Cretinism, endemic prevention

The therapeutic strategy should rely on preventative measures. Endemic goitre and endemic cretinism as well as more subtle deficits of neurological function associated with iodine deficiency have been shown to be prevented with adequate iodine prophylaxis. Adequate and continuous supply is the key to successful prevention programmes. 

In economically deprived communities a method of prophylaxis is to inject iodised oil i.m. every 3-5 years given early enough to women, this prevents endemic cretinism but occasional h5 perthyroidism occurs (see Autonomous adenoma, above). 

Another example of a maternal condition that contributes to birth defects is low circulating iodine. Cretinism is one of the most profound, but completely preventable, syndromes of malformation known. Characteristic consequences of prenatal iodine deficiency include pervasive mental and physical retardation, deaf-mutism (due to primary malformation of the inner ear), lack of muscle tone with a spastic or rigid walk, and failure to attain a height at maturity of more than 1 m. Today, this condition (known as endemic cretinism) is most prevalent in impoverished areas of African and East Asian countries. Prior to implementation of a national program of iodized salt in the early part of the twentieth century, endemic cretinism was commonplace in Switzerland. After institution of iodized salt, deaf-mutism declined 50% within 8 years and no cretins have been born in that country since 1930. 

Prevention. In areas where adequate correction of iodine deficiency has been achieved, endemic cretinism has been prevented."... 

We know that endemic cretinism can be prevented by the normalization of iodine intake in the population, for example by the introduction of iodized salt. It can also be prevented by giving injections of iodized oil to mothers during early or even late pregnancy in the case of myxedematous cretinism (Reviews in 3-6). We also know that newborns are more sensitive than children and adults to the antithyroid effects of both iodine deficiency and iodine excess (84). 

J,B, Stanbury, A,M, Ermans, B.S, Hetzel, E,A, Pretell, and A. Querido, Endemic goiter and cretinism public health significance and prevention, WHO Cron, 28 220 (1974). 

Stanbury, The effect of goiter prophylaxis with iodized oil on the prevention of endemic cretinism, Further Advances in Thyroid... 

Endemic cretinism is a complex syndrome involving a triad of severe sensory, motor and cognitive defects. The condition is related to iodine deficiency and it can be prevented by iodine prophylaxis of the mother before or very early in pregnancy The frequency of... 

The controlled trial to assess the effectiveness of iodinated oil in preventing endemic cretinism was carried out in the Jimi valley in the... 

The controlled trial indicated that iodine supplementation given after conception was not effective in preventing the endemic cretinism The birth prevalence rates of cretinism among women who were already pregnant when entered into the trial were very similar ... 

The scourge of endemic cretinism is still very much a reality. We hope that these efforts to understand it will contribute to the elimination of this anachronistic and preventable disease. 

It was in these circumstances that it was decided in 1966 to set up a controlled trial in the Western Highlands of Papua New Guinea to see whether endemic cretinism could be prevented by correction of iodine deficiency with the then recently available injection of iodised oil. ... 

The study revealed that the injection of iodised oil given prior to pregnancy would prevent the occurrence of the neurological syndrome of endemic cretinism in the infant. The occurrence of the syndrome in those who were pregnant at the time of oil injection indicated that the damage probably occurred during the first half of pregnancy. ... 

B.S.Hetzel, C.H.Thilly, R.Fierro-Benitez, E.A.Pretell, LH.Buttfield and J.B.Stanbuiy, Iodized oil in the prevention of endemic goiter and cretinism, in "Endemic Goiter and Endemic Cretinism Iodine Nutrition in Health and Disease", J.B.Stanbury and B.S.Hetzel, New York, Wiley, 513 (1980). 

OBJECTIVES To determine whether a universal ISP or an lOP targeted at a high risk group is more economically efficient from a Societal viewpoint to prevent IDD. The primary outcome measure is prevention of irreversible IDD (endemic cretinism, mild motor and mental impairment, stillbirths and neonatal deaths). The secondary outcome measure is prevention of reversible IDD (endemic goiter). 

Intramuscular iodine injections Numerous studies have confirmed that iodine supplementation by injection before a woman becomes pregnant can prevent endemic cretinism and that a single injection can prevent goitre for up to 3-4 years. Other documented benefits of maternal supplementation observed in several controlled studies include reduced infant and young-child mortality, improved birth weight, and better manual function in children born to iodine-supplemented mothers. 

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