Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-23T23:35:33.942Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of neonatal thyroid-stimulating hormone levels and indicators of iodine deficiency in school children

Published online by Cambridge University Press:  02 January 2007

Daphne L Copeland ,
Kevin M Sullivan ,
Robin Houston ,
Warwick May ,
Ivan Mendoza ,
Quazi Salamatullah ,
Noel Solomons ,
Dale Nordenberg  and
Glen F Maberly
Daphne L Copeland
Affiliation:
Rollins School of Public Health of Emory University, and the Program Against Micronutrient Malnutrition (PAMM), Department of Epidemiology,1518 Clifton Road NE,Atlanta,GA 30322, USA
Kevin M Sullivan*
Affiliation:
Rollins School of Public Health of Emory University, and the Program Against Micronutrient Malnutrition (PAMM), Department of Epidemiology,1518 Clifton Road NE,Atlanta,GA 30322, USA
Robin Houston
Affiliation:
Rollins School of Public Health of Emory University, and the Program Against Micronutrient Malnutrition (PAMM), Department of Epidemiology,1518 Clifton Road NE,Atlanta,GA 30322, USA Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
Warwick May
Affiliation:
Rollins School of Public Health of Emory University, and the Program Against Micronutrient Malnutrition (PAMM), Department of Epidemiology,1518 Clifton Road NE,Atlanta,GA 30322, USA
Ivan Mendoza
Affiliation:
Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
Quazi Salamatullah
Affiliation:
Institute of Nutrition and Food Science, Dhaka University, Dhaka, Bangladesh
Noel Solomons
Affiliation:
Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
Dale Nordenberg
Affiliation:
Rollins School of Public Health of Emory University, and the Program Against Micronutrient Malnutrition (PAMM), Department of Epidemiology,1518 Clifton Road NE,Atlanta,GA 30322, USA
Glen F Maberly
Affiliation:
Rollins School of Public Health of Emory University, and the Program Against Micronutrient Malnutrition (PAMM), Department of Epidemiology,1518 Clifton Road NE,Atlanta,GA 30322, USA
*
*Corresponding author: Email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

To compare thyroid-stimulating hormone (TSH) levels in neonatal cord blood between study sites in Bangladesh, Guatemala and the United States. Also, to compare neonatal TSH results with indicators of iodine deficiency in school children.

Design:

Consecutive births and, in school children, cross-sectional surveys.

Setting:

Savar, Bangladesh; San Pedro Sacatepequez, Guatemala; and Atlanta, United States.

Subjects:

In each study site, cord blood was spotted on to filter paper and TSH levels determined using a sensitive monoclonal assay. In the USA, heel stick blood specimens from newborns spotted on to filter paper were also obtained as well as exposure to iodine-containing antiseptics during the birthing process. Urine specimens were collected from mothers of newborns and tested for iodine concentration. School children in the same areas were surveyed for thyroid size by palpation and ultrasonography, and urine specimens collected for iodine concentration.

Results:

Between 141 and 243 cord blood specimens were collected from each study site. The prevalence of elevated cord blood TSH levels (>5 mU l−1) was high in all study sites, from 58% to 84%. All sites would be categorised as having ‘severe’ iodine deficiency based on WHO/UNICEF/ICCIDD criteria. Iodine-containing antiseptics were used during 98% of the births in the USA but not in Bangladesh or Guatemala. The neonatal TSH classification indicated more severe iodine deficiency levels than classifications based on urinary iodine and goitre in school children.

Conclusions:

In the USA, elevated TSH levels may be partially attributed to use of beta-iodine-containing antiseptics prior to birth. We recommend the cautious interpretation of TSH results in newborns for the assessment of iodine deficiency disorders when iodine-containing antiseptics are used during the birthing process.

