Iodedestic diseases in children. Iodine deficiency in children

Name of pathology: Yododeficiency Diseases (YDZ)

ICB-10 code: E00. Congenital iodine deficiency syndrome (00.0 - neurological form, 00.1. - Myxdematous form, 00.2. - Mixed form).

E01. Diseases thyroid gland (Shutter) associated with iodine deficiency, and similar states [E01.0. - diffuse (endemic) goiter associated with iodine deficiency; E01.1. - Movement (endemic) goiter associated with iodine deficiency] E02. Subclinical hypothyroidism due to iodine deficiency.

Brief epidemiological data
According to WHO, about 2 billion people live in an iodine deficit. Insufficient iodine consumption threatens more than 100 million Russians, including a threat to normal physical and mental development of 32.8 million children living in Russian Federation (Dedov I.I., Melnichenko G.A., Trohina E.A. et al., 2004). Diffuse euticoid goiter is detected on average in 20% of Russians. The frequency of the assembly colloid goiter associated with iodine deficiency, women over 30 years old in the Russian Federation reaches 30%.

Classification
The spectrum of iododephine pathology in the population is very wide and includes (WHO, 2001):

In the intrauterine period - intrauterine death (abortion), still-breeding, congenital anomalies, raising perinatal and child mortality, neurological cretinism (mental retardation, deafness, strabismus), mycladium cretinism (mental retardation, hypothyroidism, dwarfism), psychomotor disorders;
- in newborns - neonatal hypothyroidism;
- in children and adolescents - violations of mental and physical development;
- in adults - goiter and its complications, iodinducated thyrotoxicosis;
- at any age - hypothyroidism, violation of cognitive function, increase absorption radioactive iodine under nuclear catastrophes [Dedov I.I., Melnichenko G.A., Fadeev V.V., 2000; Gerasimov G.A. et al., 2002; Melnichenko G.A. et al., 2005].

In this section, we will consider the issues of iodine prevention and maintenance of women with diffuse euticoid and nodal / multi-nominal colloid goiter during pregnancy. [Melnichenko G.A., Fadeev V.V., Dedov I.I., 2003].

Diagnostics

Treatment

LITERATURE

1. Algorithms for the prevention and treatment of iododephinic diseases [Text] / Ed. G.A. Melnichenko. - M.: [B.I.], 2005. - 48 p.
2. Santov I.I. Endocrinology [Text] / I.I. Grandfall, G.A. Melnichenko, V.V. Fadeev. - M.: Medicine, 2000. - 632 p.
3. Yododephinic diseases in Russia. Simple solution to a complex problem [Text] / G.A. Gerasimov [and others]. - M.: Adamant, 2002. - 168 p.
4. Clinical recommendations of the Russian Association of Endocrinologists (RAE) on the diagnosis and treatment of nodal goiter [Text] / I.I. Grandfathers [and others] // Clinical thyroid. - 2004. - T.2, №4. - P. 47-52.
5. Melnichenko, G.A. Diseases of the thyroid gland during pregnancy. Diagnostics, Treatment, Prevention [Text]: Handbook for doctors / G.A. Melnichenko, V.V. Fadeev, I.I. Grandfathers. - M.: MedExpertpress, 2003. - 48c.
6. Prevention and treatment of iodine deficiency diseases in high-risk groups [Text] / I.I.Dedov [et al.]. - M.: [B.I.], 2004. - 56 p.
7. Modern concepts of clinical endocrinology [Text]. Abstracts of reports of the Fifth Moscow City Congress of Endocrinologists (March 23-24, 2006) / M.: Geos, 2006. - 134 p.
8. American Association of Clinical Endocrinologists and Assocazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract., 2006 - V. 12, №1. - P. 63-102.

- thyroid pathology developing as a result of a lack of iodine in the body. Signs of iodine deficiency can be an increase in the size of the thyroid gland, dysphagia, worsening memory, weakness, chronic fatigue, dry skin, nail fragility, increase in body weight. Iodine deficient diseases of the thyroid gland are diagnosed by an endocrinologist, taking into account the data of laboratory tests (TSH and thyroid hormone levels), the ultrasound of the thyroid gland, a thin-game biopsy. The therapy of iodine deficient diseases may include potassium monotherapy iodide, destination L-thyroxine or combined treatment (L-thyroxine + iodine preparations).

