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Previous Volume 339:1112-1120 October 15, 1998 Number 16 Next

	Full Text PDF Editorial by Utiger, R. D. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods Kashin–Beck disease is a degenerative osteoarticular disorder that is endemic to certain areas of Tibet, where selenium deficiency is also endemic. Because selenium is involved in thyroid hormone metabolism, we studied the relation among the serum selenium concentration, thyroid function, and Kashin–Beck disease in 575 subjects 5 to 15 years of age in 12 villages around Lhasa, Tibet, including 1 control village in which no subject had Kashin–Beck disease. Clinical, radiologic, and biochemical data were collected.

Results Among the 575 subjects, 280 (49 percent) had Kashin–Beck disease, 267 (46 percent) had goiter, and 7 (1 percent) had cretinism. Of the 557 subjects in whom urinary iodine was measured, 66 percent had a urinary iodine concentration of less than 2 µg per deciliter (157 nmol per liter; normal, 5 to 25 µg per deciliter [394 to 1968 nmol per liter]). The mean urinary iodine concentration was lower in subjects with Kashin–Beck disease than in control subjects (1.2 vs. 1.8 µg per deciliter [94 vs. 142 nmol per liter], P<0.001) and hypothyroidism was more frequent (23 percent vs. 4 percent, P=0.01). Severe selenium deficiency was documented in all villages; 38 percent of subjects had serum concentrations of less than 5 ng per milliliter (64 nmol per liter; normal, 60 to 105 ng per milliliter [762 to 1334 nmol per liter]). When age and sex were controlled for in a multivariate analysis, low urinary iodine, high serum thyrotropin, and low serum thyroxine-binding globulin values were associated with an increased risk of Kashin–Beck disease, but a low serum selenium concentration was not.

Conclusions In areas where severe selenium deficiency is endemic, iodine deficiency is a risk factor for Kashin–Beck disease.

Source Information

From the Department of Nuclear Medicine, Erasme Hospital (R.M.-R.), the Laboratory of Pharmaceutical Chemistry, Institute of Pharmacy (M.T.R., J.N.), the Department of Pediatric Radiology, Children's University Hospital (N.P.), and the Public Health School (J.V.), Université Libre de Bruxelles, Brussels, Belgium; Médecins sans Frontières, Brussels, Belgium (C.S., F.M., F.B., M.B.); the Tibetan Public Health Bureau of Tibet Autonomous Region, People's Republic of China (D.Z.); and Ambroise Paré Hospital, Mons, Belgium (J.V.).

Address reprint requests to Dr. Moreno-Reyes at the Department of Nuclear Medicine, Hôpital Erasme, Route de Lennik 808, B-1070 Brussels, Belgium.

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