Profilaxis Y Tratamiento De Bocio ,peru-ecuador

THE

AMERICAN

vol.

JOURNAL

No.

22,

OF

CLINICAL

12, December, 1969, Printed in U.S.A.

NUTRITION

pp.

1597-1607

Prophylaxis

and

Goiter

with

Rural KEVANY,2

JOHN

in

those

R0DRIG0

M.D.,

endemic

health

a major of

the

understanding

genesis,

simple

measures, have done

of

and

and little

effective

a

rising reduce

to

on a worldwide is due principally

scale. to

to the

and to between

the ubiquitous the public and of of

world its

disease

by

health

extending Mexico

to

million

people

and in the

along Chile.

endemic

goiter

stantial

incidence

South mountain

be

affected

by

1

Supported

in part

AM

12748

Association

for

can

Organization,

Health

y Bienestar

2

D.

Pan C.

mento

de de

Food

Cambridge,

The The

Fondo and

Servicio

ob-

are

in-

Service

Pan

Salud

Especial

de

Salud

Nacional,

Quito,

Ecuador.

Lima,

Peru.

Department Massachusetts

Unit of

Institute

Investiga-

(IC

of

by

of

and

cretinism

there is that, in many (apart from

dis-

severe a

subdeaf-

good cases, overt

se-

fact

have

an

health the

and

be causally been suggested

in

it has

general

unfavorable

and

educational

magnitude and Pan American

the

is

severity Health

have

enacted of

have

legislation

spite

this

effective in

of Technology,

demia

Massachusetts. 1597

exist

and

of

than

half of

are

the

still

of

the

most

without

of

17 counthe

remaining

2

consideration.

have

the

several

requiring the

under expression

many

in

an in

a defined endemic

of the

legislation salt,

programs

less

and

to

afflicted areas. Fifteen

tries

and

17 have goiter, and

known

reatile cre-

accompany

may

may

In view of the problem,

en-

be

disturbance, usually

disease

iodization

Experi-

Nutrition

addition,

these

Departa-

Instituto

In

cretinism

Ameride

goiter

an

fact,

accompanied

26 member governments, problem of endemic

National

Nacional

endemic

surscope

Organization (PAHO) has maintained active program of technical assistance this field during the past 2 decades. Of

this

Organization, Washington, de Radiois#{243}topos, Escuela

Endocrinologia, Ia Altura,

Science,

Health

10992,

vere

effect on capacity.

Peru.

Medicine,

mental

U. S. Public AM Children,

American Health ‘Departamento

Polit#{233}cnica ciones

Retarded

Social

P#{252}blica of

by and

that

the

could In

neuromuscular stature

that

be

is

Furthermore, suspecting retardation

related.

only

it

affliction.

short

of

and because in geographic

thyroid,

a trivial

tinism),

America ranges

condition. Precise figures cannot tained because morbidity statistics

as

mutism. son for mental

of interest sectors.

M.D.,

groups (1, 2). goiter implied

the

economy prevalence

the Pacific coast from As an estimate, over 10 may

of

missed

authorities

conflicts private

age

preventive

the most extensive and severe endemic goiter occurs in Latin The disease is widespread

throughout Central but is concentrated

Grants

largement

patho-

This state of affairs the low priority ac-

corded

One focuses America.

its

PRETELL,4

or unavailable been limited

have

or to special If endemic

the

generations.

A.

EDUARDO

De-

official been

concern, established

countries serious

affected, areas

any

of

preventive

en-

Downloaded from www.ajcn.org by on April 27, 2009

Substantial

veys

where

for

1

M.D.

complete

goiter

in

Peru

M.D.,

STANBURY,5

problem

world

known

and

B.

Endemic

Oil

FIERRO-BENITEZ,3

as been

has

Iodized

JOHN

EXCEPTIONS

areas

disease

of

Ecuador

AND

AuTH FEW continues

Treatment

Kevany

et al.

the PAHO demethods of pre.

moteness

1598 In to look

illeasures.

