[The problem of iodine deficiency in the Chechen republic: assessment of the current state and ways of solution].

Iodine deficiency disorders (IDD) are prevalent and highly morbidity, have hidden progression, severe disabling somatic complications, including cognitive disorders, reproductive losses, and oncopathology. This presents a serious challenge to the healthcare system of the Russian Federation, as it affects over 3 million people. The lack of relevant data on the severity of IDD and the current prevention programs at the regional level necessitates the need for appropriate research and measures in individual subjects of the Russian Federation. AIM: To conduct a comprehensive study to assess the current iodine security of the population of the Chechen Republic, to analyze the prevalence of thyroid pathology and compare it with official statistics, to formulate conclusions about the necessary preventive measures. MATERIALS AND METHODS: In the Chechen Republic, a total of 1239 people were examined, of which 921 were schoolchildren of pre-pubertal age (8-10 years) and 318 were adults. The survey of the adult population was carried out at medical organizations in four districts of the republic (Nadterechny, Shalinsky, Vedensky, Grozny) and included a questionnaire survey, a clinical examination by an endocrinologist with palpation of the thyroid gland, thyroid ultrasound, and a study by a qualitative method of samples of table salt used in households for the presence of iodine.Children's examinations were carried out by the cluster method on the basis of secondary schools in 9 out of 15 districts of the republic and included an examination by an endocrinologist and measurement of anthropometric parameters (height, weight), thyroid ultrasound to evaluate volume, determination of iodine concentration in single portions of urine and qualitative analysis of samples of table salt used in children's nutrition in families for the presence of iodine.The incidence and prevalence of thyroid disease among the population of the Chechen Republic were analyzed using data from official state statistics - form No. 12 «Information on the number of diseases registered in patients living in the area served by the medical institution¼ (ROSSTAT data as of 01.01.2021). RESULTS: According to the results of a survey of 921 pre-pubertal children, the median urinary iodine concentration was 71.3 µg/L (frequency of values below 50µg/L - 17,7%) and varies from 48.9 to 179.2 µg/L in the surveyed areas. According to thyroid ultrasound data, diffuse goiter was detected in 16.4% of the examined children, with goiter frequency ranging from 11.3% to 23.5%. The proportion of iodized salt consumed in schoolchildren's families was 4.2% in all study areas (range of values from 1.3% to 8%), which indicates an extremely low level of using iodized salt by household.According to the results of the examination of the adult population (n=318), structural changes in thyroid tissue were detected in 79.9% (n=254), while the proportion of nodular thyroid pathology being 83% (n=205), with a range of values across different districts of 52.5-80%. CONCLUSION: Based on the obtained data, according to WHO criteria, it can be stated that, overall, the degree of severity of iodine deficiency disorders in the Chechen Republic corresponds to mild severity with a tendency towards moderate severity in several districts of the foothills. The results of the examination of the adult population indicate a high prevalence of thyroid pathology, predominantly nodular, in the Chechen Republic. The data obtained in the course of large-scale research made it possible to initiate the development of necessary medical and organizational measures in the region - a program for the prevention of IDD.

[Prevention of iodine deficiency diseases: focus on regional targeted programs].

The strategy for the elimination of diseases associated with iodine deficiency throughout the Russian Federation is based on the adoption of a federal law providing for the use of iodized salt as a means of mass (population) iodine prophylaxis. Chronic iodine deficiency that exists in Russia leads to dramatic consequences: the development of mental and physical retardation in children, cretinism, thyroid diseases, and infertility. Under conditions of iodine deficiency, the risk of radiation-induced thyroid cancer in children in the event of nuclear disasters increases hundreds of times. By definition, all iodine deficiency diseases (IDDs) can be prevented, while changes caused by iodine deficiency during fetal development and in early childhood are irreversible and practically defy treatment and rehabilitation. The actual average consumption of iodine by a resident of Russia is only 40-80 mcg per day, which is 3 times less than the established norm (150-250 mcg). Every year, more than 1.5 million adults and 650 thousand children with various thyroid diseases turn to medical institutions. The cause of 65% of cases of thyroid disease in adults and 95% in children is insufficient intake of iodine from the diet. At the stage of preparing the relevant legislative act, the development and implementation of regional programs for the prevention of IDD is of utmost importance. A typical draft of such a program is proposed in this article for its adaptation and use at the regional level.

[Regional target program «Prevention of iodine deficiency diseases for 202X-202X¼].

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[Iodine Deficiency Disorders: Current State of the Problem in the Bryansk Region].

