Iodine Deficiency Goiter

Dr Sajida Naseem Assistant Professor

Section of Community & Family Medicine

Affects all the basic body functions, including physical and mental growth,

metabolism, reproduction and digestion.

Session Objectives

• At the end of the session , students should be able to understand the:

• Epidemiology of Iodine Deficiency disorders• Pakistan statistics on IDD• Importance of Iodine in life.

• Ref: WHO Guidelines, NNS 2011.

World Thyroid Day

• 25th May• To promote awareness and understanding

of thyroid health and the advances made in treating thyroid diseases.

GOITER• Is an enlarged thyroid gland• It may be diffuse or nodular• May cause a variety of compressive

syndromes.• Thyroid function may be normal (nontoxic

goiter), overactive (toxic goiter), or underactive (hypothyroid goiter).

Iodine• Iodine is important in promoting the

development and release of thyroid hormones, which are essential in driving many mental and bodily processes.

• Deficiencies are common in areas where iodine is not abundant in soil and food.

• Seafood and crops grown in nutrient-rich soil are typically the best sources for iodine, and people who live far from coastal regions and at high altitudes may not have access to such foods.

Iodine Requirements

Required Iodine Levels in Salt

On an International perspective

• Most common cause of goiter is iodine deficiency.

• Affect as many as 200 million of the 800 million people who have a diet deficient in iodine.• Affects 2% of world population• 100% treatable.

Benign or Malignant?

• Most are benign, causing only cosmetic disfigurement.

• Morbidity or mortality may result from: compression of surrounding structures, thyroid cancer,

hyperthyroidism, or hypothyroidism.

Age & Sex Distribution

Sex• The female-to-male ratio is 4:1.• Thyroid nodules are less frequent in men than in

women, but when found, they are more likely to be malignant.

Age• Decreases with advancing age. The decrease in

frequency differs from the incidence of thyroid nodules, which increases with advancing age.

Presentation of the case - History

Various ways, including:• Incidentally, as a swelling in the neck discovered by the

patient or on routine physical examination• Local compression causing dysphagia, dyspnea, stridor,

plethora or hoarseness• Pain due to hemorrhage, inflammation, necrosis, or

malignant transformation• Signs and symptoms of hyperthyroidism or hypothyroidism• Thyroid cancer with or without metastases• A finding on imaging studies performed for a related or

unrelated medical evaluation

Etiology• Iodine deficiency• Autoimmune thyroiditis - Hashimoto or postpartum thyroiditis• Excess iodine (Wolff-Chaikoff effect)[5] or lithium ingestion, which decrease release

of thyroid hormone• Goitrogens• Stimulation of TSH receptors by TSH from pituitary tumors, pituitary thyroid

hormone resistance, gonadotropins, and/or thyroid-stimulating immunoglobulins• Inborn errors of metabolism causing defects in biosynthesis of thyroid hormones• Exposure to radiation• Deposition diseases• Thyroid hormone resistance• Subacute thyroiditis (de Quervain thyroiditis)• Silent thyroiditis• Riedel thyroiditis• Infectious agentsAcute suppurative - Bacterial• Chronic - Mycobacteria, fungal, and parasitic• Granulomatous disease• Thyroid malignancy• Low selenium levels: This may be associated with goiter prevalence.

Screening• TSH.• Urinary Iodine Excretion.• An assessment of free thyroxine would be the

next step in the evaluation.

Once diagnosed……• Eat more seafood, dairy products,

vegetables, and iodized salt.

• With treatment and a healthy diet, most people are able to overcome iodine deficiency symptoms in less than one month

Medical Care• Small benign euthyroid goiters do not require

treatment. • Large and complicated goiters may require

medical and surgical treatment. • Malignant goiters require medical and surgical

treatment.• The size of a benign euthyroid goiter may be

reduced with levothyroxine suppressive therapy.

Goals of Treatment• To reduce morbidity and to prevent

complications.

In Pakistan

NNS -2011

NNS-2011

NNS-2011

NNS – 6-12 yrs old children

NNS - 2011

NS-2011

NNS-2011

NNS 2011 vs 2001

NNS 2011 VS 2001

Thyroid & Pregnancy

• Infant may be born with mental retardation and lifelong hearing problems.

• Baby may not grow as quickly or fully as healthy infants.

• Increases chances of stillbirth.

THANKYOU