Ci(ICd

vention

view of this, for alternate

of

This

endemic

decision

Priority

given

directed

1V1S

The

tiOll.

of

the

are

to

salt

finding

the

Among

that

contact

with

teristics

shared

normal

commercial

in the South

will

of

long-term

body

iodine,

parenteral

Information

prevalence ure obtained

in

not

provided

ing

the

has

been

one

to

goiter

and

that

and

New

Guinea,

enough

this

epidemiologically

in view, determine

field

studies

the

of

parenteral

iii

prevention

goiter

With

milliliter tained

of

L.

have

were

and

at high

dosage

schedule

up

in

to

2-6

1966

to

2 years

years

6-12

effectiveness

America, lected areas

for

Ecuador study

with

cretinism, were

countries

being

and since

high

prevalence

and

no

of

Peru, both of

preventive

ranza,

mg of iodine, obInc., Hicksville, plastic The

The

South

were sepresented goiter

and

programs

and

oil

was

into

the

dren

and

into

was was

01(1:

old

larly

sy-

of follow-

used:

up:

0.2

ml

of

iodized

oil

0.5

ml

of

iodized

oil

1.0

ml

of iodized

oil

2.0

ml

of

oil

administered gluteal region tile

was

deltoid

practiced

not

injected

intravenously.

used

for

sterilization.

Thyroid

skin

size was

of

iodized

intramuscusmall chil-

region

of

adults.

ensure that Merthiolate

to

evaluated

of tile classification

fication

by of

Perez

IN

ECUADOR

villages, Tocachi and La Espewere selected because of their re-

not

Grade

with

the

et aL

Oa: palpable

Ob:

palpable, raised

but

not

visible

oil

a modi-

(7). Grade

PROGRAM

a

was Ethiooil, each

undertaken. THE

#{149} Two

oil seed

as started

altitudes.

old:

‘SearS

Drawback

neighboring

was

problems

old:

12 years

it.

Two

pop-

avoid

was

by

severe

administration of iodized oil and treatment of endemic the defects that may accompany

and

sterilization

Salt used

Disposable to

both associ-

served

iodized

used

in

Tocachi

poppy

York).

were

artisans.

and

program

The

iodized

I., New

ing

The

a

capita

iodine.

the

to Espcranza

containing 475 from E. Fougera,

rillges

considerations begun

feasibility

pro-

goiter ii).

La

1966.

of

0.24 g/g

given

village.

(37%

regard-

with

these

control

(101

and have regarding that are

associated goiter.

was while

1011,

per

is severe

(Table

high

is

contains

and

low

percentage

of

of

literacy,

by the

deficiency

is a high

incidence

of

prevalence

defects

in March

results

level

small

villagers Iodine

proced-

form

the

ulat

the

however,

reducing incidence given virtually no information prevention of those disabilities

ated

those

The

information of

the

New

is precarious

a high

reflected

poverty

villages, and

tile

safe.

great

low

others

region.

There

i).

rate, a

characof

Andean

(Table

mortality

of years

reducing

in

endemic

infant

iodine

prophylactic

in

common-

world,

situation

villages

and

by

endemic is

hundreds

sociocconomic

both

Chronic

in

both,

outside with

American

income

from

that

effectiveness

piiylaxis

tile

establish

number

effective

of

in a

for

available

practical

was

on

prevention was begun

indicated

were

programs

Ihe

to

salt

methods

iodine

stores. A

(3-5)

surveys

continue

alternative

ago a program of goiter injection of iodized oil Guinea.

some

uniodized

in cretinism

head

Downloaded from www.ajcn.org by on April 27, 2009

of

rather solu-

illegitimacy,

dietary

provision

and

place. They are about 70 km north of Quito, 6 miles apart, and ethnically, socially, and biologically comparable (6). The villagers have unusually limited social mobility and

the

is implemented

various

supplying

because,

populations

people

even

and severe

affected

sources

if salt iodization national scale.

with

is

recognized

from

that

cretinism.

but interim

an

also

primitive

and

conflicted

iodization

severely

isolated

cilallnels

way

to PAHO

most

so

use

goiter no

in

goiter

Goiter Grade

in Ecuador

Peru

and

1599

I:

TABLE

easily

palpable

tion

and

visible

glands

with

head with

in head

the

presenting

with ble

head

with

easily

in

normal

head

raised

normal raised;

posithose

palpable

position

not

included

I

conditions

two

in

Ecuadorian

villages

nodules

but

were

Socioeconomic

visiin

Tocachi

this

La

Esperanza

grade Grade

Percent

ii:

easily

visible

Grade

with

head

in normal

III:

visible

at a distance

Grade

IV:

monstrous

of subjects

the

position

epidemiologic

fuse

These

glands

when

glands

were

grade

were

or

Ob

recorded

as

dif-

or nodular. of selected the left hand

gingival permanent

taken

emergence teeth.

