iodine deficiency disorders

Lecture Outlines: Functions of iodine Etiology of IDD Universal prevalence of ID Consequences of IDD Control of IDD in Sudan

Functions of iodine * Tetraiodothyronine T4 * Triiodothyronine T3 1/ Thyroid hormones biosynthesis : * Tetraiodothyronine T4 * Triiodothyronine T3 Other organs uptake the iodine are : 1/ salivary glands 2/ mammary glands 2/ gastric mucosa 4/ ciliary body of eye 5/ placenta 2/ Normal growth and development Blood level is about 8-12 micrograms/dl

* Deficiency is Geochemical Etiology Sources of iodine are : sea foods, soil & water. * The main causes of iodine deficiency is deficiency in these sources * 90% of iodine comes from foods eaten,the remainder from drinking water * Deficiency is Geochemical

Contributory factors : * Goitrogenic substances :these are chemical substances leading to the development of goitre. 1/ Thiocyanate & thio like components : act through inhibiting active conc of iodine 2/ Thiouria : inhibit organification & coupling of iodine to tyrosine

3/ others : inhibit the release of thyroxin from the thyroid gland e.g : the millit , cassava , onions , nuts & garlic * Millit contain thiocyanate

4/ hard water : contain high K or Na 5/ water that contaminated with E.coli 6/ certain trees ( brasica family ) grow in mountainous areas their leaves & roots make the water goitrogenic ** Bananas have higher iodine concentration

Summary of causing agents Thiocynate Thiourea Millit Onions Garlic nuts Brasica trees Water high in K & Na Water with E.coli

Deficiency Hypothyroidism Retarded physical growth & impaired mental function Increased rate of abortions and still birth Neurological cretinisim Myxedematous cretinism

Requirement of iodine / day The Requirement The Age 50 mg / day Children > 12 months 90 mg / day Children up to 6 years 120 mg / day 7_______ 12 years 150 mg / day Adolescent & adults 200 mg / day Pregnant & lactating ladies

Universal Prevalence 1 billion at risk ______ living in 1 area 200 million _______ having Goiter 20 million _______ with brain damage as complication of iodine deficiency

IDD IN SUDAN Darfour______________ 71% Kosti ______________ 69 % Kordofan ____________ 48 % Central states_________ 34 % Northern states________ 22 % Eastern states _________ 13.5 %

IDD IN SUDAN khartoum ____________ 17.5 % Southern.S____________ 10.3 %

Why kosti has high prevalence ? Due to : Sea weeds which its root absorb high amount of minerals washing of Nile's banks annually by the Nile May be due to high onions intake Also transportations bring pts of goiter to settle in kosti in their way to center

Grading of Goiter The Status The Grade No Goiter Grade 0 Palpable Goiter Grade 1 Visible Goiter Grade 2 Huge Goiter Grade 3

Epidemiological assessment : By using Indicators ; Prevalence of goiter Thyroid size __________ palpation & ultrasonography Prevalence of cretinism Urinary iodine excretion mostly reflect iodine intake because 90% is excreted via urine T4 and TSH (thyroid function) Prevalence of neonatal thyroidisim

Consequences Of IDD Those are : - Abortion - Still birth - Premature labour - Reduction of IQ - Goiter - Mental retardation - Decrease of productivity

IDD control programme : Objective: To increase iodine intake Components: 1- Iodized salt or oil 2- Monitoring & surveillance 3- Manpower training 4- Mass communication

Programmes implanted in Sudan for control of IDD 1/ Iodized Tablets : Distribution started south to Nyala by headmasters & teachers of any schools to students because no medical teams was available there. This program is ended without evaluations in Sudan although evaluations in others countries with noticeable success

1 tablet ___________ enough for 6 months

2/ Iodized Oil : It started near Nyala as project by a pediatrician Professor M.Ibrahim Omer, this oil can be taken in a form of capsules or injections. The capsules have 2 doses : * Old One : 1 capsule__________ for < 1 year

2 capsules __________ for > 2 years Those capsules are sufficient for at least 1 year due to their slow release. ** Each capsule contains 200 mg of iodine *** New One : They are 6 capsules 1st 3 capsules_________ taken 1 monthly 2nd 3 capsules________ 1 every 3 months

Evaluations are Successful Injections Dose : ½ cc _______________ for < 1 year 1 cc _______________ for > 1 year *** Injection is sufficient for 3-5 years Evaluations are Successful

3/ Iodized Sugar : The project started by coordination of kenana sugar factory & University of khartoum. They mixed iodine with sugar in packaging form

Evaluations not success Because some children develop iodine toxicity Due to Over-consumption

4/ Iodinated water : These program result from coordination of Sudan & Sweden which tested in Para. The machine drops iodine in water. The half life of machine is 1 year & must be change

* Expensive & difficult to expand Advantages : * Control of IDD * Purified water stops diarrheal diseases * Expensive & difficult to expand Disadvantages

5/ Salt Iodization : This program started actually after 1992 & this the only program adopted by the government

Salt is consumed by all population No over consumption Why world choose The Salt Salt is consumed by all population No over consumption Dose not change color ,taste & smell of salts Low cost of salt

Factors affecting retention of iodine With Salt Impurity of the salt Iodine can escape from pores of sacs Rains lead to iodine loss from packaged sacs Time taken for transportation lead to loss of iodine

Assessment Of Iodine Status 1/ Outcome Indicators : show the level of iodine inside the body of human beings or animals & include : Thyroid size __________ palpation & ultrasonography Urinary iodine excretion ________ mostly reflect iodine intake because 90% is excreted via urine

Thyroid hormones levels ( T3 & T4 ) Rate of cretinism in the community : cretinism asses with hyperendemicity *** The level of thyroid hormones : T3 ________________ I-3 nmol/l T4 ________________ 50-150 nmol/l

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