Keywords

Iodine deficiencyThyroid-stimulating hormoneUrinary iodineGoitreNeonatal screeningHumansNewborns
Type
Research Article
Information
Public Health Nutrition , Volume 5 , Issue 1 , February 2002 , pp. 81 - 87
Copyright
Copyright © CABI Publishing 2002

References

1WHO/UNICEF/ICCIDD Joint Consultation. Indicators for Assessing Iodine Deficiency Disorders and Their Control Through Salt Iodization. WHO/NUT/94.6. Geneva: World Health Organization, 1994.Google Scholar
2Delange, F. The disorders induced by iodine deficiency. Thyroid 1994; 4(1): 107–28.CrossRefGoogle ScholarPubMed
3Maberly, GF, Trowbridge, FL, Yip, R, Sullivan, KM, West, CE. Programs against micronutrient malnutrition: ending hidden hunger. Annu. Rev. Public Health 1994; 15: 277–301.CrossRefGoogle ScholarPubMed
4Delange, F, Heidemann, P, Bourdoux, P, Larsson, A, Vigneri, R, Klett, M, Beckers, C, Stubbe, P. Regional variations of iodine nutrition and thyroid function during the neonatal period in Europe. Biol. Neonate 1986; 49: 322–30.CrossRefGoogle ScholarPubMed
5Nordenberg, D, Sullivan, K, Maberly, G, Wiley, V, Wilcken, B, Bamforth, F, Jenkins, M, Hannon, H, Adam, B. Congenital hypothyroid screening programs and the sensitive thyrotropin assay: strategies for the surveillance of iodine deficiency disorders. In: Delange, F, Dunn, J, Glioer, D, eds. Iodine Deficiency in Europe: A Continuing Concern. New York: Plenum Press, 1993; 211–7.CrossRefGoogle Scholar
6Nordenberg, DF, Ratajczak, R, Rybakowz, M, Tylck, D, Maberly, GF. Congenital hypothyroid screening programs – a sensitive IDD surveillance system. In: Stanbury, JB, ed. The Damaged Brain of Iodine Deficiency – Cognitive, Behavioral, Neuromotor, Educative Aspects. New York: Cognizant Communications Corporation, 1994; 279–85.Google Scholar
7Nordenberg, DF, Ratajczak, R, Rybakowa, M, Tylck, D, Sullivan, K, Wiley, V, Wilcken, B, Bamforth, F, Maberly, GF. TSH levels among newborns – an indicator for community based iodine status. In: Takasugi, N, Naruse, H, eds. New Trends in Neonatal Screening, Proceedings of the First Asian Pacific Regional Meeting of International Society for Neonatal Screening. Sapporo, Japan: Hokkaido University Press, 1994; 223.Google Scholar
8Rushworth, RL, Wang, ZL, Wang, QN, Eastmann, CJ, Maberly, GF. Monitoring iodine prophylaxis programs in Qinghai Province, People's Republic of China. In: Proceedings of Symposium on IDD. Tianjin, China: Asia–Oceania Thyroid Association, 1989.Google Scholar
9Carta Sorcini, M, Diodato, A, Fazzini, C, Sabini, G, Carta, S, Grandolfo, ME, Guidi, M, Vasta, M, Locatelli De Maestri, J, Donati, L. Influence of environmental iodine deficiency on neonatal thyroid screening results. J. Endocrinol. Invest. 1988; 11: 309–12.CrossRefGoogle ScholarPubMed
10Sullivan, KM, May, W, Nordenberg, D, Houston, R, Maberly, GF. Use of thyroid stimulating hormone testing in newborns to identify iodine deficiency. J. Nutr. 1997; 127: 55–8.CrossRefGoogle ScholarPubMed
11Waite, KV, Maberly, GF, Ma, G, Eastman, CJ. Immunoradiometric assay with use of magnetizable particles: measurement of thyrotropin in blood spots to screen for neonatal hypothyroidism. Clin. Chem. 1986; 32: 1966–8.CrossRefGoogle ScholarPubMed
12Yasin, F, Ma, G, Maberly, GF. Evaluation of an iodization programme in Central Java, Indonesia – a preliminary report. In: Nagataki, S, Torizuka, K, eds. The Thyroid. New York: Excerpta Medica, 1988; 319–22.Google Scholar
