Zhongyan SHAN

10th AOTA CONGRESS

Zhongyan SHAN

Department of Endocrinology,

The First Affiliated Hospital of China Medical University

The Benefit and Concern for Universal Salt

Iodination

10th AOTA CONGRESS

• The reason for USI • The benefit about USI• The concern about USI

Content

10th AOTA CONGRESS

IDD Disorders in Developing Countries

WHO86819 Source: ACC/SCN, 1987

Distribution of Iodine Deficiency Worldwide

Iodine deficiency

10th AOTA CONGRESS

Distribution of endemic goiter in China before 1979

Ma Tai et al. People's Health Publishing House 1980

Iodine Status in China

Iodine deficiency

10th AOTA CONGRESS

Neonate

Neonatal goiterNeonatal hypothyroidism

Endemic mental retardation

Increased susceptibility of the thyroid gland to nuclear

radiation

Child and adolescent

Goiter hypothyroidism hyperthyroidism Impaired mental function Retarded physical development Increased susceptibility of thyroid gland to nuclear radiation

Adult

Goiter, with its complications

HypothyroidismImpaired mental function

Spontaneous hyperthyroidism in the elderly

Iodine-induced hyperthyroidism

Abortions Stillbirths Congenital anomalies Increased perinatal mortality Endemic cretinism Deaf mutism

Fetus

Iodine status worldwide WHO Global Database on Iodine Deficiency

Spectrum of IDD across the Life-span

10th AOTA CONGRESSM. B Zimmermann et al. Lancet 2008; 372: 1251–62.ACC/SCN State-of -the-art series nutrition policy discussion paper No 3.1988

Characteristic Features of IDD

10th AOTA CONGRESS

•Safe, feasible and highly cost-effective strategy

USI

•Iodine supplementation of foods and water for human consumption

•Iodine medications (notably oral administration of iodized oil) to directly supplement the inhabitants at risk of IDD in endemic areas.

•Active prophylaxis of domestic animals; use of iodine materials for plants or iodine deficient soils.

Others

Strategy for Iodine Supplementation

10th AOTA CONGRESS


Content

10th AOTA CONGRESS

Benefit in Infant and Childhood After IS

in moderate-to-severe iodine deficient area

Prevalence of iodine deficiency decreased

Prevalence of Cretinism reduced

Mean developmental quotient increased

Infant mortality reduced

Cognition of childhood increased

Somatic growth of childhood improved

in mild-to-moderate iodine deficient area

Potential benefit during pregnancy remain unclear

10th AOTA CONGRESS

Iodine status worldwide, WHO Global Database on Iodine Deficiency, 2004

Prevalence of ID Decreased after IS

In 2003

In 2007

M. B Zimmermann et al. Lancet 2008; 372: 1251–62

In 2012

. Zimmermann M B, and Andersson M Curr Opin Endocrinol Diabetes Obes 2012, 19:382–387

There were 32 countries with ID in total 150 WHO countries.

10th AOTA CONGRESSPharoah POD et al. Lancet. 1971, 13;1(7694):308-10.Pharoah PO, Connolly KJ. Int J Epidemiol 1987, 16:68–73

In an severe iodine deficient area in Papua New Guinea Alternate families received saline (control) or iodized oil injection.

The primary outcome was the prevalence of cretinism at 4- and 10-yr follow-up

Design

at 10 yrs

1.0 1.1 1.20.050.1

Reduction of endemic cretinism

at 4 yrs

0.17(0.05-0.58)

RR(95%CI)

0.20.30.40.50.6

0.27(0.12-0.60)Results

Prevalence of Cretinism Reduced after IS

10th AOTA CONGRESSCao XY, et al. N Engl J Med 1994,331:1739–1744

Design• In a severe iodine deficient area

in western China

• Intervention was oral iodized oil at each trimester of pregnancy

• Children were divided into Untreated children: 1–3 yr of age Treated children born to treated women were followed for 2 yr.

• The main outcomes: neurological examination head circumference Development quotient

Iodine Supplementation Reduced Cretinism in Severe Iodine Deficient Areas

treated in T1 Treated in T2 Treated in T3 or after birth

02468

10

2 2

9

Prevalence of neurological abnormalities

Developmental Quotient Increased after IS

treated children untreated children 65

70

75

80

85

90

9590

75

Developmental quotient at 2yr

10th AOTA CONGRESS

• A placebo-controlled, double-blind, 6-month intervention trial

• Moderately iodine-deficient area in Albania

• 10- to 12-yr-old children (n= 310) were randomized

• Receive either 400 mg of iodine as oral iodized oil or placebo.