General

Iodine deficient diseases of the thyroid gland include a number of pathological conditions caused by a lack of iodine in the body, the occurrence and development of which can be prevented by sufficient consumption of this trace element. The iodine deficient diseases include not only the pathology of the thyroid gland, but also the states caused by the shortage of thyroid hormones.

Iodine is an indispensable for the functioning of the body by the microelegen. Organism healthy man Contains 15-20 mg of iodine, 70-80% of which accumulates in the thyroid gland and serves as a necessary component for the synthesis of thyroid hormones consisting of 2/3 of iodine: triiodothyronine (T3) and thyroxine (T4). The need for the daily rate of iodine is from 100 to 200 μg, and for its own life, a person uses 1 teaspoon of iodine (3-5 g). Periods of increased need for iodine for the body are puberty, pregnancy and breastfeeding time.

Iodine deficiency in the environment (in soil, water, food) and, therefore, insufficient natural admission to the body causes a complex chain of compensatory processes, designed to maintain the normal synthesis and secretion of thyroid hormones. The persistent and long-lasting deficiency of iodine is manifested by a number of iodine deficient diseases of the thyroid gland (diffuse and assembly goiter, hypothyroidism), non-peculiarization of pregnancy, perinatal mortality, physical and mental retardation Children, endemic cretinism.

Views of iododeifs

Most often, the yododeficiency in the body is manifested by the development of diffuse euticide goiter - a uniform increase (hyperplasia) of the thyroid gland. Diffuse goiter arises as a compensatory mechanism, providing sufficient synthesis of thyroid hormones in a lack of iodine.

Diffuse goiter developing among people living in the area with iodine deficiency is called endemic, and in the area with sufficient content of iodine - sporadic. According to WHO's criteria, if more than 10% of the population of the region suffers from diffuse hyperplasia of the thyroid gland, this region is recognized by endemic in the goiter. Much less often the development of endemic goiter is not connected with iodine deficiency, but with the action of chemical compounds: thiocyanates, flavonoids, etc. Today, endocrinology does not have accurate data on the mechanism of the occurrence of sporadic goiter. This question is poorly studied. In most cases, sporadic goiter is associated with congenital disorders of enzymatic systems that carry out the synthesis of thyroid hormones.

The second in the frequency of the occurrence of the yodine deficient disease of the thyroid gland among the adult population is a nodal goiter - an uneven, nodular thyroid hyperplasia. In the early stages of the nodal goiter, it does not lead to a violation of the functions of the thyroid gland, but when taking the drugs of iodine can cause the development of thyrotoxicosis. The extreme degree of iodine deficiency is manifested in the form of hypothyroidism caused by a sharp decrease in the level of thyroid hormones in the body.

The most vulnerable category of the population in the lack of iodine are pregnant women and children. The iodine deficiency experienced during pregnancy is especially dangerous, since the thyroid gland of the mother and the fetus suffer. With iodine deficient diseases of the thyroid gland, pregnant women increase the risk of spontaneous miscarriages, congenital defects The development of the fetus, and in born children - the development of hypothyroidism and mental inferiority.

In the fetus, the production of own hormone T4 thyroid gland begins for 16-18 weeks. Source development, whereas before that time the development of all systems is carried out through the use of maternal thyroid hormones. Therefore, in the first trimester, the secretion of T4 in a pregnant woman increases by almost 40%.

With a heavy iodine deficiency and reducing the T4 level, at the time of pregnancy, the shortage of thyrotropic hormones during the development of the fetus is so pronounced, which leads to the most severe consequences for the child and the emergence of neurological and physical development - the extreme degree of mental and physical development associated with intrauterine iodine deficiency and disadvantage of thyroid hormones.