13UNICEF. The State of the World's Children: 1998. New York: Oxford University Press, 1998.Google Scholar
14Fisher, DA, Klein, AH. Thyroid development and disorders of thyroid function in the newborn. N. Engl. J. Med. 1981; 304: 702–12.CrossRefGoogle ScholarPubMed
15John, R, Bamforth, FJ. Serum free thyroxine and free triiodothyronine concentrations in healthy fullterm, preterm and sick preterm neonates. Ann. Clin. Biochem. 1987; 24: 461–5.CrossRefGoogle ScholarPubMed
16Illig, R. Neonatal screening for hypothyroidism by TSH determination in dried blood. In Bickel, H, Guthrie, R, Hammersen, G eds. Neonatal Screening for Inborn Errors of Metabolism. Berlin/New York: Springer-Verlag, 1980; 170–89.Google Scholar
17Ma, T, Lu, TZ. Present situation of the monitoring of neonatal hypothyroidism in iodine deficient endemic areas in China. In: Takasugi, N, Naruse, H. eds. New Trends in Neonatal Screening, Proceedings of the First Asian Pacific Regional Meeting of the International Society for Neonatal Screening. Sapporo, Japan: Hokkaido University Press, 1994; 225–30.Google Scholar
18Delange, F. Screening for congenital hypothyroidism used as an indicator of the degree of iodine deficiency and its control. Thyroid 1998; 8: 1185–92.CrossRefGoogle ScholarPubMed
19Costante, G, Grasso, L, Ludovico, O, Marasco, MF, Nocera, M, Schifino, E, Rivalta, L, Capula, C, Chiarella, R, Filetti, S, Parlato, G. The statistical analysis of neonatal TSH results from congenital hypothyroidism screening programs provides a useful tool for the characterization of moderate iodine deficiency regions. J. Endocrinol. Invest. 1997; 20: 251–6.CrossRefGoogle Scholar
20Shi, L, Shi, Z, Zhang, J, Ma, Q, Kong, D, Yong, L, Tan, Y. The measurement and application of TSH-IRMA levels among different age groups in areas with iodine deficiency disorders. Chin. Med. Sci. J. 1995; 10: 30–3.Google ScholarPubMed
21Sava, L, Delange, F, Belfiore, A, Purrello, F, Vigneri, R. Transient impairment of thyroid function in newborn from an area of endemic goiter. J. Clin. Endocrinol. Metab. 1984; 59: 90–5.CrossRefGoogle ScholarPubMed
22Lao, TT, Panesar, NS. Neonatal thyrotropin and mode of delivery. Br. J. Obstet. Gynaecol. 1990; 96: 1224–7.CrossRefGoogle Scholar
23Shi, LX, Ma, QL, Zhang, JX. Influence of perinatal factors and sampling methods on thyroid stimulating hormone and thyroid hormone levels in cord blood. Chung Huas Fu Chan Ko Tsa Chih 1984; 29: 714–6, 760–1.Google Scholar
24Virtanen, M, Maenpaa, J, Pikkarainen, J, Pitkanen, L, Perheentupa, J. Aetiology of congenital hypothyroidism in Findland. Acta. Paediatr. Scand. 1989; 78: 67–73.CrossRefGoogle Scholar
25Chanoine, JP, Boulvain, M, Bourdoux, P, Pardou, A, Van Thi, HV, Ermans, AM, Delange, F. Increased recall rate at screening for congenital hypothyroidism in breast fed infants born to iodine overloaded mothers. Arch. Dis. Child. 1988; 63: 1207–10.CrossRefGoogle ScholarPubMed
26Chanoine, JP, Pardou, A, Bourdoux, P, Delange, F. Withdrawal of iodinated disinfectants at delivery decreases the recall rate at neonatal screening for congenital hypothyroidism. Arch. Dis. Child. 1988; 63: 1297–8.CrossRefGoogle ScholarPubMed
27Clemens, PC, Neumann, RS. Influence of iodine overloading on neonatal thyroid screening results. J. Endocrinol. Invest. 1989; 12: 841.CrossRefGoogle ScholarPubMed
