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Iodine Deficiency
Iodine is a natural chemical element, like oxygen, hydrogen and iron. It occurs in a variety of chemical forms, the most important being iodide, iodate and elemental iodine. It is present in fairly constant amounts in seawater but its distribution over land and fresh water is uneven. Deficiency is especially common in mountainous areas (e.g., Himalayas, Andes, Alps) and areas of frequent flooding, but many other areas are also deficient (e.g., Central Africa, Central Asia, much of
Yodium (1)
Iodine is an essential component of the thyroid hormones, thyroxine (T4) and triiodothyronine (T3), comprising 65 and 59 percent of their respective weights. Thyroid hormones, and therefore iodine, are essential for mammalian life. They regulate many key biochemical reactions, especially protein synthesis and enzymatic activity. Major target organs are the developing brain, muscle, heart, pituitary, and kidney.
Yodium (2)
Observations in several areas have suggested possible additional roles for iodine. Iodine may have beneficial roles in mammary dys-plasia and fibrocystic breast disease (Eskin, 1977; Ghent et al., 1993). In vitro studies show that iodine can work with myeloperoxidase from white cells to inactivate bacteria (Klebanoff, 1967). Other brief reports have suggested that inadequate iodine nutrition impairs immune response and may be associated with an increased incidence of gastric cancer (Venturi et al., 1993). While these other possibilities deserve further investigation, the overwhelming importance of nutritional iodine is as a component of the thyroid hormones.
Physiology of Absorption, Metabolism, and Excretion
Iodine is ingested in a variety of chemical forms. Most ingested iodine is reduced in the gut and absorbed almost completely (Nath et al., 1992). Some iodine-containing compounds (e.g., thyroid hormones and amiodarone) are absorbed intact. The metabolic pathway of iodinated radiocontrast media, such as Lipiodol, is not entirely clear. The oral administration of Lipiodol increases the iodine stores of the organism and has been successfully used in the correction of iodine deficiency (Benmiloud et al., 1994). Iodate, widely used in many countries as an additive to salt, is rapidly reduced to iodide and completely absorbed.
Once in the circulation, iodide is removed principally by the thyroid gland and the kidney. The thyroid selectively concentrates iodide in amounts required for adequate thyroid hormone synthesis, and most of the remaining iodine is excreted in urine. Several other tissues can also concentrate iodine, including salivary glands, breast, choroid plexus, and gastric mucosa. Other than the lactating breast, these are minor pathways of uncertain significance.
A sodium/iodide transporter in the thyroidal basal membrane is responsible for iodine concentration. It transfers iodide from the circulation into the thyroid gland at a concentration gradient of about 20 to 50 times that of the plasma to ensure that the thyroid gland obtains adequate amounts of iodine for hormone synthesis. During iodine deficiency, the thyroid gland concentrates a majority of the iodine available from the plasma (Wayne et al., 1964).
Iodide in the thyroid gland participates in a complex series of reactions to produce thyroid hormones. Thyroglobulin, a large glycoprotein of molecular weight 660,000, is synthesized within the thyroid cell and serves as a vehicle for iodination. Iodide and thyroglobulin meet at the apical surface of the thyroid cell. There thyroperoxidase and hydrogen peroxide promote the oxidation of the iodide and its simultaneous attachment to tyrosyl residues within the thyroglobulin molecule to produce the hormone precursors diiodotyrosine and monoiodotyrosine.
Thyroperoxidase further catalyzes the intramolecular coupling of two molecules of diiodotyrosine to produce tetraiodothyronine (T4). A similar coupling of one monoiodotyrosine and one diiodotyrosine molecule produces triiodothyronine (T3). Mature iodinated thyroglobulin is stored extra-cellularly in the lumen of thyroid follicles, each consisting of a central space rimmed by the apical membranes of thyrocytes. Typically, thyroglobulin contains from 0.1 to 1.0 percent of its weight as iodine. About one-third of its iodine is in the form of thyroid hormone, the rest as the precursors. An average adult thyroid in an iodine-sufficient geographic region contains about 15 mg iodine (Fisher and Oddie, 1969b).
Thyroglobulin, which contains the thyroid hormones, is stored in the follicular lumen until needed. Then endosomal and lysosomal proteases digest thyroglobulin and release the hormones into the circulation. About two-thirds of thyroglobulin’s iodine is in the form of the inactive precursors, monoiodotyrosine and diiodotyrosine. This iodine is not released into the circulation, but instead is removed from the tyrosine moiety by a specific deiodinase and then recycled within the thyroid gland. This process is an important mechanism for iodine conservation, and individuals with impaired or genetically absent deiodinase activity risk iodine deficiency.
Thyrotropin (TSH) is the major regulator of thyroid function. The pituitary secretes this protein hormone (molecular weight about 28,000) in response to circulating concentrations of thyroid hormone, with TSH secretion increasing when circulating thyroid hormone decreases. TSH affects several sites within the thyrocyte, the principal actions being to increase thyroidal uptake of iodine and to break down thyroglobulin in order to release thyroid hormone into the circulation. An elevated serum TSH concentration indicates primary hypothyroidism, and a decreased TSH concentration shows hyperthyroidism.
