estimation of thyroid volume in children from … · although palpation is simple, size definition...

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Volume 6, Issue 1, Article ID: BM-017-14, 2014

eISSN: 09748369

Estimation of thyroid volume in children from oil–gas producing areas of

West Kazakhstan

Biology and Medicine

Research Article

Article ID: BM-017-14 Page 1 of 6

Research Article Biology and Medicine, 6(1), 2014

Introduction

According to WHO data, more than 2 billion people all over the world have risk of develop-ing iodine deficiency diseases. Iodine deficiency, besides increase in thyroid volume, leads to intellect decrease, mental and physical devel-opment delay, aggregates somatic pathology in children and teenagers, results in reduction of potential and is a global problem of public health of the world [1-4]. Analysis made on primary dis-ease incidence with thyroid in West Kazakhstan for the last 5 yrs showed steady growth of thy-roid pathology including acquired and congenital hypothyroidism [5].

WHO defined clinical (goiter rate) and biochemical (the median of iodine concentration in the urine) criteria to estimate endemic inten-sity. Although palpation is simple, size definition by means of US is more preferable because of subjective factors, poor sensation, and palpa-tion specificity [1]. In 2003, international nor-matives of thyroid volume were established [6]. Nevertheless, generally accepted standard values for thyroid volume in terms of adequate intake of iodine is the issue [7-9].

At present, entire territory of Kazakhstan can be referred to regions with average and

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Estimation of thyroid volume in children from oil–gas producing areas of West Kazakhstan

Khatimya Ilyasovna Kudabayeva*, Yerlan Shaymerdenonich Bazargaliev, Akmaral Muhambetzhanovna Baspakova, Klara Batenobna Darzhanova

West Kazakhstan State Medical University of Marat Ospanov, 68 Marecyev Street, 030019, Aktobe, Kazakhstan.

*Corresponding author: West Kazakhstan State Medical University of Marat Ospanov, 68 Marecyev Street, 030019, Aktobe, Kazakhstan.

Received: 26th Jul 2014; Accepted: 4th Sep 2014; Published: 22nd Sep 2014

AbstractThe aim of investigation was to estimate the volume of thyroid determined by US in schoolchildren aged 7-11 living in oil–gas producing regions of West Kazakhstan. 815 schoolchildren aged 7-11 were examined according to WHO Protocols. Goiter prevalence was 24.7 6 1.50%, 44.6 6 2.59% of them in oil producing regions and 8.3 6 1.3% in ecologically clean areas. Significant difference in the median of thyroid volume between boys (5.4 mπ) and girls (4.8 mπ) in oil–gas districts (z 5 2.65; p 0.01) and in whole region (z 5 16.96; p 0.001) was noticed. Median and 97 percentile of thyroid volume of our tested were higher than the standard values reported by WHO.

Keywords: Goiter; West Kazakhstan; oil–gas producing regions; thyroid volume; ultra scanning.

slight iodine deficiency. According to the data by Kazakh Nutrition Academy in 1999, 60% women of reproductive age in all regions of Kazakhstan had different levels of iodine defi-ciency, from 4.0 to 12.0% of them experienced severe form of iodine deficiency. It should be underlined that according to multi-indicator cluster investigation conducted by Kazakh Nutrition Academy in 2006 with the support of UNICEF, iodine prevalence among women of reproductive age reduced in fourfold in com-parison with those in 1999 and composed 15%. Today universal way of adding iodine to nutritional and fodder salt is regulated by the Law of Kazakhstan on Prevention iodine defi-ciency diseases dated from 14.10.2003. No. 489 – Public Health of Republic of Kazakhstan. Nevertheless, in spite of carried work to prevent iodine deficiency diseases goiter incidences still remains higher among schoolchildren in West Kazakhstan [10,11].

High prevalence of goiter, strumogenic factors’ impact on endemic development served the basis for conducting this investigation.

The aim of work was the estimation of the thyroid volume determined by US in school-children aged 7-11 living in oil–gas producing regions of West Kazakhstan.



Materials and Methods

After having approval by local Ethic Committee of West Kazakhstan State Medical University of Marat Ospanov (Protocol #06/01-7 dated 05.01.2013), investigation was conducted to schoolchildren between 7 and 11 yrs old.

