Lecture Outlines:• Functions of iodine

• Etiology of IDD• Universal prevalence of ID

• Consequences of IDD• Control of IDD in Sudan

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 developmentBlood level is about 8-12 micrograms/dl

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

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

3/ others :

inhibit the release of thyroxin from the thyroid gland e.g :

the millit , cassava , onions , nuts & garlic

* Millit contain thiocyanate

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

Summary of causing agents

ThiocynateThiourea

Garlicnuts

MillitOnions

Brasica trees

Water with E.coli

Water high in K & Na

Deficiency

• Hypothyroidism

• Retarded physical growth & impaired mental function

• Increased rate of abortions and still birth

• Neurological cretinisim

• Myxedematous cretinism

Requirement of iodine / day

The AgeThe Requirement

Children > 12 months 50 mg / day

Children up to 6 years 90 mg / day

7_______ 12 years 120 mg / day

Adolescent & adults 150 mg / day

Pregnant & lactating ladies

200 mg / day

Universal Prevalence

1 billion at risk ______ living in 1 area

200 million _______ having Goiter

20 million _______ with brain damage

as complication of iodine deficiency

Darfour______________ 71%

Kosti ______________ 69 %

Kordofan ____________ 48 %

Central states_________ 34 %

Northern states________ 22 %

Eastern states _________ 13.5 %

khartoum ____________ 17.5 %

Southern.S____________ 10.3 %

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

The Grade The Status

Grade 0 No Goiter

Grade 1 Palpable Goiter

Grade 2 Visible Goiter

Grade 3 Huge Goiter

Epidemiological assessment:

By using Indicators ;• Prevalence of goiter Thyroid size __________ palpation &

ultrasonography• Prevalence of cretinism• Urinary iodine excretionmostly reflect iodine intake because 90% is

excreted via urine

• T4 and TSH (thyroid function)• Prevalence of neonatal thyroidisim

Those are : - Abortion - Still birth - Premature labour - Reduction of IQ - Goiter - Mental retardation - Decrease of productivity

IDD control programme :

Objective: To increase iodine intake

Components:1- Iodized salt or oil2- Monitoring & surveillance3- Manpower training4- Mass communication

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

1 tablet ___________ enough for 6 months

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

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

Injections Dose :

½ cc _______________ for < 1 year

1 cc _______________ for > 1 year

*** Injection is sufficient for 3-5 years

Evaluations are Successful

3/ Iodized Sugar :

The project started by coordination of kenana sugar factory & University of khartoum.

They mixed iodine with sugar in packaging form

Evaluations not successBecause some childrendevelop iodine toxicity

Due to Over-consumption

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

* Control of IDD * Purified water stops diarrheal diseases

* Expensive & difficult to expand

Advantages :

Disadvantages

5/ Salt Iodization :

This program started actually after 1992

& this the only program adopted by the government

1. Salt is consumed by all population

2. No over consumption

3. Dose not change color ,taste & smell of salts

4. Low cost of salt

Why world chooseThe Salt

1. Impurity of the salt

2. Iodine can escape from pores of sacs

3. Rains lead to iodine loss from packaged sacs

4. Time taken for transportation lead to loss of iodine

Factors affecting retention of iodine With Salt

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

• 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

Thank You