Hypothyroidism in an Area of Endemic Goiter and Cretinism in Central Java, Indonesia

Abstract

In an area of severe endemic goiter in Central Java, Indonesia, clinical overt or mild hypothyroidism appeared to be present in 7 out of 20 cretins and also in 12 out of 94 non-cretinous subjects, all 5-20 years of age, living in the village of Sengi. Hypothyroidism was not found in a control group of 70 subjects of the same age living in Londjong just outside the edemia. In hypothyroid subjects the plasma PBI-concentration was 0.98+/-0.32 mug/100 ml (mean+/-SD) vs. 2.72+/-1.24 mug/100 ml in euthyroid subjects from Sengi and 4.86+/-0.80 mug/100 ml in controls from Londjong. Values for T3 were 56.3+/-3.17 ng/100 ml in hypothyroids, 140.5+/-38.5 ng/100 ml in euthyroids from Sengi and 121.6+/-27.4 ng/100 ml in controls. The TSH levels (geometric mean and range) in these 3 groups were, respectively, 210.1 (108.0-342), 15.6 (3.0-372) and 4.1 (0.8-7.0) muU/ml. The differences between the mean concentration of PBI, T3 and TSH in the hypothyroid and euthyroid groups were highly significant (P less than 0.001). These data strengthen the clinical diagnosis of hypothyroidism in cretins as well as in non-cretinous subjects. All hypothyroid subjects had a PBI less than 1.8 mug/100 ml and T3 less than 120 ng/100 ml and TSH greater than 100 muU/ml. In 8 hypothyroid subjects, restudied 18 months after iodized oil injection, hypothyroidism was either corrected or markedly improved. It therefore appears that iodine deficiency per se in postnatal life may lead to (juvenile) hypothyroidism, which can be corrected by iodine therapy. Our findings have implications for the definition and diagnosis of endemic cretinism. Not all hypothyroid subjects in an area of endemic iodine deficiency should be classified as cretins.

The Disorders Induced by Iodine Deficiency

“…The fact that in some children, hypothyroidism starts after the age of 3 years is consistent with the observation of Goslings et al (102) that hypothyroid patients in severe endemic goiter are not necessarily affected by severe and irreversible mental retardation and of Boyages et al (12) that cretins with thyroid failure may have only moderate retardation in height and bone maturation.…”

The ThyroMobil Model for Standardized Evaluation of Iodine Deficiency Disorder Control in Indonesia

“…The severity of the endemias was also attested by the presence of endemic cretinism with a prevalence up to 10% to 15% of the population. The historical studies performed by Djokomoeljanto and colleagues (3,(5)(6)(7)(8) indicated that in Indonesia, there was a continuous spectrum of impairment of the mental development in the whole population, of which cretinism was only the extreme form.…”

The Relationship Between Serum Protein-Bound Iodine Levels and Urinary Iodine Excretion and Serum Thyrotrophin Concentrations in Subjects From an Endemic Goitre Area in Central Java

“…These differences, however, do not lead to significant differences in serum TSH levels. Since the 24 h 131I uptake is lower in the cretinous sub¬ jects, primary thyroid failure may also play a part in the reduced thyroid hormone levels in these subjects as we have described previously (Goslings et al 1977).…”

“…The community with severe iodine deficiency has already been described (Goslings et al 1975(Goslings et al , 1977 and consisted of 642 subjects living in Segni, a village situated at an altitude of 600 m in a rural area on the Western slope of the Merapi vulcano in Central Java, Indonesia. The goitre rate for the area was 85 % (classification according to Perez et al (I960)).…”