Iodine Nutrition and Thyroid Disease During Pregnancy and Lactation

Summary

Principal Investigator: ANGELA MEI TIN LEUNG
Abstract: DESCRIPTION (provided by applicant): My research experience began with laboratory projects at Occidental College in Los Angeles. During my residency and fellowship training at Boston University Medical Center (BUMC), I undertook several clinical research projects with Drs. Lewis Braverman and Elizabeth Pearce. In June 2009, I completed a clinical and research fellowship in the Section of Endocrinology, Diabetes, and Nutrition at Boston University Medical Center (BUMC), the last 2 years of which were supported by an NIH T32 National Research Service Award. I completed the BUMC Clinical Research Training (CREST) program (an NIH K30 Clinical Research Curriculum Award) from 2007-2009. In July 2009, I became a junior faculty member at Boston University, a Clinical and Translational Institute (CTSI) site, (BU-BRIDGE). I received a Master of Science in Epidemiology degree at the Boston University School of Public Health in January 2010. I have had 5 original research publications related to the topics of the current proposal, including 3 as first author. I am supported by a Charles A. King Trust Postdoctoral Fellowship Award and an NIH K12 Building Interdisciplinary Research Careers in Women's Health (BIRCWH) grant at Boston University. The BIRCWH scholars program promotes career development of young investigators through mentored research, monthly research meetings, academic guidance, and national research presentations. During the K23 award period, my career development plans include participation in research-oriented seminars, presenting at national endocrine meetings, attending BUMC didactic conferences, teaching activities, and formal coursework at BUMC. I have assembled a research advisory committee who will assess my progress and provide ongoing guidance as I pursue my research plan. The skills and mentorship I will obtain through the BIRCWH and K23 awards will allow me to develop future research hypotheses aimed at specific strategies of achieving adequate iodine nutrition and normal thyroid function during pregnancy and lactation. This work will then prepare me to embark on the design and implementation of an R01 award aimed at specific strategies to achieve universal adequate iodine nutrition and normal thyroid function during pregnancy and lactation. Environment I am currently an Instructor of Medicine in the Section of Endocrinology, Diabetes, and Nutrition (Shalender Bhasin, MD;Chief) at BUMC, where the majority of my current appointment is devoted to research. The Section is comprised of 45 full-time faculty members (including one of the largest thyroid groups in the country with 7 fulltime MD faculty) and boasts over 12 million dollars in research funding, an NIH training grant, and several program and center projects. My mentor on this proposal is Dr. Lewis Braverman, Professor of Medicine at BUMC and an accomplished mentor to over 60 fellows in various aspects of thyroid physiology over his nearly 50-year career. My co-mentor is Dr. Elizabeth Hatch, Associate Professor of Epidemiology at Boston University School of Public Health, who has extensive experience and research interests in prenatal and childhood exposures relating to adverse reproductive outcomes. Research Iodine deficiency is debilitating, prevalent, and the leading cause of mental retardation worldwide. Dietary iodine is necessary for thyroid hormone synthesis. Normal thyroid function is particularly important during pregnancy and lactation, as maternal thyroid hormone levels are crucial for proper fetal and infant neurodevelopment. The impact of breast milk iodine levels on infant thyroid function is unknown. In addition, environmental exposures to perchlorate and cigarette smoke (which is metabolized to thiocyanate) decrease iodine uptake into the lactating breast, thereby further impairing iodine availability to the infant and potentially directly affecting infant thyroid function. The broad objective of this proposal is to test the hypotheses that: 1) hypothyroidism during pregnancy is associated with premature birth and other adverse obstetric/perinatal outcomes, and 2) breast milk perchlorate and thiocyanate levels, by their inhibition of NIS, decrease breast milk iodine levels (which fluctuate in relationship to dietary iodine ingestion), and are associated with infant hypothyroidism. The results of this research will have important public health implications for thyroid function screening among pregnant women and adequate maternal iodine nutrition during pregnancy and lactation. Specific Aim 1 will be a database review studying the relationships between maternal hypothyroidism during pregnancy and obstetric/perinatal outcomes. Specific Aim 2 will be an interventional assessment of an iodine load on the effects and timing of peak breast milk iodine levels in postpartum women. Specific Aim 3 will be a cross-sectional study of maternal and infant iodine intake, maternal and infant perchlorate and cigarette smoke (thiocyanate) exposures, and infant thyroid function. The pursuit of these projects, in conjunction with formal coursework in biostatistical and epidemiological methods, is intended to foster my career as an independent academic clinical investigator in thyroid disease as it relates to women's and infant health.
Funding Period: 2011-04-01 - 2016-03-31
more information: NIH RePORT

