Iodine deficiency is still a major public he alth problem worldwide. Russia belongs to the countries with mild iodine deficiency. The most difficult situation is observed in the countries of Africa and Central Asia.
Iodine deficiency in water, soil and food often leads to the development of iodine deficiency conditions, of which the most common is endemic goiter. Its prevalence among the population fluctuates around 15-40%. The article will tell all the information about iodine deficiency conditions - description, symptoms, treatment of diseases, their prevention.
Why do I need iodine
Iodine is an essential trace element required by the human body for adequate functioning and vital activity. It is the only component of thyroid hormones and is directly involved in their synthesis.
The thyroid gland has a special regulatory role in the human body. her hormonescontribute to the normal growth and development of a person, the proper differentiation of tissues, regulate various chemical reactions of the body, the exchange of energy, vitamins, fats, proteins. And iodine is involved in all these processes.
Unfortunately, our country belongs to the regions with iodine deficiency. Since Russia has a large territory, the regions also have varying degrees of iodine deficiency. The mountainous regions suffer the most - the North Caucasus, the Far East, Altai, the Siberian plateau. Regions with a mild degree of shortage include Moscow and the Moscow Region.
Due to the urgency of the problem, it is very important to know the causes and signs of iodine deficiency diseases. The main etiological factor in the development of this group of pathologies is considered to be its low concentration in local water bodies, soil and, as a result, insufficient consumption of the trace element with food.
A bit of history
For the first time, our country, still in the form of the young Soviet Union, joined the program to monitor iodine deficiency in the early twentieth century. In 1927, the first studies in the regions began, according to the results of which the areas with the highest deficiency began to receive iodized s alt. We managed to improve the situation quite quickly. In addition, methods have been developed to prevent iodine deficiency, including in children.
It seems that the problem has been solved. However, the world began to consider iodine deficiency from a different angle - the amount of the trace element was assessed not in soil or water, as before, but in human urine.
Since then, scientists have discovered that there is also a mild degreedeficiency, which can lead to a decrease in mental (cognitive) abilities, as well as cause various forms of behavioral disorders in old age. Gradually, our country lagged behind Europe somewhat in the prevention of diseases associated with iodine deficiency.
Types of iodine deficiency conditions
First of all, iodine deficiency is classified according to the degree of its deficiency in the body. This indicator is determined by the amount of trace element in the patient's urine. Divided degrees:
- Mild - the amount of iodine in the urine is from 50 to 99 mcg / l.
- Average - from 20 to 49.
- Heavy - less than 20.
In iodine-deficiency states, an enlargement of the thyroid gland often occurs. To determine its degree, the gland is palpated along the anterior surface of the neck. Highlight:
- zero degree - not enlarged or palpable;
- 1st degree - palpable and enlarged to 2 cm;
- 2nd degree - an enlarged thyroid gland is visible when the head is tilted back, the isthmus and its lobes are palpated;
- 3rd degree - goiter.
The spectrum of iodine deficiency conditions is quite large and is not limited to thyroid diseases. Different age groups have different manifestations of iodine deficiency. In the prenatal period, conditions that can be associated with iodine deficiency include abortion, stillbirth, congenital anomalies, neurological and mexedematous cretinism, and psychomotor disorders.
In newborns, this is neonatal hypothyroidism. Atchildren and adolescents - backwardness in mental and physical development. In adults, goiter with its complications and iodine-induced thyrotoxicosis.
After a full examination and examination, it is important to make the correct diagnosis. In medicine, the entire nomenclature for diseases is presented in the international classification of diseases - ICD-10. Iodine deficiency states are described under the code E00-E02. These include:
- diffuse, nodular endemic goiter;
- subclinical hypothyroidism due to iodine deficiency;
- congenital iodine deficiency syndrome (neurological, mexedematous and mixed form).
Pregnancy
Pregnant women are a special he alth monitoring group. Their condition and he alth is closely monitored throughout the entire 9 months. Gynecologists are trying to minimize the risk of developing congenital anomalies in a child.
Outside of pregnancy, for normal life, a woman needs from 100 to 150 micrograms of iodine per day, and when carrying a baby, the need for this trace element increases to 250 micrograms. In such an important period of life, the expectant mother takes care of not only herself. Her thyroid gland increases by 16%, but this is not due to increased production of hormones, but to increased blood supply to the organ. A woman is very susceptible to the occurrence of iodine deficiency conditions during pregnancy.