• Children were given a serial of seven cognitive and motor tests

• Median UI in the treated group was 172μ g/liter at 24 wks

• Mean T4 increased approximately 40% compared with placebo

Zimmermann MB, et al.Am J Clin Nutr2006 83:108–114

Cognition at School Age Improved After IS

10th AOTA CONGRESSZimmermann MB, et al.Am J Clin Nutr2006 83:108–114

1.0 1.5 2.0 2.5 3.00.5

Cognitive Improvement

Ravens matrices

4.7(3.8-5.8)

2.8(1.6-4.0)

3.5

RR(95%CI)

4.0 4.5 5.0 5.5 6.0

Rapid target marking

Symbol search

2.8(1.9-3.6)

Rapid naming

4.5(2.3-6.6)

cognitive impairment

Cognition at School Age Improved After IS

10th AOTA CONGRESS DeLong GR, et al. Lancet, 1997, 350:771–773.

58.247.4

106.2

28.7 19.1

57.3

0

20

40

60

80

100

120

Rong Ru Tusal a Bakechi

Before

After

• In three areas of severe iodine deficiency in Xinjiang, China• Potassium iodate for women of childbearing age over a 2- to 4-wk period • Observe neonatal and infant mortality in the following 2–3 yr.

the

infa

nt m

orta

lity

rate

(/

1000

birt

hs)

The odds of neonatal death were reduced by 65% in iodine treated groups

Infant Mortality Reduced after IS

10th AOTA CONGRESS

• Aim: to determine whether iodine repletion improves growth in school-age children

• Design: Three prospective, double-blind intervention studies in severely, moderately , and mildly iodine-deficient areas.

• Intervention: receiving either 400mg of oral iodized oil or placebo for 6 months

Zimmermann MB, et al. J Clin Endocrinol Metab 2007, 92:437–442

Somatic Growth of Childhood Improved After IS

10th AOTA CONGRESS

Height-for-age z-score Weight-for-age z-score

Zimmermann MB, et al. J Clin Endocrinol Metab 2007, 92:437–442

Somatic Growth of Childhood Improved After IS

10th AOTA CONGRESS

Author UI Time Number Amount Main Results

Romano(1991)Italy

31–37μg/L

T1 SI N=17Con N=18

120-180μg iodizedsalt

In controls, a 16% increase in TV. Treatment had no effect on maternal TSH

Pedersen (1993)Denmark

55μg/L

G17 to term

SI N=28Con N=26

200μg KI Maternal TV increased 16% in the treated group vs. 30% in controls. Maternal Tg and TSH were lower in the treated group.

Glinoer(1995)Belgium

36μg/L

G14 to-term

SI N=36Con N=36

100μg KI The treated women had smaller TV, and lower TSH and Tg , compared with controls.

TV: thyroid volume

Controlled Studies in Mild-to-Moderate ID

10th AOTA CONGRESS

Author UI Time Number Amount Main Results

Liesenkotteer(1996)Germany

53 g/g Cr

G11 to term

SI N=38Con N=70

300μg KI Treatment had no significant effect on maternal TSH, T3, T4, TV, or Tg.

Antonangeli(2002)Italy

74g/g Cr

G18–26 to G29–33 wk.

SI-1 N=32SI-2 N=35

200μg KI50μg KI

no differences in maternal FT4, FT3, TSH, Tg, or TV between groups.

TV: thyroid volume


10th AOTA CONGRESS

mild-to-moderate iodine deficiency： 37-70μg/L

After iodine supplementation of 150~300μg/d

• UI concentration increased

• Maternal thyroid volume decreased

• Neonatal thyroid volume decreased

• No effect on maternal FT4, FT3, TSH, and Tg

• No long-term follow-up data

Zimmermann M: Thyroid, 2007, 17: 829-835

potential benefit of iodine supplementation in mild-to-moderate iodine deficiency during pregnancy remain unclear


A Summary

10th AOTA CONGRESS

In adults, iodine supplementation can

change the subtype of thyroid cancer

decrease the risk of diffuse goiter

Benefit about USI in Adulthood

10th AOTA CONGRESS

Time SIC

(mg/kg)UIC

(μg/L) TGR(%)

palpationTGR(%)

