title: Iodised rapeseed oil for eradication of severe endemic goitre The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials Prophylaxis and treatment of endemic goiter with iodized oil in rural Ecuador and Peru. Improved iodine status is associated with improved mental performance of schoolchildren in Benin. Serum thyroglobulin and urinary iodine concentration are the most appropriate indicators of iodine status and thyroid function under conditions of increasing iodine supply in schoolchildren in Benin. The effects of oral iodized oil on intelligence, thyroid status, and somatic growth in school-age children from an area of endemic goiter. Intermittent oral administration of potassium iodide solution for the correction of iodine deficiency. Effect of iron-, iodine-, and beta-carotene-fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial. Persistence of goiter despite oral iodine supplementation in goitrous children with iron deficiency anemia in Côte d'Ivoire. Dual fortification of salt with iodine and microencapsulated iron: a randomized, double-blind, controlled trial in Moroccan schoolchildren. Infant survival is improved by oral iodine supplementation. Mild iodine deficiency is associated with elevated hearing thresholds in children in Benin Randomized clinical trial comparing different iodine interventions in school children. Development of thyroid gland volume during the first 3 months of life in breast-fed versus iodine-supplemented and iodine-free formula-fed infants Reversibility of severe hypothyroidism with supplementary iodine in patients with endemic cretinism. The effects of different doses of oral iodized oil on goiter size, urinary iodine, and thyroid-related hormones. Treatment by iodized oil (Lipiodol® UF) of a population in Mali suffering from endemic goiter Hypothyroid patients showing shortened responsiveness to oral iodized oil have paradoxically low serum thyroglobulin and low thyroid reserve. Thyroglobulin/thyrotropin ratio as a measure of thyroid damage. Efficacy of low oral doses of iodized oil in the control of iodine deficiency in Zaire. [Assessment of an interventional study on iodine deficiency in Burkina Faso, 1990-1993. Direction de la Santé de la Famille (Burkina Faso)]. [Effects of three different iodine interventions on the speed of normalization of enlarged thyroid gland due to iodine deficiency]. Prophylaxis of endemic goiter with iodized oil in rural Peru. PRELIMINARY REPORT OF AN EXPERIMENT IN THE KANGRA VALLEY FOR THE PREVENTION OF HIMALAYAN ENDEMIC GOITRE WITH IODIZED SALT. Iodine supplementation with oral or intramuscular iodized oil. A two-year follow-up of a comparative trial. Randomised trial of iodine intake and thyroid status in preterm infants Iodine supplementation: comparison of oral or intramuscular iodized oil with oral potassium iodide. A controlled trial in Zaire. Efficacy of oral iodised oil is associated with anthropometric status in severely iodine-deficient schoolchildren in rural Malawi. Randomized, double blind, placebo-controlled trial of low dose iodide in endemic goiter. Effect of voluntary intake of iodinated salt on prevalence of goitre in children. The effect of varying doses of oral iodized oil in the prophylaxis of endemic goitre in elementary schools children. Iodized Oil as a Complement to Iodized Salt in Schoolchildren in Endemic Goiter in Romania
abstract: Iodised oil is traditionally based on the fatty acids ( FAs ) of the poppyseed , an expensive commodity . An equipotent but cheaper vehicle would be welcome . Iodination of rapeseed oil yields a product ( Brassiodol ) with a total iodine content of 376 mg/mL. Brassiodol has been compared with the poppyseed-based Lipiodol in two villages in Chad in the west African goitre belt . A 2 mL dose of Brassiodol is followed by urinary spillover of half the ingested iodine . The other half undergoes tissue sequestration and slow release , allowing protection against iodine deficiency for 9 months and regression of stage I/II goitre for longer than was achieved with Lipiodol . The prolonged protection offered by Brassiodol can be attributed to its unique lipid profile . The urinary output argues that 1 mL should not be exceeded , and at that dose the cost would be only 20 US cents per person per year To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Endemic goiter is a health problem in many areas of the world ; in some areas the disease is so severe that cretinism and other defects are found . In many areas geographic , economic , and other factors prevent the use of iodized salt as a preventive measure . Field studies were begun in 1966 to determine the feasibility and effectiveness of parenteral administration of iodized oil in goiter prevention . Studies were carried out in Ecuador and Peru . In Ecuador 2 villages were chosen in which the prevalence of goiter was about 60 % ; in Peru 3 villages were chosen where incidence was about 50 % .  Prevalence of goiter decreased for 20 months during the study but then began to rise again with the maximum reduction seen up to age 18 and minimal reduction after 40 years of age . The control groups in the study experienced only slight decreases in rate of incidence . Cretinism has not yet appeared among the progeny of the population injected with iodized oil but several instances have appeared in control groups . The use of iodized oil as a public health procedure for the prevention of endemic goiter and its associated defects is an acceptable measure in regions where salt iodization can not be done BACKGROUND An adequate iodine supply in utero and shortly after birth is known to be crucial to an individual 's physical and mental development . The question of whether iodine supplementation later in life can exert a favorable influence on the mental performance of iodine-deficient population s was addressed in various studies , but with contradictory results . OBJECTIVE The aim of this study