Top Publications

  1. pmc Factors determining the persistence or recurrence of well-differentiated thyroid cancer treated by thyroidectomy and/or radioiodine in the Boston, Massachusetts area: A retrospective chart review
    Angela M Leung
    Section of Endocrinology, Diabetes, and Nutrition Boston University School of Medicine Boston, MA USA
    Thyroid Res 4:9. 2011
  2. pmc Long-term efficacy of modified-release recombinant human thyrotropin augmented radioiodine therapy for benign multinodular goiter: results from a multicenter, international, randomized, placebo-controlled, dose-selection study
    Søren Fast
    1 Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
    Thyroid 24:727-35. 2014
  3. pmc History of U.S. iodine fortification and supplementation
    Angela M Leung
    Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, 88 East Newton Street, Evans 201, Boston, MA 02118, USA
    Nutrients 4:1740-6. 2012
  4. pmc Iodine nutrition during pregnancy in Toronto, Canada
    Pamela M Katz
    Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
    Endocr Pract 19:206-11. 2013
  5. pmc Breastmilk iodine concentrations following acute dietary iodine intake
    Angela M Leung
    Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, School of Medicine, Boston University, Boston, Massachusetts 02118, USA
    Thyroid 22:1176-80. 2012
  6. pmc Environmental perchlorate and thiocyanate exposures and infant serum thyroid function
    Angela M Leung
    Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, 88 East Newton St, Boston, MA 02118, USA
    Thyroid 22:938-43. 2012
  7. ncbi Iodine-induced thyroid dysfunction
    Angela M Leung
    Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts 02118, USA
    Curr Opin Endocrinol Diabetes Obes 19:414-9. 2012
  8. pmc Thyroid function in pregnancy
    Angela M Leung
    Boston University School of Medicine, Section of Endocrinology, Diabetes, and Nutrition, 88 East Newton Street, Evans 201, Boston, MA, USA
    J Trace Elem Med Biol 26:137-40. 2012
  9. pmc Iodine nutrition in pregnancy and lactation
    Angela M Leung
    Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, MA, USA
    Endocrinol Metab Clin North Am 40:765-77. 2011
  10. pmc Thyroid testing during pregnancy at an academic Boston Area Medical Center
    Donny L F Chang
    Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, 02118, USA
    J Clin Endocrinol Metab 96:E1452-6. 2011

