Ocena skuteczności profilaktyki jodowej w ciąży — analiza przeprowadzona w jednym z referencyjnych ośrodków ginekologiczno-położniczych w Polsce

  Introduction: Iodine deficiency in pregnant women, even of a mild degree, may have adverse effects on both the mother and the foetus. Despite the obligatory model of functioning iodine prophylaxis in Poland, the iodine supply in women during pregnancy and physiological lactation is insufficient. Therefore, those groups should take additional iodine supplementation at a dose of 150–200 μg/day. The aim of this study was to examine the effectiveness of iodine prophylaxis in pregnant women in Poland. Material and methods: The assessment of iodine supply, urine iodine concentration (UIC) in the spot urine sample, as well as levels of TSH, fT4, thyroid antibodies, and thyroid volume, was performed at one time point in 115 women (7 in the 1st trimester, 61 in the 2nd trimester, and 47 in the 3rd trimester). Results: Only 45.2% of women were taking additional amounts of iodine at any time of pregnancy, and the median ioduria was 79.6 μg/L, which pointed to an insufficient supply of iodine. The percentage of women using iodine supplementation increased with the length of pregnancy, which indicates that the recommendations are implemented too late. In women who took iodine supplementation, ioduria was significantly higher than in those not applying iodine supplementation (median 129.4 μg/L vs. 73.0 μg/L; p < 0.001); however, this was still below recommended values. Conclusions: The effectiveness of iodine prophylaxis in pregnant women in Poland, evaluated on the basis of the analysis of randomly chosen sample, is not satisfactory in terms of compliance with the recommendations and, possibly, the quality of supplementation. (Endokrynol Pol 2015; 66 (5): 404–411)    Wstęp: Niedobór jodu u kobiet w ciąży, nawet łagodnego stopnia, może powodować niekorzystne następstwa zarówno u matki, jak i u płodu. Mimo obligatoryjnego modelu profilaktyki jodowej funkcjonującego w Polsce, podaż jodu u kobiet w okresie ciąży i fizjologicznej laktacji jest niewystarczająca. Dlatego osoby te powinny przyjmować dodatkową suplementację jodu w dawce 150–200 μg/dobę. Celem pracy była ocena skuteczności profilaktyki jodowej u kobiet w ciąży w Polsce na podstawie analizy podaży jodu oraz jodurii. Materiał i metody: Oceniono w jednym punkcie czasowym podaż jodu, stężenie jodu w przygodnej próbce moczu, stężenia TSH, fT4 i przeciwciał przeciwtarczycowych oraz ultrasonograficznie objętość tarczycy u 115 kobiet (7 w pierwszym trymestrze, 61 w drugim trymestrze oraz 47 w trzecim trymestrze). Wyniki: Tylko 45,2% kobiet przyjmowało dodatkowe ilości jodu, a mediana jodurii u wszystkich kobiet wyniosła 79,6 μg/l, co wskazuje na niedostateczną podaż jodu. Odsetek kobiet przyjmujących suplementację jodu wzrastał wraz z długością ciąży, co sugeruje, że rekomendacje są wdrażane zbyt późno. U kobiet przyjmujących suplementację jodu, joduria była istotnie wyższa niż u kobiet nieprzyjmujących dodatkowych ilości jodu (mediana 129,4 μg/l vs. 73,0 μg/l; p< 0,001), jednak wartości te wciąż były niższe niż rekomendowane. Wnioski: Skuteczność profilaktyki jodowej u kobiet w ciąży w Polsce, oceniona na podstawie analizy przekrojowej przypadkowo wybranych osób, nie jest zadowalająca pod względem przestrzegania zaleceń, i prawdopobnie, jakości prowadzonej suplementacji. (Endokrynol Pol 2015; 66 (5): 404–411)

Digestion and body composition in muskoxen

Muskoxen (Ovibos moschatus) are relatively large herbivores living in an arctic environment where forage is sparse and its availability during long winters is often much reduced by snow and ice. Muskoxen cope by obtaining energy and nutrients from the low-quality sedges and grasses they eat, and from body reserves accumulated in summer and autumn. The objectives of this study were to evaluate the physiological and energetic adaptation of muskoxen to digestion of graminoid forage, and to measure the extent and reproductive significance of seasonal changes in body composition of female muskoxen. The first objective was addressed using two studies with captive muskoxen in Saskatoon, and the second during a field study on Victoria Island, Northwest Territories. In the first study, changes in body weight, intake, retention time and digestibility of a supplemented brome-alfalfa hay were measured in mature muskoxen during two seasonal cycles. Mean daily dry matter intake of breeding females was highest in July and August (62 ± 3.6 g/kg0.75) then declined slowly to its lowest point in March and April (41 ± 0.7 g/kg0.75). Mean retention time of hay, calculated from a chromium marker, declined (

Evaluation of efficacy of iodine prophylaxis in Poland based on the examination of schoolchildren living in Opoczno Town (Lodz Voivodship)

