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Environmental factors are involved in goiter development. An increased number of goitrous patients were identified among outpatients in Gyrocaster, a mountainous region in Southwestern Albania. We examined possible associations of thyroid enlargement with nutritional factors. 112 consecutive patients, 104 females, aged 52.8 +/-12.1 (mean+/-SD), who either were taking thyroxine (n=27) or were suspected to have thyroid disease were examined. Thyroid parameters and nutritional habits were recorded and serum selenium and urine iodine levels were determined; thyroid ultrasound was performed. The median thyroid volume (TV) was 20.4 ml (range 4.4-97.6). All consumed food was home-produced. TV correlated negatively with the frequency of lamb-goat meat and vegetables consumption (p=0.05 and p=0.03, respectively). Mean TV was significantly lower in those eating lamb-goat >1 times/week (21.4+/-13.3 vs 31.9+/-23 ml, p<0.01). The association of TV with lamb meat consumption was independent of sex, education or occupation (p < 0.009). Selenium levels ranged from 30.6-138 microg/L (reference range 43-190). There was no association between selenium levels and TV. 43% of the subjects had TSH < 0.3 mU/L (those on thyroxine were excluded). Log TSH correlated negatively with TV and fT4 levels (p < 0.007), indicating the presence of autonomy (TSHRab positive in two subjects). Mean urinary iodine excretion was 99.8+/-35.3 microg/gr creatinine (normal >100). Nutritional factors may be involved in the development of goiter in Southwestern Albania. No role of selenium was found. The higher consumption of lamb-goat meat and vegetables, all non-industrialized, appeared to be protective. This finding may reflect better socioeconomic status, although this was not identified. Unrecognized subclinical hyperthyroidism, probably due to thyroid autonomy, was quite common.
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Address for correspondence:
Maria Alevizaki MD PhD, Professor in Endocrinology, Department of Endocrinology, Metabolism and Diabetes, Evgenideion
Hospital, Athens University School of Medicine, 18 Papadiamantopoulou Street, 115 27 Athens, Greece,
Tel +30-210-7208181 Fax +30-210-7704143, e-mail: mani@otenet.gr
Received 21-07-09, Revised 20-08-09, Accepted 10-09-09
Thyroid volume, selenium levels and nutritional habits
in a rural region in Albania
John Doupis2, Charalambos Stavrianos1, Katerina Saltiki1, Emily Mantzou1,
Antonios Mastrokostopoulos2, George Philippou1, Maria Alevizaki1
1
Department of Endocrinology, Metabolism and Diabetes, Evgenideion Hospital, Athens University School of Medicine,
Athens, Greece; 2Military Hospital of Gyrocaster, Gyrocaster, Albania
ABSTRACT
OBJECTIVE Environmental factors are involved in goiter development. An increased number
of goitrous patients were identified among outpatients in Gyrocaster, a mountainous region in
Southwestern Albania. We examined possible associations of thyroid enlargement with nutri-
tional factors. DESIGN 112 consecutive patients, 104 females, aged 52.8 ±12.1 (mean±SD),
who either were taking thyroxine (n=27) or were suspected to have thyroid disease were ex-
amined. Thyroid parameters and nutritional habits were recorded and serum selenium and
urine iodine levels were determined; thyroid ultrasound was performed. RESULTS The median
thyroid volume (TV) was 20.4ml (range 4.4-97.6). All consumed food was home-produced.
TV correlated negatively with the frequency of lamb-goat meat and vegetables consumption
(p=0.05 and p=0.03, respectively). Mean TV was significantly lower in those eating lamb-goat
>1 times/week (21.4±13.3 vs 31.9±23 ml, p<0.01). The association of TV with lamb meat con-
sumption was independent of sex, education or occupation (p<0.009). Selenium levels ranged
from 30.6-138μg/L (reference range 43-190). There was no association between selenium levels
and TV. 43% of the subjects had TSH<0.3 mU/L (those on thyroxine were excluded). Log TSH
correlated negatively with TV and fT4 levels (p<0.007), indicating the presence of autonomy
(TSHRab positive in two subjects). Mean urinary iodine excretion was 99.8±35.3μg/gr creati-
nine (normal >100). CONCLUSIONS Nutritional factors may be involved in the development
of goiter in Southwestern Albania. No role of selenium was found. The higher consumption of
lamb-goat meat and vegetables, all non-industrialized, appeared to be protective. This finding
may reflect better socioeconomic status, although this was not identified. Unrecognized sub-
clinical hyperthyroidism, probably due to thyroid autonomy, was quite common.
Key words: Albania, Iodine, Nutrition, Protein diet, Selenium, Thyroid
Research paper
HORMONES 2009, 8(4):296-302
Thyroid volume and nutrition in Albania 297
fish, vegetables, carbohydrates, dairy products. The
manner of food preparation, as boiled, fried, baked,
was also recorded. In all cases the ingredients as
well as the consumed food were home-produced.
With regard to fish only sea-fish consumption was
reported. All eggs consumed were locally obtained
from free-fed chickens and hens kept by the family.
No industrial food or mineral supplements were given
to the chickens. Dairy products (yogurt, cheese)
mainly came from sheep and goat milk. Most fami-
lies in Southwestern Albania obtain their everyday
milk from animals that are free-fed in the fields and
raised in small family units. No industrialised food
supplementation was used to feed these animals.
Recorded clinical and epidemiological data were
the following: presence of clinical goiter, height,
weight, blood pressure, tobacco use, family history
of thyroid disease, occupation and education level.
The place of residence from birth to 10yrs was also
recorded. The study was approved by the local Eth-
ics Committee. Ultrasound imaging (US) was used
in all subjects included in the study to determine
thyroid volume.
Twenty-seven patients were receiving thyroxine
for nodular goitre or hypothyroidism and 85 were
suspected to have thyroid disease based on symptoms
and/or physical examination (such as presence of
goiter, tachycardia and changes in body weight).
