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September 1997, Volume 47, Issue 9

Letter to the Editor

Iodine Deficiency Disorders : Myth or Reality

Dear Madam, Iodine a mineral element is an important requirement of body for producing thyroid hormone responsible for many important functions of the body1. Iodine deficiency can occur due to evaporation from sea or deforestation and degradation of environment - all ultimately leading to depletion of iodine in edible materials2. Iodine deficiency diseases (IDD) are a group of diseases which can vary from abortion or stillbirth in foetal life, to mild deficiency leading to goitre formation or impaired mental development since birth called cretinism3. Globally, about 30% of the population has been found to be at risk of IDD and 12% of total population has been noted to have goitre4. In Pakistan, 6.5 million people are seriously affected by IDD5, therefore, a framework has been suggested for considering target groups and criteria for  only 1.4% samples (71 out of 5000) to have high TSH levels and out of those, only 5 were confirmed lobe hypothyroid. We would like to have suggestions from the readers and raise following questions. Is a multi—centered hospital based (in contrast to community based) study epidemiologically sound? What arc the bases and criteria for using the suggested cut—off point for labelling IDD iii population? Have we any other country -wide (except for Northern areas) studies which can support the finding of the study on which a major policy decision has been made ? Considering the table, targeting the newborn does not appear to be scoring high for IDD surveillance so can’t we adopt some other target groups such as pre-school and school children using much easier and practical measurements like goitre appearance and swelling and measuring urinary iodine. In the end, we would like to draw the attention of readers that we would like to hear the relevant scientific argument and not side-tracking the actual issue and debating on rationales of iodizationof salts which is not our point of discussion!

Romaina lqbal, lnayat H. Thaver
Faculty of Health Sciences, Baqai Medical University, Karachi.


1. Carol Bellamy Global iodine deticiency diseases day Spectrum .1995,The Medical Spectrum, 16:9-10.
2. Anonymous.Biology of Iodine. The Medical Spectrum 1995:1628-29
3. John T The consequences of Iodine Deficiency. NU News, on health care in developing countries. 19948.4-17.
4. Barbra U. Current status of Iodine deliciency disoider: A global perspective N .U. News on health care in developing countries ,1994, 8:4-7
5. Carl S. Iodine deficiency disorders in Pakistan Islamabad, UNICEF, 1995, p.
6. Dale N..Kevin ,S. Glen Met a). Congenital hypothyroid screening programs and the sensitive thyrotiopin assay. Strategies for the surveillance of Iodine deficiency disorders. Iodine deficiency in Europe. Edited by F. l)elange et al New York, Plenum Press, 1993, pp,2 11-216.
7. Mayrides, J. and Khan, MA. Iodine deficiency disease in Urban areas of Pakistan. The M. edical Spectrum, 1995, 1622-23.
8. Joan F. Z., Peter R., Philip, D. Mayne Clinical ehcnusuy in diagnosis and treatment. 5th Edition, l.ondon, ELBS, 1988. PP. 357-358
9. Lakhani, M., Shehla, K.M, Naqvi, H. et at. Neonatal screening for congenital hypothyroidism in Pakistan J.Pak Mod Assoc., 1989.39 282-284.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: