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93- 110 O. Kasiyan, H. Tkachenko, J Słupskie Prace Biologiczne Nr 12 ss. 93-110 2015 ISSN 1734-0926 Przyjęto: 15.10.2015 © Instytut Biologii i Ochrony Środowiska Akademii Pomorskiej w Słupsku Zaakceptowano: 25.02.2016 ASSESSMENT OF DIFFUSE GOITER PREVALENCE AMONG ADULTS IN ENDEMIC LVIV REGION (WESTERN UKRAINE) Olha Kasiyan 1 Halyna Tkachenko 2 Jan Łukaszewicz 3 1Danylo Halytskyy Lviv National Medical University, Lviv, Ukraine e-mail: [email protected] 2Pomeranian University in Słupsk Institute of Biology and Environmental Protection Arciszewski St. 22b, 76-200 Słupsk, Poland 3Adam Mickiewicz University in Pozna ń Institute of Physical Geography and Environmental Planning ABSTRACT Even minor differences in iodine intake between populations are associated with differences in the occurrence of thyroid disorders. Both iodine intake levels below and above the recommended interval are associated with an increase in the risk of disease in the population. Optimally, iodine intake of a population should be kept within a relatively narrow interval where iodine deficiency disorders are prevented, but not higher. Monitoring and adjusting of iodine intake in a population is an im- portant part of preventive medicine (Laurberg et al. 2010). Incidence of diffuse goi- tre (DG) in Ukraine is currently higher than in past decades. Therefore, the aim of our study was the assessment of DG prevalence among adults (above 18 years old) in Lviv region (western Ukraine) during 2000-2010. For assessment of the DG prev- alence among children, adolescents, and adults of different districts (reions) in Lviv region during 2000-2010, the analysis of archival data from Lviv Regional Endocri- nology Hospital was done. The research study covered by 20 districts of Lviv Oblast (Brody, Busk, Horodok, Drohobych, Zhydachivskyi, Zhovkivskyi, Zolochivskyi, Kamianka-Buzka, Mykolaiv, Mostyska, Peremyshliany, Pustomyty, Radekhiv, Sam- bir, Skole, Sokal, Starosambirskyi, Stryiskyi, Turkivskyi, and Yavorivskyi Districts), as well as six towns of Lviv region (Lviv, Boryslav, Drohobych, Stryi, Truskavets, Chervonograd). A decrease of the DG prevalence (I degree) from 307.5 to 197.2 per 10,000 individuals during 2000-2010 was observed. A significant reduction in DG 93 prevalence among adults from towns of Lviv region was noted. It was 133.1 per 10,000 individuals in 2000 and 99.6 per 10,000 individuals in 2010. There was a de- cline of DG prevalence from 231.8 to 155.3 per 10,000 individuals among adults in Lviv region during 2000-2010. In 2010, the prevalence of disease among adults from districts was higher compared to the adults from towns (197.2 compared to 99.6 per 10,000 individuals, respectively). The highest prevalence of DG among adults was noted in Busk, Starosambirskyi, Pustomyty, Sokal, Turkivskyi districts (489.1-1448.5; 359.6-776.2, 282.4-766.0, 166.3-625.1, 443.4-518.3 per 10,000 indi- viduals, respectively), and in Truskavets, Drohobych, and Boryslav (14.1-340.2, 61.2-218.2, 96.3-160.7 per 10,000 individuals, respectively). The increase in the DG prevalence in 7 districts (Brody, Zhydachivskyi, Mykolaiv, Peremyshliany, Rad- ekhiv, Sambir, Skole) among 20 districts and in 1 town (Chervonograd) among 6 towns of Lviv region during 2000-2010 was observed. Decrease of the DG prevalence (II and III degrees) from 31.4 to 29.6 per 10,000 individuals during 2000-2010 was noted. A significant increase in DG prevalence among adults from districts of Lviv region was demonstrated. It was 29.9 per 10,000 individuals in 2000 and 37.3 per 10,000 individuals in 2010. There was a decline of DG prevalence from 33.3 to 19.4 per 10,000 individuals among adults from towns in Lviv region during 2000-2010. In 2010, the prevalence of disease among adults from districts was higher compared to the adults from towns (37.3 compared to 19.4 per 10,000 individuals, respectively). Increased DG (II and III degrees) prevalence among adults of Lviv region was ob- served in Radekhiv, Peremyshliany, Skole, Turkivskyi, and Busk districts in 2000 (80.9, 73.7, 63.7, 62.5, 51.5 per 10,000 individuals, respectively), in Busk, Rad- ekhiv, Sokal, Peremyshliany, Skole, and Turkivskyi districts in 2004 (130.2, 110.6, 86.9, 86.4, 67.5, 62.7 per 10,000 individuals, respectively), in Sokal, Radekhiv, Peremyshliany, Skole, and Turkivskyi districts in 2010 (105.7, 97.8, 90.5, 79.4, 71.0 per 10,000 individuals, respectively). The decrease of DG prevalence among adults in the 15 districts (Busk, Horodok, Drohobych, Zhydachivskyi, Zolochivskyi, Sokal, Starosambirskyi, Stryiskyi) and all towns (except Drohobych and Chervonograd) in Lviv region was noted. Our results indicate the need to clarify the relevant influ- encing factors of DG prevalence among the population of Lviv region, the defini- tion of the risk of thyroid pathology in each district of the region among the different age groups, which will propose measures to prevent further increase of DG inci- dence. Key words: Iodine Deficiency Disorders, diffuse goiter, prevalence, adults, Lviv region, Ukraine INTRODUCTION Iodine deficiency is a common cause of