Hormone and biochemical measurements
Fasting blood samples were obtained by veni-
puncture between 08:00-09:00h. The specimens were
stored at -20° C until the determination of the levels
of thyrotropin (TSH), triiodothyronine (T3), free
thyroxine (fT4) and thyroid autoantibodies using the
same or consecutive batches of assays.
TSH was measured by chemiluminescence ILMA
two-site chemiluminescence immunoassay (DPC
Immulite 2000, 5210 Pacific Concourse Drive, Los
Angeles, CA 90045-6900, USA). The reference range
was 0.3-4.0 mU/L, while the intra- and inter-assay
variability were both 5.3% at 0.32 mU/L and 3.8%
and 4.6% at 1.3 mU/L, respectively. Total triiodothy-
ronine was measured by chemiluminescence immu-
noassay (DPC Immulite 2000, Los Angeles, USA).
The reference range was 0.8-2.8 nmol/L, while the
intra- and inter-assay variability was 7.6% and 8.6%
IntroductIon
Albania is an in-transition country in the Balkan
area and among those with the lowest per capita in-
come in Europe. The Health System of Albania, as the
Albanian society itself, is now taking its first steps in
adopting the Western financial model. Globalization
in modern Western society, even at the level of dietary
practices, either in the form of food or at the level of
dietary habits, tends to eradicate the effect of local
dietary factors over various diseases mostly in urban
areas.
1
In rural areas where the socioeconomic status
is based on agriculture and farming, local dietary
patterns tend to be unchanged.2 Albania which has
not yet completely entered the modern Western way
of life may still provide the opportunity to study the
effects of traditional local diet on thyroid disease.
It is also known that Albania is a country with
iodine deficiency, mainly due to the mountainous
morphology of its terrain. Meanwhile, iodine defi-
ciency has been reported to be the main cause of the
high incidence of goiter in this country.3 Moreover,
the type of diet seems to play a role in the manifesta-
tion of goiter.4,5
There are several reports in the literature which
examine the role of nutritional factors in the aetiology
of goiter. Such nutritional factors include iodine, sele-
nium, vitamin A and iron as well as foods containing
thiocyanates and proteins.6-10
The purpose of this paper was to study thyroid
status in inhabitants of the region of Gyrocaster in
Southwestern Albania, who were attending the out-
patients’ clinic for routine examination, in relation to
their dietary habits and their socioeconomic level.
materIals and metHods
All patients attending the internal medicine out-
patients’ clinic of the General Military Hospital of
Gyrocaster, a mountainous region in Southwestern
Albania, were examined for the presence of clinical
goiter during a period of six months. We included
in the study 112 consecutive patients (mean age
52.8±12.1yrs, 104 females) who had known or sus-
pected thyroid disease.
The nutritional factors that were recorded included
the type and frequency (portions per week) of food
consumption such as lamb-goat, chicken, beef, pork,
298 J. DouPis et Al
variables were calculated using Pearson’s correlation
coefficient or Spearman’s correlation coefficient.
Multivariate analysis (step multiple regression) was
performed including as possible confounders all the
variables for which there was some correlation which
was statistically significant or tending to be significant
in the univariate analysis. Where the distribution was
normal, the t-test was used for comparing the means,
otherwise the Mann-Whitney rank-test was used.
results
Four patients were current and four were ex-smok-
ers. Twenty percent of them reported a family history
of thyroid disease, 23.8% of them had positive anti-
TPO ab and 25.7% had positive anti-TG ab.
Food consumption according to the type and fre-
quency is shown in Figure 1. The most popular food
types consumed by the patients were milk products
followed by vegetables in second place. The type of
meat consumed consisted almost exclusively of roasted
lamb and goat. Fish consumption was rare and was
never reported more than twice a week.
According to the ultrasound data the median thy-
roid volume was 20.4 ml (range 4.4-97.6). Assuming an
upper normal limit of 20 ml for non-iodine deficient
areas, roughly 50% of our patients had increased
thyroid volume. Thyroid volume was negatively cor-
related with the frequency of lamb and goat meat,
as well as vegetable consumption (r=-0.200, p=0.05
and r=-0.218 p=0.03, Spearman’s correlation coef-
ficient). Mean thyroid volume was significantly lower
in those subjects who ate lamb more than once a week
(21.4±13.3ml vs 31.9±23.0ml, p<0.01, t-test). Similarly,
when subjects with known hypothyroidism and/or
with positive TRab were excluded from the analysis,
thyroid volume was negatively associated with the
frequency of lamb and goat consumption (r=-0.483,
p=0.01 Spearman’s correlation coefficient). In the
same subgroup mean thyroid volume was significantly
lower in those who ate lamb more than once a week
(21.72±13.5 vs 42.13±27.0, p=0.02, t-test).
Stepwise multivariate analysis showed that the
association of thyroid volume with the frequency of
lamb and goat consumption was independent of sex,
of vegetable consumption, educational status or oc-
cupation (p<0.009, Table 1).
(at 1.3 nmol/L), respectively. Free thyroxine was
measured by chemiluminescence immunoassay (DPC
Immulite 2000, Los Angeles, USA). The reference
range was 10-25 pmol/L, while the intra- and inter-
assay variability were 6.4% and 7.1% (at 18 pmol/L),
respectively.
Antibodies to thyroperoxidase (anti-TPO Ab) were
measured by chemiluminescence (DPC Immulite
2000, Los Angeles, USA). The intra-assay variability
was 4.4% (at 274 IU/mL), while the inter-assay vari-
ability was 7.0% (at 349 IU/mL). Reference values of
anti-TPO Ab were lower than 30 IU/mL. Antibodies
to thyroglobulin (anti-Tg Ab) were measured by chemi-
luminescence (DPC Immulite 2000, Los Angeles,
USA). The intra-assay variability was 3.5% (at 205
U/mL) and the inter-assay variability was 5.0% (at 201
IU/mL). Reference values of anti-Tg Ab were lower
than 40 U/mL. TSH-Receptor Ab (TSHRAb) were
measured in those patients with TSH <1 mU/L using
the BRAHMS human TRAK RIA assay (BRAHMS,
Hennigsdorf, Germany).