using

medical

of

Percent

of unwed

mothers

Percent

of subjects

who

no-screen

films,

of 91.5

cm

at

(36

into

ciency

of

ciency

confirmed

subject.

by

subject

was

lived

to

the in

tube-to-film

tile

mental degree

the

to

the

communities, tinuous

relation tile

in to

the

of

medical on

and

to

the

program and of pregnancies

physical

the

who

5

9

coast

region

Percent

of

Annual

income

artisans per

capita

5

5

90

85

TABLE Prevalence

of

goiter

abnormalities,

II

and

percent

(March

of

neural

and

of

total

population

niotor

1966)

Tocachi

Esperanza

52.8

41.1

23.4

defi-

Diffuse

28.6

29.3

8.2

6.0

4.5

2.5

I .6

0.0

0.4

0.4

1 .0

0.8

0.4

1 .2

of

the

in-

the

goiter

Endemic

cretinism

Deaf-mutism ment

(severe in hearing

Deafness

impairand

(severe

impairment

Mutism

(severe

limitation

Motor

abnormalities

Other

congenital

malforma-

tions

incidence

have

20, and gram.

25 months

of

on the as they

of all

of

the children born in both villages have been studied since March 1966. Epidemiological surveys for goiter prevalence and

in

speech)

the

effects

speech)

hearing)

con-

of

keep

La

.

69.7

in both vilneuromotor

growth

subjects

visited

goiter

the

needs

occur. All pregnancies have been followed and

development

34

goiter

and

rest of

particularly

observation

the prophylactic progress and results might lages

31

General

which

completion

general but

close

14

are

Nodular

jection program a physician and a midwife were assigned full time to Tocachi and La Esperanza. These villages had not had a physician in residence before. Small dispensaries were established for administering

29

26

defi-

surveyor

manner

of

have

in after

43

a Bucky

community. Shortly

mortality

dis-

with

The

obvious

was

a

Pack

unit. Anthropometric also made. For evaluathe fundamental fact

account the

Ready

inches)

field-portable X-ray measurements were tion of cretinism, taken

infant

($)

children included and observation of the deciduous Hand X-rays were

Kodak

X-ray

tance

91

Downloaded from www.ajcn.org by on April 27, 2009

Examination an X-ray of for and

purposes

abnormal

larger.

97

illiterate

goiters

considered

in

Percent

Percent

For

born

village

been

THE

The most

plan respects

PROGRAM

the

IN

at

growth a high

m), (3,100

rate of percentage

12, pro-

PERU

similar sierra

Huasahuasi m) were 3%

6,

injection

in Peru has been (8). Three central

lages, Tapo (3,311 m), and Ataquero A net assured

conducted after

in vil-

(3,531 selected.

per annum of children.

Kevany

1600 Tarma, laboratory as

a

nearby town and hospital for

the

5 hr

away

headquarters

detailed

laboratory

in

about

Lima,

Iodized into

oil

1,771

seed and

or

a

subjects.

and

was

carried

with done

was

with the in

Administration

out

in

poppy

iodized

oil

(GrP). Inup to 45

to

match

the

size

of

goiter.

groups randomization was by consecutive alternation

(line

and

used

placebo

were

the

injection.

goiter

in

while

the

than

In

the

from

1 to 5 years

In

old:

old:

6 years

OVC1

while

but

to the ily

adult

women

close was

reduced

were

with

nodular

in

the

1st

ml ml

goiter

to 0.2 ml.

performed

1.0

All

20th

of

month)

the

also

time size

of

18

of

of and

sessment team

the

type made

throughout

the

Particular the

by

12

grade

This

After

females

in

the

old).

As

many

ble

occurring

tion. pose

serum

Newborns of

levels

vestigatecl iodine

women.

in

both

the

same

GrP

recorded

from

possiGrI

the

were as well lactating

age.

in Tocachi percent up

to

time

prevalence

was

36%

was

not

thyroid

of the in

La

of

La

were

25th-month As

Esperanza,

at

25

for

the

a single children

motllers. who

glands.

