Iodine is essential for thyroid hormone production. Iodine deficiency disorders affect over 7% of the global population and cause a spectrum of health issues from goiter to cretinism. Prevention focuses on universal salt iodization, iodized oil supplementation, monitoring iodine levels, training programs, and increasing public awareness. Controlling iodine deficiency through these measures can eliminate its health impacts across the lifespan.

1. Iodine Deficiency Disorder(IDD)
Dr. Moumita Pal
MBBS,DPH, MD
Dept. of Community Medicine
College of Medicine and Sagore Dutta Hospital

2. Iodine
• Essential micro-nutrient
• Required for synthesis of thyroid hormons-T3(
triiodothyronin) and T4 (thyroxine)
• Fetus and neonates- protein metabolism in brain
RDA of Iodine
Infants 50 mcg
Children 100 mcg
Adults 150 mcg
Pregnancy 200 mcg
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3. Sources
• Sea food ( sea fish, sea salt)
• Cod liver oil
• Small amount in milk, meat,
vegetables, cereals etc.
• Variable in water (1-50
mcg/L)
IODINE CONTENT OF WATER AND
CROPS DEPEND ON IODINE
CONTENT OF SOIL
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4. Goitrogens
• Vegetables of Brassica group- cabbage,
cauliflower, Radish etc.
• Contain goitrogens as thiocyanates and
cynoglycosides
• Make the iodine of food unavailable for body
• Can be inactivated by heating.
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5. Absorption
• Small intestine
• 30% utilized by thyroid gland for synthesis of
hormone
• Remainder excreted in urine
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7. • Iodine Deficiency Disorders refer to a
spectrum of health consequences resulting
from inadequate intake of iodine.
• Major nutritional problem
• Spectrum of diseases (from intrauterine to
childhood and adulthood)
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8. Problem burden
• >7 % of World population suffers from iodine
deficiency.
• Serious problem of third world countries like
India, Bangladesh, Bhutan, Myanmar,
Indonesia, Nepal, Sri Lanka and Thailand.
• Severity higher in South-East Asia in World
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9. • “Sub-Himalayan goitre
belt is world’s most
intense goitre
endemic region
affecting nearly 120
million people”
• Some extra Himalayan
foci close to low lying
hills: Chota Nagpur
region of Bihar, Hilly
areas of MP & CG,
Parts of Western
Ghats( Maharashtra,
Kerala,
Karnataka),Eastern
Ghats (AP and TN)
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10. Iodine deficiency disorders
Adults -Hypothyroidism & Raised TSH
-Hyperplasia results Goitre
-Lethargy
-Poor cold tolerance
-Bradycardia
-Myxoedema
-Infertility
Fetus and infants -Cretinism
-Mental retardation
-Hearing defect
-Speech defect
-Squint
-Disorder of gait
-Growth retardation
At birth -Still birth
-Miscarriage
-Neonatal hypothyroidism
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11. Spectrum with increasing severity
Disorders Levels of severity
Goitre -Grade I
-Grade II
-Grade III
-Multi-nodular
Hypothyroidism -Varying combination of clinical signs
Subnormal intelligence
Delayed motor milestones
Mental deficiency
Hearing defects
Speech defects
-Variable severity
Strabismus (squint)
Nystagmus
-Unilateral
-Bilateral
Spasticity
Neuromuscular weakness
-Muscle weakness in legs, arms, trunk
- Spastic diplegia
-Spastic quadriplegia
Endemic cretinism -Hypothyroid cretinism
-Neurological cretinism
Intrauterine death ( spontaneous abortion,
miscarriage)
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12. Clinical features through the life cycle
Fetus and neonate Abortion, stillbirth, congenital anomalies ( Umbilical
hernia, large anterior fontanel), high peri-natal and infant
mortality, low birth weight, neonatal goitre, lethargy, poor
feeding, prolonged physiological jaundice
Infant and early
childhood
S/S of cretinism- mental deficiency, squint, short stature,
hoarseness of voice, deaf-mutism, motor spasticity
Child and adolescent Retarded mental and physical development, goitre, S/S of
juvenile hypothyroidism( growth retardation, mental
retardation, hoarse voice), puffiness, thickened dry skin,
dry rare hair/eyelashes/eyebrows, delayed sexual
maturation
Adult Mental and physical underdevelopment., sleepy and slow,
impaired mental function( decision making), enlarged
thyroid, hypothyroidism S/S(intolerance to cold, weight
gain, somnolence, hoarseness, menorrhagia, non pitting
oedema. 12

13. Epidemiological assessment of Iodine
deficiency
• For surveillance of goitre control program.
• Indicators are- prevalence of goitre
-prevalence of cretinism
-urinary iodine excretion
-thyroid function test
-prevalence of neonatal hypothyroidism
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14. Iodine check up
• Iodine can be sublimate
• Constantly lost from salt
• Recommended to consume the salt with 6
months of iodization
• Rapid Test kit-MBI kit by UNIFEC available to
test: 1 drop of solution placed on salt
containing iodine produced blue/purple
colour.
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15. Prevention and control
Under National IDD control program 4 main
components are:
1. Use of iodized salt or oil
2. Iodine monitoring
3. Manpower training
4. Mass communication
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16. 1.Using Iodized salt/oil:
• Most widely used prophylactic
measure
• Iodization of salt with potassium
iodate
• In India iodization is fixed under
Prevention of Food Adulteration
(PFA) Act- ≥ 30 ppm iodine at
production point & ≥15 ppm at
consumer level
• Govt. of India proposed to replace
common salt with iodized salt (
UNIVERSAL IODIZATION)
• Double fortified salt- Two-in-one
salt
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17. Iodized oil:
Intramuscular- injection (mostly poppy seed oil)
• NIN Hyderabad developed iodized oil in safflower
or safola oil
• Dose-1ml: provide protection for 4 years
• Expensive
• Reaching every victim is difficult
• Recommended for severely endemic population
where quick response is needed
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18. • Iodized oil oral:
• Technically simple
• Oral oil or sodium iodate tablets
• Limited research available
• Costlier than IM oil
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19. 2. Iodine monitoring:
• Network of laboratories for-
1.iodine excretion detection
2.Detection of iodine in water soil and food
3.Detection of iodine in salt for quality control
• Neonatal hypothyroidism : sensitive pointer of
environmental iodine deficiency & indicator
for monitoring impact of program
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20. Cont…
3.Manpower training:
• to all related to program
• Training in all aspect of goitre control including legal
enforcement and public education, goitre survey
methodology, lab techniques
4.Mass communication: (IEC activities)
• Tool for nutritional education.
• Creation of public awareness through lectures, road
shows, audio-visual aids, school and women groups etc.
• IEC campaign to increase awareness on consumption of
Iodized salt
• Global IDD day-21st Oct.
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