Research was done within 30-cluster analysis on goiter prevalence in Aktobe region. Research methodology met protocol require-ments, recommended by WHO on endemic goiter studies [1]. Population areas where oil and gas are produced were selected on the basis of data by Regional Statistic Department. Equal amount of ecologically clean areas related to agricultural districts were selected by randomized study as a control group. Schools were also selected by randomized study. In these schools children from 3 to 4 of primary school who are the permanent residents of this district were examined by overall method. All demographic findings (gender, age, weight, and height) were recorded. Height and weight were defined by standard method. US of thyroid was done by a qualified specialist accord-ing to the generally accepted recommendations. Ultra scanning apparatus Aloka SSD-500 (Japan) with 7, 5 detector was used. The size of thyroids and standard normatives of thyroids in children were determined and estimated depending on body surface area and gender according to WHO recommendations (2007) [1,6]. It should be noted that in ultra scanning examination, thyroid is con-sidered enlarged (goiter) if its volume exceeds 97 percentile of volume, revealed in people with good iodine supply.

Group distribution and characteristics on age, gender, body mass index (BMI) are presented in Table 1.

Statistic Methods

Statistic processing of findings was done in SAS Program, version 9.2. Normality of distribution

was assessed according to Kolmogorova–Smirnova criteria. Research results are pre-sented in the average meaning (M), standard decline (SD), in case of abnormal distribution in the meaning of medium (Me). Two T-tests with various dispersion (t) and Wilcoxon criteria (z) were used to estimate statistic significance of difference. Correlative analysis was conducted with Pirson and Spirman’s coefficient correlation. Criteria corresponding to p 0.05 were consid-ered significant.

This research was conducted according to international requirements for clinical experi-ences (GCP). The research work was conducted at finance allocated by the Ministry of Health RK in the period of 2013-2015 for research on the theme “Epidemiology of endemic goiter in the west region of Kazakhstan and designing recom-mendations on prophylaxis of iodine deficiency”. Registered number RTI RK: 013PK00439.

Results and Discussion

The most significant criteria of goiter in investi-gation are thyreomegaly frequency. Goiter prev-alence in our sampling by using 97 percentile of the volume, recommended by WHO/ICCIDD (2007) composed 24.7 6 1.50% (49.8% in girls and 50.2% in boys), 44.6% of whom were from oil–gas producing districts and 8.3 6 1.3% lived in ecologically clean areas. Analysis on the dif-ference of goiter prevalence demonstrated that children living in clean districts had less thyreomegaly than those who were from oil–gas producing areas (Figure 1).

If 89 (54.3%) of 164 children with goiter in oil–gas producing district were boys and 75 (45.7%) of them were girls then in ecologi-cally clean areas among 37 children, goiter was noticed in 11 (29.7%) boys and 26 (70.3%) girls. Analysis made on goiter prevalence according to gender revealed that in oil–gas districts (t 5 1.56; p 0.05) and all over the district (t 5 3.88;

Table 1: Characteristics of examined children aged 7-11 in the region.

All – 815 Gender (boys/girls)

Age Height (cm) Weight (kg) Body mass index (kg/m2)

M ± SD M ± SD M ± SD M ± SD

Oil–gas regions (n 5 368) 52.4%/47.6% 8.35 6 0.9 129.41 6 6.8 27.27 6 4.8 16.24 6 2.4Ecologically clean areas

(n 5 447) 47.7%/52.3% 8.68 6 0.7 130.77 6 6.6 28.07 6 5.4 16.31 6 2.2

Total region# (n 5 2257) 47.8%/52.2% 9.20 6 1.2 133.58 6 9.2 30.11 6 7.5 16.66 6 2.5

Note: #Findings of 30th cluster analysis of goiter prevalence in the region.



p 0.001) goiter was noticed in boys whereas in clean areas more girls developed goiter (t 5 3.82; p 0.001).

In west Kazakhstan, several techno-genic zones of pollution of different genesis were formed. Results of completed research showed that the content of chromium, nickel, lead near chromium factories, and sulfide vanadium from oil manufactures exceeded in ground, water, and other environment [12].

30th cluster analysis of goiter prevalence in Aktobe in 2013 revealed that goiter rate com-poses in average 42.8%. According to epidemio-logic criteria defined by WHO and International Council controlling iodine deficiency diseases, the index of goiter incidence among school-children between 6 and 12 age groups which is equal or exceeding 5% shows the presence of iodine deficiency [1,11]. On the basis of criteria estimating the severity of iodine deficiency, rec-ommended by WHO, goiter endemic of severe form was noted in the region.