18

first

in

children age

di-

reduction

Reduction

of

palpable

goiter

tile

to iodized the

2 years

the

at

presented goiter

of

total

maximum

minimal

iodization

population. There of palpable

ranza ined

of

years

after

of

the

involution

in

during

40

born

as

seen

how-

those

the sharp

Tile

after

een

in-

reduction

was

total

pur-

was

20

6 months of

increased.

of life. There

instance

addition,

tissue.

of

that found

a result

age

to

after

in

certain

years months

gestafor

women, milk

to

and

In

hormone

pregnant

as

tended

not

increase

was

mci-

survey

survey,

(but

thyroid

degree

the

the

also

goiter

iodization

The

in

persisted

to

nodular

hyperplastic

illinished

(16-45 as

throughout

thyroid in

of

paid age

evaluation.

of

content

been

pregnancies

were

future

after

goiters

lt seems of

reduction

has

followed

increase

25 de-

achieved

was after

goiter

tended

size)

decrease the

increase

I

of

a

of grade

this

the 20th-month

type

population.

program.

child-bearing

in

were

this

stead-

conducted

goiters

trend

de(up

also

incidence

goiters,

grade

montlls

had

Although

large

of

after

produced

iodization.

I

as-

of the

the rise

surveys

and

of

6,

gland

Clinical

members

attention

years

groups

injection.

of

increased

goiter

survey

dence

larger

were

estimated

the

of an

ever,

the

larger,

size

of

at At

examiners

prior

of

and

made

injection.

the the

was

was

after

both

bone

Reevaluation

goiter

months

reevaluation,

ignorant

for

maturation.

prevalence and

made

and into

expense

diminisll.

had

the

at the

months.

were

neurological 12,

ill

6 months

Ethiodol of

after

survey goiter

nodularity

The

goiters

at

October

1966. Surveys

and

ratio

following

tile

decrease

crease

injections

week

men

1). After began to

diffuse

in

decreased.

months

the

the

of

nodular

distinct

ml

2.0

in

that in men increased of goiter in the total

to

time

creased,

II 0.5

the

both

The

decreased (Fig. the prevalence

noticeably

doses

old:

in

months,

and

prevalence

population 20th llTlOIlth At

following:

1 year

fall

20

separately.

women

continued less

for

population

taken

iodization,

accomof io-

The

goiter

total

in Tocachi

EightEspeexam-

survey to

overall the

re-

Downloaded from www.ajcn.org by on April 27, 2009

taken

other plished

the

oil

consistent

again.

of age and in men up to 18. Among the schoolchildren, groupings for the placebo and the iodized oil were predetermined at random within a given age. Care years

was

and

of

women

hundred the three

placebo females

of iodized

a regular

prevalence

injected

Nine in

Prevalence

caused

was

placebo

injected

848 were

Goiter

More

automobile.

placebo The

RESULTS

with served

work.

by

iodine. subjects

were

(GrI) jections

field

work

oil without twenty-three

villages

equipped facilities,

et al.

in Ecuador

(;oiter

and

Peru

1601

TOTAL

POPULATION

814

=

#{149}.

WOMEN

0

o--c

MEN

0 0 I-

70

Lii

60

.

I.0

0

:

SI

0 U-

0

#{149}

11 40

________#{149}

Li 0

z

..#{149}.#{149}.#{149}.#{149} #{149}#{149}#{149}#{149} #{149}-

30

Lii 0 0

0

0

10

MONTHS

5

10

15

IN

TIME 1.

FIG.

village

Effect

of administration

of rural

suits

Ecuador.

that

indicated

increase

during

The

were

lages

first

niarily

of

90%

than

degree;

were

nodularity

three

vil-

This

was

primore

cretinism” 1.0% to

The

and 3.6%

prevalence

Peru

after

in

decreased

injection

tile

striking

fall

from

58

as well

as from

goiter

occurred

in

placebo

from

52

to

78%

in

the

crease females.

was In

iodized

for

program

goiter the

the

steadily

latter. more addition,

to

16%

in

in

tions A

visible

the

81

to

groups

the

de-

males

than

in

decline

appeared

time

13-

of the

a

to

18-

than

in

were

to

shown

surveys

(Fig.

iodine

(UEI) UEI

determina-

would

be

mg

40th

the results

of

that

in

used

The

after that

a

reduce 5 months.

Peruvian 24-hr

re-

virtually

month

function

the

of

had elimina-

would

by only

thyroid

5.

who

iniply

4)

Since

mg),

950

Fig.

(Fig.

