Reversibility of severe hypothyroidism with supplementary iodine in patients with endemic cretinism.

The reversibility of thyroid dysfunction in children with endemic cretinism treated with supplemental iodine is unknown. To study this question we conducted a five-month follow-up of 51 patients with cretinism (age 14 and below), who were randomly assigned to treatment (0.5 ml of intramuscular iodized oil) and control groups. The geometric mean initial serum level of thyrotropin (223 microU per milliliter; SD, 97 to 513) and the mean (+/- SD) initial serum level of thyroxine (1.0 +/- 1.2 micrograms per deciliter) indicated that all patients had severe hypothyroidism. Within one month after receiving the iodized oil, 13 of 14 of the younger patients (less than 4 years) and 1 of 9 of the older patients (4 to 14 years; P less than 0.001) had thyrotropin values below 20 microU per milliliter. Five months after treatment, the levels of thyrotropin had decreased and those of thyroxine had increased in all children, but greater changes occurred in the 13 younger patients than in the 14 older patients. The mean levels of thyrotropin were 2 microU per milliliter (SD, 0.6 to 6) vs. 38 microU per milliliter (SD, 11 to 132; P less than 0.001), and the mean (+/- SD) levels of thyroxine were 13.1 +/- 2.8 vs. 8.1 +/- 4.6 micrograms per deciliter (P less than 0.001). In the untreated group, 3 of the 9 younger patients and none of the 15 older patients recovered normal thyroid function within five months. We conclude that iodine supplementation restored a biochemically euthyroid state in all younger children with cretinism but only some of the older children. In addition, some younger patients became euthyroid without iodine supplementation.

Strategy of goitre and cretinism control in Central Africa.

Goitre prevalence in Ubangi Mongala (north-western Zaïre) ranges from 27 to 60 per cent in the male population and from 48 to 78 per cent in the female population; the prevalence of cretinism ranges between 0.7 and 7.6 per cent. This severe endemia affects 1.5 million inhabitants and constitutes a major public health problem. If administered to an entire population, single injections of slowly resorbable iodized oil can reduce goitre prevalence substantially, correct the iodine deficiency and restore normal thyroid function for a period of 3 to 7 years, depending on the parameter considered. The cost of programme of endemic goitre prevention based on this method can be estimated at 0.07 US dollars per person and per year of protection. A strategy of goitre and cretinism control in Central Africa, using iodized oil in an attack phase and iodized salt in a follow-up phase, is proposed. The organization of this programme will be dovetailed into other public health activities and will strengthen the basic health service framework.

PIP: Goiter prevalence in Ubangi Mongala (northwest Zaire) ranges from 27-60% in the male population and from 48-78% in the female population; the prevalence of cretinism ranges from 0.7-7.6%. The severe endemia affects 1.5 million inhabitants and constitutes a major public health problem. If administered to an entire population, single injections of slowly resorbable iodized oil can reduce goiter prevalence substantially, correct the iodine deficiency, and restore normal thyroid function for a period of 3-7 years, depending on the parameter considered. The cost of such a program of endemic goiter prevention based on this method can be estimated at 0.07 US dollars/person/year of protection. A strategy of goiter and cretinism control in Central Africa, using iodized oil in an attack phase and iodized salt in a follow-up phase is proposed. The organization of this program will be dovetailed into other public health activities and will strengthen the basic health service framework.