Endemic goiter TASHKENT MEDICAL ACADEMY

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Presentation transcript:

Endemic goiter TASHKENT MEDICAL ACADEMY Lecture for students 4 course on the topic: Endemic goiter Done by: assoc. prof. Muhtarova M. Z.

Map prevalence of iodine deficiency disorders in the world Severe iodine deficiency (goiter> 30%) Mild iodine deficiency (goiter 5-19,9%) Moderate iodine deficiency (goiter 20-29,9%) No iodine deficiency (goiter <5%)

Iodine deficiency disorders (IDD) According to WHO, IDD are the most common non-communicable diseases of man Iodine deficiency - the most common cause of mental retardation, which can be prevented

The risk of insufficient consumption of iodine is present at the world at: 1.5 billion people, 655 million people in the world have an endemic goiter, 43 million people have mental retardation of various degrees 30 million people have cretinism due to iodine deficiency (WHO, 1994).

In all territory of the CIS iodic deficiency is defined Why? In the fertile soil and vegetation almost no iodine The vegetative and animal food contains not enough iodine Limited consumption of fish and seafood Lack of mass iodine prophylaxis through salt iodization

The main problems related to iodine deficiency in the CIS High prevalence of endemic goiter: -from 15% to 40% in some regions; -in mountain areas frequency of goiter rate can vary from 25-40% to 80%-64. The lack of objective information on the problem of iodine deficiency among the population

Regulation of the function of the thyroid gland T3,T4 FT3, FT4 ТТГ ТРГ Hypothalamus Pituitary Gland Thyroid gland T3 = Triiodothyronine T4 = Thyroxin Blood (transport system ) Peripheral tissues

Thyroid and pregnancy. Fetus 16-17 week fetal thyroid fully differentiated and starts to function actively

The main effects of thyroid hormones Ensure the formation of the nervous system and the skeleton in the perinatal period, Increases oxygen consumption in all tissues except the brain, spleen, testes, Increases the production of heat, Have positive chronotropic and inotropic effects on the myocardium, Increases receptor sensitivity to catecholamines;

The main effects of thyroid hormones Increase the number of catecholamine receptors in the heart muscles, Regulates the activity of the respiratory center, Stimulates erythropoiesis, Speeds up the metabolism and clearance of hormones and drugs, leading to a compensatory increase in the rate of their production, Stimulates both the formation and bone resorption.

Endemic goiter Iodine deficiency, Iodine deficiency develops as a result of those living in iodine-deficient regions, Endemicity is an area, if the prevalence of thyroid enlargement even 1 degree is 5% or more in children and adolescents, or 30% or more of adults living in the area.

Goiter development is contributed by Insufficient exposure: protein; - vitamin A; - bromine; - zinc; - Cobalt; - copper; - Chromium.

Goiter development is contributed by Excessive intake of: Calcium - Fluoride - Chromium - Manganese

Goiter development is contributed by Strumogen substances contained in plants: Turnip; - Radishes; - Radish; - Peanuts; - Carrots; - Soy; - Beans; - Cauliflower; - Peaches; - Mango.

Goiter development is contributed by Poor social and living and sanitary conditions: In the water there are products of protein breakdown (thiourea, thiouracil, urochrome) helminthic and bacterial contamination of the environment.

The severity of iodine deficiency Mild form - goiter occurs from 10 to 30% of the population, the average urinary iodine excretion is 50-90 mg / l. Hypothyroidism and cretinism are missing. Medium form - the frequency of goiter and 50%, the level of urinary iodine excretion is reduced to 20-49% mg / l. There may be cases of hypothyroidism. Severe form - the frequency of goiter can reach almost 100% of the average level of urinary iodine excretion less than 20 mg / l. Cretinism occurs with a frequency of 1 to 10%.

Mechanisms of adaptation to deficiency of iodine In response to iodine deficiency and reduced levels of thyroid hormone increases the level of TSH, which leads to increased capture of iodine and thyroid hormone synthesis, followed by hyperplasia or hypertrophy of parenchymal cells, Increased synthesis and metabolism of thyroid hormones in response to an increase in TSH enhances the process of circulation of iodine, that allows the body to do smaller amounts of iodine;

Mechanisms of adaptation to deficiency of iodine Changes the character of the synthesis of thyroid hormones, thyroid gland begins to produce triiodothyronine, which consumes less synthesis of iodine; Accelerating transformation into liver thyroxine in a more biologically active hormone triiodothyronine.

Inspection of patients with diseases of a thyroid gland Studying of the anamnesis. Palpation of the thyroid gland. Ultrasound examination. Hormone research. Scintigraphy. Puncture biopsy.