(950

at

3). The

pattern.

whom

A

observed

of Ethiodol

stages

in

was

adults

half

Changes

depressed

were

total effective time

different

at 6 months.

of on

of

survey

normality

done

2 ml

uptake

to be

exponential

tion of those accomplished jectiomi. These equal

Metabolism

proved

control

subjects

ceived

Iodine study,

toward

in successive

the

slightly

in

in

subjects.

thyroid

an

only

both

the groups

Ecuadorian

the

followed

changed In

tile by

excretion

while

marked

In

urinary

group

and

of goiter

in

and

other the

in palpable

former

Function

at the

group,

the

pronounced

restoration

2).

in

incidence

under-6-year-old

and

iodized

tile

more and

prev-

months

(Fig.

86 to 52%

group 45%

18

the

men.

the 6- to 12-year-old

‘‘I

villages.

Goiter

be

on

and

Thyroid

dur-

Size of goiter age.

(Ethiodol)

the

goiter

thereafter,

with

of

defects

life.

goitrous.

increased

“endemic varied from

alence

in

of

Ob

oil

in women

to

of

with

5 years the

seed

of goiter

Peruvian

25

MONTHS

year-

percent

affected

poppy

ratio

a significant

tile three Fifty

were

the

ing

in

the

was period.

same

similar.

population

shows

tllere

the

findings

of iodized

Insert

20

indose

the

tests study

thyroid

at are

uptake

Downloaded from www.ajcn.org by on April 27, 2009

20

z

Sexes

Male

Placebo

(7

odized

Oil

>

0

a-

_j_____l

3

--

24

Months

2.

Decline

in is made

goiter

in

with

three

subjects

Peruvian

villages

injected

with

after

the

noniodized

administration oil.

In

of iodized

each

case

the

poppy

ordinate

seed isfrom0

100%. 90

80

70

-

60

Li .4

50

Q-w

40

30-

3k

20

10

20

Fio.

3.

Effect

of administration

TIME

IN

MARCH

1966

of iodized

oil I

25

MONTHS -

on

602

APRIL

1968

radioactive

iodine

uptake

by

the

thyroid.

oil. to

Downloaded from www.ajcn.org by on April 27, 2009

FIG.

A comparison

Goiter

in Ecuador

and

Peru

1603

1000 900 800

OBSERVED

RESULTS

(2

ml

of

ETHI000L)

EXPECTED

RESULTS

(1 ml

of

ETHI000L)

700 600

500

EXCRETION

400

FACTOR

=

UEIt

UEI.e#{176}26

=

\

300

Li 200

Li

z 0

w

-z

z

IL

\

< 100

C.)

90

ZciI’

80

1-

70-

Li

\

Downloaded from www.ajcn.org by on April 27, 2009

0o a

60

\ \

50-

Li

\ \

40-

>-

.4

z

\

30-

\ \

20

\ \ \ 10 6

#{149}2

8

24

TIME 4.

FIG.

Urinary

of

excretion

iodide

30

IN

following

36

42

MONTHS administration

of

iodized

oil.

The

iodide

is excreted

exponentially.

fell from 15.8

±

slightly at

13

change mal

a control

1.4%

level of 75.1

at

to

19.5

and

19

9 months 0.3%

±

months, to

of both

These

reached

month

and

fell

Serum

thyroxine

normal cretion

limits.

Tile

of

(lose appear

group, dose

iodide

which of iodine

normal

values

at two III.

received per

by by

in

relation

different The 6about

kilogram

values

PBI.

perio(Is. The exponentially and therefore

of body

an

extile

the weight

both

in

2.0

UEI

higher

dose

average

equivalent

both

a

13-year-and-over

This nor-

age levels to 12-year double

ilad

the

had

1 9th

to

mg),

1.1%

within

for urinary

(41.5 than

tile 9th the

remained

(UEI)

of Ethiodol in Table

and

levels to

month.

±

iodide

maximum

then

21.9

a rise above

serum

to

increased

respectively.

corresponded levels

and

0.9%

±

but

ml

of 23.0

groups

levels

at

6 months

groups, mg.

continued

to fall to

throughout

the

UEI for the latter after 6 months. T112,

tile

an(1 0.2 ml

later

group fell The slopes,

were doses

which

However,

similar in

this

for

group

(Fig. 5).

Effects A among in

the

in Infants total

of the

three

and 92

women Peruvian

Children

deliveries

of

was

recorded

child-bearing

villages.

Of

age these,

58

Kevany

1604

et al. away. were

2

too-

lOU-

80-

8-

o

subsist there

in

2

effects

‘I-Uptake

of

6

9

Fic.

5. Effect

plasma

were

in

of

iodized

(PB!),

the

thyroxine

jects was of iodine

100 ml iodized four

iodized

7.9 in

serum

(SI).

