Deficiency

Nodular

Deficiency

Nodular

Excess: .

IODINE DEFICIENCY DISORDERS. IDD’s

IODINE: Iodine is an essential trace element It is present in the body in a minute amount (normally 20-30 mg) . 80%of the iodine in the body(15 mg in adult) is present in the thyroid gland. Used in the synthesis of thyroid hormones. The remainder is distributed throughout other tissues, particularly in the mammary, salivary, gastric glands and in the kidneys.

Excretion is primarily in urine and small amount in feces. Occurrence Within the circulation iodine occurs in the form of free iodide ion or as protein-bound iodine (PBI). Excretion is primarily in urine and small amount in feces.

Sources: Iodine is provided in the diet by food & water. In water, it occurs in form of iodide ion in amount that vary from region to region in line with variation in iodine content of the soil. These variation in iodine content of the soil are also reflected in the variations in the iodine content of the plant & animals raised on the soil.

Next come fresh water fish(20-40 microgram/100 gm meat). Other sources Sea food & salt water fish are rich sources (30-300 micro gram / 100gm meat). Next come fresh water fish(20-40 microgram/100 gm meat).

Recommended intake: Children (< 14 years): 40 microgram/day Adult(Both sexes):150 microgram/day Pregnant women: 175 microgram/day Lactating women: 200 microgram/day

Functions of iodine: It is an integral part of thyroid hormones that play a major role in regulating growth and development. They also have important role in regulation of metabolic rate. it is required for early development of nervous system during fetal life. it is needed for normal reproductive function.

IODINE DEFICIENCY: 30% of remaining, are at risk It is the leading cause of preventable intellectual impairment. It is associated with a variety of clinical disorders called “Iodine Deficiency Disorders". IDD is known to be a significant health problem in 118 countries IDD affects 740 million of people(13% of world population), 30% of remaining, are at risk

IDD’s Endemic cretinism Hypothyroidism Mental retardation Reproductive failure, abortion & still birth Endemic goiter Childhood mortality Socio-economic retardation

Target population Iodine Deficiency affects : Poor Pregnant women and Preschool children causing serious health problems

Endemic goiter: Enlargement of thyroid gland, the most obvious clinical manifestation of iodine deficiency caused by dietary deficiency . Minimum amount of I- required to cover the turnover of the thyroid gland is 50 mcg/day. Below this the thyroid gland will begin to enlarge markedly at puberty.

This enlargement is considered as a compensatory mechanism to trap more iodine. In some patients large goiter may cause pressure on the trachea & esophagus which cause 1.Difficulty in breathing 2.Cough with irritation 3.Voice changes & some times 4. Difficulty in swallowing

Related Diseases & effects Deficiency leads to goiter which is the enlargement of thyroid gland . It may be diffused where the swelling is uniform

Nodular where the swelling is patchy When it occurs in the presence of low or normal Thyroid hormone levels, it is called as non toxic goitre. It is caused by dietary deficiency.

Hypothyroid Cretinism

Hypothyroidism: Some patients develop hypothyroidism, which could be mild with low thyroid hormone level low BMR low productivity Slower mental function, Slow physical growth or Sever (classical myxoedema).

Excess: An excessive intake of iodide can lead to thyrotoxicosis.

Endemic cretinism: Iodine deficiency during pregnancy can lead to birth of cretin child who may appear normal at birth but remain : Small in size ( Dwarf) Mentally dull Retarded in reaching normal developmental milestones.

Iodine deficiency occur early in fetal life. Nervous cretinism: Mental deficiency, Deaf mute, spasticity, ataxia,

Iodine deficiency occur late in fetal life & post natal life. Myxoedematous cretinism: dwarfism, Other signs of myxoedema, Marked delay in growth & sexual development, Mental retardation, Neurological examinations mostly turn out to be normal,

( Not treatable conditions) In both types: Neurological damage, Mental retardation, Dwarfism ( Not treatable conditions)

Mental retardation: In endemic areas, large number of people fail to grow optimally either physically or mentally even though they don’t have classical features of cretinism. IDD affected people may loss 15% IQ points.

Reproductive failure: Women with severe Iodine deficiency have more miscarriage, still birth , LBW and other problem of pregnancy. Iodine deficiency is considered as one of the causes of decreased fertility of women & secondary sterility.

socio-economic retardation: Iodine deficiency affects socioeconomic development of the community in many ways: People who are mentally retarded / slower are harder to educate and lower in productivity. Increase in the rate of handicapped & mentally retarded children. Domestic animals in iodine deficient areas also suffer from Iodine deficiency & produce less meat, egg & have also more abortion.

Etiology of Iodine deficiency: Deficient intake (diet & water): in mountain areas, isolated localities depending on well or spring in which iodine content is low; Increased requirement: developing fetus, newborn, young child, adolescents Specially in female when pregnant & lactating Deficiency of enzymes needed in the metabolism of iodine.

Etiology of Iodine deficiency: 5. Intake of goitrogens: Substances occur naturally in food, that act by blocking absorption and utilization of iodine. They are found in cabbage, turnips, peanut, Soya beans . Other goitrogens include sulfonamide.

Assessing the severity of ID in the community (WHO CLASSIFICATION OF GOITER SIZE) Grade Goiter size Description No Goiter 1A Thyroid enlarged Thyroid lobes more than end of the thumb 1B Visible when the Head tilted back 2 Thyroid greatly enlarged Visible when neck in Normal position 3 visible from about 10 meters

Epidemiological criteria for assessing the severity of IDD based on the prevalence of goiter in school-age children. Degree of IDD, expressed as % of the total of the number of children surveyed: Total goiter rate 0.0-4.9% None 5.0-19.9% Mild 20.0-29.9% Moderate ≥30% Severe

Urinary iodine Examination of iodine concentration in urine could be done on 24-hour urine samples or on casual urine sample. Median urinary iodine concentration of ≥ 100 microgram/l define population which has no iodine deficiency. Urinary iodine concentration is currently the most practical biochemical marker for iodine nutrition.

3. determining thyroid size by ultrasonography safe, non invasive technique, provide more precise measurement of thyroid volume compared with palpation. Need ultrasound equipment, electricity & specially trained personnel and affordability

4.laboratory tests related to thyroid hormones: levels of thyroid stimulating hormne (TSH) and thyroglobulin (TG) can serve as surveillance indicators.

Prevention & control of IDD:

Universal salt iodization: This has greatly decreased the goiter in many countries, the amount added should be related to the usual consumption of salt in the community (5-10 g/person/day). It is recommended that iodine concentration in the salt at site of production should be within the range of 20-40 mg of iodine/kg of salt ( of iodine) in order to provide 150 microgram of iodine/person/day.

2.Administration of iodized oil either in form of injection or capsule: Alternative mean where the use of iodized salt is not possible & when endemic goiter is more severe and accompanied by endemic cretinism. Single injection (1 ml im) will provide protection for more than 1 year (2-4y), or we give iodized oil capsule every 6-18 months.

3.iodization of water supply: In remote village where distribution of iodized salt or injection of iodized oil is impractical. It reduced the prevalence of goiter in some area by about 30-61%.

4.dietary modification: To include more of the food known to be good source of iodine (sea food, sea & fresh water fish).

6. Direct administration of iodine solution Such as lugol's iodine, at regular interval (once a month).

5. good medical service & health care: For early diagnosis & treatment of goiter and hypothyroidism.

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