The trace element plays a critical role in maintaining early pregnancy. Thanks to him, the ratio of luteinizing andfollicle-stimulating function of the pituitary gland in favor of the first. This stimulates the development of the corpus luteum of pregnancy in the ovary, which prevents miscarriage.
With iodine deficiency, there is a high probability of not only premature termination of pregnancy, but also stillbirth. There are also frequent cases of the development of various developmental anomalies, such as endemic cretinism (a pronounced form of mental and physical retardation), neonatal goiter and others.
The trace element plays an important role in the development of bone and cartilage tissue, the formation of the lungs and kidneys, the central nervous system, and the development of intelligence. With an insufficient amount of thyroid hormones, the mass of the fetal brain decreases.
The process of erythrocyte formation - erythropoiesis - is also under the control of the thyroid gland. Due to the sufficient presence of iodine in the body, the absorption of iron in the gastrointestinal tract and the synthesis of transferrin, the protein responsible for its transportation to the hematopoietic organs, increase.
In the fetus, the first rudiments of the gland are formed on the 3-4th week. On the 8th it starts to function. From the 12th week, the first hormones are already formed. Since that time, the ratio of maternal and own hormones has been 50/50% and remains practically the same until the end.
As you can see, proper nutrition and prevention of iodine deficiency diseases of the thyroid gland during pregnancy can significantly reduce the risks of conditions that threaten the life and he alth of the unborn baby.
In children
In Russia, goiter is already detected in 20-40% of the child population. While atIn the absence of iodine deficiency, the disease occurs in only 5% of children. With age, the risk of developing diseases caused by iodine deficiency only increases. So in children under 1 year old, the risk is about 2%, in adolescents it rises to 30-50%.
Lack of iodine intake from food contributes to a decrease in neuropsychic, mental development, impaired cognitive functions, puberty, speech and hearing development is reduced. Doctors noted a 2-fold increase in mental retardation in iodine-deficient areas. It also revealed a decrease in school performance by 15%.
In the course of research, iodine deficiency conditions in children clearly correlate with an increase in the incidence of infectious, cardiovascular diseases, gastrointestinal diseases, and allergic rhinitis. The listed pathologies occur 2 times more often with a lack of this most important trace element. Curvature of the spine is found 4 times more often than in children without goiter.
Children, of course, are extremely susceptible to the development of diseases. Constant growth and development, accelerated metabolism require the receipt of a huge amount of resources. Including iodine. Diagnosis of iodine deficiency conditions in children is carried out by the same methods as in adults.
Symptoms
With moderate iodine deficiency, people experience difficulties in solving logical problems, there is a decrease in cognitive functions: memory worsens, working capacity decreases, attention is scattered. Such symptoms of iodine deficiency conditions are especially noticeable in children. In addition, patientsoften complain of apathy, spleen, constant fatigue, sleep disturbances, feeling of constant lack of sleep, headaches.
Since thyroid hormones primarily regulate metabolism, when they are deficient, it slows down, which leads to weight gain, despite the diet. Among the symptoms of iodine deficiency are often dry skin, brittle nails and hair. It is possible to increase blood pressure, cholesterol levels in the blood. Most women experience menstrual irregularities and infertility.
As a result of iodine deficiency, the synthesis of thyroid hormones is reduced, the body lacks them for normal functioning. Therefore, to compensate, an increase in the gland occurs - a diffuse euthyroid goiter develops, which contributes to the normalization of the level of thyroid hormones. The only symptoms of this disease may be signs of compression of the organs in the neck, for example, a violation of the act of swallowing, a feeling of a lump in the throat. There is also an increase in the thyroid gland, which can create discomfort due to appearance.
Diagnosis
Any examination consists of successive stages: questioning, examination, palpation, laboratory and instrumental examinations. The survey is conducted to determine the symptoms of iodine deficiency diseases of the thyroid gland. It is the basis of all diagnostics. Knowing the symptoms that torment the patient, the doctor narrows the circle of possible pathology.
