Iodine deficiency is still a major public health problem worldwide. Russia belongs to countries with slight 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 varies in the region of 15-40%. The article will tell all the information about iodine deficiency conditions - a description, symptoms, treatment of diseases, their prevention.
Why iodine is needed
Iodine is the most important trace element necessary for the human body for adequate functioning and life. It is the only one that is part of the thyroid hormones and is directly involved in their synthesis.
The thyroid gland has a special regulatory role in the human body. Its hormones contribute to the normal growth and development of a person, the correct 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 regions with iodine deficiency. Since Russia has a large territory, the regions also have varying degrees of iodine deficiency. The most affected mountain areas are the North Caucasus, the Far East, Altai, and the Siberian Plateau. Regions with a slight degree of deficiency 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 micronutrient intake from food.
A bit of history
For the first time, our country, still in the form of the young Soviet Union, joined the program for monitoring iodine deficiency conditions in the early twentieth century. In 1927, the first studies began in the regions, according to the results of which the regions with the highest deficit began to receive iodized salt. Pretty quickly managed to improve the situation. In addition, methods have been developed for the prevention of iodine deficiency, including in children.
It seems that the problem has been resolved. However, the world began to consider iodine deficiency from a different angle - the amount of trace elements was estimated not in soil or water, as before, but in human urine.
Since then, scientists have discovered that there is also a slight degree of deficiency, which can lead to a decrease in mental (cognitive) abilities, as well as cause various forms of behavioral disturbance in old age. Gradually, our country is somewhat behind Europe in the prevention of diseases associated with iodine deficiency.
Types of iodine deficiency
First of all, iodine deficiency is classified by its degree of deficiency in the body. This indicator is determined by the number of trace elements in the patient's urine. Share the degrees:
- Light - the amount of iodine in the urine is from 50 to 99 mcg / l.
- Medium - from 20 to 49.
- Severe - less than 20.
With iodine deficiency, an enlargement of the thyroid gland often occurs. To determine its degree, the gland is palpated along the front of the neck. Allocate:
- zero degree - not enlarged or palpated;
- 1st degree - palpated and increased to 2 cm;
- 2nd degree - an enlarged thyroid gland is visible when the head is thrown back, the isthmus and its lobes are palpated;
- 3rd degree - goiter.
The spectrum of iodine deficiency conditions is quite large and is not limited only 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, stillbirths, congenital anomalies, neurological and mexedematous cretinism, and psychomotor disorders.
In newborns, this is neonatal hypothyroidism. In children and adolescents - retardation in mental and physical development. In adults, goiter with its complications and iodine-induced thyrotoxicosis.
After a full examination and examination, the correct diagnosis is important. In medicine, the entire nomenclature for diseases is presented in the international classification of diseases - ICD-10. Iodine deficiency conditions 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 constitute a special group of health monitoring. Their condition and health are closely monitored for all 9 months. Gynecologists try to minimize the risks of developing congenital anomalies in a child.
Outside of pregnancy, a woman needs from 100 to 150 micrograms of iodine per day for normal life, and when a baby is born, the need for this microelement increases to 250 micrograms. In such an important period of life, the expectant mother cares not only about herself. Its thyroid gland increases by 16%, however, this is not associated with increased production of hormones, but with increased blood supply to the organ. A woman is very prone to iodine deficiency during pregnancy.
The trace element plays a crucial role in maintaining pregnancy in the early stages. Thanks to him, the ratio of the luteinizing and follicle-stimulating functions of the pituitary gland changes in favor of the former. Thus, the development of the corpus luteum pregnancy in the ovary is stimulated, 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 development retardation), neonatal goiter, and others.
The trace element plays an important role in the development of bone and cartilage, the formation of lungs and kidneys, the central nervous system, and the formation of intelligence. With an insufficient amount of thyroid hormones, the fetal brain mass decreases.
The formation of red blood cells - erythropoiesis - is also under the supervision 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 germs of the gland form on the 3-4th week. On the 8th, it begins to function. From the 12th week the first hormones are already forming. Since that time, the ratio of maternal and own hormones is 50/50% and remains almost 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 health of the unborn baby.
In children
In Russia, goiter is already detected in 20-40% of the child population. While in 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 of age, the risk is about 2%, in adolescents it rises to 30-50%.
The lack of intake of iodine with food helps to reduce neuropsychic, mental development, impaired cognitive functions, puberty, and the development of speech and hearing is reduced. Doctors noted a 2-fold increase in mental retardation in iodine-deficient areas. A decrease in school performance by 15% was also found there.
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 are found 2 times more often with a lack of this most important trace element. Spinal curvature is detected 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 a huge amount of resources. Including iodine. Diagnosis of iodine deficiency in children is carried out by the same methods as in adults.
Symptoms
With moderate iodine deficiency, people experience difficulties in solving logical problems, cognitive functions decrease: memory deteriorates, performance decreases, and attention is scattered. Especially noticeable are such symptoms of iodine deficiency in children. In addition, patients often complain of apathy, spleen, constant fatigue, sleep disturbances, a feeling of constant lack of sleep, headaches.
