M. Tajtakova et al., RECOGNITION OF A SUBGROUP OF ADOLESCENTS WITH RAPIDLY GROWING THYROIDS UNDER IODINE-REPLETE CONDITIONS - 7 YEAR FOLLOW-UP, European journal of endocrinology, 138(6), 1998, pp. 674-680
Objective: To evaluate whether small iodine supplements decrease the i
ncidence of adolescent thyroid hypertrophy in an iodine-sufficient pop
ulation or whether such thyroid enlargement should be considered an in
evitable physiological phenomenon. Design: Beginning in September 1991
(after an initial examination in September 1990), 54 11-year-old chil
dren in Bardejov, Slovakia were given small iodine supplements (Thyroj
od depot tablets containing 1530 mu g iodide) every 2 weeks for 2 year
s followed by once weekly for 2 years. A second group of 63 children s
erved as controls. In June 1995, there were still 52 treated and 60 co
ntrol children in the study and these were examined; 44 treated and 48
control children remained in the study until June 1997. Methods: In 1
990, 1993, 1995, 1996 and 1997 the thyroid volume (ThV) was measured b
y ultrasound. Serum levels of TSH, thyroglobulin, total and free thyro
xine and tri-iodothyronine and anti-thyroid peroxidase (anti-TPO), ant
i-thyroglobulin (anti-TG) and anti-TSH receptor (TSR) antibodies were
estimated in 1990 and 1994, while only TSH, and anti-TPO and anti-TSR
antibodies were measured in 1997. Results: There was no difference bet
ween the groups at any interval in the serum levels of the hormones me
asured. Marginally increased TSH was found in two treated and two cont
rol children. Anti-TSR antibodies were negative in all children, while
anti-TPO and anti-TG antibodies were found in one treated and four co
ntrol children. At the age of 10 years (1990), 84% of all ThVs were le
ss than 4 ml, indicating a previous life-long sufficient iodine intake
. After the treatment was completed (June 1995), a significant differe
nce in ThV (P < 0.04) was found between the whole treated (5.78 +/- 0.
19 ml) and the whole control group (6.56 +/- 0.30 ml), However, there
was already a marked difference in the 75th percentile (6.4 ml in trea
ted vs 8.5 ml in controls) due to more rapid thyroid growth in certain
children of the control group (ThV >7.0 ml in 6/52 treated children v
s 24/60 controls: P < 0.01). Since such differences were much higher i
n 1997, the children in each group whose ThV was in the range of the u
pper 25% in 1997 were retrospectively evaluated as arbitrary separate
subgroups in all the time intervals and compared with the remaining 75
% of children who showed moderate thyroid growth rate, Two years after
the termination of treatment (June 1997), excessive thyroid growth co
ntinued in the upper quarter of 12 controls with the highest ThV (13.6
0 +/- 0.40 ml or 7.60 +/- 0.29 ml/m(2); 12/12 with ThV >11.0 ml), and
a similar subgroup now also appeared in 11 previously treated children
(10.79 +/- 0.51 ml or 6.19 +/- 0.30 ml/m(2); 5/11 with ThV >11.0 ml),
At the same time, ThV in the remaining 75% of both control (8,12 +/-
0.38 ml or 4.82 +/- 0.17 ml/m(2); 3/36 with ThV >11.0 ml) and treated
(7.20 +/- 0.30 ml or 4.39 +/- 0.17 ml/m(2); 0/33 with ThV >11.0 ml) ch
ildren was significantly less (P < 0.01 to P < 0.001) than that in the
appropriate rapidly growing subgroups. During the whole observation p
eriod (1990-1997), no difference was found between treated and control
subgroups with moderate thyroid growth. Conclusions: Since iodine int
ake in Slovakia has been adequate for decades and sporadic iodine defi
ciency is highly unlikely, the observed excessive thyroid growth in ce
rtain adolescents may result from causes other than simple iodine defi
ciency (e.g. hereditary), which are nevertheless ameliorated by small
iodine supplements. The question remains whether such a subgroup with
rapidly growing thyroids should be included in the range of normal thy
roid volumes in adolescents.