was to examine the effect of an improvement in iodine status on mental and psychomotor performance of schoolchildren ( 7 - 11 y ) who were moderately to severely iodine deficient . DESIGN The study , which was originally planned as a double-blind , r and omized , placebo-controlled intervention , was carried out in an iodine-deficient population of schoolchildren ( n = 196 ) in northern Benin . As the population began to have access to iodized salt during the 1-y intervention period , the study population was split post hoc-on the basis of urinary iodine concentrations-into a group with improved iodine status and a group with unchanged iodine status . Changes in mental and psychomotor performance over the intervention period were compared . RESULTS Children with increased urinary iodine concentrations had a significantly greater increase in performance on the combination of mental tests than did the group with no change in urinary iodine concentrations . CONCLUSIONS An improvement in iodine status , rather than iodine status itself , determined mental performance in this population , which was initially iodine deficient . These findings suggest a " catch-up " effect in terms of mental performance Iodine deficiency control programs have greatly reduced iodine deficiency disorders worldwide . For monitoring changes in iodine status , different indicators may be used . The aim of this study was to evaluate the suitability of indicators of iodine status and thyroid function , thyroglobulin ( Tg ) , thyroid-stimulating hormone ( TSH ) and free thyroxine ( FT4 ) in serum , thyroid volume and urinary iodine concentration , in iodine-deficient schoolchildren under conditions of increasing iodine supply . The study was established as a double-blind , placebo-controlled oral administration of a single dose of iodized oil to schoolchildren ( 7 - 10 y old ) , living in an iodine-deficient area of Benin , with an observation period of 10 mo . However , 3 - 4 mo after supplementation , iodized salt became available in the area . The study population therefore comprised an iodized oil-supplemented group  and a nonsupplemented group  , both of which had variable , uncontrolled intakes of iodized salt during the last 6 mo of the study . Initial mean serum concentrations of TSH and FT4 were within the normal range , whereas serum Tg concentration , urinary iodine concentration and thyroid volume were indicative of moderate-to-severe iodine deficiency . At the end of the study , all indicators had improved significantly , except thyroid volume , which had decreased only in the supplemented group . The supplemented group also still had significantly lower serum Tg and higher urinary iodine concentrations than the nonsupplemented group . Serum Tg and urinary iodine concentrations are the indicators most influenced by a changing iodine supply . Current normal reference ranges of serum concentrations of TSH and FT4 are too wide for detecting iodine deficiency in this age group One hundred goitrous school children received 475 mg iodized oil by mouth , while 100 controls received mineral oil , on a double-blind basis . On follow-up 22 months later the urinary iodine had increased and goiter size had decreased in both groups , more strikingly in the iodine-treated children . There were no consistent differences between the two treatment groups in rate of somatic growth or performance on the Stanford-Binet and Bender tests . Because of the complexities introduced by increases in urinary iodine in the controls , we compared goiter reduction with improvement in IQ score in all children , regardless of group , and found a significant relationship ( p = 0.014 ) , particularly in girls ( p = 0.029 ) . We conclude that oral iodized oil is an attractive alternative to its injection but we recommend an approximate doubling of the dose used here for more effective control . Also , while our data are not conclusive , they support the possibility that correction of iodine deficiency may improve mental performance in school age children , particularly girls Iodized salt and iodized oil are the main methods used to prevent iodine deficiency , but sometimes alternative approaches are needed . We tested the efficacy of various regimens for the intermittent administration of potassium iodide in Hwedza , Zimbabwe , an area of known severe iodine deficiency . We divided 304 schoolchildren aged 7 - 13 y into five equal groups that received iodine as a 10 % solution of potassium iodide as follows : 8.7 mg every 2 wk ( group A ) , 29.7 mg every month ( group B ) , 148.2 mg every 3 mo ( group C ) , 382 mg every 6 mo ( group D ) , or 993 mg once ( group E ) . The follow-up period was 13 mo . No adverse effects were encountered with any of these doses . After 6 mo , the median blood spot thyroglobulin concentration had decreased in all groups and had normalized in groups A and B to values found in iodine-sufficient population s. The number of children with elevated thyroid-stimulating hormone concentrations decreased in groups A-C , but the changes were not significant . Urine iodine concentration generally remained low in all groups but increased in group A. After 13 mo , mean thyroid volume measured by ultrasound had decreased in groups A and B to values comparable with those in iodine-sufficient areas , and was unchanged in the other groups . We conclude that oral potassium iodide is effective for the prophylaxis of iodine deficiency if given as a dose of 30 mg I monthly or 8 mg biweekly BACKGROUND Deficiencies of iron , iodine , and vitamin A are prevalent worldwide and can affect the mental development and learning ability of schoolchildren . OBJECTIVE The aim of this study was to determine the effect of micronutrient-fortified biscuits on the micronutrient status of primary school children . DESIGN Micronutrient status was assessed in 115 children aged 6 - 11 y before and after consumption of biscuits ( fortified with iron , iodine , and beta-carotene ) for 43 wk over a 12-mo period and was compared with that in a control group ( n = 113 ) who consumed nonfortified biscuits .  