Iodine and the Brain September 9, 2005 Rajata Rajatanavin, M.D., F.A.C.E. Ramathibodi Hospital, Mahidol University, Bangkok.

งานนำเสนอเรื่อง: "Iodine and the Brain September 9, 2005 Rajata Rajatanavin, M.D., F.A.C.E. Ramathibodi Hospital, Mahidol University, Bangkok."— ใบสำเนางานนำเสนอ:

1 Iodine and the Brain September 9, 2005 Rajata Rajatanavin, M.D., F.A.C.E. Ramathibodi Hospital, Mahidol University, Bangkok

2 I OH NH 2 II OCH 2 CH COOH Triiodothyronine (T 3 ) OH I NH 2 I I I OCH 2 CH COOH Thyroxine (T 4 ) Thyroid Hormone

3 Actions of Thyroid Hormone Brain development and maturation Physical growth and development Energy expenditure Regulating function of multiple organs

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6 012 wksbirth1 yr PHASE I Thyroxine-Dependent-Human Brain Development PHASE IIPHASE III Neuronal differentiation, Axonal outgrowth, Dendritic ontogeny, synaptosis, Cerebellar neurogenesis, Gliogenesis Myelinogenesis Cerebral neurogenesis & migration 012 wksbirth1 yr Maternal T 4 Fetal T 4 Neonatal T 4

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8 No. of births No. of cretins Birth-prevalence rate of cretinism (per 1,000) Injection before conception Injection after conception Oil 592 1 1.7 Saline 487 26 53.4 Oil 95 5 52.5 Saline 90 5 55.6 Pharoah and Connolty, 1989

9 Clinical Manifestation of IDD Depends upon onset severity duration of iodine deficiency + other environmental factors

10 Adult -Multinodular goiter and its consequences In utero -Abortion -Endemic cretins Neonates -Stillbirths -Increased perinatal mortallty - congenital hypothyroidism Preschool age -Mental deficiency -Psychomotor defect School age -Goiter

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13 Endemic Cognitive Deficiency in Sicily Study areas Prevalence Psychomotor of Goiter (%) Defect (%) IDD area A 70 14 IDD area B 46 13 Control area 9 4 Vermiglio F, 1990

14 Cretinism 1-10 % 5-30 % Some Brain Damage 30-70 % loss of Energy due to Hypothyroidism IDD ICEBERG

15 The Consequences of IDD Cretinism Cognitive and psychomotor deficiency Hypothyroidism Childhood mortality Reproductive failure Goiter Socioeconomic retardation

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17 Odds ratio Rajatanavin R et al, Thyroid 1997;7:599

18 Odds ratio Rajatanavin R et al, Thyroid 1997;7:599

19 Maternal UI (  g/L) r = - 0.240 p = 0.001 n = 203

20 Maternal UI (  g/L) * P = 0.002 (9) (5) (49)

21 Indicators of IDD - UIE Population IDD Status WHO, UNICEF, ICCIDD (2001 ) Median value Iodine Status <20 µ g/l Severe iodine deficiency 20-49 Moderate iodine deficiency 50-99 Mild iodine deficiency 100-199 Ideal iodine intake 200-299* More than adequate intake (may pose risk of IIH)* > 300 Excessive iodine intake In populations with longstanding iodine deficiency and rapid improvement in iodine intake, median values above 200 µ g/l are not recommended. *IIH : iodine induced hyperthyroidism

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23 Urinary iodine level in pregnant women after supplement with iodized oil capsule Suibnugarn et al, 2003 1 capsule 2 capsules no supplement (2003) Recommended range 

24 Serum TSH Level of Neonatal Cord Blood Dansai 1998 181 5.75 5.4-6.3 Bangkok 1023 5.80 5.6-6.0 n Median TSH (mU/L) 95%Cl (mU/L) Dansai 2003 203 6.56 5.5-7.2 Suibnukarn et al, 2003

25 Median of urinary iodine in pregnant women Median urine iodine level (µg/l) Department of Health, MOPH : 2004

26 Median of urinary iodine in pregnant women Median urine iodine level (µg/l) Department of Health, MOPH : 2004

27 Median of urinary iodine in pregnant women Median urine iodine level (µg/l) Department of Health, MOPH : 2004

28 Division of Nutrition Department of Health:MOPH 2004 N = 55 provinces Status of Iodine Nutrition in Thailand

29 0 5 10 15 20 number of provinces North - East CentralSouth Adequate iodine Inadequate iodine Excessive iodine Division of Nutrition Department of Health: MOPH 2004 N = 55 provinces

30 Recommended Daily Iodine Intake and Urinary Iodine Excretion Intake Urinary Excretion  g/d  g/L RecomExcessRecomExcess Pregnant 250 > 500 150- > 300 Women 200 Breast 250 > 500 100* Feeding 0-2 years 90 > 180 100* Of age *Need More data WHO/UNICEF Technical Conference, Geneva, January 2005

31 0 5 10 15 20 number of provinces North - East CentralSouth Inadequate iodine Adequate iodine Excessive iodine Division of Nutrition Department of Health: MOPH 2004 N = 55 provinces

32 คะแนนเฉลี่ยและค่าเบี่ยงเบน มาตรฐานของระดับเชาวน์ปัญญาเด็ก วัยเรียน การศึกษา ( ปี พ. ศ.) กรุงเ ทพฯ ภาค กลาง ภาค เหนือ ภาค อีสา น ภาคใ ต้ รวมทั้ ง ประเ ทศ การสำรวจ ภาวะ สุขภาพ ครั้งที่ 2 (2539-2540) 96.5 (+13.7) 92.3 (+13.2) 87.9 (+15.9) 89.7 (+14.6) 94.7 (+14.5) 91.9 (+14.8) การศึกษา ครั้งนี้ (2545 ) 94.6 (+14.2) 88.8 (+12.0) 84.2 (+10.7) 85.9 (+11.1) 88.1 (+12.9) 88.0 (+12.6) นิชรา เรืองดารกานนท์ พัฒนาการและเชาวน์ปัญญาของ เด็กไทย, 2547

33 รายการ SD 9.83 9.66 11.44 X 85.52 88.72 84.70 SD 10.70 10.18 11.89 <.001 X 94.10 95.03 94.03 คะแนน IQ test Full IQ Verbal IO Performance IQ น้อย n = 100 รุนแ รง n = 100 ระดับการขาดสาร ไอโอดีนในพื้นที่ p Chavala Dhendhanoo, 1999

34 รายการ SD 2.21 2.58 3.64 2.51 2.27 2.70 2.31 2.36 2.34 2.43 X 8.08 7.36 8.66 8.06 8.90 7.26 7.40 8.68 7.24 8.44 SD 2.25 2.50 2.33 3.03 2.45 2.90 2.61 2.06 2.71 2.46.163.088.013.003.005.184.004.001.014 <.001 X 8.62 8.12 10.08 9.48 10.05 7.90 8.62 10.07 8.30 10.07 คะแนน subtest ของ IQ test Information Comprehension Arithmetic Similarity Digit Span Picture Completion Picture Arrangement Block Design Object Assembly Coding น้อย n = 100 รุนแรง n = 100 ระดับการขาดสารไอโอดีน ในพื้นที่ p Chavala Dhendhanoo, 1999

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