Moreover, studies on received findings proved that high prevalence of goiter was noticed not only in oil–gas producing districts (44.6%), which exceeds sporadic level of sickness rate in 10 times but also in ecologically clean areas where by WHO criteria goiter endemic of slight intensity (8.3%) was noted.

Results of our work admit that endemy might be due to increased content of xenobiotics in environment, in this case wastes from oil–gas

processing. Continuous living in areas polluted with products of technogenic origin leads to mis-balance in microelements, together with slight iodine deficiency in environment contributes to significant growth of thyroid pathology [13]. Comparative analysis on medium difference of general thyroid volume showed exact difference in indices between oil–gas and ecologically clean districts (z 5 15.49; p 0.001); between eco-logically clean districts and region according to 30 cluster analysis (z 5 16.85; p 0.001).

Received analysis demonstrated sig-nificant difference in medium of general thyroid volume between boys (5.4 ml) and girls (4.8 ml) in oil–gas producing districts (z 5 2.65; p 0.01) and in whole region (z 5 16.96; p 0.001).

Further, we compared average value of thyroid volume. Depending on living areas of children indices had statistic exact difference ( p 0.0001), and in oil–gas areas composed 4.43 6 1.66 ml and 2.9 6 1.24 ml in ecologi-cally clean districts. While comparing thyroid volume in boys, exact difference ( p 0.0001) between indices in oil–gas districts (4.62 6 1.75) and clean areas (2.78 6 0.93) was revealed. These tendencies were also noticed in girls ( p 0.0001). Thyroid volume in girls from oil–gas producing districts was larger (4.23 6 1.53) in comparison with in those who live in clean districts (3.05 6 1.52).

It is generally known that in countries where children suffer from poor protein supply,

Figure 1: Relative frequency of thyreomegaly according to the US findings in the region (%).



according to WHO recommendations, due vol-ume of thyroid must be defined into taking con-sideration body surface area. The research shows that thyroid volume, in case of body surface area, is more larger than the volume estimated accord-ing to age [14]. Significant differences were revealed by other researchers while estimating thyroid volume in children according to various criteria [15]. Nevertheless, it is recommended to use criteria based on body surface area as it allows to estimate individual constitution charac-teristics of child’s development [7].

We also conducted comparative analysis on the thyroid volume (97 percentile) depending on the age of children. Presented Figures 2 and 3 clearly show that all indices of thyroid volume is higher than indices recommended by WHO as a normative value in boys as well as in girls.

Our results are agreed with research conducted in China [16]. In all studied groups with increasing ages, gap between thyroid indices recommended by WHO and the indi-ces which we obtained is increasing. Detailed analysis revealed that in oil producing areas the

Figure 2: Comparison of thyroid volume in boys of different age in the investigated region with 97 percentile reported by WHO.

Figure 3: Comparison of thyroid volume in girls of different age in the investigated region with 97 percentile reported by WHO.



most negative values are noticed in boys aged 11 (difference to WHO indices is 3.16 ml) when this difference in girls is 2.47 ml. In ecologically favorable districts indices both in boys and girls meet WHO requirements. If forthcoming inten-sive phase of puberty is taken into consideration, one can assume that the number of children with thyreomegaly will increase in several times and consequences of formation of reproductive func-tion in children, especially in boys are supposed to be negative.

Average indices of height, weight, body mass index, body surface area were higher in ecologically clean areas in comparison with oil–gas districts, which is quite explainable. Analysis on correlation of general thyroid volume with anthropometric findings and children’s age dem-onstrated that there is poor link with only body mass index (r 5 0.3; p 0.0001).

On the whole, according to the research results, the median of the iodine concentration of in the urine was 193.9 6 86.1 mkg/l in 81 chil-dren, which indicates appropriate iodine supply of population in these regions.

It is known that thyroid enlargement remains up to 4 yrs after introducing program on usage of iodine salt [17]. Research results con-ducted by Kazakh Nutrition Academy in 2006, share of households consuming iodine salt reach 92%, median of concentration of iodine in urine is 235.9 6 166.8 mkg/l, on the basis of which Kazakhstan is related to the group of countries where the aims to remove iodine defi-ciency in nutrition were achieved [10,18]. Hence, high goiter incidence in oil–gas producing districts is, probably, due to the impact of other factors, particularly misbalance of microele-ments, nutrition specificity, strumogenic factors of xenobiotics.

