What is Iodine Deficiency?
What is Iodine Deficiency? Iodine deficiency is a condition that occurs when a person lacks iodine intake so the body is not able to produce enough thyroid hormone. Severe iodine deficiency will cause some health problems such as goiter, hypothyroidism, cretinism, and fertility decline in women. In the population sphere, severe iodine deficiency can increase infant mortality and mental retardation.
Iodine is a chemical compound that can not be produced by the body. Therefore, the adequacy of iodine levels in the body is very dependent of daily food intake.
In Indonesia alone, the disturbance due to iodine deficiency is still one of the most important nutritional problems. This condition is often found in mountainous areas, where daily food consumption is still heavily dependent on local food production with poor iodine soil conditions.
Description of Iodine Needs
Iodine is one of the important minerals needed by the body in a certain amount. The main function of iodine is to synthesize hormones in the thyroid gland. The main source of iodine is obtained from foods containing salt or from seafood.
Daily iodine requirement for adults ranges from 0.1-0.15 mg per day. Detail of iodine requirement according to age group based on recommendation of Institute of Medical United States of America can be seen as follows:
- Adults = 0.15 mg per day
- Pregnant women = 0.22 mg per day
- Breastfeeding women = 0.29 mg per day
- Children 1-11 years = 0.09-0.12 mg per day
- Baby = 0.11-0.13 mg per day
On average, the maximum iodine requirement for adults is 1.1 mg per day, and less for children. Currently, the main source of iodine is the added salt of iodine salt. While the rest comes from seafood. Keep in mind that the iodine content in the soil is very small making it difficult to get vegetables with high iodine content. Some types of food not from the sea, but contain high iodine include yolk, milk, and dairy products. Iodine content in these foods comes from additional iodine for animal feed (especially chicken and beef).
The list of foods with high iodine content is as follows:
- Iodized salt kitchen
- Sea water fish
- Cow’s milk and other dairy products (cheese, yoghurt, ice cream)
- Soy milk
- Soy sauce
- Multivitamins containing iodine
Diseases Resulting from Iodine Deficiency
Iodine in food will be absorbed directly by the intestine then stored in concentrate form in the thyroid gland. Iodine in the thyroid will be used to form two thyroid hormones, namely thyroxine (T4) and triiodotironin (T3). Both of these hormones are important for the development of neural networks, sexual development, growth, regulation of body metabolism, body temperature and energy.
When the body suffers from iodine deficiency, the hormone T4 in the blood will decrease. The body will try to balance the situation by activating thyroid-stimulating hormone (TSH). The hormone TSH will force the thyroid gland to work harder to produce thyroid hormone. The work of the hormone TSH causes a significant increase in T3 levels, which is much more active than T4 and requires less iodine. It is the body’s way of offsetting low T4 production due to iodine deficiency.
Some diseases that arise from iodine deficiency in the body are as follows:
Mumps. Mumps is a common disease that occurs due to iodine deficiency, with symptoms of enlargement of the thyroid gland. Enlarged glands initially spread (diffuse) with a slippery surface. If a person’s iodine deficiency persists, the enlarged surface of the thyroid gland will appear to be bumpy (nodular). Mumps in children are generally diffuse goiter, whereas in adults it is generally nodular goitre. If the goitre grows large enough, the following symptoms may appear:
- Sore throat
- Hard to breathe
- Difficult to swallow
Hypothyroidism. Hypothyroidism is a condition in which the thyroid gland can not produce enough hormones. One of the causes of this condition is the presence of severe iodine deficiency that occurred in the period long enough. Lack of iodine levels causes thyroid hormone, ie T3 and T4, in the blood is reduced significantly. In adults, hypothyroidism can be observed from its symptoms. While in children and fetuses, hypothyroidism can cause cretinism, developmental delay in the central nervous system, permanent mental retardation, neurological disorders, and abnormal growth. Symptoms of hypothyroidism are as follows:
- Tired or tired
- Weight gain
- Dry skin
- Intolerance to cold temperatures
- Memory interruption
- Heartbeat weakened
- Disorder of menstrual pattern or menstrual experience is more severe than usual
- Joint pain
In children, symptoms of hypothyroidism that can be observed and different from symptoms of hypothyroidism in adults are as follows:
- – Bad growth (causes the body to be shorter than average)
- – Delay of permanent dental development
- – Delayed development of puberty
- – Impaired mental development
In infants, symptoms of hypothyroidism that can be observed are as follows:
- – Skin yellowing (jaundice)
- – Frequent choking
- – Large, outstretched tongue (protruding)
- – The face is swollen
Without good medical treatment, hypothyroidism can lead to various complications such as heart problems, mental disorders, infertility (especially in women), abnormalities in infants after birth.
Cretinism is a disorder arising from iodine deficiency that occurs in the fetus while still in the womb. Cretinism is the most extreme form of iodine deficiency in a person. Cretinism is divided into two types namely neurological cretinism and miksedema creinism.