BACKGROUND: The Bryansk region is one of the regions of the Russian Federation most affected by the accident at the Chernobyl nuclear power plant on April 26, 1986.In the conditions of a chronic uncompensated deficiency of iodine in the diet in the first months after the accident, an active seizure of radioactive iodine by the thyroid tissue took place, which inevitably resulted in an increase in thyroid diseases from the population in the future. The article presents the results of a control and epidemiological study carried out in May 2021 by specialists of the National Medical Research Center of Endocrinology of the Ministry of Health of Russia, aimed at assessing the current state of iodine provision in the population of the Bryansk region. AIM: Assessment of iodine supply of the population of the Bryansk region. MATERIALS AND METHODS: The research was carried out in secondary schools of three districts of the Bryansk region (Bryansk, Novozybkov and Klintsy).The study included 337 schoolchildren of pre-pubertal age (8-10 years), all children underwent: measurement of height and weight immediately before the doctor's examination, which included palpation of the thyroid gland (thyroid gland); Thyroid ultrasound using a portable device LOGIQe (China) with a multi-frequency linear transducer 10-15 MHz; determination of iodine concentration in single portions of urine. A qualitative study for the presence of potassium iodate in samples of table salt (n = 344) obtained from households and school canteens was carried out on the spot using the express method. RESULTS: According to the results of a survey of 337 pre-pubertal children, the median urinary iodine concentration (mCIM) is 98.3 µg / L (range from 91.5 to 111.5 µg / L, the proportion of urine samples with a reduced iodine concentration was 50.1%). According to the ultrasound of the thyroid gland, 17% of the examined children had diffuse goiter, the frequency of which varied from 9.4 to 29% in the areas of study. The share of iodized salt consumed in the families of schoolchildren in the study areas was 17.8% (values range from 15.6 to 19%), which indicates an extremely low level of iodized salt consumption by the population. All salt used for cooking in school canteen areas of the study was iodized, which confirms compliance with the requirements of SanPiN 2.4.5.2409-08. CONCLUSION: Despite the active implementation in the Bryansk region of various preventive programs of IDD and social activities to promote the use of iodized salt, in the absence of mass prevention with the help of iodized salt to date, their unsatisfactory results should be noted.

[Monitoring of iodine deficiency disorders in the Republic of Tyva].

BACKGROUND: The Republic of Tyva is a region with a proven severe natural iodine deficiency and a high prevalence of IDD (iodine deficiency disorders). However, in the region in certain periods of time, measures were taken to eliminate iodine deficiency in the diet of the population. The article presents the results of the October 2020. by specialists of the Endocrinology Research Centre, a control and epidemiological study aimed at assessing the current state of iodine supply in the population of the Republic of Tyva. The study was carried out on behalf of the Ministry of Health of Russia within the framework of the state task «Scientific assessment of the need to take additional regulatory legal and other measures to eliminate iodine deficiency in pilot regions with severe iodine deficiency¼. AIM: Assessment of iodine supply of the population of the Republic of Tuva. MATERIALS AND METHODS: The research was carried out in three settlements of the republic - years. Kyzyl, Shagonar, Saryg-Sep settlement. A total of 227 pre-pubertal schoolchildren (8-10 years old) were examined with anamnesis collection, examination by an endocrinologist, palpation of the thyroid gland, collection of single urine samples into disposable eppendorfs, followed by freezing to minus 20-25 degrees to further determine the concentration of iodine in urine with using the cerium-arsenitic method in the laboratory (clinical diagnostic laboratory of the Federal State Budgetary Institution «National Medical Research Center of Endocrinology¼ of the Ministry of Health of Russia). In addition, all schoolchildren underwent an ultrasound examination of the thyroid gland (using a portable ultrasound machine LOGIQe (China) with a multifrequency linear transducer 10-15 MHz, in the supine position). The height and weight of children was determined according to the standard method at the time of the examination. A collection of samples of edible salt, which is used in families of schoolchildren, was carried out and the presence of iodine in it was determined by an express method for the qualitative determination of potassium iodate.Parents of schoolchildren signed informed consent for the examination of children. Permission of the local ethical committee of the Endocrinology Research Centre - received, date: March 25, 2020, N 5. RESULTS: 227 schoolchildren of 8-10 years old were examined. The median concentration of iodine in urine was determined, the presence of iodine in food salt was investigated, and an ultrasound examination of the thyroid gland was carried out in order to clarify the iodine supply, the coverage of the use of iodized salt in nutrition and the prevalence of goiter.The median concentration of iodine in urine was 153 µg/l, the frequency of goiter was 7.7%, and the proportion of households using iodized salt was 95.2%. CONCLUSION: Results of assessment (median urinary iodine concentration) confirm that population of Tuva, Russian Federation, has optimum iodine nutrition. The prevalence of goiter in schoolchildren significantly decreased compared to earlier assessments. The proportion of households using iodized salt indicates the effectiveness of preventive measures in the -region.