Easy iodine deficiency, easily compensated in the absence of pregnancy and does not lead to a decrease in the level of thyroid hormones, but manifested by a decrease in T4 products during pregnancy, is regarded as a relative gestational hypothiocynemi syndrome. Hypotyroxinemia, which developed during pregnancy, can lead to intellectual development disorders that do not reach the severe degree of oligophrenia.

Classification of iododic

According to the Classification of ICCIDD (International Council for Combating Yododeficiency) and WHO, the degree of increasing the thyroid gland caused by the iodine deficiency state is determined by the following dimensions:

• The degree of 0 - the thyroid gland is not increased and is not palpable or normal;
• Degree 1 - thyroid gland palpable with the first phalanx of the thumb;
• The degree 2 - the thyroid gland is determined to the eye when the head is folding, the experienses and side stakes of the gland are palpable;
• Degree 3 - euticoid goiter.

The yododeficiency tested by the body is determined by the content of the amount of iodine in the urine and may be:

• easy - when the iodine content is from 50 to 99 μg / l;
• moderate gravity - with a content in iodine from 20-49 μg / l;
• heavy - when keeping in urine iodine< 20 мкг/л.

Symptoms of thyroid yodophysics

Usually diffuse euticoid goiter develops asymptomatic. Sometimes there is an unpleasant feeling in the neck area, and with a significant increase in the dimensions of the thyroid gland - the symptoms of the surrender of neighboring neck structures: the feeling of "coma in the throat", difficulties in swallowing. A noticeable eye increase in the thyroid gland can create cosmetic inconvenience and become a reason to appeal to the endocrinologist.

Neurological cretinism is manifested by severe dementia, violation of speech, strabismus, deafness, rude violations of the development of the bone-muscular apparatus, dysplasia. The growth of patients does not exceed 150 cm, the disharmonicity of physical development is observed: violation of the proportions of the body, the severity of the deformation of the skull. Manifestations of hypothyroidism is not observed. If the patient continues to test the iodine deficiency, then the goiter develops. The level of thyrotropic hormones during the formation of the goiter may remain unchanged (the state of the eutyreosis) or increased (the state of hyperthyroidism), but its reduction is more often (hypothyroidism).

Even on the background of moderate iodine deficiency, patients have a decrease in mental abilities by 10-15%: the memory deteriorates (especially visual), decreases hearing perception Information and slow processing processes are slowed down, there is scattered, apathy, weakness, sensation of chronic lack of sleep, constant headaches. Due to the slowdown of the metabolism processes, an increase in body weight occurs, even when the diet is observed. The skin becomes dry, hair and nails - brittle. It is often observed by arterial hypertension, an increase in blood cholesterol, which increases the risk of ischemic heart disease and atherosclerosis. It is characterized by the development of dyskinesia of biliary tract and gallstone disease, in women, moma of uterus, mastopathy, menstruals of the menstrual cycle and infertility.

The consequences of the iodine deficiency are due to its severity and age in which the lack of iodine is developing. The most severe consequences leads an iodine deficiency, which has developed in the early stages of the formation of the body: from the intrauterine - to age of puberty.

Diagnostics

A patient with iodine deficient diseases of the thyroid gland, find out information on the presence of the pathology of the thyroid gland in close relatives, estimate the sizes of the neck, pay attention to the dysphony (voting weight), dysfagia (swallowing disorder). When evaluating the patient's complaints, pay attention to the manifestations of hypo-or hyperthyroidism.

During the palpation of the thyroid gland, its density, location, presence of assembly education takes place. When palpator detection of the goiter is carried out ultrasound of the thyroid gland to determine the degree of hyperplasia. The volume of the thyroid gland is normal in men does not exceed 25 ml, and in women 18 ml. According to the testimony, a thin-game biopsy of the thyroid gland is carried out.

For rate functional state The thyroid gland determine the level of TSH. In the presence of a diffuse euticide goiter, the increase in the thyroid gland occurs due to both fractions, and the level of TSH in the patient is within the normal range. Low tong contents (less than 0.5 honey / l) allow you to suspect hyperthyroidism and require a study of thyroid hormone blood content (T4 and T3).