Detail Information

Publications17

  1. pmc Factors determining the persistence or recurrence of well-differentiated thyroid cancer treated by thyroidectomy and/or radioiodine in the Boston, Massachusetts area: A retrospective chart review
    Angela M Leung
    Section of Endocrinology, Diabetes, and Nutrition Boston University School of Medicine Boston, MA USA
    Thyroid Res 4:9. 2011
    ..abstract:..
  2. pmc Long-term efficacy of modified-release recombinant human thyrotropin augmented radioiodine therapy for benign multinodular goiter: results from a multicenter, international, randomized, placebo-controlled, dose-selection study
    Søren Fast
    1 Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
    Thyroid 24:727-35. 2014
    ..The objective was to compare the long-term efficacy and safety of two low doses of modified release rhTSH (MRrhTSH) in combination with (131)I therapy...
  3. pmc History of U.S. iodine fortification and supplementation
    Angela M Leung
    Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, 88 East Newton Street, Evans 201, Boston, MA 02118, USA
    Nutrients 4:1740-6. 2012
    ..This review highlights the history of the discovery of iodine and its uses, discusses the sources of iodine nutrition, and summarizes the current recommendations for iodine intake with a focus on women of childbearing age...
  4. pmc Iodine nutrition during pregnancy in Toronto, Canada
    Pamela M Katz
    Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
    Endocr Pract 19:206-11. 2013
    ..To evaluate the status of iodine nutrition among pregnant women presenting for routine antenatal care in Toronto, Canada, as determined by the median urine iodine concentration (UIC) of this population...
  5. pmc Breastmilk iodine concentrations following acute dietary iodine intake
    Angela M Leung
    Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, School of Medicine, Boston University, Boston, Massachusetts 02118, USA
    Thyroid 22:1176-80. 2012
    ..We assessed the effect of and time to peak breastmilk iodine levels after potassium iodine ingestion, which has never been studied and is important toward interpretation of studies of breastmilk iodine measurements...
  6. pmc Environmental perchlorate and thiocyanate exposures and infant serum thyroid function
    Angela M Leung
    Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, 88 East Newton St, Boston, MA 02118, USA
    Thyroid 22:938-43. 2012
    ..The current study assessed the relationships between environmental perchlorate and thiocyanate exposures and infant serum thyroid function...
  7. ncbi Iodine-induced thyroid dysfunction
    Angela M Leung
    Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts 02118, USA
    Curr Opin Endocrinol Diabetes Obes 19:414-9. 2012
    ..To summarize the mechanisms of iodine-induced hypothyroidism and hyperthyroidism, identify the risk factors for thyroid dysfunction following an iodine load, and summarize the major sources of excess iodine exposure...
  8. pmc Thyroid function in pregnancy
    Angela M Leung
    Boston University School of Medicine, Section of Endocrinology, Diabetes, and Nutrition, 88 East Newton Street, Evans 201, Boston, MA, USA
    J Trace Elem Med Biol 26:137-40. 2012
    ....
  9. pmc Iodine nutrition in pregnancy and lactation
    Angela M Leung
    Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, MA, USA
    Endocrinol Metab Clin North Am 40:765-77. 2011
    ....
  10. pmc Thyroid testing during pregnancy at an academic Boston Area Medical Center
    Donny L F Chang
    Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, 02118, USA
    J Clin Endocrinol Metab 96:E1452-6. 2011
    ..Gestational hypothyroidism leads to adverse obstetric outcomes and intellectual impairment in offspring. Pregnancy thyroid screening is controversial...
  11. pmc Iodine status and thyroid function of Boston-area vegetarians and vegans
    Angela M Leung
    Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, Boston, Massachusetts 02118, USA
    J Clin Endocrinol Metab 96:E1303-7. 2011
    ..The iodine status and thyroid function of U.S. vegetarians and vegans have not been previously studied. Environmental perchlorate and thiocyanate (inhibitors of thyroid iodine uptake) exposures may adversely affect thyroid function...
  12. pmc Consequences of excess iodine
    Angela M Leung
    Division of Endocrinology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard 111D, Los Angeles, CA 90073, USA
    Nat Rev Endocrinol 10:136-42. 2014
    ..Hypothyroidism or hyperthyroidism as a result of supraphysiologic iodine exposure might be either subclinical or overt, and the source of the excess iodine might not be readily apparent. ..