Abstract Background In 1997 a currently obligatory model of iodine prophylaxis, based on mandatory iodization of household salt with 30 mg KI/kg, was introduced. The aim of our study was to assess the iodine intake among school-age children living in Opoczno in 3 subsequent time points – in 1994, before establishment of currently operating model of iodine prophylaxis, in 1999 – 2 years after implementation of iodine prophylaxis and in 2010, – 14 years after its implementation. Methods We assessed goitre incidence and urine iodine concentration (UIC) in 104 children in 1994, 207 children in 1999 and 174 children in 2012. Age of examined children ranged from 6 to 15 years. The thyroid volumes evaluated by ultrasound were compared to reference values for thyroid volume proposed by Zimmermann at al. Moreover, we have introduced a new index – V/BSA ratio (comparison of thyroid volume to the body surface area), which to our belief allows for more accurate assessment of thyroid volume. Results The median of UICs was 45.5 μg/L (1994), 101.1 μg/L (1999) and 100.6 μg/L (2010). The distribution of obtained results has changed as well – iodine concentrations below 50 μg/L were present in 59.1% children in 1994, in 12.6% children – in 1999 and in 7.1% children – in 2010. Although a significant decrease in goitre incidence with regard to age – 92.6% (1994) vs 18.5% (1999) and 15.8% (2010), as well as with regard to BSA – 95.4% (1994) vs 15.2% (1999) and 11.6% (2010) was observed, it still points to the iodine deficiency, which is in contradiction with UICs as they are within normal limits. V/BSA ratio avoids such discrepancy. The values of ratio V/BSA were higher in 1994 (7.079 ± 2.775) than in 1999 (2.935 ± 1.112) (p Conclusions Hitherto model of iodine prophylaxis has proved to be effective in eliminating the iodine deficiency. The iodine intake is now more even, homogenous, which translates into smaller scatter of UICs and less percentage of children, in whom UIC is less than 50 μg/L. However, the iodine intake only slightly exceeds the recommended values, so median of UICs oscillates around the lower limit of references values.</p

The Effect of Recombinant Human TSH on Sclerostin and Other Selected Bone Markers in Patients after Total Thyroidectomy for Differentiated Thyroid Cancer

The direct effect of TSH on bone metabolism in vivo is difficult to capture as the changes of its concentrations are followed by respective alterations of thyroid hormone levels. We evaluated the effect of recombinant human TSH (rhTSH) on sclerostin and other bone markers in 29 patients after total thyroidectomy for differentiated thyroid cancer (DTC), without any signs of disease recurrence, who received L-thyroxine, most at non-suppressive doses. For two consecutive days, the patients were administered a standard dose of 0.9 mg rhTSH, i.m. Concentrations of sclerostin, osteocalcin, β-CrossLaps, PTH, and some other parameters, were measured before and five days after the first rhTSH administration. The greater the increase in TSH concentration (∆TSH), the greater the decrease in: ∆sclerostin (r = −0.672; p &lt; 0.001), ∆β-CrossLaps (r = −0.580; p &lt; 0.001) and ∆osteocalcin (r = −0.405; p = 0.029) levels, were recorded. The degree of TSH increase depended on the baseline PTH (r = 0.651; p &lt; 0.001), age, and creatinine concentrations. rhTSH strongly inhibited bone turnover, thus, TSH—independently of thyroid hormones—exerted a direct protective effect on bone metabolism. Baseline PTH affected the magnitude of TSH increase and the degree of lowering in sclerostin and β-CrossLaps that suggest factors affecting PTH may play a role in the effect of TSH on the bone

Distribution of subpopulations of dendritic cells in peripheral blood of patients treated with exogenous thyrotropin

Abstract Background Dendritic cells (DCs) play a major role as regulators of inflammatory events associated with thyroid pathology. The immunoregulatory function of DCs depends strongly on their subtype, as well as maturation and activation status. Numerous hormonal factors modulate the immune properties of DCs, however, little is known about effects exerted by the hypothalamus-pituitary-thyroid-axis. Recently, we have shown a direct regulatory influence of thyroid hormones (TH) on human DCs function. The aim of the present study was to analyze the effect of systemically administered thyrotropin (TSH) on human blood DCs ex vivo. Methods Blood samples for the cytometric analysis of peripheral blood plasmacytoid and myeloid DCs subtypes were collected from patients subjected to total thyroidectomy because of differentiated thyroid carcinoma at 2 time points: (i) directly before the commencement of TSH administration and (ii) 5 days after first TSH injection. The whole blood quantitative and phenotypic analysis of plasmacytoid and myeloid DCs subtypes was performed by flow cytometry. Results Administration of TSH did not influence the percentage of plasmacytoid DCs in peripheral blood of study participants. Also the percentage of the two main myeloid DCs subpopulations – CD1c/BDCA1+ DCs and CD141/BDCA3+ DCs did not change significantly. TSH administration had no effect on the surface expression of CD86 – one of the major costimulatory molecules – neither in the whole peripheral blood mononuclear cell (PBMC) fraction nor in particular DCs subtypes. Conclusions In the present study, we demonstrated no influence of systemic TSH administration on human peripheral blood DCs subtypes. These results are in accordance with our previous work suggesting the direct effect of TH on human DCs ex vivo.</p