The urine contains the fraction of the serum iodine pool that is not concentrated by the thyroid gland. Typically, urine contains more than 90 percent of all ingested iodine (Nath et al., 1992). Most of the remainder is excreted in feces. A small amount may be in sweat.
Clinical Effects of Inadequate Intake
The so-called iodine deficiency disorders (IDD) include mental retardation, hypothyroidism, goiter, cretinism, and varying degrees of other growth and developmental abnormalities. These result from inadequate thyroid hormone production from lack of sufficient iodine. Most countries in the world currently have some degree of iodine deficiency, including some industrialized countries in
The most damaging effect of iodine deficiency is on the developing brain. Thyroid hormone is particularly important for myelination of the central nervous system, which is most active in the perinatal period and during fetal and early postnatal development. Numerous population studies have correlated an iodine-deficient diet with increased incidence of mental retardation. A meta-analysis of 18 studies concluded that iodine deficiency alone lowered mean IQ scores by 13.5 points (Bleichrodt and Born, 1994).
The most visible consequence of iodine deficiency is goiter. This word means "an enlarged thyroid." The process begins as an adaptation in which the thyroid is more active in its attempts to make enough thyroid hormone for the body's needs, despite the limited supply of raw material (iodine), much as a muscle gets bigger when it has to do more work. If this adaptation is successful and the iodine deficiency is not too severe, the person may escape with only an enlarged thyroid and no other apparent damage from the iodine deficiency.
Older individuals with goiters may develop nodules (lumps) in their thyroids, and sometimes these can begin making too much thyroid hormone when suddenly exposed to iodine. This result occurs because these nodules are independent of usual controls; they make thyroid hormone at their own rate, and may over-produce it when given more iodine. Also, the nodular goiters in iodine deficiency have an increased rate of one type of thyroid cancer, called "follicular cancer." Goiters can sometimes enlarge enough to produce compression of other neck structures and may need surgical removal for that reason.
The effects of iodine deficiency on brain development are similar to those of hypothyroidism from any other cause. The United States, Canada, and most developed countries have routine screening of all neonates by blood spot for TSH or T4 to detect among iodine-sufficient children the approximately one in 4,000 who will be hypothyroid, usually from thyroid aplasia. Iodine treatment can reverse cretinism especially when the treatment is begun early (Klein et al., 1972).
Cretinism is an extreme form of neurological damage from fetal hypothyroidism. It occurs in severe iodine deficiency and is characterized by gross mental retardation along with varying degrees of short stature, deaf mutism, and spasticity. As many as one in ten of some populations with very severe iodine deficiency may be cretins. Correction of iodine deficiency in
Sources of iodine
Most of the iodine we consume comes from what we eat and drink. Seafood is usually a good source because the ocean contains considerable iodine. Freshwater fish reflect the iodine content of the water where they swim, which may be deficient. Other foods vary tremendously in iodine content, depending on their source and what may have been added. Plants grown in iodine-deficient soil do not have much iodine, nor do meat or other products from animals fed on iodine-deficient plants. Because the breast concentrates iodine, dairy products are usually a good source, but only if the cows get enough iodine.
Iodized salt is a special case. With only a few isolated exceptions, edible salt (sodium chloride) does not naturally contain iodine. Iodine is added deliberately as one of the most efficient ways of improving iodine nutrition. Either potassium iodide or potassium iodate is used to fortify salt. The amount added varies widely in different regions.
In
These statements apply only to table salt. Most edible salt is added at cooking. If present as potassium iodate, as in most countries, little iodine is lost during cooking, depending on how pure the salt is. Many people get most of their salt from processed foods, especially in developed countries, and commercial practices vary as to whether these contain iodine or not.
· iodine lost from salt is 20% from production site to household,
· another 20% is lost during cooking before consumption, and
· average salt intake is 10 g per person per day,
Iodine exposure can come from many other sources. Certain food colorings (e.g., erythrosine) contain iodine, although it is only partially bioavailable. Some iodine from skin disinfectants, such as povidone iodine, is absorbed and reaches the bloodstream. Certain health foods, such as some types of kelp, contain large amounts of iodine. Other sources are dyes used for contrast in X-ray procedures and medicines, such as Amiodarone (used for heart failure and abnormal heart rhythm).
People also get iodine from its use in farm animals, for cleansing udders or as part of iodine-containing medicines. Iodate has been used as a bread stabilizer in commercial baking, although this practice is less common now. Many other environmental sources of iodine exist; most of them are unrecognized or unpublicized.
Di Posting Oleh : Dorin Mutoif, Poltekkes DEPKES Yogyakarta Jurusan AKL/JKL/KESLING/kESEHATAN LINGKUNGAN Politeknik Kesehatan DEPKES Yogyakarta..
Kesehatan dan Keselamatan Kerja, Fakultas Kesehatan Masyarakat Universitas Indonesia.
Munggu, Petanahan, Kebumen, Jawa Tengah, 54382
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