ICCIDD PRESS RELEASES

1. ABC's 20/20 to feature Iodine Deficiency Disorders Story

2. Statement on Iodine Induced Thyrotoxicosis (Jodbasedow)

3. New Animated Public Service Announcements for the Elimination of IDD **NEW**

 


ABC feature Iodine Deficiency Story

The American Broadcast Company's (ABC) popular 20/20 public affairs program will air the Iodine Deficiency Disorders (IDD) story on Friday, September 24th.

20/20 with Hugh Downs and Barbar Walters will focus on Indonesia as well as the global effort to eliminate iodine deficiency disorders. The segment will include footage from the United Nations Children's Fund (UNICEF) and interviews with victims of iodine deficiency disorders and health care professionals in Indonesia. A portion of the segment will also focus on Kiwanis International and their fund-raising efforts featuring members of the Builders Club in High Point, North Carolina and their school fund-raising efforts to eliminate iodine deficiency. Kiwanis International is committed to raising $75 million for this global effort.

IDD continues to be a problem putting over 1.6 billion people worldwide at-risk. Iodine is an important micro-nutrient necessary for proper mental and physical growth of both unborn fetuses and young children. As iodine is only found in soil, humans recieve their iodine by consumiong animal products and plants. The lack of iodine in the diet has devastating consequences including cretinism, goiter, and low Intelligence Quaotient (IQ). Visible goiter, often with a swollen neck, represents only the tip of the iceberg for the vast pool of IDD sufferers.

In 1990, the World Summit for Children vowed the virtual elimination of IDD by the year 2000 by promoting the iodization of salt and its use. To date, while global significant progress towards reducing iodine deficiency disorders has taken place over the past decade, much still remains to be accomplished.

Check your local listings for the time 20/20 airs on your local American Broadcasting Company (ABC) affiliate Friday, September 24th.

ICCIDD Statement on Iodine Induced Thyrotoxicosis (Jodbasedow)

Submission Date: March 1997

Submitted By: International Council for Control of Iodine Deficiency Disorders, Avenue de la Fauconnerie 153, B-1170 Brussels, Belgium, F. Delange, MD, Executive Director, Tel: 32-2-675 85 43, Fax: 32-2-675 18 98, e-mail: fdelange@ulb.ac.be

Introduction:

Iodine Induced Thyrotoxicosis (IIT) also called Iodine Induced Hyperthyroidism or "Jodbasedow" is one of the iodine deficiency disorders.

It has been reported in Europe and Latin America in the 1960's and 1970's following the introduction of iodized salt. The epidemiology was documented in Tasmania, Australia, following the introduction of iodized bread in 1966 and the addition of iodophors to milk by the dairy industry. Milk iodine has also been a major factor more recently in Europe.

The condition is recognized to be an inevitable consequence of increase in intake of iodine from any source into an iodine deficient population. It continues to be a significant problem in Europe. Its occurrence depends on the existence of an older age group (over 40) that has been iodine deficient since birth.

It can be totally prevented in the next and subsequent generations by correction of iodine deficiency.

It is not regarded as a contraindication to programs of iodine supplementation in view of the enormous benefits consequent on the correction of iodine deficiency in the whole population.

These include: improvement in child survival, child learning, women's health, economic productivity and quality of life.

Description:

The condition occurs in older goitrous subjects with thyroid nodules due to longstanding iodine deficiency. Many of these nodules are autonomous, or independent of usual physiologic controls, and have responded to iodine deficiency by enhancing their uptake and utilization of iodine. When presented with a significant increase in iodine intake, these nodules may produce too much thyroid hormone, making the subject hyperthyroid or "thyrotoxic". The clinical manifestation are rapid heartbeat, nervousness, weakness, heat intolerance, and weight loss. Frequently IIT is mild and follows a self-limited course, but in some cases it is more severe and sustained and can sometimes be lethal. The usual treatments - antithyroid drugs (such as methimazole, propylthiouracil, and carbimazole), radioactive iodine, or surgery are highly effective. The greatest threat is delay in diagnosis and treatment.

The incidence of IIT in a population is difficult to establish and relates to case finding, severity of iodine deficiency, and degree and duration of effective iodine supplementation. In some studies the incidence of thyrotoxicosis has doubled over several years following introduction of iodine into iodine-deficient populations, but the incidence then characteristically decreases to a level below that existing before correction of iodine deficiency.

Strategy for Approaching IIT:

When IIT is recognized in a community, we recommend the following:

  1. To the extent practical, advise older subjects, particularly those with nodular goiters, to reduce their salt intake.
  2. Examine the iodine levels in salt and urine to ensure they do not exceed those prescribed in the country's IDD elimination program, and correct production practices that might lead to excess iodine in salt or other factors that may cause excess iodine intake in older age groups.
  3. Alert the medical community to proper awareness, diagnosis, and treatment of IIT and provide necessary resources for medical care.
  4. Document the number of cases and clinical details in order to assess the magnitude of the problem and then to design appropriate measures for responding.
  5. Implement effective biological monitoring systems, as have already been recommended by ICCIDD and others as an essential component of IDD elimination programs.
  6. Reassure health officials and the community that IIT is transient and treatable, and that its consequences are far outweighed by the benefits of iodized salt for the development of children.
  7. Over the longer range, depending on the number and severity of cases and the actual content of iodine in the salt, consider lowering the required amounts of iodine added to salt.

Conclusions:

Some iodine induced thyrotoxicosis can be anticipated as iodine deficiency is corrected worldwide. Prompt diagnosis and treatment of individual cases are the best approaches to IIT. While IIT is significant, correcting the other iodine deficiency disorders, particularly those affecting the mental and physical development of children, is much more important for the health of the community. Therefore, concern about the development of IIT should not be used as an argument to delay, compromise, or stop a program of iodized salt.


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