Iodine deficiency is a lack of the trace element iodine, an essential nutrient in the diet. It may result in metabolic problems such as goiter, sometimes as an endemic goiter as well as cretinism due to untreated congenital hypothyroidism, which results in developmental delays and other health problems.

1. IODINE DEFICIENCY DISORDER
Kuldeep Vyas
Asst. Prof Community Health Nursing
Kuldeep Vyas M.Sc. CHN 1

2. DEFINITION
 Endemic goiter is a type of goiter that is associated with
dietary iodine deficiency
 Iodine deficiency is a lack of the trace element iodine
Kuldeep Vyas M.Sc. CHN 2

3. IODINE NEEDS
 WHO 1996
Children Adult (>12 years old) Pregnant and breastfeeding
women
• 0-12 months 50mcg/day
• 2-6 years 90mcg/day
• 7-12 years 120mcg/day
150 mcg/day 200 mcg/day
Kuldeep Vyas M.Sc. CHN 3

4. ENDEMIC GOITER
• If the prevalence of goiter is more than 5% of the population
(mostly children), it is considered an endemic goiter.
• <5% no endemic
• 5-19.9% mild endemic
• 20-29.9% moderate endemic
• >30% severe endemic
• Mongolia is considered to have a mild endemic goiter. (7%)
Kuldeep Vyas M.Sc. CHN 4

5. PATHOPHYSIOLOGY OF ENDEMIC GOITER
 Goiter: A swelling of the neck resulting from enlargement of the thyroid gland
 Iodine I2 (Iodide ion in food, such as in salt, Iodide bonds with Na+) is necessary
for the secretion of thyroid
hormones (T4, T3). Iodine accounts for 65% of the molecular weight of T4 and
59% of the T3
 The amount of TSH secreted by anterior pituitary is regulated by negative
feedback loop. If the amount of T4 and T3 gets high, TSH secretion will be
decreased
 But in iodine deficiency there is very little amount of thyroid hormones, thus
no inhibition of TSH
production, leaving the anterior pituitary to produce TSH freely
 Excess amount of TSH will cause thyroid gland cells to multiply and divide
excessively resulting in goiter.
Kuldeep Vyas M.Sc. CHN 5

6. Iodine deficieny
Low level of T4
and T3
No inhibition of
TSH production
Too much TSH
production
Hyperplasia in
thyroid gland
Goiter
Kuldeep Vyas M.Sc. CHN 6

7. Kuldeep Vyas M.Sc. CHN 7

8. CAUSES/RISKFACTORS
 Low dietary iodine
 Iron and selenium deficiency (iron, selenium are contained in proteins that are
important for synthesis of thyroid hormones, for example peroxidases)
 Pregnancy
 Exposure radiation
 Increased level of goitrogens, such as some drugs and antibiotics (substances that
interfere with iodine uptake in the thyroid gland)
 Gender (higher occurrence in women)
 Oral contraceptives
 High consumption of conserved, pickled foods that contain thyrostatics
Kuldeep Vyas M.Sc. CHN 8

9. Kuldeep Vyas M.Sc. CHN 9

10. SIGNS AND SYMPTOMS/COMPLAINTS/CONSEQUENCES
 Fetus /Neonates
• Cretinism (commonly characterised by mental
deficiency, deafness, squint,
• disorders of stance and gait, stunted growth and
hypothyroidism)
• Increased prenatal and infantile mortality
• Increased risk of deaf-mutism
• Retarded bone growth
Kuldeep Vyas M.Sc. CHN 10

11.  Children (Prevalence of iodine deficiency disorder is 28%
among school age children/7-14 y.o/ in Mongolia )
• Goiter
• Physical development delays
• Mental development delays
• Impaired sense of hearing and problems with speech
• Paralysis of limbs
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12.  Pregnant women and women of child bearing age
• Congenital anomalies
• Reduced fertility
• Irregular menstrual cycle
• Increased incidence of spontaneous abortions
• Still birth
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13.  Adults
• Goiter
• Reduced IQ (about 10-15 points)
• Risk of compression of the upper
airways
• Increased risk of thyroid cancer
• Hypothyroidism
• Constipation
• Dry, flaky skin
• Generally inactive and sleepy
• Cold intolerance Kuldeep Vyas M.Sc. CHN 13

14. DIAGNOSIS
 1. Patient lives in a country with high iodine deficiency risk
(mountanies regions and 3rd world countries)
 2. Low level of median urine iodine
 3. High absorption of radioactive iodine (I 131) during
scintigraphy
 4. Goiter
 5. Euthyroid or hypothyroid state
 6.T4 synthesis ↓; T3 synthesis ↑
 7. TSH ↑
Kuldeep Vyas M.Sc. CHN 14

15. Median urine iodine
(school aged children)
T3, T4, TSH, thyroglobulin
level in blood
Volume of the thyroid
gland
Absorption of J 131
• 100-200 mcg/L normal
• 50-99 mcg/L mild
• 20-49 mcg/L moderate
• 20 mcg/L> severe
• T3, T4 close to normal
or T4 slightly ↓, T3
slightly ↑ Euthyroid
• T4, T3 ↓, TSH ↑
Hypothyroidism
• TSH 3-5 IU/L normal,
more than 5 IU/L
infantile iodine
deficiency
• More severe the iodine
deficiency, higher level
of thyroglobulin
• Adult male >25 ml
(cm3)
• Adult female >18ml
2, 4, 24 hours later, the
absorption will be
increased up to 70-80%
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16. Treatment
 Drugs
 Surgery
If drug treatment is ineffective, the size of the goiter is
not lowering If the size of the goiter is really large
Nodule, malignancy
Kuldeep Vyas M.Sc. CHN 16

17. Euthyroid Hypothyroid
-increase the intake of high iodine food
(use of iodized salt)
-iodine supplements (potassium iodide)
-iodized oil
• L-Thyroxin 25-50mcg/ tab; daily
dosage of 100-200mcg
• Triiodothyronine hydrochloride
starting dosage: 2-5mcg/tab. Increase
the dosage up to 50mcg/tab, 50-
100mcg/day
• Thyreotom: 1 tab contains 40mcg T4,
10mcg T3. Start by 1/4 -1/8 of a tablet
and increase to 1-1.5 tab/day.
Kuldeep Vyas M.Sc. CHN 17

18. Prevention
Public
Risk groups: Pre school and
school children, pregnant and
breastfeeding women
Individual
Iodine fortified foods (salt,
flour, sugar, water, tea etc)
• Antistruminum 1mg , 1
tab/day. 1-2 tabs/week
• KJ100-150mcg 1-2
times/week
• Lipiodol 200mg, 1
capsule/6months. School
children
• Lipiodol 400 mg/12 months
Person who is going to work
and live in areas with iodine
deficiency
Kuldeep Vyas M.Sc. CHN 18

19. Kuldeep Vyas M.Sc. CHN 19