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GUA ENDEMIC

Iodine Deficiency Disorders

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putin istoric Cretinism endemic Cretinism sporadic

Dona MercedesIgnacio Zuloaga (1878-1945)Jeune crtine de ValoisGravure XIX-e sicle

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DINAMICA HORMONILOR TIROIDIENI

IN PERIOADA INTRAUTERINA SI POSTNATALA

Maturare SNC

Varsta postnatala (sapt)

50

100

150

200

T4(nmol/L)

1

4

3

2

T3(nmol/L)

0 20 30 40 6

Varsta fetala (sapt)

0

2

4

6

8

10

12

TSH (mU/L)

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Particularitati nou-nascuti

Rata de producere a hormonilor tiroidieni/ kgc/ zi> la nou-nascuti si copii

necesarul zilnic de T4: 10 g/kg nou nascut - 1,6 g/kg adult

Concentratiile

T4, T3, Tg cresc rapid in primele ore dupa nastere si ramin la nivel de hipertiroidie in primele 24 hdupa nastere

TSH creste rapid (peak in min 30 !) si se normalizeaza in 48 ore

ziua 10: T4 si T3 > adult T3 usor crescut in 1 an de viata si scade treptat

Prematuri T3, T4, TSH scazuti (ax Ht-Hfz-Tyimatur)

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EFECTE LA NOU NASCUT / COPIL

maturare sistem nevos central

maturare aparat respirator

maturare cartilagii de crestere

DEFICIT

cretinism

detresa respiratorieperinatala

deficit statural

ROLURI

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Rolul iodului

Dezvoltarea fetal

general i a sistemului

nervos fetal

Dezvoltarea sistemuluiauditiv

Funciile normale ale

corpului fetal

Produse de origineanimal: carne, lapte

Ap

Factori careinterfereaz cumetabolismul iodului:guogeni naturali,

cassava, varz,

tiocianai, fluoruri,

deficitul de seleniu

Surse

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IDD

Creterea volumului tiroidian la copii i aduli

Retard mental sever

Tulburri de cretere

Defecte de auz i de vorbire Reducerea capacitii intelectuale chiar in

zonele cu deficit iodat uor

Cretinism:

neurologic

mixedematos cnd coexist i deficitul de seleniu

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IDDs

Prenatal: retard mental, greutate

mic la natere, cretereafrecvenei morii

intrauterine Nou nscut:

gu, hipotiroidismtranzitoriu, hipotiroidismdefinitiv, creterea

frecvenei mixedemuluicongenital

Copilrie i adolescen:

gu, retard mental istatural, hipotiroidism

clinic sau subclinic

Adult :

Gua i complicaiilesale, inclusiv noduli sidezvoltarea unor

cancere tiroidiene maiagresive

Retardare mentalendemic

Hipotiroidism

Reducerea fertilitii

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IDDsaport normal de iod

50 g copii mici sub 12 luni

90 g copii ( 2-6 ani)

120 g colari(7-12 ani) 150 g pentru aduli peste 12 ani

200 g femei care alpteaz

Limita superioara a aportului nepericulos deiod

Adult 1100 g/zi

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IDDsproblem de sntate public

1. 2.2 miliarde persoane la risc

2. 50 milioane copii la risc

3. 100,000 copii cu cretinism se nasc in fiecare an

Africa

Populaie la risc: 220 million

Mori fetale: 15,000

Cretini: 30,000

Copii cu afectare cerebral: 1 million

China

Prevalena IDD: 8.4-85 %

Cretinism endemic: 0.63-11.4 %

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IDDsevaluare

1. Clinica:

Onormal,

Ipalpabil,

IIvizibiln poziie normal a capului

2. Determinarea volumului tiroidian:

Brbai aduli: pn la25 mL

Femei adulte: pn la18 mL

3. Biochimici :

iod urinar :10 g / dL

seric TSH > 5 mIU/L

Tiroglobulina seric: sub 10 ng/mL la adults

Iodul in laptele matern: 9 g / dL

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IDDs severitatemodul de apreciere

variabil Normal Uoar Moderat Sever

Gua la adult%

VTy peste normal %

Iodul urinar g/dl

Tiroglobulina ng/mL

10

5 - 19.9

5 - 19.9

5 - 9.9

10 - 19.9

20 - 29.9

20- 29.9

2 - 4.9

2039.9

> 30

> 30

40

Nou nscuti

TSH n ser > 5 mIU/L

Iod urinar ng/mL

< 3

> 10

319.9

3.59.9

2039.9

1.53.4

> 40

< 1.5

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gu istoric

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Histologia guii endemice

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Gu intratoracic gigant

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Cretinism endemic mixedematos:

Hipostatur, hipotiroidie, retardare mental

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Cretinism endemic neurologic

Paralizie spastic, retardare mental sever, surditate

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IDD cele mai afectate arii Himalaya Africa central America de SudAnzii

Prevalena

guii n

state dinAmerica

de Sud

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Tratament?

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IDD profilaxie

Aportul de iod este asigurat prin:

Sare iodat Cost cca 0,04 $/persoana/an

Ulei iodat, injectabil

Iodarea apei Universal Salt Iodization Program:

implementare, supraveghere

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Prevalena guii se coreleaz invers cu excreiede iodcare reflect aportul iodat

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Programele de iodare a srii nu a dat rezultatele scontate din cauza lipsei

de supraveghere permanent a rezultatelor severitatea endemiei s-aredus

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IDD profilaxie

Gua este considerat practic eradicat n

Europa dar zone de endemie uoar mai

persistPrima ar care a eradicat endemia de gu a

fost Elveia care a implementat programul de

iodare a srii din 1932

In ara noastr persist unele zone de deficitiodat uor

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