Genomes and Genes
Iodine Nutrition and Thyroid Disease During Pregnancy and Lactation
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
- 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 reviewAngela M Leung
Section of Endocrinology, Diabetes, and Nutrition Boston University School of Medicine Boston, MA USA
Thyroid Res 4:9. 2011..abstract:..
- 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 studySøren 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...
- History of U.S. iodine fortification and supplementationAngela 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...
- Iodine nutrition during pregnancy in Toronto, CanadaPamela 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...
- Breastmilk iodine concentrations following acute dietary iodine intakeAngela 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...
- Environmental perchlorate and thiocyanate exposures and infant serum thyroid functionAngela 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...
- Iodine-induced thyroid dysfunctionAngela 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...
- Thyroid function in pregnancyAngela 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....
- Iodine nutrition in pregnancy and lactationAngela M Leung
Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, MA, USA
Endocrinol Metab Clin North Am 40:765-77. 2011....
- Thyroid testing during pregnancy at an academic Boston Area Medical CenterDonny 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...
- Iodine status and thyroid function of Boston-area vegetarians and vegansAngela 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...
- Consequences of excess iodineAngela 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. ..
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