Serum selenium levels were determined using a
spectrophotometric assay. Selenium levels reference
range is 43-190 μg/L.
11
Urinary iodine was determined
by a spectrophotometric method employing chloric
acid as an oxidizing agent12 and was calculated as the
ratio of microgram iodine per gram creatinine (μg
I/gr creatinine). Normal urinary iodine excretion is
>100 μg/gr creatinine.
Thyroid ultrasound
Thyroid volume was determined by real-time ul-
trasonography, this test being carried out with each
subject lying supine with the neck hyper-extended.
The length (l), width (w) and depth (d) of each thyroid
lobe (in centimeters) were measured on transverse
and longitudinal scans. The volume (V) of each lobe
expressed in milliliters was estimated by the modified
formula of the rotation ellipsoid V (ml) = 0.479 x d x
w x l, as previously described.13 The thyroid volume
was defined as the sum of the volumes of both lobes.
The volume of the isthmus was not included; the
presence of nodules was also recorded.
Statistical analysis
Statistical analysis was done using the SPSS sta-
tistical package. All descriptive data are presented
as mean SD. Correlations between continuous
Thyroid volume and nutrition in Albania 299
As the number of men included in the study was
very small, these analyses were repeated in the group of
women only. Similar results were obtained in all cases
and the associations remained significant at the same
statistical level. In this subgroup, multivariate analysis
showed again an independent effect of lamb and goat
consumption as well as vegetable consumption on
thyroid volume (r=0.249, R2=0.062, p<0.05).
There was no significant association between
thyroid volume or TSH levels with other parameters
such as family history of thyroid disease (thyroid
volume in patients with vs without family history:
27.9±20.9 vs 17.11.1 ml, p<0.08, t-test), smoking
status or socioeconomic parameters such as educa-
tional level and daily occupation. Mean thyroid volume
was significantly larger in men compared to women
(41.3±29.7 vs 24.6±17.9, p<0.03, t-test). However, it
must be noted that the number of males included in
Figure 1. Type and frequency of food consumption (portions/week) in outpatients in Southwestern Albania.
Number of patients
number of patients
Number of patients
number of patients
Roast lamb/goat meat consumption Dairy products consumption
Vegetable consumption Egg consumption
Table 1. Stepwise multiple regression model for predicting thyroid volume in patients of Southwestern Albania
Variable Predictor Βeta T p R² (%)
Thyroid volume Lamb/goat meat consumption -0.274 -2.707 0.008
0.274
p<0.009
Sex -0.203 -2.019 0.046
Vegetable consumption -0.193 -1.853 0.067
Educational status or occupation 0.035 0.448 0.727
300 J. DouPis et Al
the study was small (n=8). There was no significant
association between thyroid volume or TSH levels
with consumption of other kinds of food or with the
mode of food preparation. Similarly, no significant
associations were found between T3 or fT4 levels
with any nutritional parameter.
TSH levels were 1.3±3.8 mU/L. After those on
thyroxine treatment were excluded, 43.5% of patients
had TSH <0.3 mU/L. In this group, log TSH was
negatively correlated with thyroid volume and fT4
levels (r=-0.29, p<0.006 and r=-0.680, p<0.0001,
respectively), suggesting the presence of autonomy
(Figure 2). TSHRab were found positive in only two
subjects.
Selenium levels were 84.0±22.4, range 30.6-138.0
μg/L. No correlation was found between selenium
levels and thyroid volume. Mean selenium levels
tended to be higher in those patients consuming
vegetables >3 times per week (3/w 78.7±22.7 vs
>3/w 86.8±21.8 μg/L, p<0.09).
Finally, urinary iodine excretion was measured in a
random sample of 35 patients (one sample taken from
every third patient). The iodine excretion ranged from
61.5 – 169.0 μg iodine/gr creatinine, mean 99.8±35.3
μg iodine/gr creatinine, consistent with a mild degree
of iodine deficiency in this population. There was no
significant correlation between the iodine excretion
and thyroid volume (r=-0.271, p=0.121, Figure 3),
vegetable consumption (r=-0.031, p=0.863) or lamb
and goat meat consumption (r=0.024, p=0.894).
There was no significant correlation between iodine
excretion and TSH levels. Mean iodine excretion did
not differ between those consuming goat and lamb
meat 1 times a week compared to >1 times a week
(107.3±29.4 vs 101.2±31.7, n.s.), vegetables 3 times
a week compared to >3 times a week (104.4±32, vs
103.2±30.5), eggs 2 times a week compared to >2
times a week (96.4±25 vs 113.7±35.5, n.s.) and dairy
products 4 times a week compared to >4 times a
week (101.9±28, vs 104.9±33, n.s.). It should be noted
however that iodine excretion data were available for
only a random 1/3 of the subjects.
dIscussIon
It is well recognised that dietary habits have a
role in the occurrence of goiter. For instance, the
consumption of green vegetables, not including veg-
etables that contain thiocyanate substances, prevents
the occurrence of goiter.
14
It is interesting that the
consumption of sheep-goat meat has the same if not
better effect on the prevention of goiter manifestation.
The meat consumed by the patients was from locally
bred sheep-goats which graze in fields and have never
received iodized food. The preferential consump-
tion of special parts of the sheep and lamb such as
the thyroid gland, which might contribute to iodine
and selenium intake, cannot be excluded. However,
it should be noted that the thyroid gland comprises
less than 0.5% of the total mass of a lamb, and side
Figure 3. Correlation of thyroid volume with iodine excretion
in outpatients in Southwestern Albania (r=-0.271, p=0.121,
ns).