B ultrasound

Rate of qualified

iodized salt

1995 16.2 164 20.4 - 39.9

1997 37.0 330 10.9 9.6 81.1

1999 42.3 306 8.8 8.0 88.9

2002 31.4 241 5.8 5.1 88.9

2005 30.8 246 5.0 4.0 90.2

Prevalence of Thyroid Goiter in ChinaBefore and After USI (1995–2005)

10th AOTA CONGRESS

Type of Thyroid cancer

Iodinedeficiency

Iodinesufficiency

Undifferentiated thyroid cancer

follicular thyroid cancer

papillary thyroid cancer

Changes of Type of Thyroid Cancer after USI

10th AOTA CONGRESS

Content


10th AOTA CONGRESS

Recommendation by the U.S. National Academy of Sciences

Jean Vanderpas. Annu. Rev. Nutr. 2006. 26:293–322

Recommended Dietary Allowance and Upper Limit of Iodine Intake (μg/d)

10th AOTA CONGRESSLaurberg P et al: Thyroid 2001,11(5):457

Iodine Intake Level

Thyr

oid

Dis

ease

U-Shaped Curve between Iodine Intake and Thyroid Diseases

10th AOTA CONGRESSWHO, UNICEF,ICCIDD, 2007. Geneva: WHO

Criteria for Assessing Iodine Nutrition Based on Median of urinary iodine concentrations

In school-aged children

10th AOTA CONGRESSWHO, UNICEF, ICCIDD 2001 A guide for programme managers. WHO publ., Geneva.

Optimal Iodine Nutrition and Corresponding Iodine Intake

10th AOTA CONGRESSP LaurbergBest. Practice & Research Clinical Endocrinology & Metabolism 24 (2010) 13–27

Spectrum of Disorders Depends on UIC

MUI

10th AOTA CONGRESS

18

4

0.9

3.8

0

4

8

12

16

20

38ug/ L 150ug/ L

Overt Hypo Sub Hypo

Pre

vale

nce

(%)]

*:compared with another area,P<0.05

Denmark n=523 the elderlyMUI

Laurberg： J Clin Endocrinol Meatb, 1998,83:765. Szabolcs， Clin Endocrinol,97,47:87.

10.4

7.6

1.50.8

4.2

23.9

0

5

10

15

20

25

72ug/ gCr 100ug/ gCr 513ug/ gCr

Overt Hypo Sub Hypo

*

*#

#

*:compatred with other two areas,P<0.05#:Compared with area with the lowest UI,P<0.05

Hungary n=346 the

elderly

Pre

vale

nce

(%)]

Prevalence of Hypothyroidism Increased after USI

*

*

10th AOTA CONGRESSP Laurberg, Best Practice & Research Clinical Endocrinology & Metabolism 24 (2010) 13–27

Incidence of Hypothyroidism Increase after USI

Aalborg

10th AOTA CONGRESS

90

30

2.8

7.4

0

10

20

30

40

50

60

70

80

90

100

0

1

2

3

4

5

6

7

8

SIC Incidence of hyperthyroidism

pp

m

/100

,000

10

20

1.64

1

1.36

1

0

5

10

15

20

25

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

SIC Overt Hyper Sub Hyper

pp

m %

Zimbabwe ， 1995 Austria ， 1998

Lancet 1995, 346:1563

Eur J

Nucl Med 1998, 25:367

Incidence of Hyperthyroidism Increased after USI

10th AOTA CONGRESSP Laurberg, Best Practice & Research Clinical Endocrinology & Metabolism 24 (2010) 13–27

Types of hyperthyroidism in populations with different iodine intake levels

Iodine intake level50-60 μg/day

Iodine intake level250-350 μg/day

10th AOTA CONGRESS

Prevalence of AIT in Poland Prevalence of Thyroid Cancer in Australia

Thyroid, 1997, 7: 733-741.

Euro J Endocrinol,2002,146:19-26.