Cognitive function , growth , and morbidity were assessed as secondary outcomes . RESULTS There was a significant between-group treatment effect on serum retinol , serum ferritin , serum iron , transferrin saturation , and urinary iodine ( P < 0.0001 ) and in hemoglobin and hematocrit ( P < 0.05 ) . The prevalence of low serum retinol concentrations ( < 0.70 micromol/L ) decreased from 39.1 % to 12.2 % , of low serum ferritin concentrations ( < 20 microg/L ) from 27.8 % to 13.9 % , of anemia ( hemoglobin < 120 g/L ) from 29.6 % to 15.6 % , and of low urinary iodine concentrations ( < 100 microg/L ) from 97.5 % to 5.4 % . There was a significant between-group treatment effect ( P < 0.05 ) in cognitive function with the digit span forward task ( short-term memory ) . Fewer school days were missed in the intervention than in the control group because of respiratory- ( P = 0.097 ) and diarrhea-related ( P = 0.013 ) illnesses . The intervention had no effect on anthropometric status [ corrected ] . CONCLUSIONS Fortified biscuits result ed in a significant improvement in the micronutrient status of primary school children from a poor rural community and also appeared to have a favorable effect on morbidity and cognitive function [ corrected ] BACKGROUND In developing countries , many children are at high risk of goiter and iron deficiency anemia . Because iron deficiency can have adverse effects on thyroid metabolism , iron deficiency may influence the response to supplemental iodine in areas of endemic goiter . OBJECTIVE The aim of this study was to determine whether goitrous children with iron deficiency anemia would respond to oral iodine supplementation . DESIGN A trial of oral iodine supplementation was carried out in an area of endemic goiter in western Côte d'Ivoire in goitrous children ( n = 109 ) aged 6 - 12 y. Group 1 ( n = 53 ) consisted of goitrous children who were not anemic . Group 2 ( n = 56 ) consisted of goitrous children who had iron deficiency anemia . At baseline , thyroid gl and volume and urinary iodine , thyrotropin , and thyroxine were measured by using ultrasound . Each child received 200 mg I orally and was observed for 30 wk , during which urinary iodine , thyrotropin , thyroxine , hemoglobin , and thyroid gl and volume were measured . RESULTS The prevalence of goiter at 30 wk was 12 % in group 1 and 64 % in group 2 . The mean percentage change from baseline in thyroid volume 30 wk after administration of oral iodine was -45.1 % in group 1 and -21.8 % in group 2 ( P < 0.001 ) . Among the anemic children , there was a strong correlation between the percentage decrease in thyroid volume and hemoglobin concentration ( r(2 ) = 0.65 ) . CONCLUSION The therapeutic response to oral iodine was impaired in goitrous children with iron deficiency anemia , suggesting that the presence of iron deficiency anemia in children limits the effectiveness of iodine intervention programs BACKGROUND In many developing countries , children are at high risk of both goiter and iron deficiency anemia . OBJECTIVE In a series of studies in northern Morocco , we developed and tested a dual-fortified salt ( DFS ) containing iodine and microencapsulated iron . DESIGN To establish the DFS fortification concentration , we measured salt intake by 3-d weighed food records and estimated iron bioavailability from the local diet by using published algorithms . We then formulated a DFS containing 25 micro g iodine/g salt ( as potassium iodide ) and 1 mg iron/g salt ( as ferrous sulfate hydrate encapsulated with partially hydrogenated vegetable oil ) . After storage and acceptability trials , we compared the efficacy of the DFS to that of iodized salt in a 9-mo , r and omized , double-blind trial in iodine-deficient , 6 - 15-y-old children ( n = 377 ) . RESULTS Mean salt intake in school-age children was 7 - 12 g/d , and estimated iron bioavailability from the local diet was 0.4 - 4.3 % . After storage for 20 wk , the DFS and iodized salt were not significantly different in iodine content , and color stability was acceptable when the compounds were added to local meals . During the efficacy trial , urinary iodine concentrations and thyroid volumes improved significantly ( P < 0.001 and < 0.05 , respectively ) from baseline in both groups . At 40 wk , mean hemoglobin concentrations in the DFS group had increased by 14 g/L ( P < 0.01 ) , and serum ferritin , transferrin receptor , and zinc protoporphyrin concentrations were significantly better ( P < 0.05 ) in the DFS group than in the iodized salt group . The prevalence of iron deficiency anemia in the DFS group decreased from 35 % at baseline to 8 % at 40 wk ( P < 0.001 ) . CONCLUSION A DFS containing iodine and encapsulated iron can be an effective fortification strategy Although reports suggest that infant mortality is increased during iodine deficiency , the effect of iodine supplementation on infant mortality is unknown . A double-masked , r and omized , placebo-controlled , clinical trial of oral iodized oil was conducted in Subang , West Java , Indonesia to evaluate the effect of iodine supplementation on infant mortality . Infants were allocated to receive placebo or oral iodized oil ( 100 mg ) at about 6 wk of age and were followed to 6 mo of age . Six hundred seventeen infants were enrolled in the study .  