iodine deficiency disorders

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 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

4. 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

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

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. 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. 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. 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 ________________ 50-150 nmol/l

39. Thank You