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Iodine Deficiency Goiter
Dr Sajida Naseem
Assistant Professor
Section of
Community & Family Medicine
Affects all the basic body functions,
including physical and mental growth,
metabolism, reproduction and
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.
World Thyroid Day
• 25th May
• To promote awareness and understanding
of thyroid health and the advances made
in treating thyroid diseases.
• Is an enlarged thyroid gland
• It may be diffuse or nodular
• May cause a variety of compressive
• Thyroid function may be normal (nontoxic
goiter), overactive (toxic goiter), or
underactive (hypothyroid goiter).
• Iodine is important in promoting the
development and release
of thyroid hormones, which are
essential in driving many mental and
bodily processes.
• 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
Iodine Requirements
Required Iodine Levels in Salt
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.
Benign or Malignant?
• Most are benign, causing only cosmetic
• Morbidity or mortality may result from:
compression of surrounding structures,
thyroid cancer,
hyperthyroidism, or hypothyroidism.
Age & Sex Distribution
• 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.
• Decreases with advancing age. The decrease in
frequency differs from the incidence of thyroid
nodules, which increases with advancing age.
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
• 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
• TSH.
• Urinary Iodine Excretion.
• An assessment of free thyroxine would be the
next step in the evaluation.
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
Medical Care
• Small benign euthyroid goiters do not require
• Large and complicated goiters may require
medical and surgical treatment.
• Malignant goiters require medical and surgical
• The size of a benign euthyroid goiter may be
reduced with levothyroxine suppressive
Goals of Treatment
• To reduce morbidity and to prevent
In Pakistan
NNS -2011
NNS – 6-12 yrs old children
NNS - 2011
NNS 2011 vs 2001
NNS 2011 VS 2001
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.