Figure 2. Correlation of log TSH with thyroid volume in outpa-
tients in Southwestern Albania (r= -0.29, p<0.006).
Thyroid volume and nutrition in Albania 301
effects that have been previously described from the
consumption of bovine processed meat including
large quantities of animal thyroid glands would not
be expected.15 The prevention of goiter in this group
is in all probability not related to the iodine content
of food, as we were not able to show any differences
in iodine excretion in those frequently consuming
goat meat and vegetables. Nevertheless, this result
should be regarded with the limitation that we only
had iodine data in a limited number of subjects and
thus the numbers in the subgroups were small.
After a thorough literature search, in combination
with accounts concerning specific conditions occur-
ring in developing countries, some explanations for
our data may be offered. There are reports which
correlate the manifestation of goiter with elements
of diet other than iodine, such as low levels of sele-
nium, the consumption of foods rich in thiocyanate,
the insufficiency of vitamin A, iron deficiency and
low intake of proteins.7,9,16-18 The countries in which
studies were conducted in order to assess the effect
of dietary factors in patients with sufficient intake
of iodine and which found a correlation with the
above-mentioned parameters are mainly developing
countries that have serious problems with malnutri-
tion. It is possible that in our study the lower meat
intake may have contributed to mild deficiencies in
various micronutrients; however, in this population
we did not measure iron or vitamin A concentrations.
It is interesting that studies concerning Albanian
immigrants showed either directly or indirectly low
meat consumption or low protein and micronutrients
intake.19,20
It is likely, even though our study did not defi-
nitely show it, that there may be a correlation of the
occurrence of goiter with the socio-economic level
of the patients. It could for instance be hypothesised
that patients who can afford to consume meat more
frequently are those who are economically better-off
than those that do not have this privilege. Nonetheless,
this might not always coincide with better education
which was the factor that was recorded in our study.
In transition countries like Albania, wealth and
welfare are probably not directly associated with the
educational level as in the more advanced Western
world, i.e. the salary of a social servant such as a
teacher may be so low that he/she may not be able to
carry through everyday needs.2
Selenium is an important trace element and se-
lenium containing enzymes such as glutathione per-
oxidases may have an anti-oxidative potency.21,22 No
correlation of goiter and selenium levels was found
in our study. The absence of a selenium effect was
rather expected, as it was shown from our measure-
ments that the intake of selenium was sufficient in
the area examined. The consumption of vegetables
had a tendency to be associated with higher selenium
levels and this might indirectly represent one of the
protective factors associated with lower thyroid volume
in the frequent vegetable intake group. Vegetables
consumption has been implicated in the aetiology
of goiter. Vegetables contain micronutrients, such as
vitamins and selenium, which play a significant role
in the physiological development of the thyroid gland.
This is more obvious in areas with a low standard of
living where the replenishment of such micronutrients
is of importance in the treatment of goiter.7,8,21-24 On
the other hand, thiocyanates contained in vegetables
such as cabbage, broccoli and soya are well known
goitrogens; thiocyanates also exist as environmental
toxins and in cigarette smoke.
10,25
Studies with a larger
number of cases are needed in order to clarify with a
greater statistical significance any correlation of this
or other dietary micro- and macronutrients with the
development of goiter.
The high incidence of goiter in women that we
found is a classical finding repeatedly reported in all
epidemiological studies. The greater thyroid volume
in men compared to women is a finding which has
been already described in the literature and may be
related to parameters such as differences in body
weight or lean body mass.
26
The high incidence of
goiter and hyperthyroidism with negative antibodies,
in other words autonomous goiter, is in accordance
with the findings of other researchers.27,28 The preva-
lence of autonomous multinodular goiter is directly
associated with the existence of iodine deficiency in
Albania, which, though more severe in the past, is
now becoming borderline.29 This is likely to be the
main reason for the relatively higher incidence of fol-
licular carcinomas compared to papillary carcinomas
in Albania that has recently been reported.3 0
In conclusion, nutritional factors may be involved
in the development of goiter in Southwestern Albania.
Selenium intake seems to be sufficient in this part
of Albania, while the presence of goiter in adults is
more likely related to iodine deficiency in the past;
302 J. DouPis et Al
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interesting to closely follow up Albania as well as
other developing countries in the larger area, as the
effect that the Western way of life has on the diet
may bring about changes in the incidence, type and
severity of some diseases that are related to diet such
as thyroid diseases.
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... Goiter was defined as a thyroid volume exceeding 18.8 mL for males and 14.4 mL for females. The cut-off levels were derived from the mean (+2 SD) thyroid volume in 597 subjects (315 males and 282 females) without thyroid dysfunction, without a previous thyroid disease, without a family history of thyroid disease, without positive thyroid autoantibodies, and without goiter or nodules on ultrasonography [12]. ...
... The status of serum selenium has diverse effects on thyroid volume and goiter in a mild iodine-deficient or (borderline) iodine-sufficient area. John et al. [12] found that when the intake of selenium was sufficient, there was no correlation between goiter and serum selenium levels even in a mild iodine-deficient area. A study in school-age children in Turkey [22] with moderate iodine deficiency, found that mean selenium was 50 μg/L, a relatively low level, and serum selenium concentration was not associated with thyroid volume, thyroid goiter, or THS levels. ...
