Observations on Endemic Cretinism in the Chitral and Gilgit Valleys

McCarrison, E.; Berry, James

doi:10.1177/003591570900200601

Cited by 35 publications

(37 citation statements)

References 3 publications

(3 reference statements)

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“…More importantly, a higher goiter prevalence was observed in areas that were afterwards reported as goiter-endemic areas. Later, in 1908 16 and 1927, 30 McCarrison identified the region as severely iodine deficient (Table 1). Shortly after independence in 1947, a local newspaper in 1954 reported epidemics of goiter in Multan, which was later confirmed in formal investigations 31 …”

Section: Resultsmentioning

confidence: 99%

Factors affecting sustainable iodine deficiency elimination in Pakistan: A global perspective

Khattak

Ittermann³

et al. 2017

Journal of Epidemiology

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Iodine deficiency remains a considerable challenge worldwide, even after decades of efforts to address the problem. The aim of this review is to present the current situation in historically iodine-deficient Pakistan regarding iodine nutritional status and place it in a global perspective. We collected relevant articles from online bibliographic databases and websites of concerned organizations that addressed prevalence of goiter/iodine deficiency and barriers to sustainable control. We divided the studies into pre- and post-1994, a landmark year when Pakistan formally adopted the universal salt iodization (USI) programme. Overall, 56 studies reported goiter/iodine deficiency prevalence in Pakistan. Before 1994, six studies (30%) reported a goiter prevalence ≥70%, while nine studies (45%) reported a goiter prevalence between 30% and 70%. Only five studies (25%) found a goiter prevalence less than 30%, of which only two studies reported prevalence <10%. From 1994 onwards, 15 studies (41.7%) reported a goiter/iodine deficiency (ID) prevalence ≥50%, of which seven studies reported prevalence ≥70%, while three studies (8.3%) found a goiter prevalence of 30%–49%, nine studies (25%) found a goiter prevalence of 10%–29%, and five studies (13.9%) reported prevalence of <10%. Four studies (11.1%) reported lower goiter prevalence but higher prevalence of iodine deficiency. The efforts in the past two decades resulted in up to a 50% decline in iodine deficiency disorders (IDD). Variable remaining factors and the recent results, however, indicate that this decline may be non-uniform and even over-estimated. Coordinated and regionally adopted efforts for eradication of IDD from all stakeholders should be pursued. Policy makers should take steps to protect future generations and alert concerned organizations about the importance of careful assessments and estimates of iodine nutritional status.

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Section: Resultsmentioning

confidence: 99%

Factors affecting sustainable iodine deficiency elimination in Pakistan: A global perspective

Khattak

Ittermann³

et al. 2017

Journal of Epidemiology

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“…The materials ranged from 50 to 2244 cases and the age of the subjects from 0 to 20 years. Differences in daily iodine intake, genetic back¬ ground, and environmental factors could contrib¬ ute to the differences in mean thyroid volume (24). The volume certainly varies from one report to another, and iodine deficiency appears to be the decisive factor in endemic goitre areas (25).…”

Section: Discussionmentioning

confidence: 99%

Thyroid gland volume and echo structure in 13-year-old children in northern Finland

Takalo

Mäkäräinen²,

Jaakkola³

1991

Acta Endocrinologica

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The purpose of this work was to determine by ultrasound the volume and echo structure of the thyroid gland in 13-year-old schoolchildren in northern Finland. 76 healthy schoolchildren underwent cervical ultrasound examinations during the period of Jan-Feb 1990, performed with a real-time scanner using a 7.5 MHz linear transducer and direct contact method. The volume of each lobe was calculated according to the formula for a volume of rotation ellipsoid by multiplication of maximal thickness, width and height of the lobe by the correction factor 0.479. Any focal lesion that could be distinguished in the homogenous thyroid parenchyma was assessed for echogenicity as compared with the normal thyroid gland and was measured with electronic calipers. The mean thyroid volume was 6.5\m=+-\1.6ml (mean \m=+-\sd),being 6.3\m=+-\1.8 ml in the boys and 6.7\m=+-\1.4 ml in the girls. The sex difference was not significant. The right lobe was significantly larger than the left one (mean 3.7 and 2.8 ml, respectively). Thyroid volume was correlated with body weight and body surface area in both sexes. Abnormal lesions in terms of echo structure were noted in one subject (1.3%). Comparing the results with the findings reported from other countries, it can be concluded that the thyroid volume in these 13-year-old Finnish schoolchildren was about 30% less than that reported for the same age group in the FRG (with insufficient iodine intake) and about 35% more than in 13-year-old schoolchildren in Sweden (with sufficient iodine intake).

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“…Thyroid hormone is required for normal neuronal migration; myelination of the brain during fetal and early postnatal life and hypothyroxinemia during these critical periods causes irreversible brain damage, with mental retardation and neurological abnormalities (109). The consequences depend upon the timing and severity of the hypothyroxinemia.…”

Section: Neurological Development Of the Offspringmentioning

confidence: 99%

Iodine Deficiency

2009

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Iodine deficiency has multiple adverse effects in humans, termed iodine deficiency disorders, due to inadequate thyroid hormone production. Globally, it is estimated that 2 billion individuals have an insufficient iodine intake, and South Asia and sub-Saharan Africa are particularly affected. However, about 50% of Europe remains mildly iodine deficient, and iodine intakes in other industrialized countries, including the United States and Australia, have fallen in recent years. Iodine deficiency during pregnancy and infancy may impair growth and neurodevelopment of the offspring and increase infant mortality. Deficiency during childhood reduces somatic growth and cognitive and motor function. Assessment methods include urinary iodine concentration, goiter, newborn TSH, and blood thyroglobulin. But assessment of iodine status in pregnancy is difficult, and it remains unclear whether iodine intakes are sufficient in this group, leading to calls for iodine supplementation during pregnancy in several industrialized countries. In most countries, the best strategy to control iodine deficiency in populations is carefully monitored universal salt iodization, one of the most cost-effective ways to contribute to economic and social development. Achieving optimal iodine intakes from iodized salt (in the range of 150-250 microg/d for adults) may minimize the amount of thyroid dysfunction in populations. Ensuring adequate iodine status during parenteral nutrition has become important, particularly in preterm infants, as the use of povidone-iodine disinfectants has declined. Introduction of iodized salt to regions of chronic iodine deficiency may transiently increase the incidence of thyroid disorders, but overall, the relatively small risks of iodine excess are far outweighed by the substantial risks of iodine deficiency.

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Observations on Endemic Cretinism in the Chitral and Gilgit Valleys

Cited by 35 publications

References 3 publications

Factors affecting sustainable iodine deficiency elimination in Pakistan: A global perspective

Factors affecting sustainable iodine deficiency elimination in Pakistan: A global perspective

Thyroid gland volume and echo structure in 13-year-old children in northern Finland

Iodine Deficiency

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