Prevalence of AIT and Thyroid Cancer after USI

1. 50%

5. 70%

0%

1%

2%

3%

4%

5%

6%

Before USI After USI

P=0.03 7. 80

3. 07

0

2

4

6

8

10

Before USI After USI

/ 10（万）P=0.04

10th AOTA CONGRESS

From 1995 to 2005

241 246

330 306

164

0

100

200

300

400

1995 1996 1997 1999 2001 2002 2005 Year

MUI(ug/L)

Excessive

More than Adequate

Adequate

Deficient

241 246

MU

I(m

cg/L

)

330306

165

USI Salt iodine was adjusted

Iodine Nutrition of Population in China

10th AOTA CONGRESS

Date Subject Contents population

1999 IITD-1 3 rural communities with MUI 84μg/L, 243 μg/L and 651 μg/L.

3,761

2004 IITD-2 IITD-1 follow-up ( 5 years) 3,018

2007 IITD-3 2 rural communities with MUI 145 μg/L and 261μg/L

3,813

2010 IITD-4 6 cities with more than adequate iodine intake and 4 cities with adequate iodine intake

15,181

2002 PPT Screening pregnant women and followed-up for 12 months

610

IITD: iodine-induced thyroid diseases; PPT: postpartum thyroiditis;

Epidemiologic Studies about Iodine and Thyroid Diseases in China

10th AOTA CONGRESS Teng WP, Shan ZY, et al: New Engl J Med 354: 2783-2793

IITD-1, IITD-2

10th AOTA CONGRESS

Zhangwu

PanshanHuanghua

• Three communities with iodine- :

– Mild deficiency (84μg/L)

– More than adequacy (243μg/L)

– Excess (614μg/L)

Study Design

• Baseline study in 1999 and follow-up in 2004

• To obtain prevalence and incidence of thyroid

diseases and an association with iodine intake

IITD-1, IITD-2

Teng WP, Shan ZY, et al: New Engl J Med 354: 2783-2793

10th AOTA CONGRESS

1.6

3.7

2

3.9

1.2 1.1

0

0.8

1.6

2.4

3.2

4

4.8

Prev

alen

ce ra

te[%

]

*:Compared with Panshan and Zhangwu， P<0.05

*

Overt hyperthyroidism

Subclinical hyperthyroidism

Panshan 103μg/L Zhangwu 375μg/L Huanghua 615μg/L

HYPERTHYROIDISM, Prevalence

IITD-1, IITD-2

10th AOTA CONGRESS

1.36 1.36

0.94

1.97

0.811.04

0

0.5

1

1.5

2

Overthyperthyroidism

Subclinical hyperthyroidism

Cum

ulati

ve in

cide

nce[

%]

HYPERTHYROIDISM, Incidence

IITD-1, IITD-2

Panshan 103μg/L Zhangwu 375μg/L Huanghua 615μg/L

10th AOTA CONGRESS

0.27

0.910.95

2.9

2.05

5.96

0

1

2

3

4

5

6

Clinical hypothyroidism Subclinical hypothyroidism

Pre

vale

nce

(%)

Panshan103μg/L Zhangwu375μg/L Huanghua615μg/L

*

*

#

#

*: Compared with Panshan, P<0.05#: Compared with Panshan and Zhangwu, P<0.05

HYPOTHYROIDISM, Prevalence

6.1

2.9

0.9

2.0

0.90.3

IITD-1, IITD-2


10th AOTA CONGRESS

0.23 0.23

0.47

2.6

0.44

2.89

0

0.5

1

1.5

2

2.5

3

Clinical hypothyroidism Subclinical hypothyroidism

1999

-200

4 C

umul

ativ

e In

cide

nce(

%)

Panshan103μg/L Zhangwu375μg/L Huanghua615μg/L

*: Compared with Panshan， P<0.05

HYPOTHYROIDISM, Incidence

**

2.92.6

0.20.30.5

0.2

IITD-1, IITD-2


10th AOTA CONGRESS

19.5

13.6

5.1

0

5

10

15

20

Panshan

Zhangwu

Huanghua

Prev

alen

ce ra

t (%

)

3.7 3.5 2.5

0

5

10

15

20

Panshan

Zhangwu

Huanghua

Diffuse goiter Nodular goiter

#

*

*

*:Compared with Huanghua,P<0.05#: Compared with Huanghua and Panshan,P<0.05

THYROID GOITER, Prevalence

IITD-1, IITD-2

10th AOTA CONGRESS

7.08

4.46.9

0

2.5

5

7.5

10

Panshan

Zhangwu

HuanghuaIn

cide

nce

rate

(‰/y

ear)

5.01

2.410.85

0

2.5

5

7.5

10

Panshan

Zhangwu

Huanghua

Diffuse goiter Nodular goiter

*

* *

*:Compared with Zhangwu,P<0.05*:Compared with Huanghua,P<0.05#: Compared with Huanghua and Zhangwu,P<0.05