Treatment of yodood deficient diseases of the thyroid gland

Detected in elderly patients a slight hyperplasia of the thyroid gland, not accompanied by functional disorders, usually does not require medical therapy. Conducting active therapy for yodood deficient diseases of the thyroid gland is shown by young patients. In the endemic area of \u200b\u200bthe area, the patient's treatment is beginning with the prescription of iodine drugs in doses that do not exceed the daily rate, followed by a dynamic estimate of the thyroid gland. In most cases, during the six months, the sizes of the thyroid gland decrease or come back.

If the desired result is not achieved, the treatment continues to L-thyroxine (levothyroxine), sometimes in combination with potassium iodide. Typically, this therapeutic scheme causes a decrease in the size of the thyroid gland. In the future, continues monotherapy drugs potassium iodide. Neurological violationsEmbrances developing in the period of embryogenesis and leading to the emergence of neurological cretinism, irreversible and are not amenable to therapy with thiyode hormones.

Prediction and prevention

Acquired iodine deficiency in most cases reversible. Conducted therapy allows to normalize the volume and function of the thyroid gland. In the regions where light iodine deficiency is observed, the development of diffuse eutheroid goiter in patients rarely achieves a significant extent. A number of patients may form nodal formations, leading further to the functional autonomy of the thyroid gland. Psycho-neurological disorders caused by iodine deficiency, irreversible.

The prevention of the iodine deficiency can be carried out by individual, group and massive methods. Individual and group prevention include the use of potassium iodide drugs in physiological doses, especially in those periods when the need for an additional iodine increases (children's and adolescence, pregnancy, breastfeeding). Mass prophylaxis of iodine deficiency involves the use of iodized cooking salts.

Useful products containing high iodine concentrations: seaweed, sea fish, seafood, fishery. Before planning and during pregnancy, a woman needs a definition of thyroid status. To ensure the daily physiological need for an iodine for a children's and adult organism, as well as for risk groups for the development of iodine deficiency diseases, the following iodine use regulations are defined by the World Health Organization in 2001.

• breast children - (0-23 months) - 50 μg per day;
• young children (2-6 years old) - 90 μg per day;
• children of junior and middle school age (6-11 years old) - 120 μg per day;
• teens and adults (from 12 years and older) - 150 μg per day;
• pregnant and nursing women - 200 μg per day.

Worldwide. Russia belongs to countries with light iodine deficiency. The hardest situation is observed in Africa and Central Asia countries.

Insufficiency of iodine in water, soil and food often leads to the development of iodineic states, of which the endemic goiter occurred is the most common. Its prevalence among the population hesitates around 15-40%. The article will tell all information about iodine deficient states - description, symptoms, treatment of diseases, their prevention.

Why need iodine

Iodine is the most important trace element required by the human body for adequate functioning and vital activity. It is the only one part of the hormones of the thyroid gland and directly participates in their synthesis.

The thyroid gland performs a special regulatory role in the human body. Its hormones contribute 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 in all these processes Iodine is involved.

Unfortunately, our country refers to regions with yodmethty. Since Russia has a large territory, the regions have a different degree of iodine deficiency. Mountain areas are most affected - the North Caucasus, the Far East, Altai, Siberian Plateau. To regions with a slight degree of deficit, Moscow and the Moscow region belong.

In connection with the relevance of the problem, it is very important to know the causes and signs of iodine deficient diseases. The main etiological factor in the development of this group of pathologies is considered to be a small concentration in local water bodies, soil and, as a result, insufficient consumption of trace element with food.

A bit of history

For the first time, our country, as early as the Young Soviet Union, joined the program to track the iodineific states at the beginning of the twentieth century. In 1927, the first studies in the regions began, based on the results of which areas with the highest shortage began to receive quite quickly managed to correct the situation. In addition, methods of insufficiency were developed, including children.

It seems to be solved. However, the world began to consider iodine deficiency under a different angle - the number of trace element was not evaluated in soil or water, as before, but in the urine of a person.

