1. Iodine Deficiency Goiter
Dr Sajida Naseem
Assistant Professor
Section of
Community & Family Medicine

2. Affects all the basic body functions, including physical and mental growth, metabolism, reproduction and digestion.

3. Session Objectives
At the end of the session , students should be able to understand the:
Epidemiology of Iodine Deficiency disorders
Pakistan statistics on IDD
Importance of Iodine in life.
Ref: WHO Guidelines, NNS 2011.

4. World Thyroid Day 25th May
To promote awareness and understanding of thyroid health and the advances made in treating thyroid diseases. 

5. GOITER Is an enlarged thyroid gland It may be diffuse or nodular
May cause a variety of compressive syndromes.
Thyroid function may be normal (nontoxic goiter), overactive (toxic goiter), or underactive (hypothyroid goiter).
. A goiter may extend into the retrosternal space, with or without substantial anterior enlargement.

6. Iodine
Iodine is important in promoting the development and release of thyroid hormones, which are essential in driving many mental and bodily processes.

7. Deficiencies are common in areas where iodine is not abundant in soil and food.
Seafood and crops grown in nutrient-rich soil are typically the best sources for iodine, and people who live far from coastal regions and at high altitudes may not have access to such foods.

8. Iodine Requirements

9. Required Iodine Levels in Salt

10. On an International perspective
Most common cause of goiter is iodine deficiency. 
Affect as many as 200 million of the 800 million people who have a diet deficient in iodine.
Affects 2% of world population
100% treatable.

11. Benign or Malignant?
Most are benign, causing only cosmetic disfigurement.
Morbidity or mortality may result from: compression of surrounding structures, thyroid cancer,
hyperthyroidism, or hypothyroidism.

12. Age & Sex Distribution Sex The female-to-male ratio is 4:1.
Thyroid nodules are less frequent in men than in women, but when found, they are more likely to be malignant.
Age
Decreases with advancing age. The decrease in frequency differs from the incidence of thyroid nodules, which increases with advancing age.

13. Presentation of the case - History
Various ways, including:
Incidentally, as a swelling in the neck discovered by the patient or on routine physical examination
Local compression causing dysphagia, dyspnea, stridor, plethora or hoarseness
Pain due to hemorrhage, inflammation, necrosis, or malignant transformation
Signs and symptoms of hyperthyroidism or hypothyroidism
Thyroid cancer with or without metastases
A finding on imaging studies performed for a related or unrelated medical evaluation

15. Etiology Iodine deficiency
Autoimmune thyroiditis - Hashimoto or postpartum thyroiditis
Excess iodine (Wolff-Chaikoff effect)[5] or lithium ingestion, which decrease release of thyroid hormone
Goitrogens
Stimulation of TSH receptors by TSH from pituitary tumors, pituitary thyroid hormone resistance, gonadotropins, and/or thyroid-stimulating immunoglobulins
Inborn errors of metabolism causing defects in biosynthesis of thyroid hormones
Exposure to radiation
Deposition diseases
Thyroid hormone resistance
Subacute thyroiditis (de Quervain thyroiditis)
Silent thyroiditis
Riedel thyroiditis
Infectious agentsAcute suppurative - Bacterial
Chronic - Mycobacteria, fungal, and parasitic
Granulomatous disease
Thyroid malignancy
Low selenium levels: This may be associated with goiter prevalence.

16. Screening TSH. Urinary Iodine Excretion.
An assessment of free thyroxine would be the next step in the evaluation.

17. Once diagnosed……
Eat more seafood, dairy products, vegetables, and iodized salt.
With treatment and a healthy diet, most people are able to overcome iodine deficiency symptoms in less than one month

18. Medical Care Small benign euthyroid goiters do not require treatment.
Large and complicated goiters may require medical and surgical treatment.
Malignant goiters require medical and surgical treatment.
The size of a benign euthyroid goiter may be reduced with levothyroxine suppressive therapy.
The effectiveness of medical treatment using thyroid hormone for benign goiters is controversial.

19. Goals of Treatment
To reduce morbidity and to prevent complications.

20. In Pakistan
NNS -2011

21. NNS-2011

22. NNS-2011

23. NNS – 6-12 yrs old children

24. NNS

25. NS-2011

26. NNS-2011

27. NNS 2011 vs 2001

28. NNS 2011 VS 2001

29. Thyroid & Pregnancy
Infant may be born with mental retardation and lifelong hearing problems.
Baby may not grow as quickly or fully as healthy infants.
Increases chances of stillbirth.

30. THANKYOU