Conclusion

In conclusion, endemic goiter is preventable and is a public health problem worldwide, affecting 13% of the world's population. Iodination is cost-effective, and although it results in a transient increase in hyperthyroidism, overall the benefits greatly outweigh the risks. Significant progress has been achieved in a global effort in eliminating IDD in the last decade, with 68% of the 5 billion people living in countries with IDD having access to iodized salt. The global rates of goiter, mental retardation, and cretinism are falling.

For established goiters, treatment with thyroid hormone is helpful in some patients in stabilizing or decreasing goiter size. Thyroidectomy becomes indicated for mechanical and cosmetic reasons or because of possible or documented malignancy.

Acknowledgment

The author is grateful to Mrs. Pat Soong for providing technical assistance in the preparation of the chapter and Ms. Veronica Chan for typing the manuscript.

REFERENCES

1. WHO/UNICEF/ICCIDD. Progress Towards the Elimination of Iodine Deficiency Disorders (IDD). Document WHO/NHD/99.4. Geneva, Switzerland, World Health Organization, 1999.

2. Delange F, Bastani S, Benmiloud M, et al. Definitions of endemic goiter and cretinism, classification of goiter size and severity of endemias, and survey techniques. In: Dunn JT, Pretell EA, Daza CH, et al (eds), Towards the Eradication of Endemic Goiter, Cretinism, and Iodine Deficiency, No. 502. Washington, DC, Pan American Health Organization, 1986, p 373.

3. WHOAJNICEF/ICCIDD. Indicators for assessing iodine deficiency disorders and their control through salt iodization. Document WHO/ NUT/94.6. Geneva, Switzerland, World Health Organization, 1994.

4. Hetzel BS, Dunn JT, Stanbury JB (eds), The Prevention and Control of Iodine Deficiency Disorders. Amsterdam, Elsevier, 1987.

5. Fierro-Benitez R, et al. Long-term effects of correction of iodine deficiency on psychomotor and intellectual developments. In: Dunn JT, Pretell EA, Daza CH, et al (eds), Towards the Eradication of Endemic Goiter, Cretinism, and Iodine Deficiency. Washington DC, Pan American Health Organization, 1986, p 182.

6. Kelly FC, Snedden WW. Prevalence and geographical distribution of endemic goiter. In: Endemic Goiter, Monograph Series No. 44. Geneva, Switzerland, World Health Organization, 1960, p 27.

7. WHO/UNICEF/ICCIDD. Global Prevalence of Iodine Deficiency Disorders. In: Micronutrient Deficiency Information System (MDIS), No.l. Geneva, Switzerland, World Health Organization, 1993.

8. Ma T, et al. The present status of endemic goiter and endemic cretinism in China. Food Nutr Bull 1982;4:13.

9. Gaitan E, Nelson NC, Poole GV. Endemic goiter and endemic thyroid disorders. World J Surg 1991;15:205.

10. Clements FW. Health significance of endemic goiter and related conditions. In: Endemic Goiter, Monograph Series No. 44. Geneva, Switzerland, World Health Organization, 1960, p 235.

11. World Health Organization. Trace Elements in Human Nutrition and Health. Geneva, Switzerland, World Health Organization, 1996.

12. Koutras DA, Papapetrou PD, Yataganas X, et al. Dietary sources of iodine in areas with and without iodine deficiency goiter. Am J Clin Nutr I970;23:870.

13. Bourdoux P, Thilly C, Delange F, et al. A new look at old concepts in laboratory evaluation of endemic goiter. In: Dunn JT, Pretell EA, Daza CH, et al (eds), Towards the Eradication of Endemic Goiter, Cretinism, and Iodine Deficiency, No. 502. Washington, DC, Pan American Health Organization, 1986, p 115.

14. Furnee CA, van der Haar F, West CE, et al. A critical appraisal of goiter assessment and the ratio of urinary iodine to creatinine for evaluating iodine status. Am J Clin Nutr 1994;59:1415.

15. Stanbury JB, Hetzel B. Endemic Goiter and Endemic Cretinism. New York, Wiley, 1980.

16. Gaitan E. Iodine deficiency and toxicity. In: White PL, Selvey N (eds), Proceedings of the Western Hemisphere Nutrition Congress IV. Acton, MA, Publishing Sciences, 1975, p 56.

17. Gaitan E. Environmental Goitrogenesis. Boca Raton, FL, CRC Press, 1989.

18. Gaitan E, Lindsay RH, Reichert RD, et al. Antithyroid and goitrogenic effects of millet: Role of C-glycosylflavones. J Clin Endocrinol Metab 1989:68:707.

19. Vanderpas J, Bourdoux P, Lagasse R, et al. Endemic infantile hypothyroidism in a severe endemic goiter area of Central Africa. Clin Endocrinol 1984;20:327.

20. lngenbleek Y, Luypaert B, De Nayer P. Nutritional status and endemic goiter. Lancet 1980; 1:388.

21. Greer MA, Grimm Y, Studer H. Qualitative changes in the secretion of thyroid hormones induced by iodine deficiency. Endocrinology I968;83:l 193.

22. Delange F, Camus M, Ermans AM. Circulating thyroid hormones in endemic goiter. J Clin Endocrinol Metab 1972;34:891.

23. Pharoah POD, Lawton NF, Ellis SM, et al. The role of triiodothyronine (T3) in the maintenance of euthyroidism in endemic goiter. Clin Endocrinol 1973;2:193.