Since then, scientists have discovered that there is an easy degree of deficiency, which can lead to a decrease in mental (cognitive) abilities, as well as cause various forms of behavior in old age. Gradually, our country has slightly lagging behind Europe in matters of preventing diseases associated with iodine deficiency.

Views of iodhyatic states

First of all, the lack of iodine is classified according to the degree of its deficit in the body. This indicator is determined by the number of trace element in the patient's urine. Share degrees:

• Easy - the amount of iodine in the urine - from 50 to 99 μg / l.
• Average - from 20 to 49.
• Heavy - less than 20.

With iodhythic states, the thyroid gland often occurs. To determine its degree, the gland is palpable along the front surface of the neck. Allocate:

• the zero degree - not increased and is not palpable;
• 1st degree - palpulated and increased to 2 cm;
• The 2nd degree - the increased thyroid show can be seen when the head is folding back, the experienses and its shares are palpable;
• 3rd degree - goiter.

The spectrum of iodhythic states is quite large and is not limited to the diseases of the thyroid gland. Different age groups have different manifestations of the lack of iodine. In the intrauterine period to the states that can be associated with iodine deficiency include abortions, stillbirth, congenital anomalies, neurological and methamatic cretinism, psychomotor disorders.

The newborn is neonatal hypothyroidism. Children and adolescents are backwardness in mental and physical development. In adults - goiter with its complications and iodinducated thyrotoxicosis.

After a full inspection and surveys, the setting of the correct diagnosis is important. In medicine, the whole range of diseases is presented in the international classification of diseases - MKB-10. Iodhyatic states are described under the E00-E02 code. These include:

• diffuse, nodal endemic goiter;
• subclinical hypothyroidism due to iodine deficiency;
• congenital iodine deficiency syndrome (neurological, methematous and mixed form).

Pregnancy

Pregnant women make a special group of health observation. For their condition and health, careful observation is underway for all 9 months. Gynecologists try to minimize the risks of development congenital anomalies The child has.

Outside pregnancy For normal life, a woman is required from 100 to 150 μg iodine per day, and when you wear a baby, the need for this microelegen increases to 250 μg. In such an important period of life, the future mother cares no longer only about himself. Its thyroid gland increases by 16%, but this is not connected with increased hormone products, but with increased blood circulation of the organ. The woman is very susceptible to the occurrence of iodhyatic states during pregnancy.

The trace element plays a crucial role in preserving pregnancy in the early stages. Due to it, the ratio of the luteinizing and follicularity of the pituitary function is changing in favor of the first. Thus, the development of the yellow body of pregnancy in the ovary is stimulated, which prevents the miscarriage.

With iodine deficiency, the likelihood of not only premature interruption of pregnancy, but also stilling. There are also frequent cases of the development of various developmental anomalies, such as endemic cretinism (a pronounced form of mental and physical development delay), neonatal goiter and others.

The trace element plays an important role in the development of bone and cartilage tissue, formation of lungs and kidney, central nervous system, formation of intelligence. With an insufficient number of thyroid hormones, the mass of the fetal brain is reduced.

The process of formation of erythrocytes - erythropoes - is also under the jurisdiction. Due to the sufficient availability of iodine in the body increases the absorption of iron in the gastrointestinal tract and the transferpin synthesis - the protein responsible for its transportation to the hematopoietic authorities.

In the fetus, the first primitive glands are formed 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 its own hormones is 50/50% and practically it remains to the end.

As can be seen, the full nutrition and prevention of iodine deficient diseases of the thyroid gland during pregnancy can significantly reduce the risks of the emergence of states, threatening the life and health of the future kid.

In children

In Russia, goiter is already detected by 20-40% of the children's population. While in the absence of a deficit of iodine, the disease is found only in 5% of children. With age, the risk of developing diseases caused by iodine deficiency is only increasing. So in children up to 1 year, the risk is about 2%, adolescents increase to 30-50%.

The insufficiency of Iodine intake with food contributes to a decrease in neuropsychic, mental development, violation of cognitive functions, puberty, the development of speech and hearing is reduced. Doctors noted an increase in mental retardation 2 times in iodhythic areas. There was also a decrease in schoolchildren's performance by 15%.

