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Endemic infantile hypothyroidism in a severe endemic goitre area of central Africa.

Abstract：

:Thyroid function and exposure to dietary goitrogenic factors (iodine deficiency and thiocyanate overload) were studied at birth and from birth to 7 years in 200 neonates and 347 children living in the severe endemic goitre area of Ubangi, Northern Zaire. Serum T4 was at the lower limit of normal at birth (104 +/- 4 nmol/l) and stayed at that level during the first year of life (123 +/- 9) (NS), but decreased to 75 +/- 8 (P less than 0.001) at 2-4 years and to 62 +/- 6 (P less than 0.001) at 5-7 years of age. Mean serum FT4 decreased from 10.4 +/- 0.9 pmol/l during the first year to 8.2 +/- 1.0 (NS) at 2-4 years (NS) and to 7.7 +/- 0.9 (P less than 0.05) at 5-7 years. Mean serum TSH was 10.4 (8.4-12.9) mU/l (geometric mean +/- 1 SEM) during the first year, 10.1 (7.5-13.7) (NS) at 2-4 years and 24.3 (18.5-31.9) (P less than 0.05) at 5-7 years. Mean serum T3 was 3.23 +/- 0.12 nmol/l during the first year and remained stable thereafter. The frequencies of low T4 (T4 less than 77 nmol/l), high TSH TSH (TSH greater than 50 mU/l), and low T4 and T3 (T3 less than 1.69 nmol/l) were twice as high at 5-7 years as in the first year (respectively 65%, 42% and 15%). The urinary iodide concentration of the children was stable and low throughout the study period. By contrast, serum thiocyanate concentration which was high at birth (129 +/- 5 mumol/l) decreased to normal values between 3 and 12 months of age and increased again during and after weaning (1 to 3 years of age) to reach a value of 138 mumol/l which was comparable to that observed in adults in the same area. Thiocyanate concentration was high (133 +/- 7 mumol/l) in the mothers' serum but low in the mothers' milk (57 +/- 3 mumol/l) (P less than 0.001). Multivariate analysis showed that both iodine deficiency and thiocyanate overload were explanatory factors of the serum levels of T4, FT4 and TSH in children. In conclusion, our results show that infantile hypothyroidism is much more frequent at 5-7 years of age than at birth or during the first year of life. The deterioration in thyroid function during and after weaning is linked to persistent iodine deficiency accompanied by an increase in thiocyanate overload. The variability in the age of onset, the severity, and the duration of infantile hypothyroidism might explain the wide range of psychomotor and physical abnormalities observed in a large proportion of subjects in this area. :Thyroid function and exposure to dietary goitrogenic factors (iodine deficiency and thiocyanate overload) were studied at birth and from birth to 7 years in 200 neonates and 347 children living in the severe endemic goiter area of Ubangi, Northern Zaire. Serum T4 was at the lower limit of normal at birth (104 +or- 4 nmol/1) and stayed at that level during the 1st year of life (123 +or- 9) (NS), but decreased to 75 +or- 8 (P0.001) at 2-4 years and to 62 +or- 6 (P.001) at 5-7 years of age. Mean serum FT4 decreased from 10.4 +or- 0.9 pmol/1 during the 1st year to 8.2 +or- 1.0 (NS) at 2-4 years (NS) and to 7.7 +or- 0.9 (P0.05) at 5-7 years. Mean serum TSH was 10.4 (8.4-12.9) mU/1 (geometric mean +or- 1 SEM) during the 1st year, 10.1 (7.5-13.7) (NS) at 2-4 years, and 24.3 (18.5-31.9) (P0.05) at 5-7 years. Mean serum T3 was 3.23 +or- 0.12 nmol/1 during the 1st year and remained stable thereafter. The frequencies of low T4 (T477 nmol/1), high TSH TSH (TSH50 mU/1), and low T4 and T3 (T31.69 nmol/1) were twice as high at 5-7 years as in the 1st year 65%, 42%, and 15%, respectively). The urinary iodide concentration of the children was stable and low throughout the study period. By contrast, serum thiocyanate concentration which was high at birth (129 +or- 5 cmol/1) decreased to normal values between 3-12 months of age and increased again during and after weaning (1-3 years of age) to reach a value of 138 umol/1 which was comparable to that observed in adults in the same area. Thiocyanate concentration was high (133 +or- 7 umol/1) in the mothers' serum but low in the mothers' milk (57 +or- 3 umol/1) (P0.001). Multivariate analysis showed that both iodine deficiency and thiocyanate overload were explanatory factors of the serum levels of T4, FT4, and TSH in children. The results show that infantile hypothyroidism is more frequent at 5-7 years of age than at birth or during the 1st year of life. The deterioration in thyroid function during and after weaning is linked to persistent iodine deficiency accompanied by an increase in thiocyanate overload. Variability in age at onset, severity, and duration of infantile hypothyroidism might explain the wide range of psychomotor and physical abnormalities observed in a lage proportion of subject, in this area.

journal_name

Clin Endocrinol (Oxf)

journal_title

Clinical endocrinology

authors

Vanderpas J,Bourdoux P,Lagasse R,Rivera M,Dramaix M,Lody D,Nelson G,Delange F,Ermans AM,Thilly CH

doi

10.1111/j.1365-2265.1984.tb00089.x

subject

Has Abstract

pub_date

1984-03-01 00:00:00

pages

327-40

issue

eissn

0300-0664

issn

1365-2265

journal_volume

pub_type

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Endemic infantile hypothyroidism in a severe endemic goitre area of central Africa.