505 1: 1.4 45.0±15.2 18-83
Guiyang 1512 1: 1.4 45.2±14.8 20-78
Jinan 1500 1: 1.5 45.3±14.9 20-82
Nanjing 1572 1: 1.2 44.7±15.4 17-92
Shanghai 1500 1: 1.2 45.1±14.9 17-82
Shenyang 1549 1: 1.4 45.1±15.1 20-84
Wuhan 1500 1: 1.5 45.1±14.9 17-85
Xi’an 1500 1: 1.5 46.1±14.8 20-83
Total 15181 1: 1.4 45.5±14.9 15-92
Demographic Characteristics of 10 Cities
IITD-4
10th AOTA CONGRESS
0
100
200
300
400
总体 北京 成都 广州 贵阳 济南 南京 上海 沈阳 武汉 西安
MU
I(u
g/L
)
Excessive
Iodine Nutrition Status in 10 Cities
156 169 169
282
241
207
185174184
228
196
More than Adequate
Adequate
Deficient
Tota
l
Beijin
g
Chengdu
Guangzh
ou
Guiyan
g
Jinan
Nanjin
g
Shanghai
Shenya
ng
Xi’an
Wuhan
Tota
l
Beijin
g
Chengdu
Tota
l
Beijin
g
Guangzh
ou
Chengdu
Tota
l
Beijin
g
Guiyan
g
Guangzh
ou
Chengdu
Tota
l
Beijin
g
Jinan
Guiyan
g
Guangzh
ou
Chengdu
Tota
l
Beijin
g
Nanjin
g
Jinan
Guiyan
g
Guangzh
ou
Chengdu
Tota
l
Beijin
g
Shanghai
Nanjin
g
Jinan
Guiyan
g
Guangzh
ou
Chengdu
Tota
l
Beijin
g
Shenya
ng
Shanghai
Nanjin
g
Jinan
Guiyan
g
Guangzh
ou
Chengdu
Tota
l
Beijin
g
Wuhan
Shenya
ng
Shanghai
Nanjin
g
Jinan
Guiyan
g
Guangzh
ou
Chengdu
Tota
l
Beijin
gXi’a
n
Wuhan
Shenya
ng
Shanghai
Nanjin
g
Jinan
Guiyan
g
Guangzh
ou
Chengdu
Tota
l
Beijin
g
6 cities with adequate iodine intake 4 cities with more than adequate iodine intake
IITD-4
10th AOTA CONGRESS
0
0.5
1
1.5
2
2.5
3
3.5
临床甲亢 亚临床甲亢
甲亢
患病
率 (
%)
碘充足地区 碘超足量地区 *
P=0.000
1.6%
3.2%
1.2%1.0%
N=15,177
HYPERTHYROIDISM - Prevalence
IITD-4Pr
eval
ence
(%)
Clinical Hyperthyroidism Subclinical Hyperthyroidism
10th AOTA CONGRESS
0
1
2
3
4
5
6
7
8
9
临床甲减 亚临床甲减
甲减
患病
率 (
%)
碘充足地区 碘超足量地区
*
P=0.000
8.2%
3.8%
0.8%
2.1%
*P=0.043
N=15,181
Subclinical Hypothyroidism Overt Hypothyroidism
Pre
vale
nce
(%
)
HYPOTHYROIDISM - Prevalence
IITD-4
10th AOTA CONGRESS
0
2
4
6
8
10
12
14
16
TPOAb TgAb
An
tib
od
y P
osit
ive(%
)
Adequate
More Than Adequate
11.0%
12.4%
*P=0.006
12.0%
13.4%
*P=0.008
N=15,181
ANTITHYROID ANTIBODIES - Prevalence
IITD-4
10th AOTA CONGRESS
00.5
11.5
22.5
33.5
44.5
5
Adequate More Than Adequate
Goi
ter P
reve
lanc
e(%
)
*
P=0.000
1.4%
4.5%
N=15,181GOITER - Prevalence
IITD-4
10th AOTA CONGRESS
0
2
4
6
8
10
12
14
Single Multiple
Th
yro
id N
od
ule
Pre
vale
nce (
%)
AdequateMore Than Adequate12.4%
9.3%
*
P=0.000
8.4%
3.4%
*
P=0.000
N=15,181
THYROID NODULE - Prevalence
IITD-4
10th AOTA CONGRESS
Postpartum Thyroiditis
10th AOTA CONGRESS
Effect of Iodine Intake on Post-partum Thyroiditis
Guan HX, Li CY, Teng WP J Endocrinol Invest. 2005, 2 : 876
Study Design
• 610 pregnant women enrolled from an iodine-
sufficient area
• The patients with thyroid dysfunction were
followed for 12 months after delivery
• TSH, thyroid hormones and urinary iodine
were tested every 3 months
Iodine and Postpartum Thyroiditis
10th AOTA CONGRESS
7.25
11.39
18.58
0
5
10
15
20
<150(n=138) 150-300(n=237) >300(n=113)
Individual's mean level of UI during the studying period (μg/L)
Pre
vale
nce(%
)
Overt PPT Subclinical PPT PPT total *
*
Guan HX, Li CY, Teng WP J Endocrinol Invest. 2005, 2 : 876
PPT prevalence
Iodine and Postpartum Thyroiditis
10th AOTA CONGRESSSang Zhongna et al. J Clin Endocrinol Metab 2012, 97: E1363-1369
Iodine and Thyroid Dysfunction during Pregnancy
Thyroid dysfunction during late gestation is associated with excessive iodine intake in pregnant women
10th AOTA CONGRESS
Excessive Iodine Intake Increase Thyroid Dysfunction during late Gestation
Sang Zhongna et al. J Clin Endocrinol Metab 2012, 97: E1363-1369
10th AOTA CONGRESS
Summary
USI is a feasible and highly cost-effective strategy
Iodine supplementation (IS) can prevent and treat
iodine-deficiency disorders
Iodine levels that are more than adequate or excessive
could increased risk of subclinical hypothyroidism and
autoimmune thyroiditis
Iodine intake should be maintained at a safe level,
MUI between 100 and 200µg/L is a optimal range
10th AOTA CONGRESS
China Medical University
The First Hospital of CMU