Research Grants30

  1. The Shelf Live Evaluation of Investigational Dosage Forms
    Jonathan White; Fiscal Year: 2013
    ..This contract is essential for continued assurance of the quality of drugs undergoing clinical investigation for different types of cancer by Cancer Therapeutics Evaluation Program. ..
  2. Caloric Restricted Rodent Colony
    RICK MORIN; Fiscal Year: 2013
    ..The purpose of this project is to develop, maintain and distribute a standing colony ofaged, calorically restricted rodents ofdefined strains for use by investigators in studies of aging. ..
  3. Southern California Children's Enviromental Health Center (SC-CEHC)
    Rob S McConnell; Fiscal Year: 2013
    ....
  4. Semi-volatile PCBs: Sources, Exposures, Toxicities
    Larry W Robertson; Fiscal Year: 2013
    ..These data and dietary studies in the last Aim will provide a scientific basis for risk assessment and advice for stakeholders with the ultimate goal to protect highly-exposed individuals and populations. ..
  5. The UCSF Pregnancy Exposures to Environmental Chemicals (PEEC) Children's Center
    Tracey J Woodruff; Fiscal Year: 2013
    ..Finally, the Administrative Core will work closely with a program evaluator, to monitor the progress of the PEEC Children's Center and ensure the achievement of its goals. ..
  6. Lifecourse Exposures &Diet: Epigenetics, Maturation &Metabolic Syndrome
    KAREN EILEEN PETERSON; Fiscal Year: 2013
    ..Career development and training activities will draw upon extensive institutional resources and will be fully integrated with the Center's Research Projects and Cores. ..
  7. UC Berkeley/Stanford Children's Enviromental Health Center
    Gary M Shaw; Fiscal Year: 2013
    ..7) To support the data management and QA/QC operations of CHAPS-SJV. 8) To support and implement the data sharing plan. 9) To support the annual CEHC meetings and the travel of CHAPS-SJV investigators to these meetings. ..
  8. Center for Transdisciplinary ELSI Research in Translational Genomics
    Carol P Somkin; Fiscal Year: 2013
    ..To enhance transdisciplinary collaboration, we will develop a one year ELSl fellowship for clinicians from multiple fields, including nursing, pharmacy, genetic counseling, and clinical medicine. ..
  9. The Role of Human Milk in Infant Nutrition and Health
    Ardythe L Morrow; Fiscal Year: 2013
    ..Our focus and approach addresses NIH Road Map 2008 priorities pertaining to inflammation, the microbiome, and phenotyping. ..
  10. EPIDEMIOLOGY OF ALCOHOL PROBLEMS
    Thomas K Greenfield; Fiscal Year: 2013
    ..We plan to build research capacity in the Center and other organizations, enhance careers of new investigators, and make key findings accessible to researchers, policy makers, practitioners, and the public. ..
  11. Program Project: GENE MUTATION AND RESCUE IN HUMAN DIAPHRAGMATIC HERNIA
    Patricia K Donahoe; Fiscal Year: 2013
    ..Further, the methods devised for this study of CDH may have broader implications across other congenital anomalies. ..
  12. Developmental Exposure Alcohol Research Center
    Linda Patia Spear; Fiscal Year: 2013
    ..Thus, the DEARC will serve as a nexus of alcohol research in Central New York and as a beacon for national activities. ..
  13. Chicago Center for Diabetes Translation Research
    Marshall H Chin; Fiscal Year: 2013
    ..abstract_text> ..
  14. Human Capital Interventions Across Childhood and Adolescence
    GREG JOHN DUNCAN; Fiscal Year: 2013
    ..Taken together, the group's involvement with multiple projects as well as seminars, jointly-authored papers and other core activities will constitute a research network - the Irvine Network on Interventions in Development. ..
  15. PERCHLORATE AND THYROID HORMONES IN PREGNANCY AND INFANTS IN SOUTHERN CALIFORNIA
    Craig M Steinmaus; Fiscal Year: 2013
    ....
  16. Mechanisms of Health Effects of Exercise in Children
    Dan M Cooper; Fiscal Year: 2013
    ..Collectively, the PPG will promote novel preventive and adjunctive exercise therapies in children with chronic inflammation- therapies grounded in a firm understanding of biological mechanisms. ..
  17. Elucidating Risks: From Exposure and Mechanism to Outcome
    James A Swenberg; Fiscal Year: 2013
    ..This Program is highly relevant to Superfund by addressing high-priority chemicals and by focusing on mechanisms underlying health effects, exposure assessment, and remediation to mitigate exposure and toxicity. ..
  18. Puerto Rico Testsite for Exploring Contamination Threats (PRoTECT)
    Akram N Alshawabkeh; Fiscal Year: 2013
    ..The cross-disciplinary approach will employ the data-rich centralized data repository and integrated modeling/analysis capabilities to better understand complex interrelationships between multiple risk factors. ..
  19. Superfund Metal Mixtures, Biomarkers and Neurodevelopment
    David C Bellinger; Fiscal Year: 2013
    ..Aim 4- To promote rapid dissemination of significant research findings;and Aim 5- Compliance- To ensure compliance with NIH requirements for data and resource-sharing and the human and animal institutional review board requirements ..
  20. Beryllium: Exposure Immune and Genetic Mechanisms
    Lee S Newman; Fiscal Year: 2013
    ..The productivity and continuance demonstrate quality, commitment and ability to work together. PROGRAM AS INTERGRATED EFFORT ..
  21. Neurodevelopmental Effects of Early Life Arsenic Exposure
    Maitreyi Mazumdar; Fiscal Year: 2013
    ..Mazumdar in meeting the objectives of her career development and research plans. ..
  22. Molecular Regulation of Mammalian Meiosis
    Kenneth Paigen; Fiscal Year: 2013
    ..Results of the program project will significantly increase the understanding of the mechanisms that regulate meiosis as well as their involvement in other important biological processes. ..
  23. Stanford University Cancer Center
    BEVERLY SHRIVER MITCHELL; Fiscal Year: 2013
    ..abstract_text> ..