endemic goitre. Recently, the World Health Organization (WHO) calculated that about 740 million people, equivalent to 13% of the world’s population, have goiter due to an excessively low intake of iodine (Hetzel 1989, Thyroid Disease in Adults 2011). When the physiological require- 94 ments of iodine are not met in a given population, a series of functional and deve- lopmental abnormalities occur including thyroid function abnormalities and, when iodine deficiency is severe, endemic goiter and cretinism, endemic mental retarda- tion, decreased fertility rate, increased perinatal death, and infant mortality. These complications, which constitute a hindrance to the development of the affected popu- lations, are grouped under the general heading of iodine deficiency disorders (IDD) (Delange 1994). Iodine deficiency leads to hyperplasia of the thyroid epithelium. Over time, some follicles will become inactive and distended with colloid. This will lead to focal nodular hyperplasia and nodular changes that can assume grotesque proportions and be associated with a risk for hypothyroidism. Even in countries without iodine defi- ciency, goitre is a very common condition. The majority of patients with goitre have a multinodular nontoxic benign goitre. In some cases, a local change in thyroid folli- cles dominates so that the goitre behaves like a unilateral goiter or even as a palpable solitary lump (Thyroid Disease in Adults 2011). The clinical course of sporadic nodular goitre is highly varied. As a rule, younger or middle-aged individuals in the early phase of the pathophysiological process pre- sent with diffuse goitre, while the tendency with increasing age is a gradual deve- lopment towards the characteristics of multinodular goitre. In adults and the elderly, a slow but continuous further growth of the goitre is often observed. The rate of growth varies greatly from person to person. About 10% of cases with euthyroid multinodu- lar goiter progress to toxic multinodular goiter with sufficient availability of iodine, a diffuse enlargement of the thyroid can otherwise be caused by autoimmune thy- roiditis. From a global perspective, iodine deficiency is the most common cause of goitre in adolescents. Rarely occurring defects in enzymatic processes for synthesis of thyroid hormone or in the TSH receptor function can also cause dysfunction and/or increased size of the thyroid (Thyroid Disease in Adults 2011). Now, there is an ongoing global iodination program in a collaboration between the International Council for Control of Iodine Deficiency Disorders (ICCIDD), UNICEF and WHO, with the goal of eradicating iodine deficiency throughout the world. The iodination program also includes monitoring goitres and measuring the concentration of iodine in the urine in the population as quality assurance of the program. The recommended dietary allowances of iodine are 100 micrograms/day for adults and adolescents, 60-100 micrograms/day for children aged 1 to 10 years, and 35-40 micrograms/day in infants aged less than 1 year (Delange 1994). Over the past decade, the number of countries that are iodine deficient has fallen from 54 to 30. The number iodine-sufficient countries has increased from 67 to 112, while the number with excessive iodine intake has increased from 5 to 10. In most coun- tries with excess intake, this is due to over iodization of salt and/or poor monitoring of salt iodization. Out of 128 countries with household coverage of adequately io- dized salt data, at least 90% of households in 37 countries consume adequately iodized salt, but in 39 countries, coverage rates are below 50%. Overall, about 70% of house- holds worldwide have access to iodized salt. There has been substantial recent progress in the global effort to control iodine deficiency. However, iodized salt pro- grams need to be carefully monitored to ensure adequate iodine intake while 95 avoiding iodine excess (Zimmermann 2013). Although international public health efforts over the past several decades have been highly effective, nearly one third of children worldwide remain at risk for iodine deficiency, and iodine deficiency is considered the leading preventable cause of preventable intellectual deficits (Pearce 2014). Endemic goiter is one of the earliest and most visible sign of iodine deficiency (WHO, UNICEF... 1999, 2001). According to iodine deficiency level this response may be adequate to preserve euthyroidism, but at the cost of an enlarged thyroid and the attendant risks of neck compression and eventual hyperfunctioning autono- mous nodules with hyperthyroidism. An insufficient adaptation in adults produces hypothyroidism with its usual clinical stigmata. The damage is greater when iodine deficiency provokes hypothyroidism during fetal or early postnatal life, because thy- roid hormone is necessary for proper development of the central nervous system, particularly its myelination. Individuals who were hypothyroid at this critical period frequently have permanent mental retardation, which cannot be corrected by later administration of thyroid hormone or iodine.
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