Excess urinary iodine concentration and thyroid dysfunction among school age children of eastern Nepal: a matter of concern.

OBJECTIVES:Deficiency as well as excess dietary iodine is associated with several thyroid disorders including Grave's disease and goitre. Previously, cross sectional studies conducted among school children in Nepal showed high prevalence of iodine deficiency. In contrast, recently, few studies have revealed emerging trends of excess urinary iodine concentration in children. This paper, reports excess urinary iodine excretion and thyroid dysfunction among school age children from eastern Nepal. RESULTS:It was a community based cross sectional study in which we measured urinary iodine excretion levels among school age children at baseline and after educational program. The educational program consisted of audio-visual and pamphlets on thyroid health. We also screened them for thyroid function status by physical examination and measuring serum thyroid hormones. Our results show that 34.4% of the children had excess urinary iodine concentration above the WHO recommended levels. Overall, 3.2% of the children were identified to have thyroid dysfunction. Urinary iodine concentration was significantly different between types of salt used and between salt iodine content categories

Thyroid Function and Thyroglobulin Level in Iodine-Deficient Children of Eastern Nepal

Iodine deficiency during childhood affects physical and mental development. Iodine deficiency or excess both can negatively impact thyroid function. We conducted this study to assess iodine nutrition and thyroid function in children with insufficient urinary iodine concentration. A community-based cross-sectional study was conducted among the selected schools of Udayapur district. Urinary iodine concentration (UIC) was measured in 1012 school children (6-14 years). Based on UIC data, 83 blood samples were collected to measure serum thyroglobulin (Tg), thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4). UIC was measured by ammonium persulfate digestion method, and Tg, TSH, fT4, and fT3 were measured using ELISA kits. The median UIE was 236 µg/L, and 11.1% of the children had insufficient UIC. The mean fT3, fT4, and TSH in children with insufficient UIC were 2.55±0.43 pg/mL, 0.96±0.28 ng/dL, and 3.60±1.44 mIU/L respectively. Among children with low UIC levels, the median Tg was 17.5 ng/mL. Overt hypothyroidism was seen in 6%, and subclinical hypothyroidism in 3.6%. The children had sufficient iodine nutrition, and the frequency of thyroid dysfunction was low among the children with insufficient UIC

Anemia, Iron Deficiency and Iodine Deficiency among Nepalese School Children

Objectives To assess iodine and iron nutritional status among Nepalese school children. Methods A cross-sectional, community based study was conducted in the two districts, Ilam (hilly region) and Udayapur (plain region) of eastern Nepal. A total of 759 school children aged 6–13 y from different schools within the study areas were randomly enrolled. A total of 759 urine samples and 316 blood samples were collected. Blood hemoglobin level, serum iron, total iron binding capacity and urinary iodine concentration was measured. Percentage of transferrin saturation was calculated using serum iron and total iron binding capacity values. Results The mean level of hemoglobin, serum iron, total iron binding capacity, transferrin saturation and median urinary iodine excretion were 12.29 ± 1.85 g/dl, 70.45 ± 34.46 μg/dl, 386.48 ± 62.48 μg/dl, 19.94 ± 12.07 % and 274.67 μg/L respectively. Anemia, iron deficiency and iodine deficiency (urinary iodine excretion <100 μg/L) were present in 34.5 %, 43.4 % and 12.6 % children respectively. Insufficient urinary iodine excretion (urinary iodine excretion <100 μg/L) was common in anemic and iron deficient children. Conclusions Iron deficiency and anemia are common in Nepalese children, whereas, iodine nutrition is more than adequate. Low urinary iodine excretion was common in iron deficiency and anemia

Iodine Deficiency Disorders Among Primary School Children in Eastern Nepal

Objective To assess the iodine status among primary school children of Dhankuta and Dharan in eastern Nepal. Methods A population based cross sectional study was conducted on schools of Dhankuta and Dharan from January–March 2008. 385 samples of both urine and salt were collected from school children aged 6–11 yrs. Urinary iodine excretion (UIE) was measured in casual urine samples by the ammonium-persulphate digestion microplate (APDM) method and salt iodine content by using a semi quantitative rapid test kit. Results The median UIEs of school children of Dhankuta and Dharan were 157.1 μg/L and 180.3 μg/L respectively. The percentage of iodine deficient (UIE <100 μg/L) children were 26.6% in Dhankuta and 15.6% in Dharan. The majority of children consumed packet salt. The percentages of salt samples with adequately iodized salt (≥15 ppm) were 81.3% in Dhankuta and 89.6% in Dharan. Conclusions Eastern Nepal is continuously progressing towards the sustainable elimination of iodine deficiency disease as illustrated by a normal median UIE and the majority of households consuming adequately iodized packet salt. It is necessary to maintain the program continuously to ensure adequate iodine nutrition of the population

Effect of Delay Separation and Short Term Storage of Serum on Thyroid Stimulating Hormone (TSH)

Introduction: Thyroid stimulating hormone (TSH) regulates the level of thyroid hormones synthesized in the thyroid gland. Its measurement greatly facilitates the clinical diagnosis as well as management of pituitary-thyroid diseases. The level of analytes in biological sample is affected by pre-analytical, analytical and post-analytical factors.Objective: To find the effect of delay separation and short term storage on serum TSH level.Materials and Methods: A total of 15 blood samples were collected from the patients visited to the immunoassay laboratory, Department of Biochemistry, BPKIHS for thyroid function test. Serum TSH was estimated on the day of sample collection, after 24 hours in delay separated samples and after seven days in short-term stored sample by sandwich ELISA method (Eliscan, India).Results: There were no significant difference in median serum TSH in baseline and delay separated samples (1.43 (0.18-6.52) IU/mL, vs 1.61 (0.25-6.51) IU/mL, p = 0.069) as well as baseline and short term stored samples 1.43 (0.18-6.52) IU/mL vs 1.57 (0.26-5.75), p = 0.925).</p