PE13.3 | Iodine Nutrition — Summary & Reflection

KEY TAKEAWAYS

Iodine Nutrition — Key Takeaways:

• Iodine is the only micronutrient incorporated into a hormone molecule (T3/T4); essential for thyroid hormone synthesis via thyroperoxidase in thyroid follicular cells.

• RDA: 90 mcg/day (1–8 yr), 120 mcg/day (9–13 yr), 150 mcg/day (14+ yr). Best sources: seafood, iodised salt. Most Indian land-grown foods are iodine-poor in endemic areas.

• IDD spectrum:
• Mild: subclinical cognitive impairment (10–15 IQ point loss at population level)
• Moderate: endemic goitre (>10% prevalence in school children = endemic)
• Severe fetal (first trimester): neurological cretinism — deaf-mutism + spastic diplegia
• Severe perinatal: myxoedematous cretinism — hypothyroid features, NO deaf-mutism

• USI standard in India: production ≥30 ppm; household/retail ≥15 ppm (potassium iodate).

• NIDDCP: salt iodisation enforcement, UIC surveys in school children (target 100–199 mcg/L), neonatal TSH screening, community education.

• Key trap: neurological cretinism is NOT reversible with postnatal iodine — prevention must occur BEFORE or DURING the first trimester. Prevention = universal iodised salt for all women, especially in endemic areas.

REFLECT

Consider the community context:

• In your community posting you find that a family uses traditional rock salt because 'our elders always used it and it tastes better.' How would you counsel them about iodised salt without dismissing their cultural practice? What evidence would you cite?

• A pregnant woman in an iodine-endemic zone comes to the antenatal clinic at 14 weeks. You find she has been using non-iodised salt throughout her pregnancy so far. The fetal thyroid becomes functional at approximately 12 weeks. Is there still a role for iodine intervention? What would you do?

• The NIDDCP mandates neonatal TSH screening on filter paper on day 3–5 of life. In your district hospital, this test is rarely performed outside of the neonatal ward. What systemic steps would you take to improve coverage? Who are the key stakeholders?

Jot your reflections in your clinical log.