The

plasma

oil was was 1.9

placebo

children

March

were

content injected

9.7

16 (17%)

in

1968

died

and

excretion

0.2 ml

on

the

and

deThese

enhanced

kind

found

in

crement

went

per

by

has

gen-

American

old.

handicap

there in

height

expected

height

is,

at

height

of

40.5%

Tocachi

The and

after delivery

and

of adults.

signs

developmental 6 months

12 months

Tocachi in

for

stand-

and height lagged more this age. The percentage

Thus,

weight

obvious

24-hr

in

same

The

iodized

2 (2%)

growth

with

in height

Esperanza.

ml in

Tocachi

(to

of iodine

children.

Somatic

weight after

37%

was

g/

TABLE

Urinary

and

was a falloff in of children around

increase

1.2

±

0.7

±

with zg/100

born

growth

materially

compared

when

Gains in markedly

oil.

to April

1966

been

period.

ards. There averages

as normally iodized sub-

0.7 g/ 100 ml. The milk from 9 women

the

mothers);

to rise, in the

still

0.4 /Lg/ of preg-

±

infants

placed

on

erally been similar in children from Tocachi and La Esperanza. It has been lower in both villages than in a low income infant group from Quito, and relatively lower

noniodized

value of 5.2 last 5 months

women injected and 0.0 to 0.5

perinatal

protein-

±

in oil,

Ninety

iodine

(I-T4), iodine

group.

of iodized whereas it

given

from

total

thus failed mean value

2 ml ml,

with

radioactive

levels in the pregnant

and The

g/100

on

iodine

and

group had a mean 100 ml during the nancy, occurs.

oil

thyroxine

have

been

oil

in

La

is

the

as

normal this

age,

is in-

50%.

deceleration

are

undernutrition,

possibly

III

period

after

Dose

administration Months

after

Ethiodol

of injection

Age in years Ethiodol, ml

6-12

Iodine,

6

mg/kg

2.0

41.5

±

1.1

13 or

over

2.0

23.0

±

0.7

13

over

0.2

2.0

or Values

are

in

micrograms.

1,079

9

13

15

19

±

101

497

±

49

346

±

29

274

±

24

169

±

859

±

64

621

±

47

345

±

29

253

±

25

168

±

15 16

230

±

45

76

±

16

62

±

6

48

±

4

Downloaded from www.ajcn.org by on April 27, 2009

Months

uptake,

has

iodized

the availability of a full-time physician and a midwife for the program in Ecuador. Particular attention has been given to the

9

13

of undernutrition.

of

studies

iodine

children untreated

poor environment; morbidity and mor-

emphasis

velopment

0

generally infant

degree

Special

2-

bound

seventy-seven Esperanza (to

Children of Tocachi presented a degree of morbidity and also showed

a higher 4.

2O

a high

is

tality. higher

40

hundred in La

mothers) during the same period; 17 (9.6%) died and 5 (2.7%) went away. The children of both Ecuadorian villages

E 0 0

“

D60

One born

Goiter including iodine high incidence

undernutrition, of

the

was

American were

in La

Esperanza

A

large

children

Ob

slightly

were

was

No

found

age

of

found

thyroids

goiter.

lower it in

than

those

and

young

in all age groups.

number

in

and

4%

case

of

in

infants La

with

Esperanza

grade

had

I

diffuse

thyroid

enlargement

in

comparable

Tocachi

the

neurologic were

older

than

ages

was

progressive

both

villages

Tocachi

by

and

92.77%

in La Esperanza

in

manipulative,

gross

developmental was

There

retardation

tested

linguistic,

at

motor quotient

(normal).

(low

normal).

Toxic

In the survey administration about 15 subjects a

clinical

ism.

was

elderly

with tests

the

large

nodular

useful

for

basal

metabolic

nol-extractable

iodine

tests were exactly iodized subjects of

having

sponded nor

the

newborn

or

weeks

found roid

of cretinism

as not

begun was

seen

within

goiter. at

rate

and

Treatment once

made.

when

and

may after

months

in

indicate

tributing of serious

Most

of

a few

days

none

was

these

thy-

and

with

a diagnosis

appear

oil,

since

iodide

needs

at a

for

a single injection.

this

than

In

have

the

in

palpable

goiter

40%,

respectively,

as

a

of goiters have

not

result of

Whether

they

in

remains

group visible

all

interby

of

large

the

progressive

size.

