iodine def
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Iodine deficiency disorders
Iodine is an essential component in thyroidhormone production
Thyroid hormone regulates basic metabolism
:energy consumption, cellular activity, growthand in particular brain development.
Hypothyroidism: slow, cold, sluggish brainfunction, short stature, mental and motordevelopment delayed or slowed. In extremesgeneral neurological development delayed.
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Hormone regulationHypothamalus
TSHT3 T4
Hypofysis
- SomatostatinTSHRF
T4 T3
I pool
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Hormones and iodine deficiency
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Spectrum of disease
Table 1. The Spectrum of Iodine Deficiency Disorders, IDD.
Fetus Abortions StillbirthsCongenital 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 HypothyroidismImpaired 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).
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Importance of the problem
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Prevalence
1 billion persons exposed
200 million persons affected (goitres)
26 million cases of mental problems
6 million cases of cretinism
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Goitre
Increase in size four to five times distal phalanxof the thumb
Aesthetic
Compression
Related hypothyroidism: is not a compensation
cancer
Iod Basedow (hyperthyroidism) due tohyperstimulation, mutation autonomous nodules
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Iodine deficiency and the foetus
Brain development fast between 3-5 monthspregnancy and from third trimester till end ofsecond year
Maternal T4 essential for first 24 weeksFoetal T4 starts at 24 weeks
30% cord blood is of maternal origin
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Iodine and the neonate
Perinatal mortality
Infant mortality
Low birth weight
Brain development needs T4
Iodine deficiency mental retardation, retardedmotor development.
General IQ decrease of 15 Points
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Iodine deficiency and adults
Lack of energy
apathy, slow brains
goitre and mechanical complications
Nodular thyroid
hyperthyroidism
Pregnancy and cretinism
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Aethiology
Low iodine uptake. Soil dependent
erosion, wash away: deltas
Goitrogens
Manioc: linnamarin thiocyanateBlocs uptake of Iodine at the thyroid, competitive
inhibition
Traditional preparations
Konzo
Brassica family
polutants
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IDD and selenium deficiency
Se part of peripheral type I de-Iodinase (kidneyand liver)
Se deficiency: slower T4 to T3 metabolisation
Se part of Glutathion peroxidase : protector ofH2O2 damage Thyroid damage, disfunction ofthyroid
Cerebral de-iodinase is not Se dependentGlutathion peroxidase stimulates T4 production
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Iodine needs
RECOMMENDED INTAKE ug/day
0 - 6 months 35 8 ug/kg
5 ug/100ml of milk7 ug/100 kcal
6 - 12 months 45
1 - 10 years 60 100
>= 11 years 100 - 115pregnancy lactation 125 - 150
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Diagnosis of endemicity
Prevalence of goitre
Dosage of urinary iodine
TSH dosage
Prevalence of cretinism
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Prevalence of goitre
Class Description
0Absence of goitre
Ia Detectable goitre only by palpation and invisible, even when thehead 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 subjects 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
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IODE DEFICIENCY SEVERE MODERATE MILD
Number of cases of
goitre among the
school children (6-12)
visible goitre
total goitre
> 50 %
> 10 %
20-49 %
5-9 %
10-19 %
1-5 %
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Urinary Iodine
Reflects directly intake
Is best to follow up programme response, goitretakes time to decrease in size
Samples needed are smallerTechnique is simple and not expensive
Samples can be taken easily, cheap, acceptable
and dont need conservation techniques
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Table 5. Epidemiological criteria for assessing iodine nutritionbased on median urinary iodine concentrations in school-aged children
Medianurinary
iodine
Iodine intake(g/L)
Iodine nutrition
< 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 introductionof iodized salt in susceptible
> 300 Excessive Risk of adverse health consequences
(iodine-induced hyperthyroidism,
autoimmune thyroid diseases)
From WHO/UNICEF/ICCIDD (2)
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Endemic cretinism
Neurological
Severe motor and mental deficit
cerebral palsy
deafness, mutismeuthyroid
Myoedematous
Severe mental deficit
Hypothyroid, destruction of the thyroid
Iodine deficiency combined with goitrogens and Sedeficiency
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Control strategies
Supplementation: injections, oral
Fortification
changing food habits
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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
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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 marketWho pays?
Success story of Iran
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Food habits
Very limited approach, food reflects iodine soilcontent
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Control complications
Need for intensive follow up
Changing consumption patterns in salt
Variations in salt consumption
Transient hyperthyroidism
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