Since thyroid hormones primarily regulate the metabolism, when they are deficient, their slowdown is observed, which leads to weight gain, despite the diet. Among the symptoms of iodine deficiency are often dry skin, brittle nails and hair. Perhaps an increase in blood pressure, cholesterol in the blood. In most cases, women have menstrual irregularities and infertility.
Due to iodine deficiency, the synthesis of thyroid hormones decreases, the body lacks them for normal life. Therefore, to compensate, an enlargement of the gland occurs - a diffuse euthyroid goiter develops , which helps to normalize the level of thyroid homons. The only symptoms of this disease may be signs of organ compression in the neck, for example, a violation of the act of swallowing, a feeling of a coma in the throat. An increase in the thyroid gland also occurs, which can create discomfort due to the appearance.
Diagnostics
Any examination consists of successive stages: a survey, 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 there is a suspicion of a deficiency of iodine or thyroid hormones, they first examine the neck area for a visible organ enlargement, then look for additional signs: 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, it is possible to identify small nodules in the thickness of the tissue.
For laboratory diagnosis, an indicator of TSH (thyroid stimulating hormone) is used. According to the negative feedback mechanism, it can increase with a reduced content of thyroid hormones or decrease with their increase. If TSH is in normal values, then the main fractions in the diagnosis are free fractions T4 and T3. Their decrease indicates hypothyroidism. Low levels of TSH are combined with a high content of thyroid hormones in the blood and indicate hyperthyroidism, which is also possible with the formation of goiter.
In addition to laboratory tests, the doctor prescribes an ultrasound of the thyroid gland without fail. This examination method allows you to evaluate the structure of tissue, nodes, their size, the presence of increased blood flow in the organ. But unfortunately, ultrasound can not determine the possible malignancy of formations.
For this, a fine-needle aspiration puncture biopsy is used. This is a needle piercing with a thyroid gland followed by sampling a tissue sample. The procedure is carried out under the supervision of an ultrasound, because it is very important to get into the focus of the altered tissue. Then the biopsy specimen is examined under a microscope and an opinion is made on the malignancy or benignity of the formation.
Another method of research is scintigraphy. It shows the intensity of the formation of hormones in the thyroid gland and has clear indications:
- a knot of medium size with hyperthyroidism;
- a large node with a size of half a share or more (blood tests in this case do not matter);
- improper location of the thyroid gland or its tissue.
The procedure involves the introduction of radioisotope iodine, which accumulates in the thyroid gland. Over certain periods of time, images of the organ are taken, which are then studied. The doctor concludes that there are so-called hot nodes that accumulate the isotope, and cold nodes - without it.
Treatment
With endemic goiter of the 1st degree, only iodine preparations are prescribed. With the 2nd degree, there are 3 treatment regimens. The doctor can prescribe only iodine preparations. If they do not help, then instead of the previous medicine or together with it, L-thyroxine is prescribed as a replacement therapy. The described schemes should reduce the size of the thyroid gland. In this case, the patient further begins 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 or L-thyroxine, as a rule, has no effect.
There is a surgical method of treatment that can be used in case of ineffective drug therapy. It is also chosen for suspected malignant degeneration of goiter, in the presence of symptoms of compression of neighboring organs, with rapid growth of goiter. After surgery, a person is prescribed lifelong hormone replacement therapy.
It is worth noting that treatment in children of iodine deficiency conditions obtained in the prenatal period is not carried out. Such effects of iodine deficiency are irreversible.
Condition Prevention
Conditions caused by a lack of iodine intake in the human body are the second most common among endocrine diseases after diabetes. However, in contrast, a micronutrient deficiency is much easier to prevent.
Prevention of iodine deficiency conditions can be mass, group or individual. Bulk is carried out by adding iodine to various foods: bread, eggs, salt. Some countries even add trace elements to livestock feed.
The most vulnerable to these conditions populations are pregnant and lactating women, children and adolescents. It is with regard to them that the measures aimed primarily at preventing diseases caused by a deficiency of the most important trace element are directed in the first place. This is a group prevention.
Each person spends individually for himself. If he understands the importance of iodine, knows what its deficiency leads to, and takes care of his health, he makes the right decision on introducing the necessary foods into his diet.
Iodine sources
It is possible to fill the deficit not only with the help of products with artificial introduction of iodine into their composition, but also by eating foods that are initially rich in them. These are primarily marine products: shrimp, crab, squid, fish, sea kale.
It is easy to trace a small pattern. In countries where food culture is concentrated around seafood, such as Greece, Italy, Japan, iodine deficiency conditions are extremely few among the population. And in most of the territory of our country, due to the lack of full access to the above provisions, increased iodine deficiency indicators are almost everywhere observed. Therefore, in Russia iodine deficiency diseases are the second most common among endocrine pathologies.
But the easiest way to prevent is to replace ordinary table salt with iodized. This method is considered the cheapest and most affordable for our country.