Investigation of iodine deficient state and iodine supplementation in patients with severe motor and intellectual disabilities on long-term total enteral nutrition

Abstract

IODINE is an essential trace element for synthesis of thyroid hormones and thyroxine (T4) is also essential for brain development. Iodine deficiency (ID) might cause hypothyroidism resulting in severe developmental delay in infants and stillbirth in pregnant women [1,2]. Patients on long-term total enteral nutrition (TEN) are at risk of ID because of the low iodine content of EN formulae (Table 1) [3][4][5]. We measured urinary iodine concentration (UIC) in patients with severe motor and intellectual disabilities (SMID) receiving long-term TEN. We also provided iodine supplementation (IS) for ID cases in the form of powdered kelp and monitored their thyroid function, UIC, biochemical parameters and vital signs. SubjectsWe enrolled 35 SMID (Male 24, Female 11, Investigation of iodine deficient state and iodine supplementation in patients with severe motor and intellectual disabilities on long-term total enteral nutrition Abstract. Iodine concentrations of enteral nutrition (EN) formulae available in Japan are very low and long-term total EN (TEN) might result in hypothyroidism due to iodine deficiency (HID). Our aim of this study was to determine the degree of iodine deficiency (ID) and need for iodine supplementation (IS) in patients with severe motor and intellectual disabilities (SMID) on long-term TEN. Thyroid function including urinary iodine concentration (UIC) was monitored, and powdered kelp was provided as a source of iodine supplement. Thirty-five SMID on TEN participated in our study. UIC less than 100 μg /L, representing ID, were detected in 97 % of them. Their TSH ranged from 0.5 to 90 μIU/mL. IS using powdered kelp raised their UIC to the normal range. Thyroid function also recovered in the five hypothyroidism cases, which were diagnosed as HID, was also detected. In Japan, there must be many cases with ID associated with long term TEN. We also discuss the regulation of thyroid function in the iodine deficient state.

Prevalence of thyroid dysfunction with adequate and excessive iodine intake in Hebei Province, People’s Republic of China

“…Iodine is an essential trace element for the synthesis of thyroid hormones and thyroxine is also critical for brain development. Iodine deficiency may cause hypothyroidism and results in severe developmental delay in infants and stillbirth in pregnant women (1)(2)(3) . WHO, UNICEF and the International Council for Control of Iodine Deficiency Disorders (ICCIDD) endorse the policy of iodine supplementation for pregnant and breast-feeding women in iodine-deficient countries where salt iodization is not regulated or is ineffective, in order to improve the nutritional status of iodine (4) .…”