Iodine deficiency in Calabria
resent a sensitive method for the surveillance of io-
dine deficiency (17). The latest WHO-ICCIDD-
UNICEF report has established that in the absence
of iodine deficiency, less than 3% of newborns have
TSH levels above 5 μU/ml whole blood (11). In the
present report, a frequency of approximately 15%
of TSH levels above 5 μU/ml whole blood was ob-
served. These results are compatible with mild to
moderate iodine deficiency (18). It is important to
point out that at sea level the frequency of TSH lev-
els >5 μU/ml was higher than one could expect ac-
cording to goiter prevalence data and resulted al-
most as elevated as in the inland territory. This ap-
parent discrepancy cannot be readily explained.
Probably, in mild iodine deficiency conditions the
frequency of neonatal TSH levels >5 μU/ml is not
a parameter sensitive enough to reveal small dif-
ferences of iodine supply. In this respect, we have
previously demonstrated that the determination of
the 97th percentile of neonatal TSH values repre-
sented a valuable tool, allowing to dissect the ter-
ritory according to the risk of endemic goiter and
other IDD (14).
situation has been described in other Southern Italy
regions (10, 19).
In terms of public health, our data represent an im-
portant baseline for future monitoring of IDD in
Calabria and suggest that a generalized iodine pro-
phylaxis program should probably be taken into
consideration, even though it could transiently lead
to an increased risk for hyperthyroidism (20, 21).
ACKNOWLEDGEMENTS
The Authors wish to thank F. Vermiglio and F. Trimarchi from
the University of Messina for suggestions and support during
the early phase of the study. The skillfull collaboration provided
regionwide by the “Servizi di Medicina Scolastica” and by the
GP’s is also gratefully acknowledged.
REFERENCES
1. Delange F., Ermans A.M.
Iodine deficiency.
In: Braverman L.E., Utiger R.D. (Eds.), The thyroid.
A fundamental and clinical text.
J.B. Lippincott, Philadelphia, 1991, p. 368.
Urinary iodine excretion is presently considered the
most useful impact indicator to evaluate the sever-
ity of iodine deficiency (11). In Calabria the urinary
iodine excretion results confirmed that both the in-
land territory and the coastal areas of the region
are exposed to various degrees of iodine deficien-
cy. In the inland territory, the median iodine excre-
tion values were in perfect agreement with goiter
prevalence data, indicating a condition of moderate
iodine deficiency. At the sea level, urinary iodine
excretion resulted marginally low in Reggio Calabria
main town, with values comparable to those re-
ported in other Italian coastal areas (19). However,
a situation of mild iodine deficiency was found in
Crotone in spite of the localization at sea level. The
peculiarity of these results deserves particular con-
sideration. In fact, goiter prevalence in Crotone
main city was even higher than one could expect
based on urinary iodine excretion values. The
strong immigration rate from the inland territory
and the water supply provided from sources locat-
ed on the Sila ridges could contribute in determin-
ing such a situation. Theoretically, the presence of
goitrogens (i.e. thyocyanate) in the foodstuff (1)
should also be considered, even though this seems
unlikely. The eating habits in the town, in fact, do
not include major use of nutrients rich in natural
goitrogens. Indeed, other genetic or epigenetic fac-
tors might also be involved.
2. Hetzel B.S.
The story of iodine deficiency: an international chal-
lenge in nutrition.
Oxford University Press, New York, 1989.
3. Delange F., Burgi H.
Iodine deficiency disorders in Europe.
Bull. WHO 1989, 67: 317-325.
4. Editorial.
Prevention and control of iodine deficiency disorders.
Lancet 1986, 2: 433-434.
5. Delange F., Benker G., Caron P., Eber O., Ott W.,
Peter F., Podoba J., Simescu M., Szybinsky Z.,
Vertongen F., Vitti P., Wiersinga W., Zamrazil V.
Thyroid volume and urinary iodine in European
schoolchildren: standardization of values for as-
sessment of iodine deficiency.
Eur. J. Endocrinol. 1997, 136: 180-187.
6. Aghini-Lombardi F., Antonangeli L., Vitti P., Pinchera A.
Status of iodine nutrition in Italy.
In: Delange F., Dunn J.T., Glinoer D. (Eds.), Iodine
deficiency in Europe: A continuing concern.
Plenum Press, New York, 1993, p. 403
7. Andò S., Maggiolini M., Di Carlo A., Diodato A.,
Bloise A., De Luca G.P., Pezzi V., Sisci D., Mariano
A., Macchia V.
Endemic goiter in Calabria: etiopathogenesis and
thyroid function.
J. Endocrinol. Invest. 1994, 17: 329-333.
8. Delange F., Vigneri R., Trimarchi F., Filetti S., Pezzino
V., Squatrito S., Bourdoux P., Ermans A.M.
Etiological factors of endemic goiter in north-eastern
Sicily.
In conclusion, this study indicates that endemic goi-
ter is present region-wide in Calabria and is asso-
ciated to mild-moderate iodine deficiency. Such a
J. Endocrinol. Invest. 1978, 1: 137-142.
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