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    Add as FriendIodine deficiency disorder in children

    by: Mofazzol

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    2 : Iodine: It is a chemical trace element essential for synthesis of thyroid hormones in human body. An adult contains 10 – 20 mg of iodine.
    3 : Daily requirement: The WHO recommendations Adults and adolescents – 150 mcg/d pregnant or lactating mother - 200 mcg/d women and Children – 90-120 mcg/d Infants - 50 – 90 mcg/d
    4 : Dietary sources of iodine Sea food Dairy products Plants Food coloring agents Iodized salt
    5 : Goitrogens: Substances which inhibit iodination of Tyrosine in the thyroid gland. Include – Green leafy vegetables, Cabbage and Kale
    6 : Absorption, Circulation and Function of iodine: Iodine in diet absorbed as iodide which Circulates in blood when enters in thyroid gland becomes radioactive iodine then combines with tyrosine form mono > di > triiodotyrosine (T3) and tetraiodotyrosine (T4)
    7 : IDDs – Population effects of severe iodine deficiency disorders termed IDDs. IDDs include – • Endemic goiter • Hypothyroidism • Cretinism • Decreased fertility rate • Increased infant mortality rate • Mental retardation
    8 : Iodine Deficiency Characteristics
    9 : Symptoms and Signs of IDDs Endemic goiter Pathophysiology – Lack of iodine decrease T3, T4 TSH Stimulates Follicular cells of thyroid gland cause hyperplasia of those cells resulting enlargement of thyroid gland called goiter.
    10 : Histological sections: The normal thyroid (A) contains thyroid in a monolayered sheet around a storage form of thyroid hormone, colloid, while the endemic goiter (B) shows intense hyperplasia with no colloid. Histology of endemic goiter
    11 : Clinical features of Endemic goiter Children present with diffuse goiters, while adults present with nodular goiters. If a goiter is large enough, patients may complain of compressive symptoms such as hoarseness, shortness of breath, cough, or dysphagia.
    12 : Presentation of Endemic goiter
    13 : Differential diagnosis of goiter Autoimmune Hypothyroidism Hyperthyroidism (Toxic nodular) De Quervain thyroiditis Thyroid carcinoma Thyroxine binding globulin deficiency
    14 : Clinical features of Hypothyroidism Fatigue weight gain cold intolerance dry skin constipation depression
    15 : Clinical features of Cretinism – It is most extreme form of IDDs: Two types – Neurologic and myxedematous Neurologic: mental retardation, abnormal gait, and deaf-mutism but not by goiter or hypothyroidism in the child. Myxedematous: mental retardation, short stature, goiter, and hypothyroidism
    16 : A man and 3 females (age range, 17-20 y)with myxedematous cretinism from the Republic of the Congo in Africa, a region with severe iodine deficiency
    17 : Summary of World’s iodine Nutrition Population in millions
    18 : World’s Iodine Nutrition by population distribution
    19 : World’s Iodine Nutrition by Number of countries
    20 : Iodine Nutrition in the World
    21 : Investigation of Iodine deficiency 24 hours urinary iodine - 50 – 100 mcg/L – Mild deficiency 20 – 49 mcg/L - Moderate deficiency < 20 mcg/L - Severe deficiency TSH T4 24 hour radio iodine uptake Thyroid ultrasound will show increase size
    22 : Treatment of IDDs Iodine supplementation – 150 mcg/d In non toxic goiter – Thyroxine In large goiter – Surgical intervention Prevention – Diet ; Seafood, iodized salt (iodized salt – 100 mcg/gm as potassium iodide that is 2 gm iodized salt contain daily adult requirement of iodine)
    23 : Pediatric doses: 6-12 months: 50-75 mcg/d 1-5 years: 75-100 mcg/d 6-12 years: 100-150 mcg/d >12 years: 150 mcg/d

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