The next step is inspection. If a deficiency of iodine or thyroid hormones is suspected, the neck area is first examined fora visible increase in the organ, then they look for additional signs: they determine the condition of the hair, nails, skin, visible mucous membranes. Then proceed to palpation of the thyroid gland. The specialist carefully probes the isthmus, both lobes, evaluates their structure and density. Thus, small nodules in the thickness of the tissue can be detected.
For laboratory diagnostics, TSH (thyroid-stimulating hormone) is used. According to the mechanism of negative feedback, it can increase with a reduced content of thyroid hormones or decrease with their increase. If TSH is in normal values, then free T4 and T3 fractions become the main thing in making a diagnosis. Their decrease indicates hypothyroidism. Low TSH levels are combined with a high level of thyroid hormones in the blood and indicate hyperthyroidism, which is also possible with the formation of a goiter.
In addition to laboratory tests, the doctor must prescribe an ultrasound of the thyroid gland. This examination method allows you to assess the structure of tissue, nodes, their size, the presence of increased blood flow in the organ. But unfortunately, ultrasound is not able to determine the possible malignancy of formations.
For this, a fine-needle aspiration puncture biopsy is used. This is a piercing with a needle of the thyroid gland, followed by taking a tissue sample. The procedure is carried out under the control of ultrasound, because it is very important to get into the focus of the altered tissue. Then the biopsy is examined under a microscope and a conclusion is issued on malignancy or benignity.education.
Another research method is scintigraphy. It shows the intensity of hormone formation in the thyroid gland and has clear indications:
- node of average size in hyperthyroidism;
- large nodule the size of half a lobe or more (blood tests are irrelevant in this case);
- incorrect location of the thyroid gland or its tissue.
The procedure involves the introduction of radioisotope iodine, which accumulates in the thyroid gland. During certain periods of time, images of the organ are taken, which are then studied. The doctor makes a conclusion about the presence of so-called hot nodes that accumulate the isotope, and cold nodes - without it.
Treatment
In case of endemic goiter of the 1st degree, only iodine preparations are prescribed. At the 2nd degree, there are 3 treatment regimens. The doctor can prescribe only iodine preparations. If they do not help, then L-thyroxine is prescribed instead of the previous medication or together with it as replacement therapy. The described schemes should reduce the size of the thyroid gland. In this case, the patient continues to take only iodine preparations.
Conservative or drug therapy is effective only in the case of a diffuse or mixed form of the disease. Therapy with iodine preparations or L-thyroxine, as a rule, does not give an effect.
There is also a surgical method of treatment that can be used in case of ineffective drug therapy. It is also chosen for suspected malignant degeneration of the goiter, withthe presence of symptoms of compression of neighboring organs, with the rapid growth of goiter. After surgery, the person is put on lifelong hormone replacement therapy.
It is worth noting that the treatment of iodine deficiency conditions in children obtained in the prenatal period is not carried out. These effects of iodine deficiency are irreversible.
Prevention of Conditions
Conditions caused by a lack of iodine intake in the human body are the second most common among endocrine diseases after diabetes mellitus. However, in contrast, a micronutrient deficiency is much easier to prevent.
Prevention of iodine deficiency conditions can be mass, group or individual. Mass is carried out by adding iodine to various foods: bread, eggs, s alt. Some countries even add the micronutrient to farm animal feed.
The populations most vulnerable to these conditions are pregnant and lactating women, children and adolescents. It is in relation to them that first of all measures are aimed at preventing diseases caused by a lack of the most important microelement. This is group prevention.
Individual conducts for himself each person independently. If he understands the importance of iodine, knows what its deficiency leads to, and takes care of his he alth, then he makes the right decision to introduce the necessary foods into his diet.
Sources of iodine
It is possible to fill the deficit not only with the help of products with artificial introduction of iodine into their composition, but alsoby eating food that is originally rich in it. This is primarily seafood: shrimp, crabs, squid, fish, sea kale.
It's easy to see a little pattern. In countries where the food culture is centered around seafood, such as Greece, Italy, Japan, there are very few iodine deficiency conditions among the population. And in most of the territory of our country, due to the lack of full access to the above provisions, almost everywhere there are increased rates of iodine deficiency. Therefore, in Russia, iodine deficiency diseases are the second most common among endocrine pathologies.
But the easiest way to prevent is to replace regular table s alt with iodized s alt. This method is considered the cheapest and most affordable for our country.