Infant survival was apparently improved , as indicated by a 72 % reduction in the risk of death during the first 2 mo of follow-up ( P < 0.05 ) and a delay in the mean time to death among infants who died in the iodized oil group compared with infants who died in the placebo group ( 48 days vs. 17.5 d , P = 0.06 ) . Other infant characteristics associated with reduced risk of death included weight-for-age at base line , consumption of solid foods , female gender and recent history of maternal iodine supplementation . Oral iodized oil supplementation had a stronger effect on the mortality of males compared with females . This study suggests that oral iodized oil supplementation of infants may reduce  infant mortality in population s at risk for iodine deficiency Objective : Elevated hearing thresholds have been demonstrated in population s afflicted by endemic cretinism as a result of severe iodine deficiency . However , data on the effects of less severe iodine deficiency on hearing thresholds in apparently normal children are scant . This study addresses the question whether there is a relationship among iodine variables , hearing and mental performance in a mildly iodine-deficient population . Design : A r and omized , placebo-controlled intervention trial with an observation period of 11 months . Setting : An iodine-deficient area in northern Benin . Subjects : A total of 197 school children , aged 7–11 y. Interventions : A total of 97 children received an oral dose of iodized oil , containing 540 mg I , while 100 children received a placebo . About 3–4 months after supplementation , the whole population began to have access to iodized salt .  Non-verbal mental tests were administered and biochemical indicators ( thyrotropin , free thyroxine , thyroglobulin and urinary iodine ) were measured at the beginning and the end of the study . Hearing was measured at the end of the study in both ears by pure-tone audiometry at seven frequencies . Results : In this mildly iodine-deficient child population children with higher serum thyroglobulin concentrations had significantly higher hearing thresholds in the higher frequency range ( ≥2000 Hz ) than children with lower serum thyroglobulin concentration . Moreover children with lower hearing thresholds performed significantly better on the mental tests used . Conclusions : Even when iodine deficiency is ‘ mild ’ , promotion of adequate iodine intake through salt iodization programs and other means remains crucial . Sponsorship : Nestlé Foundation , Lausanne , Switzerl and ; Wageningen University , Wageningen , The Netherl and s . European Journal of Clinical Nutrition ( 2001 ) 55 , OBJECTIVE The purpose of this trial was to compare three different iodine interventions . DESIGN School children aged 8 - 10 years were r and omized into one of three groups : group A was provided with iodized salt by research ers with an iodine concentration of 25 ppm ; group B purchased iodized salt from the market ; and group C was similar to group B with the exception that they were given iodized oil capsules containing 400 mg iodine at the beginning of the study . Salt iodine content was measured bimonthly for 18 months and indicators of iodine deficiency were measured at baseline and 6 , 9 , 12 and 18 months after r and omization . RESULTS The prevalence of abnormal thyroid volumes , based on the World Health Organization ( WHO ) body surface area reference > 97th percentile , was 18 % at baseline and declined to less than 5 % by 12 months in groups A and C , and to 9 % after 18 months in group B. Results for goitre by palpation were similar . The median urinary iodine was 94 microg l(-1 ) at baseline and increased in all groups to > 200 microg l(-1 ) at the 6-month follow-up . CONCLUSIONS In this population of school children with initially a low to moderate level of iodine deficiency , the group receiving salt with 25 ppm ( group A ) was not iodine deficient on all indicators after 18 months of study . When the iodine content of the salt varied , such as in group B , by 18 months thyroid sizes had not yet achieved normal status Summary The spontaneous development of thyroid gl and volume ( TGV ) during the first 3 months of life was studied in entirely breast-fed infants ( n = 21 ) and compared to those fed an iodine-supplemented formula ( n = 19 ) , an iodine-free formula ( n = 5 ) , or partially breast-fed in addition to an iodine-free ( n = 4 ) or an iodine-supplemented formula ( n = 16 ) . The TGV of the infants and their mothers was determined sonographically in addition to their urinary iodine concentrations 57 days postpartum and 3 months later . In ten additional lactating mothers the breast milk concentrations of thyroid hormones and iodine were determined . It was shown that at 3 months of age an infant consuming about 1000 ml breast milk per day receives about 2 μg thyroid hormones and 55 μg iodine per day . At the end of their first week of life the infants showed a TGV between 0.28 and 1.5 ml ( median 0.61 ml ) and a urinary iodine concentration between 0.03 and 16.3 μg/dl ( median 3.0 μg/dl ) . At 3 months of age the TGV of the breast-fed infants had decreased by a median of 0.24 ml (= −34 % ; median of percentage changes ) whereas those fed a formula without iodine had increased by a median of 0.26 ml (= + 50 % ; median of percentage changes ) . Those receiving an iodine-supplemented formula  showed a TGV reduction of 0.14 ml (= + 2 % ; median of percentage changes ) . The TGV development of the partially breast-fed infants lay between those being exclusively breast or formula fed . It is concluded that with respect to the development of TGV , breast milk is superior even to the feeding of an iodine-supplemented formula The reversibility of thyroid dysfunction in children with endemic cretinism treated with supplemental iodine  is unknown . To study this question we conducted a five-month follow-up of 51 patients with cretinism ( age 14 and below ) , who were r and omly assigned to treatment ( 0.5 ml of intramuscular iodized oil ) and control groups . The geometric mean initial serum level of thyrotropin ( 223 microU per milliliter ; SD , 97 to 513 ) and the mean ( + /- SD ) initial serum level of thyroxine ( 1.0 + /- 1.2 micrograms per deciliter ) indicated that all patients had severe hypothyroidism . Within one month after receiving the iodized