Patel Tejal, Longendyke Rachel, Kanakatti Shankar Roopa, Merchant Nadia
Division of Endocrinology, Children's National Hospital, Washington, District of Columbia, USA.
Department of Pediatrics, George Washington School of Medicine, Washington, District of Columbia, USA.
Endocrinol Diabetes Metab Case Rep. 2024 Jun 26;2024(2). doi: 10.1530/EDM-24-0038. Print 2024 Apr 1.
Iodine nutrition is a growing issue within the USA due to newer trends of non-iodized salts. There are no recent reviews looking at the current state of iodine deficiency-induced hypothyroidism in children in the USA. We performed a retrospective chart review at our tertiary pediatric endocrine clinic; four met the diagnostic criteria for iodine deficiency defined by a low urine iodine level. We further characterized severity of disease, risk factors, goiter, thyroid labs and antibodies. All cases had significant goiter and were diagnosed within the last 2 years. One case had iodine deficiency due to no iodized salt intake along with concurrent diagnosis of developmental delay and multiple food allergies, while others involved the use of non-iodized salts. Two cases had iodine deficiency along with autoimmunity. It is critical to obtain a dietary history for all patients who present with goiter and/or hypothyroidism. There may be a need to consider reevaluating current preventative measures for iodine deficiency, especially for certain vulnerable populations such as children who do not consume iodized salt.
In recent decades, iodine nutrition has become a growing concern due to changing dietary patterns and food manufacturing practices. A dietary history is crucial to obtain in children presenting with hypothyroidism and goiter, especially in children with restrictive diets due to behavioral concerns, developmental delays, or multiple food allergies. Of the 12 different types of salts commercially available, only table salt contains iodine in an appropriate amount; thus, individuals using specialty salts can develop mild to moderate iodine deficiency-related thyroid disease.
由于非碘盐的新趋势，碘营养在美国已成为一个日益严重的问题。目前尚无针对美国儿童碘缺乏所致甲状腺功能减退症现状的近期综述。我们在我们的三级儿科内分泌诊所进行了一项回顾性病历审查；4例符合尿碘水平低所定义的碘缺乏诊断标准。我们进一步对疾病严重程度、危险因素、甲状腺肿、甲状腺实验室检查结果及抗体进行了特征描述。所有病例均有明显的甲状腺肿，且均在过去2年内确诊。1例因不摄入碘盐而出现碘缺乏，同时并发发育迟缓及多种食物过敏，其他病例则与使用非碘盐有关。2例碘缺乏合并自身免疫性疾病。对于所有出现甲状腺肿和/或甲状腺功能减退症的患者，获取饮食史至关重要。可能需要考虑重新评估当前针对碘缺乏的预防措施，尤其是对于某些易受影响的人群，如不食用碘盐的儿童。
近几十年来，由于饮食模式和食品制造方式的改变，碘营养问题日益受到关注。对于出现甲状腺功能减退症和甲状腺肿的儿童，尤其是因行为问题、发育迟缓或多种食物过敏而饮食受限的儿童，获取饮食史至关重要。在市售的12种不同类型的盐中，只有食用盐含有适量的碘；因此，使用特殊盐类的个体可能会发展为轻至中度碘缺乏相关的甲状腺疾病。
