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. 2024 Jan 18;109(2):e495-e507.
doi: 10.1210/clinem/dgad593.

Fifteen Years of Iodine Prophylaxis in Italy: Results of a Nationwide Surveillance (Period 2015-2019)

Simona De Angelis  1 , Emanuela Medda  2 , Daniela Rotondi  1 , Maria Masocco  3 , Valentina Minardi  3 , Benedetta Contoli  3 , Valentina Possenti  3 , Angela Sorbo  4 , Marilena D'Amato  4 , Anna Chiara Turco  4 , Alberto Augusto Pastorelli  4 , Paolo Stacchini  4 , Roberto Da Cas  5 , Marcello Bagnasco  6 , Daniela Bonofiglio  7 , Maurizio Gasperi  8 , Domenico Meringolo  9 , Caterina Mian  10 , Mariacarla Moleti  11 , Francesco Vermiglio  11 , Efisio Puxeddu  12 , Augusto Taccaliti  13 , Massimo Tonacchera  14 , Salvatore Ulisse  15 , Antonio Dimida  14 , Teresa Rago  14 , Elena Nazzari  6 , Mara Schiavo  6 , Irene Bossert  6 , Giacomo Sturniolo  11 , Carlo Corbetta  16 , Cristina Cereda  17 , Laura Cappelletti  17 , Marta Camilot  18 , Francesca Teofoli  18 , Renzo Ciatti  19 , Elisabetta Tarsi  19 , Nicola Perrotti  20 , Onorina Marasco  21 , Giovanna Scozzafava  21 , Francesca Righetti  22 , Sebastiano Andò  7 , Stefania Catalano  7   23 , Mariarosaria Cristofaro  24 , Giovanni Sorrenti  9 , Simona Censi  10 , Silvia Morelli  12 , Enke Baldini  15 , Giuseppe Plutino  25 , Roberto Copparoni  25 , Elena Alonzo  26 , Claudia Giacomozzi  1 , Marco Silano  1 , Antonella Olivieri  1
Affiliations

Fifteen Years of Iodine Prophylaxis in Italy: Results of a Nationwide Surveillance (Period 2015-2019)

Simona De Angelis et al. J Clin Endocrinol Metab. .

Abstract

Context: In 2005, a nationwide program of iodine prophylaxis on a voluntary basis was implemented in Italy by law. However, recent data on iodine status are lacking.

Objective: The aim of this study was to evaluate efficiency, effectiveness, and possible adverse effects (increased occurrence of thyroid autoimmunity and hyperthyroidism) of the Italian iodine prophylaxis program.

Methods: From 2015 to 2019, a nationwide survey was performed. The use of iodized salt was evaluated in a sample of 164 593 adults and in 998 school canteens. A sample of 4233 schoolchildren (aged 11-13 years) was recruited to assess urinary iodine concentration, prevalence of goiter, and thyroid hypoechogenicity on ultrasound, with the latter being an indirect indicator of thyroid autoimmunity. Neonatal TSH values of 197 677 infants screened in regions representative of Northern, Central, and Southern Italy were analyzed to investigate the percentage of TSH values >5.0 mIU/L. Data on methimazole prescriptions were analyzed as indirect indicators of new cases of hyperthyroidism.

Results: The prevalence of the use of iodized salt was 71.5% in adult population and 78% in school canteens. A median urinary iodine concentration of 124 μg/L, a prevalence of goiter of 2.2%, and a prevalence of thyroid hypoechogenicity of 5.7% were observed in schoolchildren. The percentage of neonatal TSH values >5.0 mIU/L resulted still higher (5.1%) than the World Health Organization threshold of 3.0%, whereas the prescriptions of methimazole showed a reduction of 13.5%.

Conclusion: Fifteen years of iodine prophylaxis have led to iodine sufficiency in Italy, although there still is concern about iodine nutritional status during pregnancy.

Keywords: iodine; iodine prophylaxis; iodized salt; surveillance; thyroid.

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Figures

Figure 1.
Figure 1.
Italian regions participating in the cross-sectional survey in schoolchildren (aged 11-13 years). The closed circles indicate the location where the survey was conducted (white circles, urban areas; black circles, rural areas).
Figure 2.
Figure 2.
Trend of iodized salt consumption in the population by area of residence from 2015 through 2019. Monthly prevalence observed and estimated from time series models. LOWESS, locally weighted scanner plot smoothing.
Figure 3.
Figure 3.
Frequency of neonatal TSH values >5.0 mIU/L at 3 to 4 days of life.
Figure 4.
Figure 4.
Trend of methimazole prescriptions in Italy, from 2005 through 2019. DDDs, defined daily doses.
See this image and copyright information in PMC

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