oil , 13 of 14 of the younger patients ( less than 4 years ) and 1 of 9 of the older patients ( 4 to 14 years ; P less than 0.001 ) had thyrotropin values below 20 microU per milliliter . Five months after treatment , the levels of thyrotropin had decreased and those of thyroxine had increased in all children , but greater changes occurred in the 13 younger patients than in the 14 older patients . The mean levels of thyrotropin were 2 microU per milliliter ( SD , 0.6 to 6 ) vs. 38 microU per milliliter ( SD , 11 to 132 ; P less than 0.001 ) , and the mean ( + /- SD ) levels of thyroxine were 13.1 + /- 2.8 vs. 8.1 + /- 4.6 micrograms per deciliter ( P less than 0.001 ) . In the untreated group , 3 of the 9 younger patients and none of the 15 older patients recovered normal thyroid function within five months . We conclude that iodine supplementation restored a biochemically euthyroid state in all younger children with cretinism but only some of the older children . In addition , some younger patients became euthyroid without iodine supplementation The prevention of iodine deficiency is still a worldwide concern . This study , conducted in Soja in western Sudan , was carried out to evaluate the effects of a dose of iodized oil sufficient enough to give maximum protection against goiter and provide an acceptable iodine supply without side-effects over a sufficiently long period of time . Adult goitrous subjects ( n = 117 ) were r and omly assigned to three groups , A , B , and C , and received a single oral dose of 200 , 400 , or 800 mg iodine , respectively . Urine and blood sample s were collected at the start of the study and monitored for 1 yr . In the 3 groups , mean serum T4 and median urinary iodine and serum TSH values were restored to reference limits , and these were maintained for about 1 yr . In each treatment group , about two thirds of the subjects displayed a reduction in goiter size , and the 400- and 800-mg doses were not more efficient than the 200-mg dose to accomplish normalization of thyroid hormone values . A temporary rise in TSH was noted 1 week after iodine administration in 1 , 3 , and 10 subjects , respectively , and 1 , 0 , and 3 subjects showed biochemical signs of thyrotoxicosis during the year after treatment with the 3 different doses . The data indicate that oral administration of 200 mg iodine is effective and acceptable for treating iodine deficiency in adults for 1 yr . Because of the risks of side-effects and the shortage of medical re sources , higher doses are not recommended In order to reduce the prevalence of goiter in a village of Mali liable to iodine deficiency , an iodized product ( Lipiodol ® Ultra Fluide ) was orally administered to their inhabitants . Taking into account a series of demographic variables and goiter types , a protocol was conducted using Lipiodol at three different dosage levels . Six months after the treatment , the hormone levels regained normal values , whereas only the smallest dose reduces the volume of goiters significantly In Central Africa , all of northern Zaire is very severely deficient in iodine . A peculiar feature of this endemia is that iodine deficiency and the ensuing thyroid gl and stimulation not only leads to goitre formation but also to progressive thyroid involution and to myxoedematous cretinism . An iodine supplementation trial based on oral administration of small doses of iodine was made in 81 schoolchildren . All of them received a small dose of iodine ( 0.1 ml containing 48 mg ) per os and the thyroid status was followed during 4 months . Blood and urine sample s were collected at the start of the study , then 2 weeks , 2 months and 4 months after iodine administration . Before iodine supplementation the mean urinary iodine level was 0.18 + /- 0.02 micromol/l , and 10 % of the subjects had a urinary iodine level below 0.08 micromol/l . Fifty-two percent of the subjects had a serum thyrotropin ( TSH ) level above 10 mU/l . All the subjects responded to the administration of iodine . and all of them recovered a euthyroid status . Most of them were still euthyroid at the end of the study . However . within 4 or even 2 months , some subjects ( 15 % of the total ) reverted to hypothyroidism . At the entry of the study these subjects were all hypothyroid and had elevated TSH and paradoxically low serum thyroglobulin ( TG ) values . In myxoedematous cretins living in the same area , even lower serum TG levels were found . Together with the absence of goitre , a paradoxically low serum TG Suggests a low thyroid reserve , and in the present case a reduced amount of functional thyroid tissue . We show that the serum TG/TSH ratio may be used as a predictive index of thyroid reserve and of positive response to iodine administration . These data further suggest that thyroid damage is not confined to myxoedematous cretins . but is widely distributed in the phenotypically normal population . Widely distributed thyroid damage may render iodine prophylaxis based on oral administration unpredictable BACKGROUND About one billion people worldwide are at risk for iodine deficiency . Despite existing programs of prophylaxis , the prevention of iodine deficiency is still a challenge throughout the developing world . We studied the efficacy of low doses of iodized oil in an area of severe iodine deficiency in Zaire . METHODS Seventy-five subjects with visible goiter were r and omly assigned to receive a single oral dose of placebo or either 0.1 or 0.25 ml of iodized oil , corresponding to 0 , 47 , and 118 mg of iodine , respectively . The mean ages of the subjects in the three groups were 23 , 22 , and 22 years , respectively , and the ratios of males to females were 0.25 , 0.32 , and 0.19 .  