Zimmermann Michael B, Wegmüller Rita, Zeder Christophe, Torresani Toni, Chaouki Noureddine
Human Nutrition Laboratory, Swiss Federal Institute of Technology, Rüschlikon, Switzerland.
Am J Clin Nutr. 2004 Apr;79(4):642-5. doi: 10.1093/ajcn/79.4.642.
In programs to control iodine deficiency disorders (IDD), sustainability is a major concern. IDD has recently recurred in countries where salt iodization programs have lapsed.
The objective of the study was to describe the evolution of thyroid dysfunction after the discontinuation of salt iodization in a cohort of children in an area of severe endemic goiter.
Moroccan children (aged 6-16 y, n = 159) with severe IDD received iodized salt (IS) for 1 y. Because of practical and financial constraints, including a lack of infrastructure and electricity at the production site, salt iodization abruptly ceased. The children were followed for another 14 mo, and concentrations of urinary iodine, thyrotropin, total thyroxine, and thyroglobulin and thyroid volume were measured.
Before iodization, median urinary iodine was 18 microg/L, 88% of children had elevated serum thyroglobulin concentrations, and 72% were goitrous. One year after the introduction of IS, median urinary iodine and thyroglobulin concentrations had normalized, mean thyroid volume had decreased by 34%, and median thyrotropin and mean total thyroxine concentrations were improved. Five months after the discontinuation of salt iodization, median urinary iodine had fallen to 20 microg/L. Fourteen months after the discontinuation of salt iodization, the rate of goiter was again similar to the rate before salt iodization; median thyrotropin and thyroglobulin concentrations were sharply higher than before the introduction of IS (P < 0.001); and the prevalence of hypothyroidism was 10%, compared with 3% before the introduction of IS (P < 0.001).
In IDD-affected areas, cessation of salt iodization is associated with a rapid deterioration of thyroid function in school-age children. These findings underline the importance of sustainability in IDD control and the vulnerability of children to even short-term lapses in IS programs.
在碘缺乏病（IDD）控制项目中，可持续性是一个主要问题。在食盐碘化项目中断的国家，碘缺乏病最近又有复发。
本研究的目的是描述在一个严重地方性甲状腺肿地区的一组儿童中，食盐碘化停止后甲状腺功能障碍的演变情况。
患有严重碘缺乏病的摩洛哥儿童（6 - 16岁，n = 159）接受了1年的碘盐（IS）。由于实际和经济限制，包括生产现场缺乏基础设施和电力，食盐碘化突然停止。对这些儿童又进行了14个月的随访，并测量了尿碘、促甲状腺激素、总甲状腺素、甲状腺球蛋白浓度以及甲状腺体积。
在碘化之前，尿碘中位数为18微克/升，88%的儿童血清甲状腺球蛋白浓度升高，72%的儿童患有甲状腺肿。引入碘盐1年后，尿碘和甲状腺球蛋白浓度中位数恢复正常，甲状腺平均体积减少了34%，促甲状腺激素中位数和总甲状腺素平均浓度有所改善。食盐碘化停止5个月后，尿碘中位数降至20微克/升。食盐碘化停止14个月后，甲状腺肿发生率再次与食盐碘化之前的发生率相似；促甲状腺激素和甲状腺球蛋白浓度中位数显著高于引入碘盐之前（P < 0.001）；甲状腺功能减退的患病率为10%，而引入碘盐之前为（P < 0.001）。
在受碘缺乏病影响的地区，停止食盐碘化与学龄儿童甲状腺功能的迅速恶化有关。这些发现强调了碘缺乏病控制中可持续性的重要性以及儿童对碘盐项目即使短期中断的脆弱性。
