Endemic goitre and iodine deficiency

 

– Goitre is the increase in volume of the thyroid. Endemic goitre appears in iodine deficiency areas. It can also be caused or aggravated by the regular consumption of goitrogens foods (cassava, cabbage, turnips, millet, etc.).

– The development of goiter is an adaptive process: iodine is essential for the production of thyroid hormones. Iodine deficiency causes a deficit of production by the thyroid which to offset increases in volume. Thyroid function is often normal.

– In addition to goitre, iodine deficiency in pregnant women has very serious repercussions on the child (fetal and perinatal mortality, developmental delay, cretinism). These risks must be prevented by iodine supplementation in deficient areas.

Clinical signs:

– WHO simplified classification based on the significance of goitre:

Group 0: normal thyroid, no palpable or visible

Group 1: palpable thyroid, not visible when the neck is in the normal position

Group 2: thyroid clearly visible when the head is in the normal position

– Possible mechanical complications rare: compression of the trachea or esophagus deviation.

Prevention and treatment:

Prevention aims to reduce the consequences of iodine deficiency in neonates and children. The salt iodine fortification is the best prevention and depends on a national program.

For the curative treatment of patients with goiter and prevention in areas of deficiency when the salt is not iodized:iodized oil, to comply with the national protocol. For information (according to WHO)

The doses used in healing (single dose) and prevention are the same. Prefer the oral form. Use injectable prevention if the annual oral administration is not possible. The target populations are pregnant women, breastfeeding, child-bearing age and children.

Goitre disappears after a few months in children. It disappears more slowly (or never) in adults despite the normalization of thyroid function, resulting in 2 weeks. Surgery is indicated in cases of local mechanical dysfunction.

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