University HealthCare Alliance

May 25, 2017

Dr. Mariam Manoukian authors an abstract on iodine nutrition

Congratulations to Dr. Mariam Manoukian for authoring an abstract on iodine nutrition in Armenia, which was accepted for presentation at the 87th Annual Meeting of the American Thyroid Association in Victoria, BC, Canada.

“It is always great to see our UHA providers making additional contributions to healthcare outside of the clinic,” said Dr. Bryan Bohman, Chief Medical Officer, UHA.

“Each year, along with Dr. John Bilezikian, I participate in the international osteoporosis symposium. While seeing patients with thyroid pathology, we noticed the need to evaluate iodine nutrition status in the country. We worked with researchers from Columbia University,” said Mariam Manoukian, MD.

For more information, please reference the abstract submission below.

87th Annual Meeting of the American Thyroid Association – Abstract Submission

Title: Investigating Iodine Nutrition in Nagorno Karabakh

Authors: Nicholas Hutchings1,2,*, Sisak Baghdasaryan, Mushegh Qefoyan3, Mariam Manoukian4, Karine Atayan5, John Bilezikian1

1 – Columbia University – College of Physicians & Surgeons, New York
2 – Dept of Endocrinology, Yerevan State Medical University, Yerevan
3 – National Institute of Health, Ministry of Health, Yerevan
4 – Manoukian Medical Group, Stanford Health Care – University HealthCare Alliance, Mountain View
5 – Ministry of Health, Stepanakert

Topic: Public Health

Key words: Iodine, Thyroid, Karabakh, Public-Health, Nutrition  


Iodine is a required nutrient for thyroid function. The mountainous terrain of the Republic of Nagorno Karabakh in the south Caucasus suggests that it is likely to be endogenously deficient in iodine. The region is heavily dependent on the Republic of Armenia for food imports including iodized salt, however there has never been a study of iodine nutrition in the region.

We sought to determine in the level of iodine nutrition in Nagorno Karabakh and iodine content of table salt in the region. We conducted a cross-sectional study using a modified cluster model to measure urine and salt iodine concentrations from a representative sample of children living in Karabakh. Urine and table salt samples from 772 children aged 8-12 were obtained from 30 schools throughout the country. Repeat urine samples from 19% of participants were obtained. Urine and salt samples were analysed for iodine content, and repeat samples were used to reduce intra-individual variability and provide adjusted urine iodine concentrations (UICs). The median adjusted UIC was 206 mcg/L, with 89% of samples within 100-299 mcg/L. Within the group, there were small but statistically significant differences found between the adjusted UIC values of 10 geographic regions of the country (p = 0.015), but there was no difference between individual sites. A random sampling of 294 salt samples representing all study sites were analysed; all were iodized, with a median iodine content of 36.2 mg/kg, and 95% of samples within 25-55 mg/kg.

These findings indicate sufficient iodine nutrition among the school-age children in Karabakh, and excellent coverage of appropriately iodized salt. Together, these results indicate remarkable success of the salt iodization program in providing sufficient but not excessive iodine to a mountainous region likely naturally deficient in iodine.