28Novaes Junior, M, Biancalana, MM, Garcia, SA, Rassi, I, Romaldini, JH. Elevation of cord blood TSH concentration in newborn infants of mothers exposed to acute povidone iodine during delivery. J. Endocrinol. Invest. 1994; 17: 805–8.CrossRefGoogle ScholarPubMed
29Chabrolle, JP, Rossier, A. Goitre and hypothyroidism in the newborn after cutaneous absorption of iodine. Arch. Dis. Child. 1978; 53: 495–8.CrossRefGoogle ScholarPubMed
30Delange, F, Chanoine, JP, Abrassart, C, Bourdoux, P. Topical iodine, breastfeeding, and neonatal hypothyroidism. Arch. Dis. Child. 1988; 83: 106–7.CrossRefGoogle Scholar
31Smerdely, P, Lim, A, Boyages, SC, Waite, K, Wu, D, Roberts, V, Leslie, G, Arnold, J, John, E, Eastman, CJ. Topical iodine-containing antiseptics and neonatal hypothyroidism in very-low-birthweight infants. Lancet 1989; 2: 661–4.CrossRefGoogle ScholarPubMed
32L'Allemand, D, Gruters, A, Beyer, P, Weber, B. Iodine in contrast agents and skin disinfectants is the major cause for hypothyroidism in premature infants during intensive care. Horm. Res. 1987; 28: 42–9.CrossRefGoogle ScholarPubMed
33Fisher, DA. Euthyroid low thyroxine (T4) and triiodothyronine (T3) states in prematures and sick neonates. Pediatr. Clin. North Am. 1990; 37: 1297–312.CrossRefGoogle ScholarPubMed
34Tuuminen, T, Tsukerman, G, Dhondt, JL. Population-based differences in thyrotropin and thyroxine distributions in health newborns: revealing results from independent reagent evaluation. Eur. J. Clin. Chem. Clin. Biochem. 1996; 34: 565–8.Google Scholar
35Dean, AG, Dean, JA, Coulombier, D, Brendel, KA, Smith, DC, Burton, AH, Dicker, RC, Sullivan, K, Fagan, RF, Arner, TG. Epi Info, Version 6: A Word Processing, Database, and Statistics Program for Epidemiology on IBM Microcomputers. Atlanta, GA: Centers for Disease Control and Prevention, 1995.Google Scholar
36Delange, F, Benker, G, Caron, P, Eber, O, Ott, W, Peter, F, Podoba, J, Simescu, M, Szybinsky, Z, Vertongen, F, Vitti, P, Wiersinga, W, Zamrazil, V. Thyroid volume and urinary iodine in European schoolchildren: standardization of values for assessment of iodine deficiency. Eur. J. Endocrinol. 1997; 136: 180–87.CrossRefGoogle ScholarPubMed
37Dunn, JT, Crutchfield, HE, Gutekunst, R, Dunn, AD. Two simple methods for measuring iodine in urine. Thyroid 1993; 3: 119–23.CrossRefGoogle ScholarPubMed
38May, SL, May, WA, Bourdoux, PP, Pino, S, Sullivan, KM, Maberly, GF. Validation of a simple, manual urinary iodine method for estimating the prevalence of iodine deficiency disorders, and interlaboratory comparison with other methods. Am. J. Clin. Nutr. 1997; 65: 1441–5.CrossRefGoogle ScholarPubMed
39Gahlinger, PM, Abramson, JH. Computer Programs for Epidemiologic Analysis: PEPI Version 2. Stone Mountain, GA: USD, Inc., 1995.Google Scholar
40Gardner, M, Altman, D. Statistics with Confidence: Confidence Intervals and Statistical Guidelines. London: British Medical Journal, 1989.Google Scholar
41Hollowell, JG, Staehling, NW, Hannon, WH, Flanders, DW, Gunter, EW, Maberly, GF, Braverman, LE, Pino, S, Miller, DT, Garbe, PL, DeLozier, DM, Jackson, RJ. Iodine nutrition in the United States. Trends and public health implications: iodine excretion data from National Health and Nutrition Examination Surveys I and III (1971–1974 and 1988–1994). J. Clin. Endocrinol. Metab. 1998; 83: 3401–8.Google Scholar