Журнал «Здоровье ребенка» 8 (51) 2013

Introduction. Diffuse nontoxic goiter occupies a leading position in structure of endocrine disorders in children and adolescents. The development of goiter is most often associated with a decrease of thyroid hormone synthesis due to iodine deficiency. Goiter increases risk of chronic diseases. Introduction of preparation potassium iodide promotes adequate thyroid hormone synthesis, normalizing the size of thyroid gland (TG) and the functioning of other organs and systems.

Objective: to study the effects of the diffuse non-toxic goiter treatment on the functional state of the digestive system in children.

Materials and methods. The screening survey was based on primary classes of ordinary schools. There were examined 695 children of the age 5–11 years (continuous sample method). Questioning of families, anthropometry and examination of children, palpation of TG were performed. The second part of research was in-depth medical examination of 88 children with goiter: thyroid and digestive tract ultrasonography, the detection of thyroid stimulating hormone (TSH), free thyroxin (FT4), serotonin, melatonin, vasoactive intestinal peptide (VIP). For the correction of thyroid status potassium iodide was prescribed to children with goiter in age-appropriate doses for 6 months. The children were randomized in two groups. In Group I there were 55 children with goiter, who continuously taking potassium iodide (100 mg/day) for 6 months. In Group II there were 33 children with goiter who did not fully comply with treatment recommendations. The groups were homogeneous in gender, age and physical development. Control examination was performed in 6 months. The control group consisted of 39 children of similar age and sex without thyroid disease, acute and chronic infectious and somatic diseases. The obtained data were processed by the SP Statistica 7.0 and MS Office Excel 2007.

Results. The high rate of non-toxic diffuse goiter (25.8 %) junior school-children was demonstrated. During the in-depth medical examination goiter was confirmed by ultrasonography in 100 % of children (WHO 2007). The most of children with goiter have decreased functional activity of thyroid gland: the minimal thyroid dysfunction in 42.2 ± 5.3 % (37/88) and subclinical hypothyroidism in 10.2 ± 3.2 % (9/88).

The complaints related to disruption of the digestive system’s function were present in 92.0 ± 2.9 % (81/88) of children. Functional gastrointestinal disorders were diagnosed according to Rome criteria III in 92.0 ± 2.9 % (81/88) of cases. The symptoms of functional dyspepsia were detected in 44.3 ± 5.3 % (39/88) of patients. In most cases functional dyspepsia proceeded with postprandial distress syndrome (24/39, 61.5±7.8 %). Diagnosis «Irritable bowel syndrome» was proved in 25.0 ± 4.6 % (22/88) patients with goiter. Irritable bowel syndrome with constipation detected in 86.4 ± 7.3 % (19/22) of all cases. The functional disorders of the biliary tract was observed in 68.2 ± 5.0 % (60/88) children with goiter. The most frequently the hypokinetic type functional disorders of the gallbladder including was diagnosed: in 65.0 ± 6.2 % (39/60) of all cases. During the treatment the rate of goiter in the Group I decrease to 27.3 ± 6.0 % (15/55), the levels of TSH from 2.31 [1.47–3.19] IU/L to 1.66 [1.30–1.92] IU/L, p = 0.000. Children from the Group II demonstrated further increasing of TSH levels from 1.75 [1.39–2.18] IU/L to 2.94 [2.51–3.25] IU/L, p = 0.01. Clinical observation of the patients in Group I demonstrated an improvement in their health and reducing of the rate of complaints related to the disruption of the digestive tract functions in comparison with patients in Group II. Serotonin levels increased from 4.58 [2.15–5.89] ng/ml to 6.14 [2.13–9.97] ng/ml (p = 0.000) in Group I and reached the Control group levels, while in Group II there was a slight increase. In both groups the content of melatonin in the blood serum at the time of the control examination was statistically lower than at the beginning: 2.51 [1.02–3.69] pmol/L vs 23.84 [11.83–36.61] pmol/L (p = 0.000) and 2.38 [0.99–3.84] pmol/L vs 15.86 [11.29–31.60] pmol/L respectively. Every group managed to reach comparison group levels. In both groups the average concentrations of vasoactive intestinal peptide (VIP) during the treatment were increased from 4.29 [0.81–17.60] ng/ml to 117.86 [55.76–175.48] ng/ml (p = 0.000) in Group I and 7.72 [0.89–15.07] ng/ml to 128.33 [62.54–227.86] ng/ml (p = 0.000) in Group II and also there was not difference from those in the Control group.

Conclusions. The treatment of diffuse nontoxic goiter by Potassium iodide allows to achieve normalization of thyroid size in 87.3 ± 4.5 % of cases and to improve functional state of thyroid-pituitary system (TSH 1.66 IU/l). The normalization of thyroid status is accompanied by reducing of the rate of the gastrointestinal complaints. The optimization of thyroid hormonogenesis leads to increasing of serotonin production (up to 6.14 ng/ml) and VIP (up to 117.86 ng/ml), melatonin reduction (up to 2.51 pmol/l).