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Selenium (Se) is a necessary element for the biosynthesis of thyroid hormones. We investigated the relationship between selenium status, thyroid volume, and goiter in a cross-sectional study in an iodine-sufficient area. We selected residents of Chengdu (over 18 years old and living in the city for more than 5 years) using a stratified cluster sampling technique. Fifteen hundred subjects were selected for the study, which involved a questionnaire survey, physical examination, thyroid ultrasound, serum thyroid function test, and determination of serum selenium level. Thyroid volume was calculated from the thickness, width, length, and a corrective factor for each lobe. Ultimately, 1,205 subjects completed the investigation and were included in our study. Additionally, 80 school-age children were selected to provide urine samples for urinary iodine analysis. We analyzed the data using appropriate nonparametric and parametric statistical tests. The median urinary iodine value was 184 mug/L in school-age children, indicating iodine sufficiency. The median serum selenium level of the 1,205 subjects was 52.63 (interquartile range [IQR] : 40.40-67.00) mug/L. The median thyroid volume was 9.93 (IQR: 7.71-12.57) mL; both log-transformed serum selenium and log-transformed thyroid volume were Gaussian distributions (P = .638 and P = .046, respectively). The prevalences of goiter and thyroid nodules were 8.8% and 18.6%. The prevalences of positive thyroid autoantibodies, thyroperoxidase autoantibodies and thyroglobulin autoantibodies were 16.7%, 12.0%, and 11.1%, respectively. In the general linear regression model, there were positive associations between serum selenium and age, and body mass index. We found no association between serum selenium and thyroid-stimulating hormone. In simple linear regression analyses, we found no association between thyroid volume and serum selenium. There were no significant differences in serum selenium between persons with or without goiter. Serum selenium was not a risk factor for goiter. In our study population, serum selenium was neither associated with thyroid volume nor with goiter in an iodine-sufficient area. More studies should be conducted by following non-goitrous persons over time and monitoring their selenium status.
... St´˝enia selenu we krwi w ró˝nych populacjach osób chorych dost´pne w analizowanych 26 artyku-∏ach opublikowanych w latach 2005-2010 przedstawiono w tabeli II [26,30,31,34,35,40,47,54,58,59,61,62,[65][66][67][68][69][71][72][73][74][75][76][77][78][79]. Ârednie st´˝enie selenu waha∏o si´ w badanych populacjach od 35,55 µg/L surowicy dla noworodków z ostrymi zaburzeniami oddechowymi [26] do 291 µg/L krwi pe∏nej dla kobiet chorujàcych na raka piersi [71], a nawet do 400,45 µg/L krwinek czerwonych dla chorych na osteoporoz´ [40]. ...
... Wi´kszoÊç prowadzonych badaƒ dotyczy∏a roli selenu w procesach nowotworzenia [34,35,54,58,62,71,79], przede wszystkim nowotworów z∏oÊliwych prostaty, piersi i okr´˝nicy [34,58,62,71,79]; w nast´pnej kolejnoÊci: znaczenia selenu w patogenezie chorób uk∏adu krà˝enia i cukrzycy [61,[65][66][67]72] oraz st´˝eƒ selenu u zara˝onych wirusami HIV i HCV [47,68,78]. Pojedyncze badania koncentrowa∏y si´ na zwiàzku st´˝enia selenu z przebiegiem cià˝y [31], z wyst´powaniem zaburzeƒ oddechowych u noworodków [26], z chorobami skóry [69], tarczycy [73], wàtroby [76] i uk∏adu pokarmowego [75,77], z cz´stoÊcià i nasileniem astmy [74], anemii [59] i osteoporozy [40]. W badaniach Kapki i wsp. ...
... In this group of women, the 3 rd and 97 th percentiles of TV were set at 4.6 mL and 14.2 mL, respectively (23). While information is lacking as to whether a gland of below normal volume should be regarded as displaying hypoplasia, data from this study indicated goitre in <5% of subjects (23), as reported in several other similar evaluations (26,27). ...
Article
Context: Large variations in thyroid volume (TV) have been reported in Hashimoto's thyroiditis (HT). The need for long-term levo-thyroxine (L-T4) administration in order to control TV, as well as to normalise thyroid function, has not been well defined. Subjects and methods: Retrospective data on TV in 94 adult women with HT were analysed in an ambulatory setting in Liguria, an area of moderate iodine sufficiency. TV was evaluated by means of ultrasonography (US). Thyroid function, anthropometric data, smoking habits and pharmaceutical drugs were registered at each examination. Results: At the baseline, an atrophic gland was noted in 16% of the women, and goitre in 13%. The women were evaluated 56 and 102 months after the baseline examination. At the time of each examination, 50%, 78% and 83% of women, respectively, were on L-T4 treatment. Baseline TV was not significantly different in women on/off L-T4 treatment. However, in those on L-T4, TV decreased significantly over the period of follow-up, while in those without L-T4 treatment, it did not change. By the end of the study, the percentage of L-T4-treated women with an atrophic gland had increased to 27%, and that of women with goitre had dropped to 6%; in untreated women, only minor changes were noted. There was a significant negative correlation between TV% change and baseline TSH levels in HT women on L-T4 treatment. Conclusion: The majority of HT women living in an area of moderate iodine sufficiency have normal TV. Moreover, long-term L-T4 treatment can be used to control TV, as well as to maintain normal thyroid parameters.
... In the present study, serum Se concentrations from a population of elderly healthy Swedes were low (~67.1 μg/l) compared with the reported Se levels in the United States 25,26 and also relatively low in comparison with values in other regions in Europe. 18,19,[27][28][29][30][31][32] The difference in concentrations between smokers and nonsmokers in the present study was not significant, which may be an effect of the small size of the smoking group (n = 40; 9.0%), as some studies have found decreased levels in current smokers. 33,19 However, there are also studies where such an association has not been found. ...