24. Bachtarzi H, Benmiloud M. TSH regulation and goitrogenesis in severe iodine deficiency. Acta Endocrinol (Copenh) 1983; 103:21.

25. Weber P, Krause U, Gaffga G, et al. Unilateral pulsatile and circadian TSH release in euthyroid patients with endemic goiter. Acta Endocrinol (Copenh) 1991;124:386.

26. Tseng YC, Burman KD, Schaudies RP, et al. Effects of epidermal growth factor on thyroglobulin and adenosine 3',5'-monophosphate production by cultured human thyrocytes. J Clin Endocrinol Metab 1989;69:771.

27. Medeiros-Neto GA, Halpern A, Cozzi ZS, et al. Thyroid growth immunoglobulins in large multinodular endemic goiters: Effect of iodized oil. J Clin Endocrinol Metab 1986;63:644.

28. Vitti P, Chiovato L, Tonacchera M, et al. Failure to detect thyroid growth-promoting activity in immunoglobulin G of patients with endemic goiter. J Clin Endocrinol Metab 1994;78:1020.

29. Zakarija M, McKenzie JM. Do thyroid growth-promoting immunoglobulins exist? J Clin Endocrinol Metab 1990;70:308.

30. Weetman AP. Is endemic goiter an autoimmune disease? J Clin Endocrinol Metab 1994;78:1017.

31. Studer H, Peter HJ, Gerber H. Natural heterogeneity of thyroid cells: The basis for understanding thyroid function and nodular goiter growth. EndocrRev 1989;10:125.

32. Perez C, Scrimshaw NS, Munoz JA. Technique of endemic goiter surveys. In: Endemic Goiter, Monograph Series No. 44. Geneva, Switzerland, World Health Organization, 1960, p 369.

33. World Health Organization/International Council for Control of Iodine Deficiency Disorders. Recommended normative values for thyroid volume in children aged 6-15 years. Bull WHO 1997:75:95.

34. Steward JC, Vidor GI, Butterfield IH, et al. Epidemic thyrotoxicosis in northern Tasmania. Aust N Z J Med 1972;3:203.

35. Wahner HW, Cuello C, Correa P, et al. Thyroid carcinoma in an endemic goiter area—Cali, Columbia. Am J Med 1966:40:58.

36. Harach HR, Escalante DA, Onativia A, et al. Thyroid carcinoma and thyroiditis in an endemic goiter region before and after iodine prophylaxis. Acta Endocrinol (Copenh) 1985;108:55.

37. Lowhagen T, Granberg PO, Lundell G, et al. Aspiration biopsy cytology (ABC) in nodules of the thyroid gland suspected to be malignant. Surg Clin North Am 1979;59:3.

38. Marine D, Kimball OP. Prevention of simple goiter in man. JAMA 1921:77:1068.

39. Sooch SS, Deo MG, Karmarkar MG, et al. Prevention of endemic goiter with iodized salt. Bull WHO 1973:49:307.

40. Aykroyd WR. Endemic goiter. In: Conquest of Deficiency Disease: Achievements and Prospects. Geneva, Switzerland, World Health Organization, 1970, p 78.

41. UNICEF. Nutrition. In: Adamson P (ed), The Progress of Nations— 1994. New York, UNICEF, 1994, p 8.

42. Hetzel BS, Thilly CH, Fierro-Benitez R, et al. Iodized oil in the prevention of endemic goiter and cretinism. In: Stanbury JB, Hetzel BS (eds), Endemic Goiter and Endemic Cretinism. New York, Wiley, 1980, p 513.

43. Bautista S, Barker PA, Dunn JT, et al. The effects of oral iodized oil on intelligence, thyroid status, and somatic growth in school-aged children from an area of endemic goiter. Am J Clin Nutr 1982;35:127.

44. Connolly RJ, Vidor GI, Stewart JC. Increase in thyrotoxicosis in endemic goiter area after iodination of bread. Lancet 1970; 1:500.

45. United Nations. World Declaration on the Survival, Protection, and Development of Children, and Plan of Action. New York, United Nations, 1990.

46. Grant JP. Iodine Deficiency Disorders on the Run. New York, UNICEF, 1994.

47. UNICEF. The State of the World's Children, 1995. Oxford, England, Oxford University Press for UNICEF, 1995.

48. Hintze G, Emrich K, Kobberling J. Treatment of endemic goiter due to iodine deficiency with iodine, levothyroxine, or both: Results of a multicentre trial. Eur J Clin Invest 1989; 19:527.

49. Wilders-Truschning MM, Warnkrob H, Leb G, et al. The effect of treatment with levothyroxine or iodine on thyroid size and thyroid growth-stimulating immunoglobulins in endemic goiter patients. Clin Endocrinol 1993;39:281.

50. Roher HD, Goretzki PE. Management of goiter and thyroid nodules in an area of endemic goiter. Surg Clin North Am 1987;67:233.

51. Bockisch A, Jamitzky T, Derwanz R, et al. Optimized dose planning of radioiodine therapy of benign thyroidal disease. J Nucl Med 1993:34:1632.

52. Nygaard B, Hegedus L, Gervil M, et al. Radioiodine treatment of multinodular nontoxic goiter. BMJ 1993:307:828.

53. Shapiro B. Optimization of radioiodine therapy of thyrotoxicosis: What have we learned after 50 years? J Nucl Med 1993;34:1638.

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook


Responses

  • rhiannon
    What is the conclusion of goiter?
    2 years ago

Post a comment