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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^1,2,3

¹ From the Laboratory for Human Nutrition, Swiss Federal Institute of Technology Zürich, Rüschlikon, Switzerland (MBZ and SYH); the Growth and Development Section, University Children's Hospital, Zürich, Switzerland (LM); the Department of Nutrition for Health and Development, World Health Organization, Geneva (BdB); the International Council for the Control of Iodine Deficiency Disorders, Brussels (FD); the Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, Boston (LEB and ENP); the Department of Pediatrics, Asahikawa Medical College, Asahikawa, Japan (KF and YI); the Nutritional Intervention Research Unit, Medical Research Council, Cape Town, South Africa (PLJ); the Nutrition Department, Ministry of Health, Manama, Bahrain (KM); the Endocrine and Metabolism Unit, High Altitude Research Institute, Cayetano Heredia Peruvian University, Lima, Peru (EAP); and the Mishuku Hospital, Tokyo (YS).

Background: Goiter prevalence in school-age children is an indicator of the severity of iodine deficiency disorders (IDDs) in a population. In areas of mild-to-moderate IDDs, measurement of thyroid volume (Tvol) by ultrasound is preferable to palpation for grading goiter, but interpretation requires reference criteria from iodine-sufficient children.

Objective: The study aim was to establish international reference values for Tvol by ultrasound in 6–12-y-old children that could be used to define goiter in the context of IDD monitoring.

Design: Tvol was measured by ultrasound in 6–12-y-old children living in areas of long-term iodine sufficiency in North and South America, central Europe, the eastern Mediterranean, Africa, and the western Pacific. Measurements were made by 2 experienced examiners using validated techniques. Data were log transformed, used to calculate percentiles on the basis of the Gaussian distribution, and then transformed back to the linear scale. Age- and body surface area (BSA)–specific 97th percentiles for Tvol were calculated for boys and girls.

Results: The sample included 3529 children evenly divided between boys and girls at each year ( ± SD age: 9.3 ± 1.9 y). The range of median urinary iodine concentrations for the 6 study sites was 118–288 µg/L. There were significant differences in age- and BSA-adjusted mean Tvols between sites, which suggests that population-specific references in countries with long-standing iodine sufficiency may be more accurate than is a single international reference. However, overall differences in age- and BSA-adjusted Tvols between sites were modest relative to the population and measurement variability, which supports the use of a single, site-independent set of references.

Conclusion: These new international reference values for Tvol by ultrasound can be used for goiter screening in the context of IDD monitoring.

Key Words: Thyroid volume • children • international reference • ultrasound • iodine • goiter

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