In developing countries, children are at high risk for both the
iodine deficiency disorders (IDD) and
vitamin A deficiency (VAD). The study aim was to determine the effects of VAD and
vitamin A (VA) supplementation on thyroid function in an area of
endemic goiter. In a double-blind, randomized, 10-month trial, Moroccan children with IDD and VAD (n = 138) were given
iodized salt and either VA (200,000 IU) or placebo at 0 and 5 months. At 0, 5, and 10 months, measurements of VA status and thyroid function were made. At baseline, increasing VAD severity was a predictor of greater thyroid volume and higher concentrations of TSH and
thyroglobulin (P < 0.001). In children with VAD, the odds ratio for
goiter was 6.51 (95% confidence interval, 2.94, 14.41). VAD severity was also a strong predictor of higher concentrations of total T(4) (P < 0.001); the odds ratio for
hypothyroidism in VAD was 0.06 (95% confidence interval, 0.03, 0.14). During the intervention, mean
thyroglobulin, median TSH, and the
goiter rate significantly decreased in the VA-treated group compared with those in the placebo group (P < 0.01). The findings indicate that VAD in severely IDD-affected children increases TSH stimulation and thyroid size and reduces the risk for
hypothyroidism. This effect could be due to decreased VA-mediated suppression of the pituitary TSHbeta gene. In IDD- and VAD-affected children receiving
iodized salt, concurrent VA supplementation improves
iodine efficacy.