Many

of

disappeared goiters

will

in at

completely

as palpable time

disclosed

evident

and

io-

size and, failure of

Peruvian

more

dis-

in the Ecuadorian

in goiter groups, a

been

month)

remain

surveys the

both

of

simple, free to a consider-

studies

appear.

(72%

method

is technically and effective

has

shrinkage

gree.

par-

fulfill

reduction to control

to

18th

for

by

iodide

Peruvian

a decline vals

forms is

their

that

iodine risk,

a gratifying compared goiter

these

results that have been obtained to the reports of similar field New Guinea and recently in Africa

and

goiter

observed.

of

of iodized

the

“iodism,”

and

release

and

re-

of ancient of which

alternative

the

buta-

in

strictures

One

preparations

many

(9)

consider

iodine.

degree. Sequential population in

three

were

delivery,

to

able dized

The

for other suspected

All

economic

diagnosis

to therapy.

were

to have was

and

thyroiditis,

reactions

after

disall

since the other

the same who were

iodine

local

hos-

goiter. their

rate

satisfactorily

for

The women,

serum,

of

administration

The conform trials

there were presented

Quito

hyperthyroidism.

Neither

after

hyperthyroidto

examination. in three

and

and

were

taken

confirmed

laboratory

who

suggesting

were

pitalization ease

of Ethiodol, in Tocachi

picture

They

6 months

Anof

implemented these countries.

to an endemic causative factor a deficiency of iodine.

supplying

slow

conducted

been of

points primary

enteral

Effects

communities of Peru. Iodization

geographical isolation there is little expectation that national programs for manufacture and distribution of iodized salt will reach some of these rural populations in the near future. Accordingly, it has been

these Possible

its accompanying in their virgin form

The socioeconomic conditions of the Andean people, basically composed of Amerindian and mixed European stock, have varied little since Spanish colonial times.

necessary

It was

rural and

has not regions

Because

villages

normal.

behavioral

Average

89%

common salt the highland

(Gesell’s

in both

is considered

as

perceptual, in

reached

and today

of

completely to be

seen.

Ob

dedis-

Similar

Downloaded from www.ajcn.org by on April 27, 2009

standards)

maturation

goiter found

in some of the dean Ecuador

has been of

tasks.

Endemic defects are

Everything date, the

group. Levels

1605

Peru COMMENTS

in

However, averages

better

and

the

circumference group was

standard. note that

to

interesting

Tocachi

and

disease.

The increase in head both villages and for each than

in Ecuador

Kevany

1606 results

been rise

have

but

a

small

rence

of

goiter

obtained was seen

between

25th dized

month. The oil treatment is demonstrated 1.5% of new cases

children A that rise

versus

in

Ecuador, the occur-

in

the

19th

and

effectiveness as a preventive by the fact were recorded

7.2%

in the

the

of

the iomethod that only in iodized

controls.

to occur in prophylactic were in the

corresponding were even

lower.

the group iodine. hypothyroid

tem may nomenon,

have this

out by pregnant

normally women.

doubtedly

shares

rising The with

sys-

of this pheto be ruled

values fetal

in iodized thyroid un-

mother’s

gland

the low iodine supply from the diet. This sharing results in a lower amount of iodine being available for the mother’s gland, which in turn is unable to maintain the required hormone levels. In any case, it contribution must be

be expected that the hormone of the mother to the fetus small, because free T4 in all sub-

may

jects is decreased during Whether the fetus is capable sizing its own T4 is unknown. It is too early to know the

pregnancy. of syntheeffectiveness

of the iodization program in terms of linear growth, honey development, psychological and neurological growth, and learning ability. sistent effect

Data

presently

available

with, and suggestive on the prevention

the

numbers

The

data

involved

are

advise

other

are

severe

or change,

i.e.,

performance large, but

seemed admittedly

of iodine. improved preliminary,

small. dentiimfact

Mental in

where

Endemic

the

an

be

of

the

appraised.

every

reason

program

to

endemic

there

is

effective

one survey

goiter

health

world.

goiter

no

present

program

of

salt

continues

problem

In

some

to

in areas

be

many the

a

sig-

areas

disease

of is so

severe that cretinism and other associated defects are found. In many areas, geographic, economic, and other factors prevent the use of iodized salt as a preventive

measure.

