CORRESPONDENCE

A rare cause of thyroid goitre in a UK adolescent

Sir,

We report a 15-y-old Caucasian girl from Manchester,

England, who presented with a month history of

developing a large, diffuse, non-tender goitre (Figure

1). She was asymptomatic, had normal menstruation

and was clinically euthyroid, but had dry, eczematous

skin. Initially, TSH was increased (8.4 mU/l, nor-

malB/5), but normalized spontaneously and free T4

was normal (fT4 15 mmol/l, normal 11�24). Ultra-

sound scan showed a hypoechogenic goitre with

nodular areas. Thyroid antibodies were negative.

A thyroxine trial was prescribed to reduce the size of

the goitre, but she immediately developed swollen lips

and urticaria. At this point, a history of multiple

allergies, asthma and atopic dermatitis was uncov-

ered, particularly to wheat and dairy products. A

significantly restricted diet, consisting of no dairy

products or red meat, was noted, but there were no

excessive goitrogenic substances and normal salt

intake. Urine collection showed reduced iodine ex-

cretion (B/0.08 mmol/l, normal�/0.7), consistent with

iodine deficiency, suggesting that her intake of salt

was un-iodinated. Oral iodine reduced the goitre size

over 6 months.

Dairy products and iodized salt are the major

source for dietary iodine [1]. Iodine deficiency is

endemic in the developing world [2]; however, iodine

deficiency goitre is rarely seen in the UK, usually in

cases of vegan diets [3]. Much effort is taking place to

encourage iodized salt usage in the developing world,

but it has recently been recognized that, in many

European households, iodized salt consumption is

also low [4]. There have been no UK cases reported

of iodine deficiency goitre associated with allergy-

related exclusion diets, although a case has been

reported in the US [5].

Early consideration of dietary history and iodized

salt intake in cases of non-autoimmune thyroid goitre,

even in non-iodine-deficiency endemic areas, may

allow more rapid diagnosis and appropriate treatment

of iodine deficiency.

References

[1] Ministry of Agriculture Fisheries and Food. Dietary intake of

iodine and fatty acids. Food Surveillance Information Sheet

No. 127; 1997.

[2] Delange F. The disorders induced by iodine deficiency. Thyroid

1994;/4:/107�28.

[3] Park C, Watson W, Bevan J, Abraham P. Iodine deficiency

goitre in the United Kingdom�the result of a vegan diet.

Endocrine Abstracts 2005;/9:/176.

[4] European Salt Producers Association. Iodized salt: eliminating

iodine deficiency. Position Paper 6, 2005. Available from URL:

http://www.eu-salt.com/images/paper6.pdf

[5] Pacaud D, Van Vliet G, Delvin E, Garel L, Chad Z, Delange F,

et al. A Third World endocrine disease in a 6-year-old North

American boy. J Clin Endocrinol Metab 1995;/80:/2574�6.

Figure 1. Patient on presentation.

MORRIS GORDON, CATHERINE HALL & RAKESH AMIN.

Royal Manchester Children’s Hospital, Manchester, UK.

Correspondence: Dr Rakesh Amin, Department of Endocrinology, Royal

Manchester Children’s Hospital, Manchester, M27 4HA. E-mail:

rakesh.amin@cmmc.nhs.uk

(Received 3 February 2006; accepted 3 February 2006)

ISSN 0803-5253 print/ISSN 1651-2227 online # 2006 Taylor & Francis

DOI: 10.1080/08035250600615184

Acta Pædiatrica, 2006; 95: 1016�1020