Efficacy was assessed by evaluating goiter size and measuring urinary iodine and serum thyroid hormone concentrations for 12 months . RESULTS Goiter size decreased in most of the subjects who received either dose of iodized oil . Their urinary iodine concentrations were normal for six to nine months and their serum thyroxine and thyrotropin concentrations were nearly all normal throughout the study period . There were no side effects , even in subjects whose serum thyroxine concentrations had initially been low . In the placebo group , neither goiter size nor any of the biochemical values changed . CONCLUSIONS The oral administration of a single small dose of iodized oil is capable of correcting iodine deficiency for about a year . This method of supplementation is likely to be more effective , efficient , and acceptable than the administration of either intramuscular or large oral doses of iodized oil OBJECTIVES To find how the urinary parameters of iodine excretion evolved in a community with deficiencies , after administering iodine orally and IM in two provinces in Burkina Faso ; to recommend a national strategy to tackle iodine deficits . Design . A longitudinal survey before and after the iodine was given ( 12 months ) . Descriptive analysis of the data . SETTING Provinces of Namentenga and Passoré in Burkina Faso . PARTICIPANTS The general population of the two provinces who satisfied age-sex criteria : males from 0 to 25 , females from 0 - 45 . R and omised two-stage sampling . 423 people in all took part ( 210 in Namentenga and 213 in Passoré ) . INTERVENTIONS The administration of 1 ml of iodised oil ( Lipiodol ) orally in Namentenga and IM in Passoré . MEASUREMENTS AND MAIN RESULTS The urinary parameters of micrograms of iodine per gr . of Creatinine , and micrograms of iodine per dl of urine , were used . Figures for normalisation of the urinary parameters 12 months after iodisation was significantly higher in Passoré province , where iodine was administered IM . CONCLUSIONS The intramuscular pathway has more longlasting effects , but the characteristics of Burkina Faso 's health system and the feasibility of a medium or long-term intervention make it advisable that iodine supplements be administered orally OBJECTIVE To compare the effects of three different iodine interventions on the speed of normalization of enlarged thyroid gl and . METHODS Schoolchildren aged 8 - 10 years were r and omized divided into one of three groups : group A was given iodized salt by research ers with an iodine concentration of 25 mg/kg ; group B used iodized salt purchased from the market ; and group C was similar to group B with additional intake of iodized oil capsules containing 400 mg iodine at the beginning of the study . Salt iodine content was measured bimonthly for 18 months and indicators of iodine deficiency were measured at baseline and 6 , 9 , 12 and 18 months thereafter . RESULTS The prevalence of goiter measured by ultrasound , based on the World Health Organization ( WHO ) body surface area reference > 97(th ) percentile , was 18 % at baseline and declined to less than 5 % by 12 month in groups A and C respectively , and to 9 % after 18 months in group B. Rates of goiter were similar by palpation or by ultrasound . The median urinary iodine was 94 micro g/L at baseline and increased in all groups to > 200 micro g/L at the 6-month follow-up . CONCLUSIONS In this sample of schoolchildren with initially low or moderate level of iodine deficiency , the group receiving salt with 25 mg/kg ( group A ) recovered from iodine deficient on all indicators after 18 months of study . However when the iodine content of salt was floating , as seen in group B , the sizes of thyroid did not yet achieve normal status by 18 months Three And ean villages at altitudes of 3,100 to 3,500 meters above sea level were studied in order to determine the prophylac— ' tic effect of iodized oil administration on endemic goiter \ and cretinism ( 1 ) . At the time of the study the population in | these villages was approximately 4,000 , with an annual growth ' rate of about three percent . In a group of 3,000 subjects i examined in a house-to-house survey , the visible goiter rate , : as defined in an accompanying paper ( 2 ) , was 55 percent . However , ? when the cccurrence of palpable goiter was considered as well , | the incidence of goiter rose to 83 percent . Fifty percent of * the children in the 0 - 5 yr age group were goitrous and of these , | 20 percent demonstrated visible goiter . Goiter prevalence l increased with age , as did nodularity . An example of this is ‘ shown in Fig. 1 . In some families every member was found with ii goiter as illustrated in Fig. 2 . Goiter was also found among 4 the domestic animals . The percentage of defective persons in the i three villages ranged from 1.0 to 3.6 percent . Although these _ . x villages are accessible by automobile , they are still quite remote * , and isolated This report incorporates the results of an investigation design ed to test the effectiveness of potassium iodide and potassium io date in the control of Himalayan endemic goitre when these compounds are added in small physiological doses to the domestic salt habitually consumed by the people in the endemic belt . In a prospect i ve study lasting five years , a striking reduction in the prevalence of goitre was observed in areas receiving salt fortified with either potassium iodide or potassium io date . During the same period , goitre prevalence remained unchanged in the control zone , which received plain , unfortified salt . The study has an important bearing on the problem of goitre control in developing countries that use moist , coarsely crystalline salt A controlled trial of iodine supplementation comparing oral with intramuscular iodized oil has been carried out in an iodine deficient area of Zaire . Two years after the administration of 2 ml of oral iodized oil to the population of four villages the overall goitre prevalence had fallen from 64 to 54 % . In a further two villages given 2 ml of intramuscular oil the prevalence fell from 65 to 50 % . The effectiveness