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

Abstract

Indonesia used to be affected by varying degrees of iodine deficiency. Salt iodization has been the adopted strategy on a national basis since 1979. The prevalence of goiter in school-age children (SAC) determined by palpation subsequently markedly decreased within the next 15 years. The objective of the present work was to perform an updated evaluation of the status of iodine nutrition in Indonesia by using standardized methods for the measurement of thyroid volume by ultrasounds and the concentration of urinary iodine in SAC. The survey included 7,447 SAC ages 6 to 12 years from 129 sites selected by multistage and stratified sampling in five provinces (4 in Java plus Sumatra and the Province of Bali). A mobile unit (ThyroMobil van) equipped with a sonographic device and facilities for the collection of urine samples visited all sites. In Java plus Sumatra, the median urinary iodine was 195 microg/L. Thirty-four percent of the values were within normal limits (between 100 and 200 microg/L); 17.2% were below 100 microg/L and 48.8% were above 200 microg/L, including 18.2% above 300 microg/L and 0.7% above 1000 microg/L. In Bali, the median was 81 microg/L with 58.3% of the values below 100 microg/L and only 14.7% of the values above 200 microg/L. The prevalence of goiter determined by ultrasounds and using the World Health Organization/International Council for Control of Iodine Deficiency Disorders (WHO/ICCIDD) normative values for gender and age was 3.0% in Java plus Sumatra and 1.9% in Bali. The values were 8.0% and 12.5%, respectively, when using reference values for Indonesia established during the present survey in an iodine replete area in central Java. In conclusion, (1) iodine deficiency has been eliminated in large parts of Indonesia; (2) Bali is still affected by mild iodine deficiency; (3) in many places, iodine deficiency has been replaced by iodine excess, occasionally potentially toxic; (4) the WHO/ICCIDD normative values for thyroid volume measured by ultrasound in SAC are not valid for Indonesia; (5) in Indonesia, the level of salt iodization could be decreased and the biological monitoring of urinary iodine at the population level should be reinforced and maintained; (6) the ThyroMobil model has, as in other parts of the world, demonstrated its efficiency in the organization of partnership evaluation and monitoring of iodine nutrition, as well as in social mobilization.

Are Australian children iodine deficient? Results of the Australian National Iodine Nutrition Study

“…We used a purpose‐built vehicle known as a “ThyroMobil” (Merck, Darmstadt, Germany), which has been used for similar studies of iodine nutrition in other countries 12 . ‐ 14 At each school, students who brought their first morning urine sample to school with a pre‐labelled specific identification number were registered, weighed and their height was measured (to calculate body surface area [BSA]) and they underwent a thyroid ultrasound scan.…”

Thyroid volumes and iodine status in Egyptian South Sinai schoolchildren

“…Since their introduction in 1997, the recommended normative values for thyroid volume in children have been revised on two occasions. The validity of the 1997 WHO/ICCIDD recommended values was challenged by a number of studies, including surveys using a ThyroMobil [22]. A new set of international reference values for thyroid volume assessed by ultrasound examination, based on studies of children living in areas of long-term iodine sufficiency, was released in 2003 [11].…”

“…According to WHO/UNICEF/ICCIDD criteria [21, 22], the proportion of the population with UIC less than 100 µg/l should not exceed 50% and those with UIC less than 50 µg/l should not exceed 20%. Our UIC corresponds exactly to those reported earlier in Egypt and from iodine-sufficient areas such as Campania in southern Italy (median UI = 80 µg/l) [31], Switzerland (median UI = 150 µg/l) [32], Malaysia (median UI = 132.8 µg/l) [6], the Netherlands (median UI = 154.4 µg/l) [26], and Australia (median UI = 132.8 µg/l) [33].…”

“…Urine samples from 87 children were randomly selected from different cities of South Sinai to measure urinary iodine excretion by the catalytic method [20]. WHO/UNICEF/ICCIDD-recommended criteria have been used to classify a population's severity of iodine deficiency disorders (IDD) based on schoolchildren [21, 22]. The epidemiological criteria for assessing iodine nutrition are based on median UI and are as follows: mild deficiency, 50–99 µg/l; moderate deficiency, 20–49 µg/l; and severe deficiency, < 20 µg/l [11].…”

Egg, iodine, and iron supplementation increase nutrition: iodine and iron status in elementary school children in rural Indonesia

“…According to Djokomoeljanto et al, the protein intake can reduce the occurrence of IDD and improve the condition of the disease in endemic IDD. 25 According to Mayes, the adequacy of protein in endemic goiter area is very beneficial to its role in reducing the prevalence of goiter, if protein intake is insufficient, the thyroid hormone is unable to form tiroglobulin. 26 The analysis of this study concluded that especially in young children in the endemic goiter should be anticipated adequacy of the protein.…”