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BACKGROUND/OBJECTIVES: The daily dietary intake of selenium (Se), an essential trace element, is still low in Sweden in spite of decades of nutritional information campaigns and the effect of this on the public health is presently not well known. The objective of this study was to determine the serum Se levels in an elderly Swedish population and to analyze whether a low Se status had any influence on mortality. SUBJECTS/METHODS: Six-hundred sixty-eight (n=668) elderly participants were invited from a municipality and evaluated in an observational study. Individuals were followed for 6.8 years and Se levels were re-evaluated in 98 individuals after 48 months. Clinical examination of all individuals included functional classification, echocardiography, electrocardiogram and serum Se measurement. All mortality was registered and endpoints of mortality were assessed by Kaplan-Meier plots, and Cox proportional hazard ratios adjusted for potential confounding factors were calculated. RESULTS: The mean serum Se level of the study population (n=668) was 67.1 μg/l, corresponding to relatively low Se intake. After adjustment for male gender, smoking, ischemic heart disease, diabetes, chronic obstructive pulmonary disease and impaired heart function, persons with serum Se in the lowest quartile had 43% (95% confidence interval (CI): 1.02-2.00) and 56% (95% CI: 1.03-2.36) increased risk for all-cause and cardiovascular mortality, respectively. The result was not driven by inflammatory effects on Se concentration in serum. CONCLUSION: The mean serum Se concentration in an elderly Swedish population was 67.1 μg/l, which is below the physiological saturation level for several selenoprotein enzymes. This result may suggest the value of modest Se supplementation in order to improve the health of the Swedish population.
... Furthermore, the relationship between cancers of various organs with selenium deficiency has long been known [7,8]. In the same way, selenium deficiency could be a risk factor for the development of thyroid nodules, but differing results on this issue have been reported [9][10][11][12]. ...
Article
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The thyroid gland is susceptible to nodulation. The mechanism responsible for the growth of only some follicular cells, which results in nodule formation, is not yet clear. Selenium deficiency may be a risk factor in the development of thyroid nodules. The aim of this study was to investigate the relationship between selenium levels in patients with euthyroid nodular thyroid disease. Seventy patients with a solitary euthyroid thyroid nodule, 70 patients with more than one euthyroid nodule, and 60 healthy patients without thyroid nodules were included in the study. Venous serum samples were stored at -80°C and analyzed the same day using spectrometry. The selenium levels of patients with multiple thyroid nodules, solitary nodules, and patients without nodules were 57.3 ± 14.8 μg/L; 58.8 ± 15.1 μg/L; and 57.6 ± 13.3 μg/L, respectively. The mean serum selenium level of all patients included in the study was 57.9 ± 14.4 μg/L. Although serum selenium levels were slightly higher in men, a statistically significant difference was not observed. In our study, a significant relationship between serum selenium levels and nodular thyroid disease was not seen. Our study was undertaken in an iodine sufficient region. Mean serum selenium levels were lower compared with many other studies, which may be associated with the low selenium content of the soil. Nodular thyroid disease shows multifactorial features. When our study is considered together with previous studies, serum selenium levels may considered to be effective on structural thyroid diseases if combined with additional factors such as severe iodine deficiency. Further studies are required to assess the role of selenium in thyroid nodule formation.
Article
Selenium (Se) has a multilevel, complex and dynamic effect on the human body as a major component of selenocysteine, incorporated into selenoproteins, which include the selenocysteine-containing enzymes iodothyronine deiodinases. At the thyroid level, these proteins play an essential role in antioxidant protection and hormone metabolism. This is a narrative review based on PubMed/Medline database research regarding thyroid physiology and conditions with Se and Se-protein interferences. In humans, Se-dependent enzyme functions are best expressed through optimal Se intake, although there is gap in our knowledge concerning the precise mechanisms underlying the interrelation. There is a good level of evidence linking low serum Se to autoimmune thyroid diseases and, to a lesser extent, differentiated thyroid cancer. However, when it comes to routine supplementation, the results are heterogeneous, except in the case of mild Graves’ orbitopathy. Autoimmune hypothyroidism is associated with a state of higher oxidative stress, but not all studies found an improvement of thyroid function after Se was introduced as antioxidant support. Meanwhile, no routine supplementation is recommended. Low Se intake is correlated with an increased risk of developing antithyroid antibodies, its supplementation decreasing their titres; there is also a potential reduction in levothyroxine replacement dose required for hypothyroidism and/or the possibility that it prevents progression of subclinical hypothyroidism, although not all studies agree. In thyroid-associated orbitopathy, euthyroidism is more rapidly achieved if the micronutrient is added to traditional drugs, while controls appear to benefit from the microelement only if they are deficient; thus, a basal assay of Se appears advisable to better select patients who need substitution. Clearly, further Se status biomarkers are required. Future introduction of individual supplementation algorithms based on baseline micronutrient levels, underlying or at-risk clinical conditions, and perhaps selenoprotein gene polymorphisms is envisaged.
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The therapeutic effect of selenium (Se) has already been proven in thyroid disease and thyroid associated ophthalmopathy (TAO). In spite of clear scientific proof of its benefits in TAO, there appears to be no clear agreement among the clinicians regarding its optimum dose, duration of the treatment, efficacy and safety to date. In this review, the author summarises the findings of 135 English language articles published on this subject over the past four decades from 1973 to 2013. The regulation and metabolism of thyroid hormones require a steady supply of Se and recent studies have revealed several possible mechanisms by which Se improves the severity of thyroid disease and TAO. These mechanisms include 1) inhibitory effect of HLA-DR molecule expression on thyrocytes; 2) profound reductions of thyroid stimulating hormone (TSH) receptor antibodies (TSHR-Ab) and TPO antibodies (TPO-Ab); 3) prevention of dysregulation of cell-mediated immunity and B cell function; 4) neutralising reactive oxygen species (ROS) and inhibition of redox control processes required for the activation, differentiation and action of lymphocytes, macrophages, neutrophils, natural killer cells involved in both acute and chronic orbital inflammation in TAO; 5) inhibition of expression of pro-inflammatory cytokines and 6) inhibition of prostaglandin and leukotriene synthesis. An increased oxidative stress has been observed in both acute and chronic phases of thyroid disease with raised tissue concentrations of ROS. The benefits of Se supplementation in individuals with TAO appear to be proportionate to the degree of systemic activity of the thyroid disease. The maximal benefit of Se supplementation is therefore seen in the subjects who are hyperthyroid. Restoration of euthyroidism is one of the main goals in the management of TAO and when anti-thyroid drugs are combined with Se, the patients with Graves' disease (GD) and autoimmune thyroiditis (AIT) achieved euthyroidism faster than those treated with anti-thyroid drugs alone. Se status of normal adult humans can vary widely and Se supplementation may confer benefit only if serum Se levels are insufficient. The author recommends that serum Se levels of patients with TAO to be assessed prior to and during Se supplementation at regular intervals to avoid potential iatrogenic chronic Se overdose.