#*

THYROID GOITER, Incidence

IITD-1, IITD-2

10th AOTA CONGRESSTeng XC, Shan ZY, Teng WP: Euro J Endocrinol, 2011,164: 943-950

IITD-3

10th AOTA CONGRESS

Study Design

• Two communities with iodine- :

– Adequate (145μg/L)

– More than adequate (261μg/L)

A cross-sectional study in 2007

Compare difference of thyroid diseases between adequate iodine intake and more than adequate iodine intake

Rongxing

Chengshan

Teng XC, Shan ZY, Teng WP: Euro J Endocrinol, 2011,164: 943-950

IITD-3

10th AOTA CONGRESSTeng XC, Shan ZY, Teng WP: Euro J Endocrinol, 2011,164: 943-950

Characteristics of Two Communities

IITD-3

10th AOTA CONGRESS

0.16

1.99 2.15

0.42

4.935.35

0

2

4

6

Clinicalhypothyroidism

Subclinicalhypothyroidism

Clinical andsubclinical

Pre

vale

nce(

%)

Chengshan145μg/L Rongxing261μg/L

*

##

#: Compared with Chengshan, P<0.01 *: Compared with Chengshan, P<0.05

HYPOTHYROIDISM prevalence


IITD-3

10th AOTA CONGRESS

ANTI-THYROID ANTIBODIES prevalence

8.47.93

10.69 10.32

0

3

6

9

12

TPOAb TgAb

Pre

vale

nce(

%)

Chengshan145μg/L Rongxing261μg/L

*

*: Compared with Chengshan, P<0.05

*


IITD-3

10th AOTA CONGRESS

National Cooperation Group of IITD-4 Study

Weiping Teng Lulu Chen Chao Liu

Binyin Shi Lixin Shi Zhongyan Shan

Nanwei Tong Shu Wang Jianping Weng

Xiaoping Xing Jiajun Zhao

A survey of iodine status and thyroid diseases in ten cities in China

IITD-4

10th AOTA CONGRESS

Distribution of Samples – 10 Cities

Chengdu

Guangzhou

Shanghai

Jinan

Nanjing

Beijing

Guiyang

Xi’an

Shenyang

Wuhan

IITD-4

10th AOTA CONGRESS

City nGender(M： F)

Average of Age Range of Age

Beijing 1539 1： 1.9 47.3±13.4 20-88

Chengdu 1500 1： 1.2 45.8±15.2 15-82

Guangzhou 1505 1： 1.4 45.0±15.2 18-83

Guiyang 1512 1： 1.4 45.2±14.8 20-78

Jinan 1500 1： 1.5 45.3±14.9 20-82

Nanjing 1572 1： 1.2 44.7±15.4 17-92

Shanghai 1500 1： 1.2 45.1±14.9 17-82

Shenyang 1549 1： 1.4 45.1±15.1 20-84

Wuhan 1500 1： 1.5 45.1±14.9 17-85

Xi’an 1500 1： 1.5 46.1±14.8 20-83

Total 15181 1： 1.4 45.5±14.9 15-92

Demographic Characteristics of 10 Cities

IITD-4

10th AOTA CONGRESS

0

100

200

300

400

总体北京成都广州贵阳济南南京上海沈阳武汉西安

MU

I(u

g/L

)

Excessive

Iodine Nutrition Status in 10 Cities

156 169 169

282

241

207

185174184

228

196

More than Adequate

Adequate

Deficient

Tota

l

Beijin

g

Chengdu

Guangzh

ou

Guiyan

g

Jinan

Nanjin

g

Shanghai

Shenya

ng

Xi’an

Wuhan

Tota

l

Beijin

g

Chengdu

Tota

l

Beijin

g

Guangzh

ou

Chengdu

Tota

l

Beijin

g

Guiyan

g

Guangzh

ou

Chengdu

Tota

l

Beijin

g

Jinan

Guiyan

g

Guangzh

ou

Chengdu

Tota

l

Beijin

g

Nanjin

g

Jinan

Guiyan

g

Guangzh

ou

Chengdu

Tota

l

Beijin

g

Shanghai

Nanjin

g

Jinan

Guiyan

g

Guangzh

ou

Chengdu

Tota

l

Beijin

g

Shenya

ng

Shanghai

Nanjin

g

Jinan

Guiyan

g

Guangzh

ou

Chengdu

Tota

l

Beijin

g

Wuhan

Shenya

ng

Shanghai

Nanjin

g

Jinan

Guiyan

g

Guangzh

ou

Chengdu

Tota

l

Beijin

gXi’a

n

Wuhan

Shenya

ng

Shanghai

Nanjin

g

Jinan

Guiyan

g

Guangzh

ou

Chengdu

Tota

l

Beijin

g

6 cities with adequate iodine intake 4 cities with more than adequate iodine intake

