Iodine Deficiency Disorder, PSM, Community Medicine

1. Iodine Deficiency Disorder
(IDD)
Dr. Narendra Kumar Yadav
MBBS,MD

2. Case-Scenario:
Q. A hilly woman has brought her 8-year-old child to the hospital with
complaints of swelling in the neck, retarded physical and mental
development, school dropout, and squint in her left eye.
a. What is your probable diagnosis? Justify your diagnosis.
b. What are the clinical manifestations of the disorder?
c. How will you carry out community assessment of this problem?
d. How this disorder can be prevented in the community?

3. Iodine:
ØMicronutrients (< 1 teaspoon iodine is required over lifetime)
ØMinerals
ØFunction of Iodine: Required by the thyroid gland for the synthesis of
Thyroid Hormones (T3 and T4)
ØFunctions of Thyroid Hormones: Required for proper physical growth and
mental development during the fetal stage & after birth.
ØLow intake of Iodine: Enlargement of thyroid gland (Goiter: grade
1,2,3,Multinodular)

4. Classification of Goitre:
In order of increasing severity:
vGrade 1: Goitre palpable but not visible
vGrade 2: Goitre is visible on extension of neck
vGrade 3: Goitre is visible when neck is in normal position
vMultinodular Goitre: The presence of multiple nodudules.

5. The Endemicity of Goiter:
The endemicity of goiter depends upon total goiter rate (Prevalence
rate):
Goiter Prevalence rate: Grade of endemicity
<10% Not significant
10-20% Mild endemicity
20-30% Moderate endemicity
>30% Severe endemicity

6. A/C to WHO/UNICEF the daily requirement of iodine:
vMan: 150 mcg/day
vWoman: 150 mcg/day
vPregnancy: 250 mcg/day
vLactation: 250 mcg/day
v Preschool children (0-59 month): 90 mcg/day
v School children (5-12 years): 120 mcg/day

7. Burden of disease:
IDD: Major Nutritional problems in Nepal, India, Bhutan, Bangladesh, Shri Lanka,
Myanmar, Thailand, Indonesia.
vWorld’s biggest goiter belt: Himalayas
vA/C to the latest report of WHO on iodine deficiency there are 1.88 billion people,
including 241 million school-age children have insufficient dietary intake.
vWorld:
vNepal:
vIndia:

8. Epidemiological determinants of IDD:
Agent factor: Iodine Deficiency
Host factors: Pregnant, Children, Adolescent
Environment factor: Hilly areas

9. Clinical manifestations of IDD:
1. Hypothyroidism (Deficiency of T3 and T4)
2. GOITRE ( Grade 1,2,3 and Multinodular Goitre)
3. Mental deficiency, Low IQ
Delayed motor milestones
Speech defect, Hearing defect
4. ENDEMIC CRITINISM (Congenital iodine deficiency syndrome)
5. Eye: Strabismus(Squint), Nystagmus
6. Neuromuscular weakness and Spasticity
7. IUD

10. v Multinodular Goiter: A goiter where there are many lumps (nodules)
appear in a gland.
vCongenital hypothyroidism(previously known as cretinism): M/C/C is Iodine
deficiency
vCongenital hypothyroidism(Major cause is Iodine deficiency) →Not
treated → Abnormal physical and mental development

11. vNystagmus is a condition of involuntary eye movement
A/K/A: Dancing eyes
vStrabismus(Squint): A/K/A: Crossed eyes, is a condition in which both
eyes do not look in the same direction at the same time.

12. How will you carry out a community assessment of IDD?
The indicators of Epidemiological assessment of IDD:
vPrevalence of goiter
vPrevalence of cretinism
vPrevalence of neonatal hypothyroidism
vMeasurement of thyroid function: TFT (T3, T4 and TSH)
vUrinary iodine excretion

13. Prevention and control of IDD in the community:
vThe Universal Iodization of salt
vMass communication(Nutrition Education): Aware of the community regarding
the use of iodized salt for optimum iodine intake
vManpower training
vMonitoring of the quality of iodized salt: Assessing the urinary iodine excretion
vEvaluation of iodine deficiency control programme: Survey in goiter endemic
region after five years continuous supply of iodized salt to assess the impact of the
control programme.

14. MCQ
Q. Daily requirement of Iodine in adult is:
a. 50 mcg
b. 100 mcg
c. 150 mcg
d. 200 mcg

15. Ans: C (150 mcg)

16. MCQ
Q. Recommended Iodine dose in pregnancy is:
a. 15 mcg
b. 100 mcg
c. 150 mcg
d. 250 mcg

17. Ans: d (250 mcg)

18. MCQ
Q. Endemic cretinism is seen when iodine uptake is less than:
a. 5 mcg/day
b. 20 mcg/day
c. 50 mcg/day
d. 75 mcg/day

19. Ans: b (20 mcg/day)

20. MCQ
Q. As per WHO guidelines, iodine deficiency disorders are endemic in a
community if the prevalence of goiter in school age children is more than:
a. 1%
b. 5%
c. 10%
d. 15%

21. Ans: C (10%)

22. The End