of supplementation was also assessed by measuring changes in thyroid function in women of reproductive age . Among women in the villages given oral iodized oil , the geometric mean thyroxine concentration , measured in dried bloodspots , rose from 27.2 to 52.6 nmol/L at the two-year follow-up . This was similar to the response of the intramuscularly treated villages in which thyroxine levels rose from 32.1 to 65.4 nmol/L. There was no change in goitre prevalence or thyroid function in two control villages . Oral iodized oil is a cheaper and simpler alternative to the injected form providing effective iodine prophylaxis for up to two years after a single dose BACKGROUND Low levels of circulating thyroid hormones have been associated with poorer general and neurodevelopmental outcome in preterm babies and it has been speculated that the association is causal . Low levels of circulating thyroid hormone have been reported after inadequate intake of iodine in preterm infants being fed milk formula . AIM To investigate whether increased iodine intake from supplemented preterm formula would improve thyroid hormone levels in preterm babies ( this study ) and hence improve neurodevelopmental status ( planned subsequent study ) . METHOD A total of 121 preterm infants were entered into a r and omised controlled trial of st and ard ( 68 μg/l ) versus increased ( 272 μg/l ) iodine in preterm formula . RESULTS The two groups were comparable at recruitment . No evidence of an effect of the intervention on thyroid hormone levels was seen up to 41 weeks after conception . CONCLUSION Calls for increased iodine content of preterm infant formulas are not justified by this study . Key message Increasing milk iodine content in line with the latest recommendations for preterm babies had no effect on thyroid hormone levels in the perinatal A community-based controlled trial of iodine supplementation comparing oral or intramuscular iodized oil with oral potassium iodide has been carried out in 23 severely iodine-deficient villages in Eastern Zaire . The overall goitre prevalence in the population ( n = 5999 ) was 61 % and mean urinary iodine excretion in sample of 57 women 10.9 ( SD 6.8 ) micrograms/g creatinine . All adults in three groups of four villages were given single doses of potassium iodide of 0.5 g , 1.0 g , and 2.0 g respectively . A fourth group was given oral iodized oil ( 2 ml ) and a fifth placebo-treated . A further three villages were given intramuscular iodized oil ( 2 ml ) . The effectiveness of supplementation was assessed by measurements of bloodspot thyroxine ( T4 ) concentration in women of reproductive age in the villages . The effects of iodide were small and inconsistent . Eight months after supplementation with oral iodized oil the distribution of T4 concentrations was similar to that seen with intramuscular oil . We conclude that oral iodized oil is an effective alternative to injected oil and would be feasible for iodine supplementation in remote areas with untrained people The effect of anthropometric status on the efficacy of an oral supplement of iodised oil ( 1 ml Lipiodol Ultrafluide , 490 mg I ; Laboratoire Guerbet , Aulnay-sous-Bois , France ) was examined in 8 - 10-year-old schoolchildren ( n 197 ) of Ntcheu , a severely I-deficient district of Malawi . The study was a controlled trial using the I concentration of casual urine sample s to monitor the I status . The median urinary I concentration increased from 0.15 micromol/l at baseline ( 51.3 % of children < 0.16 micromol/l , 89.7 % < 0.40 micromol/l , 95.7 % 0.79 micromol/l ) to 0.32 micromol/l at 40 weeks ( 29.1 % of the children < 0.16 micromol/l , 71.0 % < 0.40 micromol/l , 96.1 % < 0.79 micromol/l ) while the total goitre prevalence fell from 63 % to 21 % . Variables of efficacy were estimated from a hyperbolic function describing the longitudinal pattern of urinary I excretion after the dose . The I retention and I elimination rate , and the periods of protection from mild ( < 0.79 micromol/l ) or moderate ( < 0.40 micromol/l ) I deficiency were obtained for groups of children with differing anthropometric status at baseline . Initial height-for-age and mid upper-arm circumference were not significantly related to efficacy . However , both the I retention and I elimination rate were reduced in children with lower initial weight-for-height . Children with lower skinfold thickness at baseline also had reduced I retention , which result ed in shorter protection periods from recurrent moderate and mild I deficiency . The efficacy of the oral iodised-oil supplement was not related to changes in anthropometric status during follow-up , nor was it related to the consumption of a food supplement of 1610 kJ immediately before the iodised-oil dose . Very low ( < 0.16 micromol/l ) urinary I concentration , and the presence of goitre at baseline were both associated with higher I retention and elimination rate .  Children with goitre at baseline were found to have a prolonged duration of protection against recurrent moderate I deficiency . We conclude that in apparently healthy schoolchildren in I-deficient areas , general anthropometric status has a little influence on the efficacy of oral iodised oil for correcting I deficiency Iodine ( I ) is essential for normal thyroid function , and the majority of subjects tolerate a wide range of dietary levels . However , a subset of individuals upon exposure to normal or elevated levels of I develop thyroid dysfunction and autoimmunity . In this double blind trial , we evaluated efficacy and tolerability of low dose I in adults with euthyroid , diffuse , endemic goiter . Sixty-two subjects were r and omly assigned I ( 0.2 mg/day ) or placebo for 12 months . After termination of therapy , both groups were followed for a further 6 months . Thyroid sonography and determinations of thyroid-related hormones , urinary I excretion per 24 h , and thyroid antibodies