1. iodine deficiency disorders

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

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

4. * 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

5. 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

6. 3/ others :
inhibit the release of thyroxin from the thyroid gland e.g :
the millit , cassava , onions , nuts & garlic
* Millit contain thiocyanate

7. 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

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

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

15. 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

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

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

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

20. 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

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

22. 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

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

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

25. 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

26. 1 tablet ___________ enough for 6 months

27. 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

28. 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

29. 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

30. 3/ Iodized Sugar :
The project started by coordination of kenana sugar factory & University of khartoum.
They mixed iodine with sugar in packaging form

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

32. 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

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

34. 5/ Salt Iodization :
This program started actually after 1992
& this the only program adopted by the government

35. 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

36. 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

37. 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

38. 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 ________________ nmol/l

39. Thank You