Iodine deficiency disorders

 Iodine is an essential component in thyroid

hormone production
 Thyroid hormone regulates basic
metabolism :energy consumption, cellular
activity, growth and in particular brain
development.
 Hypothyroidism: slow, cold, sluggish brain
function, short stature, mental and motor
development delayed or slowed. In extremes
general neurological development delayed.
Hormone regulation
Hypothamalus

TSHRF - Somatostatin

Hypofysis

T4 T3

TSH
T3 T4

I pool
Hormones and iodine deficiency
 Spectrum of disease
Table 1. The Spectrum of Iodine Deficiency Disorders, IDD.
Fetus Abortions Stillbirths
Congenital 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 Hypothyroidism
Impaired 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).
Importance of the problem
 Prevalence

 1 billion persons exposed

 200 million persons affected (goitres)
 26 million cases of mental problems
 6 million cases of cretinism
 Goitre

 Increase in size four to five times distal phalanx

of the thumb
 Aesthetic
 Compression
 Related hypothyroidism: is not a compensation
 cancer
 Iod Basedow (hyperthyroidism) due to
hyperstimulation, mutation autonomous nodules
 Iodine deficiency and the foetus

 Brain development fast between 3-5 months

pregnancy and from third trimester till end of
second year
 Maternal T4 essential for first 24 weeks
 Foetal T4 starts at 24 weeks
 30% cord blood is of maternal origin
 Iodine and the neonate

 Perinatal mortality
 Infant mortality
 Low birth weight
 Brain development needs T4
 Iodine deficiency mental retardation, retarded
motor development.
 General IQ decrease of 15 Points
 Iodine deficiency and adults

 Lack of energy
 apathy, slow brains
 goitre and mechanical complications
 Nodular thyroid
 hyperthyroidism
 Pregnancy and cretinism
 Aethiology

 Low iodine uptake. Soil dependent

 erosion, wash away: deltas
 Goitrogens
 Manioc: linnamarin thiocyanate
 Blocs uptake of Iodine at the thyroid, competitive
inhibition
 Traditional preparations
 Konzo
 Brassica family
 polutants
 IDD and selenium deficiency

 Se part of peripheral type I de-Iodinase (kidney

and liver)
 Se deficiency: slower T4 to T3 metabolisation
 Se part of Glutathion peroxidase : protector of
H2O2 damage Thyroid damage, disfunction of
thyroid
 Cerebral de-iodinase is not Se dependent
 Glutathion peroxidase stimulates T4 production
 Iodine needs

RECOMMENDED INTAKE ug/day

0 - 6 months 35 8 ug/kg
5 ug/100ml of milk
7 ug/100 kcal
6 - 12 months 45
1 - 10 years 60 – 100
>= 11 years 100 - 115
pregnancy – lactation 125 - 150
 Diagnosis of endemicity

 Prevalence of goitre
 Dosage of urinary iodine
 TSH dosage
 Prevalence of cretinism
 Prevalence of goitre

Class Description

0
Absence of goitre

Ia Detectable goitre only by palpation and invisible, even when the

head 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 subject’s 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

IODE DEFICIENCY SEVERE MODERATE MILD

Number of cases of
goitre among the
school children (6-12)

visible goitre > 50 % 20-49 % 10-19 %

total goitre > 10 % 5-9 % 1-5 %
 Urinary Iodine

 Reflects directly intake

 Is best to follow up programme response, goitre
takes time to decrease in size
 Samples needed are smaller
 Technique is simple and not expensive
 Samples can be taken easily, cheap, acceptable
and don’t need conservation techniques
Table 5. Epidemiological criteria for assessing iodine nutrition
based on median urinary iodine concentrations in school-
aged children
Median Iodine intake Iodine nutrition
urinary (µg/L)
iodine
< 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 introduction
of iodized salt in susceptible
> 300 Excessive Risk of adverse health consequences
(iodine-induced hyperthyroidism,
autoimmune thyroid diseases)
From WHO/UNICEF/ICCIDD (2)
 Endemic cretinism

 Neurological
 Severe motor and mental deficit
 cerebral palsy
 deafness, mutism
 euthyroid
 Myoedematous
 Severe mental deficit
 Hypothyroid, destruction of the thyroid
 Iodine deficiency combined with goitrogens and Se
deficiency
 Control strategies

 Supplementation: injections, oral

 Fortification
 changing food habits
 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
 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 market
 Who pays?
 Success story of Iran
 Food habits

 Very limited approach, food reflects iodine soil

content
 Control complications

 Need for intensive follow up

 Changing consumption patterns in salt
 Variations in salt consumption
 Transient hyperthyroidism