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Iodine deficiency disorders
Iodine is an essential component in thyroid
hormone production
Thyroid hormone regulates basic metabolism
:energy consumption, cellular activity, growth
and in particular brain development.
Hypothyroidism: slow, cold, sluggish brain
function, short stature, mental and motor
development delayed or slowed. In extremes
general neurological development delayed.
Hormone
regulation
Hypothamalus
TSHRF
- Somatostatin
Hypofysis
T4
T3
TSH
T3 T4
I pool
Hormones and iodine deficiency
Spectrum of disease
Table 1. The Spectrum of Iodine Deficiency Disorders, IDD.
Fetus Abortions
Stillbirths
Congenital anomalies
Increased perinatal mortality
Endemic cretinism
Neonate Neonatal goiter
Neonatal hypothyroidism
Endemic mental retardation
Increased susceptibility of the thyroid gland
to nuclear radiation
Child and Goiter
adolescent (Subclinical) hypothyroidism
Impaired mental function
Retarded physical development
Increased susceptibility of the thyroid gland
to nuclear radiation
Adult Goiter with its complications
Hypothyroidism
Impaired mental function
Spontaneous hyperthyroidism in the elderly
Iodine-induced hyperthyroidism
Increased susceptibility of the thyroid gland
to nuclear radiation
Adapted from Hetzel (1), Laurberg et al. (52, 171) and Stanbury et al. (158).
Importance of the problem
Prevalence
1 billion persons exposed
200 million persons affected (goitres)
26 million cases of mental problems
6 million cases of cretinism
Goitre
Increase in size four to five times distal phalanx
of the thumb
Aesthetic
Compression
Related hypothyroidism: is not a compensation
cancer
Iod Basedow (hyperthyroidism) due to
hyperstimulation, mutation autonomous nodules
Iodine deficiency and the foetus
Brain development fast between 3-5 months
pregnancy and from third trimester till end of
second year
Maternal T4 essential for first 24 weeks
Foetal T4 starts at 24 weeks
30% cord blood is of maternal origin
Iodine and the neonate
Perinatal mortality
Infant mortality
Low birth weight
Brain development needs T4
Iodine deficiency mental retardation, retarded
motor development.
General IQ decrease of 15 Points
Iodine deficiency and adults
Lack of energy
apathy, slow brains
goitre and mechanical complications
Nodular thyroid
hyperthyroidism
Pregnancy and cretinism
Aethiology
Low iodine uptake. Soil dependent
erosion, wash away: deltas
Goitrogens
Manioc: linnamarin thiocyanate
Blocs uptake of Iodine at the thyroid, competitive
inhibition
Traditional preparations
Konzo
Brassica family
polutants
IDD and selenium deficiency
Se part of peripheral type I de-Iodinase (kidney
and liver)
Se deficiency: slower T4 to T3 metabolisation
Se part of Glutathion peroxidase : protector of
H2O2 damage Thyroid damage, disfunction of
thyroid
Cerebral de-iodinase is not Se dependent
Glutathion peroxidase stimulates T4 production
Iodine needs
RECOMMENDED INTAKE
ug/day
0 - 6 months
35
6 - 12 months
1 - 10 years
>= 11 years
pregnancy – lactation
45
60 – 100
100 - 115
125 - 150
8 ug/kg
5 ug/100ml of milk
7 ug/100 kcal
Diagnosis of endemicity
Prevalence of goitre
Dosage of urinary iodine
TSH dosage
Prevalence of cretinism
Prevalence of goitre
Class
Description
0
Absence of goitre
Ia
Detectable goitre only by palpation and invisible, even when the
head is stretched. More voluminous thyroid than usual, the lobes
have a volume that is at least equal to the volume of the last
phalanx of the subject’s thumb.
Ib
Palpable and visible goitre when the head is stretched. Also all the
cases where there is a nodule - even when there is no goitre.
II
Visible goitre when the head is in a normal position.
III
Very big goitre, visible from a distance
IODE DEFICIENCY
SEVERE
MODERATE
MILD
> 50 %
> 10 %
20-49 % 10-19 %
5-9 %
1-5 %
Number of cases of
goitre among the
school children (6-12)
visible goitre
total goitre
Urinary Iodine
Reflects directly intake
Is best to follow up programme response, goitre
takes time to decrease in size
Samples needed are smaller
Technique is simple and not expensive
Samples can be taken easily, cheap, acceptable
and don’t need conservation techniques
Table 5. Epidemiological criteria for assessing iodine nutrition
based on median urinary iodine concentrations in schoolaged children
Median
Iodine intake
Iodine nutrition
urinary
(µg/L)
iodine
< 20
Insufficient
Severe iodine deficiency
20-49
Insufficient
Moderate iodine deficiency
50-99
Insufficient
Mild iodine deficiency
100-199
Adequate
Optimal
200-299
More than adequate Risk of iodine-induced
hyperthyroidism within 5-10 years
following introduction
of iodized salt in susceptible
> 300
Excessive
Risk of adverse health consequences
(iodine-induced hyperthyroidism,
autoimmune thyroid diseases)
From WHO/UNICEF/ICCIDD (2)
Endemic cretinism
Neurological
Severe motor and mental deficit
cerebral palsy
deafness, mutism
euthyroid
Myoedematous
Severe mental deficit
Hypothyroid, destruction of the thyroid
Iodine deficiency combined with goitrogens and Se
deficiency
Control strategies
Supplementation: injections, oral
Fortification
changing food habits
Supplementation
Need to start early in pregnancy
supplement women of child bearing age
Operational difficulties
Injections and hepatitis and HIV
Covers need for about 4 years injections
Oral covers needs for one year
Fortification
Add iodine to a vehicle: salt or water
Additive must be stable, not change the carrier
No by-pass, centralised production
Need for a comprehensive approach
Packaging, evaporation
Access of all the population to the fortified food
Policy and protection of the market
Who pays?
Success story of Iran
Food habits
Very limited approach, food reflects iodine soil
content
Control complications
Need for intensive follow up
Changing consumption patterns in salt
Variations in salt consumption
Transient hyperthyroidism