A seed

pilot program oil has been

communities Results after

using instituted

in Ecuador approximately

iodized poppy in two rural and

three in Peru. 2 years indi-

cate the feasibility and effectiveness of the programs. There has been a sharp reduction in the incidence of goiter. Cretinism has not of the oil, but control a public tion

yet appeared among the progeny population injected with iodized several instances have appeared in groups. The use of iodized oil as health procedure for the preven-

of

defects where

endemic

goiter

and

is an acceptable salt-iodization

presently

its

associated

measure programs

in regions cannot be

undertaken. REFERENCES

World

little single

be

to

where

of

nificant

of, a dramatic of cretinism, but

on honey development, linear growth show resulting from the

extension

and

possibility

1. World

presently

an

can

seems

communities

con-

tion, and provement

injection

to

health

there

SUMMARY

cause seems

the

of

Meanwhile,

iodization.

values genetically

protein

been the possibility

aspects

many

Health

Geneva:

Organ.

World

J.

2. STANBURY, Meeting

3.

of

Mexico.

World

oil. Med.

27-29,

Goitre

MASON

AND

L. B.

In

1968,

Puebla, in of

New iodized

1964.

BLACK,

S.

3rd

press.

injections 1: 505,

M.

44,

in Endemic

prophylaxis

intramuscular I. H.,

no.

Symp.

Research

Organ.

J. Australia

4. BUi-FFIELD,

Goiter. on

June B.

Goitre. Ser.,

1960.

Endemic

Health

W. with

Organ.,

Group

PAHO,

HENNESSY,

Guinea

K.

B.

Endemic

Monograph

Health

Scientific

Goiter

E.

Organization.

Health

HETZEL.

M. J.

HOFFMANN,

Correction

of

Downloaded from www.ajcn.org by on April 27, 2009

thyroxine-binding

impaired

is

that did not Many of these range, and

plasma thyroxine Although a

among young schoolchildren. It will require at least 2 additional years of observation before the impact of the program on

is

finding of possible significance in pregnant women the physiologic of PBI during normal pregnancy

failed receive values

et al.

Goiter

5.

iodine

deficiency

iodised

oil

36:

243,

H.,

the

in

gram

design,

roid

function

Meeting Goiter

Mexico.

7. PflREZ,

of Goitre.

Health

goitre

Health

Effect

in

of

goiter

World

3rd

Health

Organ.

Scientific of

World

Puebla,

goiter In:

En-

Group June Organ.

on

1960,

Organ. C.

iodized

on Research In

1968,

In of

oil.

in

Symp.

size

3rd

in Meeting

Endemic

Goiter

Puebla,

Mexico.

press. P0URBAIX

Idjwi 3rd

in Endemic Puebla,

rural

and

metabolism

Symp.

P.

THILLY,

Treatment

27-29,

iodine

1968,

M.

in

prevalence

Research 27-29,

R.

SALINAS, GUTIERREZ,

goiter

on

thyroid on

June F.,

by

oil

populations.

Health

ERMANS.

L.

Endemic

iodized

Group

PAHO,

R.

MONCLOA, KAWANO,

PRETELL.

of

goitrous

9. DELANGE,

Endemic

Monograph

F.

A.

and

known

J. A. Muoz.

surveys.

Organ.

A.,

J.

AND

Peru:

press.

AND

Geneva:

E.

PRETELL,

WAN

thy-

Symp. in

1968,

In

44,

no.

C.

I. Pro-

Ecuador.

27-29,

Organ.

oil

prevalence,

Research

1607

GUERRA-GARCIA,

associated

excretion.

SCRIMSHAW

endemic

and

of

on

June

World

ESTRELLA, Iodized

goiter

iodine

Health S.

E.

goiter

Ser.,

8.

Endemic

World

URRESTA.

Group

PAHO, N.

J.

on

and

World C.,

by

Peru

p. 369.

HETZEL.

RAMIREZ,

region

effects

of

natives

and

1965.

Bull.

endemic

Andean

Scientific

Technique demic

I. AND

of the

Ecuador

1967.

C. DIAz

defects

S.

Guinea.

K.,

prevention

Guinea 2: 767,

B.

AND

New

FIERRO-BENITEz,

JARAMILLO,

New Lancet

in eastern

Organ.

6.

I.

Bui-rFiELD,

goitre

in

injection.

in

Mexico.

AND

Island

A.

Meeting

Scientific

Goiter

of PAHO,

World

M.

endemic

Health

press.

Downloaded from www.ajcn.org by on April 27, 2009