Busnardo B, Nacamulli D, Frigato F, Vianello-Dri A, De Vido D, Mian C, Candiani F, Tomasella G, Zambonin L, Piccolo M, Girelli M E
Endocrinology Unit, Department of Medical and Surgical Sciences, University of Padua, Italy.
J Endocrinol Invest. 2003 Oct;26(10):991-6. doi: 10.1007/BF03348197.
Goiter prevalence in school-age children and median urinary iodine concentration (UIC) are the main indicators of iodine deficiency in a population. In areas of mild iodine deficiency, where goiters are small, ultrasound is preferable to physical examination to estimate goiter prevalence. The World Health Organization (WHO) has adopted thyroid volume ultrasonography results from a survey of European schoolchildren as an international reference, but these values have recently been questioned. The aims of the study were: a) to determine regional normal echographic reference values of thyroid volume in children aged between 11 and 14 yr in the Veneto Region, in North-East Italy; b) to determine goiter prevalence by physical and ultrasonographic examination; c) to determine UIC in this section of the population. A cross-sectional study was carried out on 1730 schoolchildren, aged between 11 and 14, living in towns in low-lying areas, in the valleys of the pre-Alps and in the mountains between 600 and 1200 m. Thyroid volume was evaluated by inspection and palpation using the WHO criteria. In 560 children thyroid volume was determined by ultrasound. UIC was measured in 1368 children. On physical examination a grade I goiter was found in 7.5% of children. No goiter grade II or grade III was found. The regional thyroid volume reference values by ultrasonography were similar, or slightly lower (5-20%), to the corresponding WHO reference values. Mean UIC was 148 +/- 110 microg/l, with no difference between lowlands and uplands; UIC values less than 100 microg/l were found in about 30-35% of the children. UIC was higher in children using iodized salt than in non-users. No correlation was found between thyroid volume by ultrasonography and UIC. Thyroid volume was found to be bigger in upland children than in those in low-lying areas, probably because of low iodine intake in people living in the mountains in previous generations. This data show that Veneto is not a iodine-deficient area, with no presence of endemic goiter. However, the great number of children with a UIC of less than 100 microg/l also suggests the use of iodized salt in the Veneto Region.
学龄儿童的甲状腺肿患病率和尿碘中位数浓度（UIC）是人群碘缺乏的主要指标。在碘轻度缺乏地区，甲状腺肿较小，超声检查比体格检查更适合用于评估甲状腺肿患病率。世界卫生组织（WHO）采用了一项对欧洲学龄儿童调查的甲状腺体积超声检查结果作为国际参考标准，但这些数值最近受到了质疑。本研究的目的是：a）确定意大利东北部威尼托地区11至14岁儿童甲状腺体积的区域正常超声参考值；b）通过体格检查和超声检查确定甲状腺肿患病率；c）确定该人群的尿碘中位数浓度。对1730名年龄在11至14岁之间、居住在低洼地区城镇、前阿尔卑斯山谷以及海拔600至1200米山区的学龄儿童进行了一项横断面研究。根据WHO标准通过视诊和触诊评估甲状腺体积。在560名儿童中通过超声确定甲状腺体积。对1368名儿童测量了尿碘中位数浓度。体格检查发现7.5%的儿童有I级甲状腺肿。未发现II级或III级甲状腺肿。超声检查的区域甲状腺体积参考值与相应的WHO参考值相似，或略低（5 - 20%）。尿碘中位数浓度平均为148±110微克/升，低地和高地之间无差异；约30 - 35%的儿童尿碘中位数浓度值低于100微克/升。食用加碘盐的儿童尿碘中位数浓度高于未食用者。超声检查的甲状腺体积与尿碘中位数浓度之间未发现相关性。发现高地儿童的甲状腺体积比低洼地区儿童的大，这可能是因为前几代生活在山区的人碘摄入量低。这些数据表明威尼托不是碘缺乏地区，不存在地方性甲状腺肿。然而，大量尿碘中位数浓度低于100微克/升的儿童也表明威尼托地区应使用加碘盐。