In the course of research, iodhya states in children are clearly correlated with an increase in the frequency of the development of infectious, cardiovascular diseases, diseases of the gastrointestinal tract, allergic rhinitis. The listed pathologies are 2 times more often when the most important trace element is lacking. The curvature of the spine is found 4 times more often than children without goiter.

Children are definitely extremely subject to disease development. Permanent growth and development, accelerated metabolism require the receipt of a huge amount of resources. Including iodine. The diagnosis of iodineic states in children is carried out by the same methods as in adults.

Symptoms

With a moderate iodine deficiency, people experience difficulties in solving logical tasks, there is a decrease in cognitive functions: the memory deteriorates, the performance is reduced, attention is reduced. Such symptoms of iodineic states in children are especially noticeable. In addition, patients often complain about Apathy, Handra, constant fatigue, sleep disorders, sense of constant lack of sleep, headaches.

Since the hormones of the thyroid gland primarily regulate the metabolism, then during their deficiency there is a slowdown, which leads to a set of body weight, despite the observed diet. Among the dry skin dry, nail and hair fragility. It is possible to increase blood pressure, cholesterol levels in the blood. In most cases, there are violations in most cases menstrual cycle And infertility.

As a result of the iodine deficit, the synthesis of hormones of the pin is reduced, they are not enough organism for normal life. Therefore, it is developing an increase in the gland to compensate, it develops that it contributes to the normalization of the level of thyroid gomon. The only symptoms of this disease can be signs of comprehension of organs in the field of neck, for example, a violation of the act of swallowing, a feeling of coma in the throat. Also an increase in the bridge, which can create discomfort due to appearance.

Diagnostics

Any survey consists of alternate steps: a survey, inspection, palpation, laboratory and instrumental examinations. The survey is made in order to determine the symptoms of the yodfeithic diseases of the thyroid gland. It is the basis of all diagnosis. Knowing the symptoms that torment the patient, the doctor narrows the circle of possible pathology.

The next step is to inspect. In suspected of a deficiency of iodine or thyroid hormones, primarily examine the area of \u200b\u200bthe neck for a visible increase in the organ, then it is searched for additional features: determine the condition of hair, nails, skin, visible mucous membranes. Then proceed to the palpation of the pin. The specialist gently proves the experiencing, both shares, assesses their structure and density. Thus, you can reveal small nodules in the thickness of the fabric.

For laboratory diagnostics Using the indicator of TSH (thyrotropic hormone). According to the negative feedback mechanism, it may increase with a reduced content of the hormones of pin or decrease with them. If the TST is in normal values, then the free T4 and T3 fractions are becoming the main in the diagnosis. Their decrease indicates hypothyroidism. Low tong indicators are combined with a high content of thyroid hormones and indicate hyperthyroidism, which is also possible in the formation of goiter.

In addition to laboratory tests, the doctor must necessarily appoint an ultrasound of the thyroid gland. This method of examination allows you to assess the structure of the tissue, nodes, their size, the presence of enhanced blood flow in the organ. But unfortunately, to determine the possible malignancy for the formations of ultrasound examination is not forces.

This uses a thin game aspiration puncture biopsy. This is piercing the needle of the thyroid gland, followed by the fence of the tissue sample. The procedure is underway under the control of the ultrasound, because it is very important to get into the focus of the altered fabric. The biopsytte is then examined under the microscope and issue a conclusion about malignancy or good quality of education.

Another research method is scintigraphy. It shows the intensity of the formation of hormones in the chart and has clear indications:

• node of medium size in hyperthyroidism;
• a large assembly of half a share or more (blood tests in this case do not matter);
• improper arrangement of the bridge or its fabric.

The procedure provides for the introduction of radioisotope iodine, which accumulates in the thyroid gland. For certain periods of time, the organs are made, which are then studied. The doctor makes a conclusion about the presence of so-called hot knots, accumulating isotope, and cold knots - without it.