Palpation of the thyroid gland The upper pole The lower pole

Classification of endemic goiter (Nikolayev O. V., 1955) 0 degree - Thyroid not palpable; 1 degree - an enlarged thyroid gland is well detectable, especially the isthmus, 2 degree - an enlarged thyroid gland is clearly determined not only feeling, but also clearly visible when viewed during swallowing, and 3 degree - an enlarged thyroid gland with the formation of a 'thick neck', 4 degree - Form the neck dramatically changed, clearly visible goiter, 5 degree - goiter reaches a very large size;

Classification of goiter (WHO, 1994) 0 degree – no goiter; 1 degree - greater than the size of the share of the distal phalanx of the thumb. Goiter palpable, but not visible; 2 degree - goiter palpable and visible to the eye;

Classification by structural changes Diffuse goiter; Nodular goiter; Mixed goiter. Classification by functional changes: Euthyroid goiter, hypothyroid goiter; hyperthyroid goiter.

Ultrasound examination of the thyroid gland Ultrasonic 'slice' of the thyroid gland and surrounding structures The surface of the skin Thyroid lobe Blood vessel Trachea

Basic laboratory indicators norm TSH 0,4 - 4 MU/l General Т4 5,5-1mkg/DL 77-142 nmol/l FreeТ4 0,8-1,8 ng/DL 10-23 pmol/l General Т3 0,9-1,8 ng/ml 1,4-2,8 nmol/l Free Т3 3,5-8,0 ng/l 5,4-12,3 pmol/l

Normal volume of thyroid (ml) Thyroid volume For calculation of the volume of the thyroid gland add two volumes of shares, the size of the neck is neglected. Ml volume fraction = [(SHP x DP x TA) (SL x L x TL)] x 0,479 Patients Normal volume of thyroid (ml) Children 6-10 years <8 Children11-14 years <10 15-18 years <15 Women <18 Men <25

How does the goiter develop? Deficiency of iodine + hereditary predisposition the Increase of a thyroid gland the Normal size: Men – up to 25 ml, Women up to 18 ml

Iodine deficiency goiter When iodine deficiency is a compensatory enlargement of the thyroid gland - formed goiter Long-lived iodine deficiency leads to the formation of thyroid nodules In some individuals formed the functional autonomy of the thyroid gland, most often seen in multinodular toxic goiter

women of childbearing age, pregnant and nursing women, Special risk group for the most threatened in the medico-social consequences of goiter Teenage girls, women of childbearing age, pregnant and nursing women, children and adolescents

Consequences of chronic iodic deficiency Pregnancy and breast-feeding thyroid dysfunction in women, violations of intellectual and physical development children's age learning disabilities, developmental disorders, euthyroid goiter Adults memory loss, infertility, fatigue, thyroid Mature multinodular toxic goiter

Disease (condition) associated with endemic goiter A reduction of intellectual capacity of a population infertility, inability pregnancy, high perinatal and infant mortality - demographic problems worsening the health of the people : a high level of morbidity, high level chronic diseases, increase in cardiovascular diseases

A simple solution to a complex problem Restores iodine deficiency: mass iodine prophylaxis (iodized salt); Group iodine prophylaxis (iodide 100, Iodide 200); Individual iodine prophylaxis (iodide 100, Iodide 200).

Contraindications to iodine preparations Thyrotoxicosis of any etiology Nodular goiter with increased accumulation of radioactive isotope (hot site) or decrease in basal TSH concentrations less than 0.5 Miu/l.

goiter prevalence <5% (the proportion of pupils who have goiter) Criteria for elimination of iodine deficiency diseases, proposed by WHO, UNICEF and ICCIDD (1999) Iodization of salt> 90% (the proportion of households consume iodized salt) goiter prevalence <5% (the proportion of pupils who have goiter) urinary iodine of 100-300 mg / l (reflects real iodine in the body)

Methods of iodic preventive maintenance The mass – introduction of salts of potassium (iodide or potassium iodated) in the most widespread food: In bread; In water; In salt, at: - easy iodic insufficiency of 10-25 mg/kg; - average weight - 25-40 mg/kg; - at the heavy – from 45 to 60 mg/kg.

Methods of iodic prevention The group – purpose of the preparations containing iodine to groups of the population with the greatest risk of development of iodic deficiency diseases. At easy or moderate deficiency of iodine daily additional amount of iodine is appointed: - children of dopubertatny age - 50-100 mkg; - teenagers – 150-200 mkg; - pregnant and feeding – 200-250 mkg.

Methods of iodic prevention The individual – prescribe transferred a strumectomy, to immigrants, and persons with existence of goitrogenic factors in a life or production. Prescribe an antistrumin or iodide a potassium in a dose not less than 150-200 mgk per day.

Methods of iodic prevention At group and individual it is possible to apply lipodol – the iodated oil in capsules to intake or in ampoules for in/m introductions. 1 ml of a capsule contains 0,3 g of an iodine 1-2 times a year are accepted. At in/m preparation introduction – the effect proceeds within 2-3 years. Action duration lidopidol it is bound to that the iodated fatty acids of a preparation are used for synthesis of a fatty tissue and the iodine slowly arrives in a blood channel in process of a fat metabolism.