Conclusions

1. In west region of Kazakhstan, as a sample Aktobe, goiter endemic of severe form is noticed (42.8%).

2. The size of thyroid in schoolchildren of Aktobe region is higher than the standard values reported by WHO.

3. High prevalence of goiter in oil–gas produc-ing districts (44.6%) on the background of appropriate iodine supply which was known as a result of studies on iodine concentra-tion in the urine assumes the influence of

other factors causing goiter in this region and needs further studies.

References

1. WHO, UNICEF, ICCIDD (2008). Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination: A Guide for Programme Managers, Third Edition (updated 1st September 2008), Publication date 2007, WHO/UNICEF/ICCIDD, p. 98.

2 Andersson M, Karumbunathan V, Zimmermann MB (2012) Global iodine status in 2011 and trends over the past decade. Journal of Nutrition 142(2): 744.

3. Speeckaert MM, Speeckaert R, Wierckx K, Delanghe JR, Kaufman JM (2011) Value and pitfalls in iodine fortification and supplementation in the 21st century. British Journal of Nutrition 106(7): 964-973.

4. Zimmermann MB, Andersson M (2011). Prevalence of iodine deficiency in Europe in 2010. Annales of Endocrinology 72(2): 164-166.

5. Kudabaev HI, Bazargaliev AS, Kosmaganbetov GK (2013) Analysis of the incidence of thyroid cancer in the Western region of the Republic of Kazakhstan. Astrakhan Medical Journal 8(4): 103-108.

6. Zimmermann MB, Hess SY, Molinari L (2004) New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren. A World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group Report. American Journal of Clinical Nutrition 79(2): 231-237.

7. Mickuviene N, Krasauskiene A, Kazanavicius G (2006) The results of thyroid ultrasound examination in randomly selected schoolchildren. Medicina (Kaunas) 42: 751-758.

8. Kim BK, Choi YS, Oak CH, Park Y-H, Kim JH, et al. (2012) Determination of thyroid volume by ultrasonography among schoolchildren in Philippines. International Journal of Endocrinology 2012: 6.

9. Moradi M, Hashemipour M, Akbari S (2014) Ultrasonographic evaluation of the thyroid gland volume among 8-15-year-old children in Isfahan, Iran. Advanced Biomedical Research 9: 3-9.

10. Ospanova FE, Ter-Minassian Nusibalieva ME, Tazhibayev SHS (2007) Experience achieving



sustainability of prevention of iodine deficiency disorders in Kazakhstan. Health and Disease 4(60): 68-69.

11. Kudabaev HI, Bazargaliev AS, Referring GT (2013) The results of the pilot study thyromegaly in Aktobe region. Medical Journal of Western Kazakhstan 1(37): 193-195.

12. Abramova NA, Fadeev VV, Gerasimov GA (2006) Subgenii substances and factors. Clinical and Experimental Thyroidology 1: 10-28.

13. Mamyrbayev AA (2012) Toxicology of Chromium and its Compounds. LLP Information-Printing Center, CCIC, Aktobe, p. 284.

14. Henjum S, Barikmo I, Gjerlaug AK (2010). Endemic goitre and excessive iodine in urine and drinking water among Saharawi refugee children. Public Health Nutrition 13(9): 1472-1477.

15. Zou Y, Ding G, Lou X (2013) Factors influencing thyroid volume in Chinese children. European Journal of Clinical Nutrition 67(11): 1138-1141.

16. Abd EL, Naser YG, Kamel AF, Abd-El DS (2013) Thyroid volumes and iodine status in Egyptian South Sinai schoolchildren. Archives of Medical Science 9(3): 548-554.

17. Zimmermann MB, Hess SY, Adou P (2003) Thyroid size and goiter prevalence after introduction of iodized salt: A 5-y prospective study in schoolchildren in Côte d'Ivoire. American Journal of Clinical Nutrition 77(3): 663-667.

18. Timmer A, Gerasimov GA (2008) Progress towards sustainable elimination of IDD in countries of Central and Eastern Europe and the Commonwealth of Independent States. Clinical and Experimental Thyroidology 4(2): 4-7.

Citation: Kudabayeva KI, Bazargaliev YS, Baspakova AM, Darzhanova KB (2014) Estimation of thyroid volume in chil-dren from oil–gas producing areas of West Kazakhstan. Biol Med 6(1): BM-017-14.

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