Treatment

In case of endemic zob 1, only iodine drugs are appointed. With a 2nd degree, there are 3 therapy schemes. The doctor can appoint only iodine preparations. If they do not help, instead of the previous medicine or together with it, L-thyroxine is prescribed as replacement therapy. The schemes described must reduce the thyroid sizes. In this case, the patient begins to take only iodine preparations.

Conservative or drug therapy Effective only in the case of a diffuse or mixed form of the disease. Therapy or L-thyroxine, as a rule, does not give effect.

There is I. surgical method Treatment, which can be used in the event of non-efficiency of drug therapy. It is also chosen in suspected of malignant rebirth of the goiter, if there are symptoms of the surrender of neighboring organs, with the rapid growth of the goiter. After surgery, a lifelong replacement hormone therapy is appointed.

It is worth noting, treatment in children of iodineific states obtained in the intrauterine period is not carried out. Such consequences of iodine deficiency irreversible.

Prevention of states

The states caused by the disadvantage of iodine intake into the human body are the second prevalence among endocrine diseases after diabetes. However, in contrast to him, the lack of trace element is much easier to prevent.

Prevention of iodhyatic states can be a mass, group or individual. Mass is carried out by adding iodine to various foods: bread, eggs, salt. Some countries even add a trace element in agricultural animals.

The most vulnerable to such state categories of the population are pregnant and lactating women, children and adolescents. It is in relation to them are primarily aimed at preventing diseases caused by the disadvantage of the most important trace element. This is a group prevention.

Individual holds for itself every person alone. If he understands the whole importance of iodine, knows what his lack leads, and takes care of his health, it takes the right decision to introduce the necessary foods to its diet.

It is possible to replenish the deficit not only with the help of products with artificial introduction into their composition of iodine, but also by eating food originally rich in them. This is primarily marine products: shrimp, crabs, squid, fish, sea cabbage.

Easily trace a small pattern. In countries where food culture is concentrated around seafood, such as Greece, Italy, Japan, iodhythic states are extremely few among the population. And most of our country in connection with the lack of full access to the provision described above, there are almost everywhere increased indicators iododeficiency. Therefore, in Russia, iodineic diseases are the second prevalence among endocrine pathologies.

But most simple way Prevention is the replacement of the usual table salt on the iodized. This method is considered the cheapest and affordable for our country.

Iodicial diseases are a serious health problem in many regions of the world. According to WHO, 1570 million people (30% of the world's population) have the risk of developing iodineic diseases, including more than 500 million people live in regions with severe iodine deficiency and high prevalence of endemic goiter

Term " yodmeteric diseases"Currently used to designate all the adverse effects of iodine deficiency on the growth and development of the body, primarily on the formation of a child's brain, which can be prevented by iodine prevention. The spectrum of iodhythic diseases is very wide, the most serious of them are found in children (starting from the period of intrauterine development): congenital malformations, congenital hypothyroidism, cretinism, violations of mental, physical and sexual development.

Yodmeteric diseasesare a serious health problem in many regions of the world. According to WHO, 1570 million people (30% of the world's population) have the risk of developing iodineic diseases, including more than 500 million people live in regions with a heavy deficit of iodine and the high prevalence of endemic goiter. About 20 million people have mental backwardness due to iodine deficiency. Yodhyatic diseases include pathological conditions associated with a disorder of the thyroid function due to a decrease in iodine consumption. Most often, in this group of diseases, the disease is encountered as iodhyatic, or endemic, goiter or an increase in the thyroid gland, which develops as a result of iodine deficiency in individuals living in the iodineic regions. Also, such a condition is called eutheroid goiter, since most patients have a normal background of thyroid hormones in the blood. Despite the fact that with eutheroid zob, patients do not impose significant complaints, and clinical symptoms are often represented only directly by the increase in the thyroid gland, it is impossible to treat this disease with carelessness. A deep analysis of the health of such patients showed that children with goiter have the worst figures of physical and sexual development, with difficulty study at school, their health of their health in many indicators is worse: they are more and more severe, more often have chronic diseases, changes from the cardiovascular system, Blood indicators and others. In adult patients with eutheroid goiter, cardiovascular diseases are more common, in women of childbearing age - violations of the reproductive system.