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This study aimed at determining the relationship between environmental exposure to lead (Pb) and cadmium (Cd) and blood selenium (Se) concentration in randomly selected population of children inhabiting the industrial regions of Silesian Voivodship, Poland. The study was conducted on a group of consecutive randomly selected 349 children aged below 15 years and inhabiting the industrial regions in Upper Silesia. The examined variables included whole blood Cd concentration (Cd-B), whole blood Pb concentration (Pb-B) and whole blood Se concentration (Se-B). The concentration of Cd-B, Pb-B and Se-B in the studied group of children amounted to 0.26 ± 0.14, 37.62 ± 25.30 and 78.31 ± 12.82 μg/L, respectively. In the entire examined group a statistically significant negative linear relationship was noted between Pb-B and Se-B (r = -0.12, p < 0.05). Also, a statistically insignificant negative correlation was detected between Cd-B and Se-B (r = -0.02, p > 0.05) and a statistically insignificant positive correlation between Pb-B and Cd-B (r = 0.08, p > 0.05). A multivariate backward stepwise regression analysis demonstrated that in the studied group of children higher Pb-B and a more advanced age-represented independent risk factors for a decreased Se-B. Environmental exposure to Pb may represent an independent risk factor for Se deficit in blood of the studied population of children. In children, the lowered Se-B may create one of the mechanisms in which Pb unfavourably affects human body.
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Deficiencies of iodine, iron, and vitamin A are the 3 most common micronutrient deficiencies in developing countries, although control programs, when properly implemented, can be effective. We investigated these deficiencies and their possible interaction in preschool children in the southern Blue Nile area of Sudan. Goiter, signs of vitamin A deficiency, and biochemical markers of thyroid, vitamin A, and iron status were assessed in 984 children aged 1-6 y. The goiter rate was 22. 3%. The median urinary iodine concentration was 0.79 micromol/L and 19.3% of the children had a concentration >1.57 micromol/L. Although serum thyroxine and triiodothyronine concentrations were within reference ranges, the median thyrotropin concentration was 3.78 mIU/L and 44% of the children had thyrotropin concentrations above normal. The mean urinary thiocyanate concentration was high (259 +/- 121 micromol/L). The prevalences of Bitot spots and night blindness were 2.94% and 2.64%, respectively, and 32% of the subjects had serum retinol binding protein concentrations <15 mg/L. A significant positive correlation was observed between thyrotropin and retinol binding protein. Whereas 88% of the children had hemoglobin concentrations <1.86 mmol/L, only 13.5% had serum ferritin concentrations below the cutoff of 12 microg/L and 95% had serum transferrin concentrations above the cutoff of 2.50 g/L. Our results indicate that goiter is endemic in this region of Sudan despite iodine sufficiency and that both anemia and vitamin A deficiency are health problems in the area. Moreover, consumption of millet, vitamin A deficiency, and protein-energy malnutrition are possible etiologic factors in this endemic area.
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We report an outbreak of thyrotoxicosis without true hyperthyroidism that occurred between April 1984 and August 1985 among residents of southwestern Minnesota and adjacent areas of South Dakota and Iowa. One hundred twenty-one cases were identified through surveillance of medical clinics, laboratories, hospitals, and physicians' offices. Investigation of the outbreak demonstrated an association between the occurrence of thyrotoxicosis and the consumption of ground beef prepared from neck trimmings processed by a single slaughtering plant (odds ratio, 19.0; P = 0.0001). The cause was confirmed by the findings of bovine thyroid tissue in samples of these trimmings and high concentrations of thyroid hormone in implicated samples of ground beef and the demonstration of prompt increases in serum thyroid hormone concentrations in volunteers who ate the implicated ground beef. Bovine thyroid tissue had been introduced into the neck trimmings inadvertently during the process of "gullet trimming," a procedure that harvests muscles from the bovine larynx. The outbreak resolved after this procedure was discontinued at the plant. The clinical features of the illness suggested the diagnosis of silent thyroiditis, and it is possible that sporadic cases--or even outbreaks--of thyrotoxicosis factitia caused by this mechanism may have occurred in the past but were not recognized.
Article
It is difficult to determine the role of Selenium (Se) in the etiology of (nodular-)goiter, because there are considerable variations of Se concentrations in different populations as reflected by dietary habits, bioavailability of Se compounds and racial differences. Moreover, most previous clinical trials, which investigated the influence of Se on thyroid volume, harboured a bias due to the coexistence of severe iodine deficiency in the study populations. Therefore, we investigated the influence of Se on thyroid volume in a mildly iodine deficient area. First, we investigated randomly selected probands for iodine (UI) and creatinine excretion in spot urine samples and determined the prevalence of goiter and thyroid nodules by high resolution ultrasonography. Iodine concentration was measured manually according to the protocol described by Sandell and Kolthoff and Creatinine as described by Jaffe. Thyroid volume determination was performed using a high resolution real-time instrument. Thyroid volumes were calculated according to the spherical ellipsoid formula. After this, we determined urinary Se excretion (USe) in probands with goiter as well as in matched probands without goiter. Urinary selenium excretion was measured according to the method previously described by Vezina et al. Adjustments between the 2 compared groups were made for age, gender, history of thyroid disorders, smoking and urinary iodine excretion. The mean USe and UI rates of all 172 probands were 24µg Se/l or 27µg Se/g creatinine and 96µg I/l or 113µg I/g creatinine indicating borderline selenium (20–200µg/l) and iodine (100–200µg/l) sufficiency of the study population. Probands with goiter (n=89) showed significantly higher USe levels than probands with normal thyroid volume (n=83; p<0.05). USe rates were not influenced by current smoking or pregnancy. In our investigation, USe was not an independent risk factor for development of goiter. Se does not significantly influence thyroid volume in borderline iodine sufficiency because the iodine status is the more important determinant.
