Risk for Iodine Deficiency and Hypothyroidism High in Children on Parenteral Nutrition

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There was no patient identified with clinical goiter, and none of the children screened for autoimmune thyroiditis had positive test results.
There was no patient identified with clinical goiter, and none of the children screened for autoimmune thyroiditis had positive test results.

Children who are receiving chronic parenteral nutrition (PN) therapy may be at a higher risk of developing an iodine deficiency and subsequent hypothyroidism, according to a study published in Pediatrics.

Researchers performed a cross-sectional study in 27 children at Cincinnati Children's Hospital in Ohio who were younger than 17 years old who have received PN for more than 6 months and who received less than 50% of their total nutrition enterally, to determine the prevalence of iodine deficiency and hypothyroidism.

The average age at the time of screening was 48 months, 74% of children were boys, and the average duration of PN treatment was 30 months.

Study results showed that of the 24 patients with available thyroid function tests, 8 patients had hypothyroidism, defined as thyrotropin (TSH) level >4 µIL/L, 6 had a TSH level >10 µIL/mL, and 4 had severe hypothyroidism with concurrent low free thyroxine levels.

However, there were no children with a clinical goiter and no significant associations observed between length of time receiving PN and the subsequent development of severe iodine deficiency (urine iodine concentration, <20 vs >20; 35.4 months [interquartile range (IQR), 20.1-48.1 months] vs 61.5 months [IQR, 36.2-76.6 months]; P =.08) or hypothyroidism (TSH level >10 vs <10; 33.6 months [IQR, 19.8-77.2 months] vs 36.3 months [IQR, 24.6-64.9 months]; P =.96), respectively.

Overall, 85% of the participants had low iodine stores, and 33% were found to have hypothyroidism. The children found to have hypothyroidism were also observed to have elevated levels of thyroglobulin, which is known to be correlated with iodine deficiency severity.

Researchers concluded that children who are receiving PN therapy are at a higher risk of developing iodine deficiency and subsequent hypothyroidism. Therefore, children receiving PN who are not being supplemented with iodine should be regularly screened by clinicians for thyroid dysfunction.

Reference

Ikomi C, Cole CR, Vale E, Golekoh M, Khoury JC, Jones NY. Hypothyroidism and iodine deficiency in children on chronic parenteral nutrition. Pediatrics. 2018;141(4):e20173046.

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