Increase thyroid gland With iodhyrate states, it is explained by its compensatory hyperplasia (the growth of tissue) in response to the low intake of iodine into the body, insufficient for normal secretion of thyroid hormones. In response to a decrease in the level of thyroid hormones in the blood, an increase in the secretion of TSH, which is the reason for the initial diffuse gland hyperplasia, and then the development of nodal forms of goiter. The thyroid gland, testing "iodine hunger", is capable of more active seizure of iodine entering the body (on which one of the methods of diagnosing these states - a sample with the accumulation of radioactive iodine), but its concentration in the gland remains reduced. If normally in the thyroid gland accounts for 500 μg of iodine per 1 g of tissue, then with iodineic goiter - 100 μg of iodine per 1 g of tissue.

Risk factors for the development of iodine deficiency diseases

It should be noted that besides direct iodine deficiency big role In the development of euthyroid goiter, various additional factors can play. It has been proven that the increase in the manifestation of iodine deficiency on the body contributes to the decrease in trace elements such as cobalt, copper, zinc, molybdenum, etc. Insufficient nutrition and especially the decrease in vitamin A device leads to a violation of the structure of thyroidoglobulin and, accordingly, the synthesis of thyroid hormones. In some plant foods (soy, peanuts, tour, cauliflower, etc.) contains substances that can disturb the synthesis of thyroid hormones or an iron seizure of Iodine. Intestinal wand in the process of its livelihoods, it produces unknown proteins or enzymes that reduce the ability of the thyroid gland to capture iodine. It is also shown that in the pathogenesis of iodhythic diseases and simple non-toxic Zoba An autoimmune processes are involved. The existence of such resolved factors leads to the fact that even with a minimal decrease in iodine intake, euticoid goiter can develop into the body.

The daily need for iodine is 150-250 μg (In Europe, up to 300 μg / day, and in the USA - 400-500 μg / day or more). If iodine is received below 100 μg per day, a compensatory increase in the thyroid gland is developing.

Jodmeteric Risk Groups

There are groups of people who are particularly high risk of developing iodhyatic diseases. These are children, adolescents before and during the period of puberty, as well as pregnant. The greatest frequency of the eutheroid goiter in adolescents in comparison with other age groups is associated with increased requirements for the level of formation of thyroid hormones at this age, due to the following factors:

- shortening the half-life of thyroxine due to increased destruction of it in tissues against the background of the increased need of the body in thyroid hormones during the period of rapid growth and sexual formation;

- features of the iodine exchange at this age: intensifying the absorption of iodine by the thyroid gland, increase the release of iodine with urine, decreased by virtue of this concentration of iodine in the blood, that when it leads to relative iodine insufficiency, even in the conditions of the normal intake of iodine from the outside and, moreover, with a deficit iodine in the environment.

During pregnancy, the daily need for iodine increases by 2 times, which is associated with the change in the hormonal background of the woman, as well as the fact that the iodine entering the mother's body is used on the synthesis of thyroid hormones in the fetus that it is absolutely necessary for adequate formation of the central nervous system, Skeleton, and in fact to ensure protein synthesis in almost any cell. To overcome iodine deficiency, various methods of prophylaxis are used.

Mass iodine prophylaxis - This prevention at the level of the entire population of people living in the iodhyatic areas, carried out by making iodine into common food - salt, bread. The advantage of these measures is their low cost when covering a large number of people. However, with similar mass of prevention, individual control over the state of people is impossible, which can lead to the adverse consequences of the chronic overdose of iodine. Group iodine prophylaxis - Events on the scale of high-risk groups for the development of iodineic diseases: children, teenagers, pregnant and nursing women. It is carried out by long-term reception of iodine-containing drugs. Individual prophylaxis It is carried out in individuals by taking drugs containing physiological doses of iodine.

Joda preparations for iodhyatic diseases

Joda preparations: iodide

The active ingredient of the drug is the potassium iodide. According to the mechanism of action, the testimony for use and side effects is similar to the preparation of potassium Yodid Berlin Hemi. Produced in tablets containing 100 or 200 μg iodine.