IITD-4

10th AOTA CONGRESS

0

0.5

1

1.5

2

2.5

3

3.5

临床甲亢亚临床甲亢

甲亢

患病

率 (

%)

碘充足地区碘超足量地区 *

P=0.000

1.6%

3.2%

1.2%1.0%

N=15,177

HYPERTHYROIDISM - Prevalence

IITD-4Pr

eval

ence

(%)

Clinical Hyperthyroidism Subclinical Hyperthyroidism

10th AOTA CONGRESS

0

1

2

3

4

5

6

7

8

9

临床甲减亚临床甲减

甲减

患病

率 (

%)

碘充足地区碘超足量地区

*

P=0.000

8.2%

3.8%

0.8%

2.1%

*P=0.043

N=15,181

Subclinical Hypothyroidism Overt Hypothyroidism

Pre

vale

nce

(%

)

HYPOTHYROIDISM - Prevalence

IITD-4

10th AOTA CONGRESS

0

2

4

6

8

10

12

14

16

TPOAb TgAb

An

tib

od

y P

osit

ive(%

)

Adequate

More Than Adequate

11.0%

12.4%

*P=0.006

12.0%

13.4%

*P=0.008

N=15,181

ANTITHYROID ANTIBODIES - Prevalence

IITD-4

10th AOTA CONGRESS

00.5

11.5

22.5

33.5

44.5

5

Adequate More Than Adequate

Goi

ter P

reve

lanc

e(%

)

*

P=0.000

1.4%

4.5%

N=15,181GOITER - Prevalence

IITD-4

10th AOTA CONGRESS

0

2

4

6

8

10

12

14

Single Multiple

Th

yro

id N

od

ule

Pre

vale

nce (

%)

AdequateMore Than Adequate12.4%

9.3%

*

P=0.000

8.4%

3.4%

*

P=0.000

N=15,181

THYROID NODULE - Prevalence

IITD-4

10th AOTA CONGRESS

Postpartum Thyroiditis

10th AOTA CONGRESS

Effect of Iodine Intake on Post-partum Thyroiditis

Guan HX, Li CY, Teng WP J Endocrinol Invest. 2005, 2 : 876

Study Design

• 610 pregnant women enrolled from an iodine-

sufficient area

• The patients with thyroid dysfunction were

followed for 12 months after delivery

• TSH, thyroid hormones and urinary iodine

were tested every 3 months

Iodine and Postpartum Thyroiditis

10th AOTA CONGRESS

7.25

11.39

18.58

0

5

10

15

20

<150(n=138) 150-300(n=237) >300(n=113)

Individual's mean level of UI during the studying period (μg/L)

Pre

vale

nce(%

)

Overt PPT Subclinical PPT PPT total *

*

Guan HX, Li CY, Teng WP J Endocrinol Invest. 2005, 2 : 876

PPT prevalence

Iodine and Postpartum Thyroiditis

10th AOTA CONGRESSSang Zhongna et al. J Clin Endocrinol Metab 2012， 97： E1363-1369

Iodine and Thyroid Dysfunction during Pregnancy

Thyroid dysfunction during late gestation is associated with excessive iodine intake in pregnant women

10th AOTA CONGRESS

Excessive Iodine Intake Increase Thyroid Dysfunction during late Gestation

Sang Zhongna et al. J Clin Endocrinol Metab 2012， 97： E1363-1369

10th AOTA CONGRESS

Summary

USI is a feasible and highly cost-effective strategy

Iodine supplementation (IS) can prevent and treat

iodine-deficiency disorders

Iodine levels that are more than adequate or excessive

could increased risk of subclinical hypothyroidism and

autoimmune thyroiditis

Iodine intake should be maintained at a safe level,

MUI between 100 and 200µg/L is a optimal range

10th AOTA CONGRESS

China Medical University

The First Hospital of CMU

Documents

Zhongyan SHAN