Dorin Mutoif Putra Kebumen: Iodine deficiency

Teman - teman pada saat Orientasi Kampus Departemen kesehatan dan keselamatan kerja, Fakultas Kesehatan Masyarakat, Universitas Indonesia

GAKY

· Iodine deficiency occurs when iodine intake falls below recommended levels.

· It is a natural ecological phenomenon that occurs in many parts of the world.

· The erosion of soils in riverine areas due to loss of vegetation from clearing for gricultural production, overgrazing by livestock and tree-cutting for firewood, results in a continued and increasing loss of iodine from the soil.

· Groundwater and foods grown locally in these areas lack iodine.

• When iodine intake falls below recommended levels, the thyroid may no longer be able to synthesize sufficient amounts of thyroid hormone. The resulting low level of thyroid hormones in the blood (hypothyroidism) is the principal factor responsible for the damage done to the developing brain and the other harmful effects known collectively as the Iodine Deficiency Disorders (5).

• The adoption of this term emphasized that the problem extended far beyond simply goitre and cretinism (see Table 1).

Table 1. The Spectrum of Iodine Deficiency Disorders (IDD)

• FOETUS

• Abortions

• Stillbirths

• Congenital anomalies

• Neurological cretinism:

– mental deficiency,

– deaf mutism, spastic diplegia, squint

• Hypothyroid cretinism:

– mental deficiency, dwarfism,

– hypothyroidism

• Psychomotor defects

Table 1. The Spectrum of Iodine Deficiency Disorders (IDD)

• NEONATE

• Increased perinatal mortality

• Neonatal hypothyroidism

• Retarded mental and physical development

• CHILD &

• ADOLESCENT

• Increased infant mortality

• Retarded mental and physical development

Table 1. The Spectrum of Iodine Deficiency Disorders (IDD)

• ADULT

• Goitre with its complications

• Iodine-induced hyperthyroidism (IIH)

• ALL AGES

• Goitre

• Hypothyroidism

• Impaired mental function

• Increased susceptibility to nuclear radiation

From Hetzel (1983) WHO/UNICEF/ICCIDD (2001)

Pembesaran kelenjar tiroid

Table 2. Effects of Iodine Interventions and Measurements ofEconomic Benefits

• Human Populations

• EFFECTS BENEFITS

• Reductions in:

• 1. Mental deficiency 1. Value of higher work output in

• household and labour market

• 2. Deaf mutism 2. Reduced costs of medical and

• custodial care

• 3. Hypothyroidism 3. Reduced educational costs from

• reduced absenteeism and grade

• repetition

• 4. Goitre 4. Reduced costs of investigation

• and treatment

• From: Levin et al (1993)

• Several international groups have made recommendations, which are fairly similar. ICCIDD, WHO, and UNICEF recommend the following daily amounts:

• age 0-7 years, 90 micrograms (mcg)

• age 7-12 years, 120 mcg

• older than 12 years, 150 mcg

• pregnant and lactating women, 200 mcg

Correction of iodine deficiency

An iodine deficient environment requires the continued addition of iodine, which is most conveniently and cheaply achieved by the addition of iodine to the salt supply. Most humans eat salt in roughly the same amount each day.

• A decrease in salt intake can be readily met by increasing the iodine content.

• Where a significant amount of processed food is consumed, it is important that the salt used by the food industry in preparing such food - as well as the salt used in the home - is iodized.

USI

• Universal salt iodization, which ensures that all salt for human and animal consumption is adequately iodized, has been remarkably successful in many countries. At this stage, however, sustainability of this successful correction of iodine deficiency becomes the challenge, as iodine deficiency may recur at any time

• In some regions, iodization of salt may not be a practical option for the sustainable elimination of IDD, at least in the short term. This is particularly likely to be the case in remote areas where communications are poor or where there are numerous very small-scale salt producers

• In such areas, other options for correction of IDD may have to be considered,such as:

– administration of iodized oil capsules every 6-18 months (10);

– direct administration of iodine solutions, such as Lugol’s iodine,at regular intervals (once a month is sufficient); or

– iodization of water supplies by direct addition of iodine solution or via a special delivery mechanism.

• government ministries (legislation and justice, health, industry,agriculture, education, communication, and finance);

• salt producers, salt importers and distributors, food manufacturers;

• concerned civic groups; and

• nutrition, food and medical scientists, and other key opinion makers.

• iodine concentration in salt at the point of production should be within the

• range of 20-40 mg of iodine per kg of salt (i.e., 20-40 ppm of iodine) in order to

• provide 150 mg of iodine per person per day. The iodine should be added as

• potassium (or sodium) iodate. Under these circumstances median urinary