were carried out at baseline and at 3 , 6 , 9 , 12 , 15 , and 18 months . Markedly elevated urinary I values were found during therapy in subjects receiving I ( 32 at baseline vs. 213 micrograms/24 h at 12 months ; P = 0.0001 ) compared to placebo ( 34 and 33 micrograms/24 h , respectively ; P < 0.0001 vs. I ) . I substantially reduced thyroid volume ( 29 vs. 18 mL at 12 months ; -38 % ; P = 0.0001 ) , and at 18 months , the therapeutic effect was sustained . In the placebo group , no significant changes were observed . High microsomal and thyroglobulin autoantibody titers were present in 3 of 31 ( 9.7 % ) subjects receiving I , and I-induced hypo- and hyperthyroidism developed in 2 and 1 , respectively . Fine needle biopsy revealed marked lymphocytic infiltration in all 3 cases . After withdrawal of I , thyroid dysfunctions spontaneously remitted , and antibody titers as well as lymphocytic infiltration decreased markedly . Follow-up of these 3 subjects for an additional 2 yr showed normalization of antibody titers in 2 . Thus , among subjects with endemic goiter , low dose I successfully normalized thyroid volume and body I supplementation ; nevertheless , reversible I-induced thyroid dysfunctions and autoimmunity were observed in nearly 10 % of the subjects The availability of iodinated salt containing 20 mg of iodine as io date /kg salt consumed on a voluntary basis enabled us to investigate its effect on goitre prevalence and iodine excretion in urine in a longitudinal , prospect i ve , r and omized study over 4 years . With this salt , under the assumption of a consumption of 5 g salt per day and person , an additional intake of 100 micrograms of iodine can be achieved . The study was performed on initially 334 children ( 168 boys , 166 girls ) at the age of 10 years living in an area of iodine deficiency . After 4 years , 286 children still participated in the study . Initially , goitre prevalence as assessed by palpation was found to be 30.5 % ( 37.4 % in girls and 23.8 % in boys ) . Neck circumference was found to be significantly higher in children with goitre compared with those without ( 30.2 + /- 1.4 vs 29.4 + /- 1.4 cm ; P less than 0.001 ) . Iodine excretion in the urine was significantly lower in children with goitre compared with those without ( 40.4 + /- 16.7 micrograms/g creatinine vs 46.1 + /- 24.9 micrograms/g creatinine ; x + /- SD ; P less than 0.05 ) . The children were r and omly assigned to two different groups : group A ( N = 146 ) was asked to use iodinated salt , group B ( N = 188 ) non-iodinated salt . Over the 4 years , a continuous increase in iodine excretion in urine could be demonstrated in group A. ( ABSTRACT TRUNCATED AT 250 WORDS The effect of oral iodine supplementation on total goitre rate ( % TGR ) and urinary iodine excretion among school children 4 to 16 years of age was studied . In the first group ( n = 57 ) 200 mg oral iodized oil reduced % TGR from 31.6 % to 17.5 % and 33.3 % to 24.6 % in males and females respectively , while in the second group ( n = 53 ) , 400 mg iodine reduced the % TGR from 34.0 % to 20.8 % in males and 35.9 % to 24.5 % in females after 13 months of intervention . This gave a relative indication that the 200 mg is as effective as the 400 mg in goitre reduction . In subsequent tests , the maximum urinary iodine excretion was obtained from the groups which received two doses of iodized oil 24 hours after the intervention . A significant ( p = 0.003 ) greater increase in urinary iodine excretion was noted at 24 hours among both male and female children administered 400 mg than among those who received 200 mg . Measurements after 24 hours showed no significant difference between urinary iodine excretion of the two dose groups . These results suggest that : ( i ) 200 mg is likely equally effective as 400 mg for iodine deficiency disorders control and prevention among children and ( ii ) iodine could be administered annually rather than biannually Objective : To evaluate the long-term efficacy and possible side effects of low doses of iodized oil on iodine nutrition and thyroid function in endemic goiter in Romania . Methods : R and om selection of 214 schoolchildren aged 6–14 years . Serial measurements of urinary iodine , thyroid volume with ultrasound , serum concentrations of thyrotropin , free thyroxine , thyroglobulin and thyroid autoantibodies before and up to 2 years after the oral administration of 200 mg iodine in iodized oil . Results : Urinary iodine concentrations indicated a moderate iodine deficiency before therapy , sharply increased soon after therapy and slowly decreased thereafter but remained within the normal range up to more than 1 year after therapy . The prevalence of goiter was 29 % before the administration of iodized oil and 9 % 1 year later . Thyroid function tests and autoantibodies were normal before and up to 2 years after therapy . Conclusion : A single dose of 200 mg iodine from oral Lipiodol ® appears adequate and safe for correcting moderate iodine deficiency in children
target: REVIEW ERS ' CONCLUSIONS Despite most of the included studies being of low quality , the results suggest that iodine supplementation , especially iodised oil , is an effective means of decreasing goitre rates and improving iodine status in children .
  Indications of positive effects on physical and mental development and mortality were seen , although results were not always significant .
  Adverse effects were generally minor and transient .
background: BACKGROUND Iodine deficiency is the main cause of potentially preventable mental retardation in childhood , as well as causing goitre and hypothyroidism in people of all ages .
  It is still prevalent in large parts of the world .
  OBJECTIVES To assess the effects of iodine supplementation overall , and of different forms and dosages of iodine supplementation separately , in the prevention of iodine deficiency disorders in children .