Impact of Nutritional Iodine Optimization on Rates of Thyroid Hypoechogenicity and Autoimmune Thyroiditis: A Cross-Sectional, Comparative Study

Background: Since several countries have established mandatory food iodine fortification, there has been a decrease in rates of iodine deficiency disorders in parallel with an increase in prevalence of autoimmune thyroid diseases. This study compared the nutritional iodine status and the prevalence of autoimmune thyroiditis and thyroid hypoechogenicity on ultrasound in schoolchildren in Sao Paulo (Brazil) in two distinct periods of time in which fortified salt had different concentrations of iodine. Methods: We conducted a cross-sectional study evaluating 206 children aged 7-14 years and without a history of thyroid disease. Assessments included measurements of thyrotropin (TSH), free thyroxine, antithyroperoxidase (anti-TPO), and antithyroglobulin (anti-TG) antibodies, urinary iodine concentration, and thyroid ultrasound. Results: Mean urinary iodine concentration was 165.1 mu g/L. Eleven children (5.3%) were diagnosed with autoimmune thyroiditis based on at least two of four criteria adopted in our study: positive anti-TPO or anti-TG antibody, hypoechogenicity of the thyroid parenchyma on ultrasound, and a TSH >4.0 mu U/mL. Comparing our results with those from a similar study conducted during a period in which concentrations of iodine in the salt were higher (median urinary iodine concentration >300 mu g/L), we observed a trend toward a lower prevalence of autoimmune thyroiditis, although no definitive conclusion could be established. Conclusion: The current nutritional iodine status in our cohort was within optimal levels and lower than levels found in 2003. The prevalence of autoimmune thyroiditis seems to be decreasing in parallel with a decrease in iodine intake, although we could not reach a definitive conclusion.