Neurologic cretinism is caused by iodine deficiency and hypothyroidism in the mother during pregnancy. The characteristics of neurological cretinism are:
- Mental retardation
- How to walk that is not normal
- Mute-deaf to the child
Mixedema cretinism is caused by iodine deficiency and hypothyroidism in pregnant women, especially late in pregnancy or neonatal phase. The characteristics of cretinism miksedema namely:
- Mental retardation
- Short stature
- Mumps in children
- Hypothyroidism in children
Mental retardation. Globally, iodine deficiency is one of the factors of mental retardation in children, especially in areas susceptible to iodine deficiency, such as mountains. Although children born to mothers with iodine deficiency have normal thyroid function, they tend to have lower than average language and memory abilities.
Diagnosis of Iodine Deficiency
Diagnosis and detection of iodine levels in pregnant women and children is becoming increasingly important today, especially in endemic areas of iodine deficiency. Detection of iodine deficiency in the two groups is quite important given the risk of various diseases caused by iodine deficiency. Some types of methods that can be used for the diagnosis of iodine deficiency are as follows:
- Physical examination. The doctor may be immediately aware of an enlarged thyroid gland just by checking the neck area of the patient. Patients will be asked to perform swallowing several times during the examination to ensure a palpable gland. The thyroid gland will go up and down at the time of swallowing.
- Examination of thyroid function. Diagnosis method of study of thyroid function is by measuring levels of hormone TSH, triiodotironin (T3) and thyroxine (T4) in the blood. In patients with iodine deficiency and eutyroidism, TSH content in the blood is generally at normal levels or increased. T3 content in blood will tend to increase while T4 will decrease. In patients with extreme iodine deficiency, both T3 and T4 contents will decrease from normal levels followed by an increase in TSH levels above normal.
- Study of thyroid scanning. This method uses radioactive iodine injected to monitor the thyroid response, then scanned using ultrasound. The initial diagnosis before this test is to monitor the hormone levels of TSH. If TSH levels increase, these tests can be used. In people with normal iodine levels, the absorption of radioactive iodine by the thyroid occurs only slightly. Whereas in people who experience iodine deficiency, there will be absorption of radioactive iodine by the thyroid in large quantities
- Examination of iodine in urine. The principle of this examination is the kidney will get rid of 90% of iodine absorbed by the body. This examination can be used to diagnose whether a population is suffering from iodine deficiency or not. Urine taken for diagnosis is median urine per 24 hours. The table below explains the correlation between the iodine value in urine, the possibility of iodine intake, as well as the iodine sufficiency condition in a person
- Biopsy. To take a sample of thyroid gland tissue using fine needles, which will then be checked in the laboratory. This procedure can be guided by ultrasound to determine the exact location of tissue taking.
Treatment of Iodine Deficiency
The goal of treating patients with iodine deficiency is to avoid morbidity and complications from iodine deficiency. Some types of treatment that can be done to treat iodine deficiency are:
- Observation. In people with mumps, if the size of the goiter is still small and does not cause problems and works well, the doctor will make an observation before giving treatment.
- Levotyloin. Levotyloxin (L-thyroxine) is a thyroxine hormone (T4) synthesized as a natural thyroxine replacement. Giving levothyroxine is generally effective in pregnant women and children, but is less effective in adults. Giving levothyroxine should be monitored its use because it is feared thyrotoxicosis occurs, where levels of T3 and T4 in the body is very high.
- Potassium Iodide (KI). Potassium iodide is one of the most commonly used salts for the treatment of iodine deficiency and belongs to the class of antithyroid agents. Potassium iodide can be taken in tablets, oral solutions, intramuscular, or as a supplement to foods and beverages. Potassium iodide is often used as an iodine enhancer supplement because it is easily absorbed by the intestine.
- Radioactive iodine. Radioactive iodine has been shown to decrease the size of eutyroid goiter by 40-60%. The side effect that can occur from therapy using radioactive iodine is permanent hypothyroidism.
- Surgical thyroidectomy. Surgery is the standard treatment method used to treat large goitre. Large hyacinths can cause a variety of disorders in patients such as hoarseness and swallowing disorders. If the goiter spreads to the anterior mediastinum, thyroidectomy surgery is highly recommended even if there is no interruption of the patient’s throat. After surgery, the patient will be given levothyroxine as a substitute for thyroid hormone.
Prevention of Iodine Deficiency
The principle of preventing various illnesses due to iodine deficiency is to get adequate iodine intake according to the recommendation. At the population level, iodine deficiency in one area can be prevented by adding iodine to food and drink. This step is done by adding iodine to table salt that is used everyday. In some developing countries, additional iodine is done by injection of iodine supplements in the form of oil.
The addition of iodine to food and beverage supplements should be in accordance with the recommendations of the relevant health authorities. In adults, 0.15 mg of iodine intake per day is sufficient to maintain optimal thyroid function. The easiest way to keep iodine intake is to use iodized salt on food. In vegetarian people, in addition to the iodine intake of salt, it may be advisable to consume other sources of iodine such as milk, milk products, and eggs.