ESPEYB15 13 Global Health for the Paediatric Endocrinologist Advances in the Diagnosis and Management of Congenital Hypothyroidism (5 abstracts)
The five papers included in this section reflect the increasing interest by resource-limited countries in developing such a program but also highlight specific points that need to be considered in countries that embark in this wonderful initiative to make it successful.
Gowachirapant S , Jaiswal N , Melse-Boonstra A , Galetti V , Stinca S , Mackenzie I , Thomas S , Thomas T , Winichagoon P , Srinivasan K & Zimmerman MB
Institute of Nutrition, Mahidol University, Nahjon Pathom, Thailand; Division of Human Nutrition, Wageningen University and Research, Wageningen, Netherlands; St John’s Research Institute, Bangalore, India; Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland; Hearing Impairment Research Group, Liverpool School of Tropical Medicine, Liverpool, UK
To read the full abstract: Lancet Diabetes Endocrinol 2017; 5:853-63
This prospective, randomized trial investigates the benefits of iodine supplementation (200 mcg per day) in pregnant women from Thailand and India on the neurological development of their children. Iodine readily crosses the placenta and is required for the synthesis of thyroid hormones by the fetal thyroid gland. In addition, iodine is actively concentrated by the mammary gland and serves as the sole source of iodine for the breastfed infant. The authors chose a dose of 200 mcg of iodine per day, between the dose propose by the American Thyroid Association and the European Thyroid Association (150 mcg) and the dose proposed by the WHO (250 mcg) for pregnant and lactating women.
The study found no benefit of iodine supplementation during pregnancy on several developmental tests administered to the child at the age of 4-5 years. However, these results need to be interpreted in the context of a population of euthyroid pregnant women with an initial, pre-supplementation urinary iodine excretion (commonly used as a proxy for iodine intake) of ~130 mcg/L, only moderately below the threshold for iodine deficiency. This is much higher than the urinary concentrations associated with severe iodine deficiency (defined as a median urinary iodine concentration of less than 20 mcg/L) and with severe developmental delay in the offspring. In addition, the children in this study were iodine-sufficient at the age of developmental evaluation (4-5 years).
These data should not lead us to conclude that iodine supplementation during pregnancy is not important but rather show that very mild iodine deficiency during pregnancy does not affect neurodevelopment in the child and that supplementation of the pregnant mother with 200 mcg of iodine per day is safe.
Volume 15
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ESPE Yearbook of Paediatric Endocrinology
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