Article
Thiocyanate (e.g. as industrial waste product) has antithyroid properties and its role in the etiology of goiter has been shown in central Europe. An epidemiologic survey in 1991 in the region of Halle/Leipzig demonstrated a relationship between urinary iodine and thiocyanate excretion and goiter prevalence. Patients with goiter had lower urinary iodine/ thiocyanate values than patients without thyroid disorders.10 years later, we reinvestigated the same industrial area to clarify the influence of thiocyanate after elimination of most industrial waste products. We investigated a cohort of 708 probands for iodine, thiocyanate and creatinine excretion in spot urine samples and determined the prevalence of goiter and thyroid nodules in our probands by high resolution ultrasonography.Probands with goiter had significantly higher urinary thiocyanate excretion than probands without (3,9±2,8 vs. 3,1±3,4mg SCN((macr)) /g creatinine)and significantly lower urinary iodine/ thiocyanate quotients than patients without thyroid disorders (41±38 vs. 61±71µg I((macr))/mg SCN((macr)) /l). Mean urinary iodine excretions were not different between patients with goiter or without. The frequency of thyroid nodules was 30% and the frequency of goiter 11%. Still today with decreased cyanide pollution, thiocyanate is a cofactor in the aetiology of goiter. Moreover, the urinary iodine/ thiocyanate quotients were able to detect probands with an increased risk of developing goiters.
Article
Im direkten Vergleich mit der durch Submersion ermittelten wahren Schilddrüsengröße wurde bei Leichen mit einem Real-time-Gerät ein Verfahren zur Volumenbestimmung durch sonographische Messungen erarbeitet. Länge mal Breite mal Dicke des Schilddrüsenlappens, multipliziert mit dem Faktor π/6, entsprechen einem Rotationsellipsoid, während sich bei Multiplikation mit dem optimierten Korrekturfaktor f = 0,479 das bestmögliche rechnerische Volumen des Lappens ergibt. Die Richtigkeit dieser Bestimmung ist definitionsgemäß 100 %; der. durchschnittliche Fehler der Methode beträgt 16 %. Die Messungen sind einfach durchzuführen und verlangen keinerlei Zusatzeinrichtungen für Planimetrie oder Rechneroperationen. Die Volumetrie der Schilddrüse ist vor allem zur Therapiebeurteilung und zur Berechnung der Dosis bei einer Radiojodtherapie erforderlich. Thyroid volume as measured by real-time ultrasound in cadavers was compared with direct measurements obtained by submersion. Length × width × thickness of the thyroid lobe multiplied by factor π/6, correspond to a rotation ellipsoid, while the best calculated volume of the lobe is obtained by multiplying with the optimised correction factor f = 0.479. The correctness of this calculation is, by definition, 100 %; average error of the method is 16 %. The measurements are easy to do and require no additional equipment for planimetry or calculations. Volumetric analysis of the thyroid gland is especially necessary in assessing results of treatment and for measuring dosage in connection with radioiodine therapy.
Article
The prevalence of goiter still remains high in some areas of Iran in spite of iodine supplementation. In the present study, we investigated the role of selenium (Se) deficiency in the etiology of goiter in Isfahan. Two thousand three hundred thirty-one schoolchildren were selected by multistage random sampling. Thyroid size was estimated in each child by inspection and palpation. Urinary iodine concentration (UIC) and plasma Se were measured. Overall, 32.9% of the 2,331 children had goiter. The median UIC was 19.55 microg/dl. Plasma Se was measured in 96 goitrous and 72 nongoitrous children. The mean +/- SD of plasma Se in goitrous and nongoitrous children was 66.86 +/- 21.82 and 76.67 +/- 23.33 microg/l, respectively (P = 0.006). Goitrous girls had lower plasma Se level than nongoitrous girls (65.62 +/- 21.64 vs. 76.51 +/- 22.61 microg/dl, P = 0.02). Goitrous boys had lower plasma Se level than nongoitrous boys (68.45 +/- 22.21 vs. 76.91 +/- 24.76 microg/l, P = 0.14). The prevalence of Se deficiency was significantly higher in goitrous boys and girls than nongoitrous children. Se deficiency is among the contributors of goiter in Isfahan goitrous schoolchildren. However, the role of other micronutrient deficiencies or goitrogens should be investigated in this region.
Article
Serum vitamin A levels were determined in two groups of subjects living in an endemic goiter area in Iran. The first group consisted of 242 non-goitrous subjects, and the second, contained 603 subjects with different grades of goiter. Serum vitamin A concentrations were correlated with goiter, sex, and age. Serum retinol values were not statistically different between goitrous and non-goitrous females, but goitrous male subjects especially those under 13 years of age, had lower serum retinol values than non-goitrous male subjects. The prevalence of low vitamin A levels was higher in goitrous boys. In both groups the prevalence of low serum vitamin A decreased with the increase in age. The prevalence of goiter was not statistically different between boys and girls under 18 years, but was more prevalent in women over 18 years, than men in the same age group (P less than 0.001). This difference was in accordance with serum vitamin A status between women and men after the age of 18 (P less than 0.001). Serum vitamin A increased with age up to 18 years, in both sexes and remained unchanged afterwards. The increase was gradual in girls under 18 years but was sharper in boys during puberty years. Although the values for serum vitamin A in each sex covered wide overlapping ranges, but a general superiority of male serum vitamin A levels over the females was observed.