Yodium Micronutrient

penting yang Terlupakan

Adhi Pribadi
Divisi kedokteran Fetomatermal Departemen Obstetri & Ginekologi
RS dr.Hasan Sadikin/FK Unpad
Introduction 2.Human cannot make elements of
iodine in his body must obtain it from
1. Iodine is the second type of micro
outside the body (naturally) through
mineral element after Iron that is
the absorption of iodine contained in
considered important for human health
food and beverages.

3. Iodium is a monovalent anion. Its state in

the mammalian body is only as a thyroid
hormone
4.

5.
Pregnancy
Why is Iodine Need increasing?
1. TSH
2. ⍺ HCG

↑Hormone 3. Estrogen↑ ↓ catabolism TBG

↑ TBG ↑Thyroid free production
Thyroid
↑T3,T4
4. ↑ Glomerular Filtration
Thyroid Hormone Production Phase
Phase I (0-12 Weeks) Phase II (12 Weeks-delivery) Phase III (Neonatus)

+ - + + +
Brain stem development Neuronal differentiation Growth Acceleration
Neurogenesis Axonal growth
Cerebral migration Dendritic ontogeni
Synaptogenesis
Neurogenesis cerebelar
Gliogenesis
Critical Phase
Phase I (0-12 Weeks)

T3,T4,Io

+ - T3,T4,Io ↓ T3,T4,Io ↓

Brain stem development • Severe iodine deficiency during gestation typically results in cretinism,
characterized by severe mental retardation accompanied by other neurologic or
Neurogenesis physical defects.
Cerebral migration • Cretinism is divided into two subtypes according to clinical manifestations
(neurologic and myxomatous cretinism, which may reflect the different timing of
intrauterine insult to the developing fetal nervous system and whether the iodine
deficiency continues into the postnatal period.
• Both types can be prevented by adequate maternal iodine intake before and
during pregnancy.
Effects of Iodine
Deficiency
Prenatal Diagnostics
Prevention
1. Supplements

2. Anti Iodine !!!

 Anti Iodine

Chlorate Nitrate

Cyanide/Thiocyanate
source

Seafood: salmon, assorted shellfish.

Dairy products: cow's milk, yogurt,
Supplements cheese.
Other food sources: chicken eggs,
beef, chicken meat, various legumes.
Lactation Period
• Thyroid hormone production and renal iodine clearance return to the
prepregnancy state.
• Iodine is excreted into breast milk at a concentration 20 to 50 times
greater than that in plasma.
• It is recommended to continue high iodine intake to ensure sufficient
iodine in breast milk to build reserves in the newborn’s thyroid gland.
Lactation Period
• The iodine requirement during lactation is 225 to 350 μg/day.
• Breast milk containing 100 to 200 μg/L of iodine appears to provide
adequate iodine to meet Institute of Medicine recommendations for
infants.
• The amount of iodine excreted into breast milk depends on maternal
iodine intake.
Take Home Messages
• Adequate iodine intake during pregnancy is critical for normal fetal
development.
• The daily iodine requirement for nonpregnant adults is 150 μg, and
for pregnant women it is 220 to 250 μg.
• Pregnant and lactating women should take a daily iodine supplement
to ensure adequate iodine intake.
• Assessing the risk of iodine deficiency from clinical signs and from the
history is key to diagnosing iodine deficiency.
 References
• Almandoz JP, Gharib H. Hypothyroidism: etiology, diagnosis, and management. Med Clin N Am.2012;96:203–221.
• Brahmbhatt SR et al. Thyroid ultrasound is the best prevalence indicator for assessment of iodine deficiency disorders: a study in rural/tribal schoolchildren from Gujarat (Western India). Int J Endocrinol. 2000;143:37-46.
• Brahmbhatt SR et al. Study of biochemical prevalence indicators for the assessment of iodine deficiency disorders in adults at field conditions in Gujarat (India). Asia Pacific J Clin Nutr. 2001;10(1):51–57.
• Cao Y et al. Goitrogenic anions, thyroid-stimulating hormone, and thyroid hormone in infants. Environ Health Perspect. 2010;118(9):1332-1337.
• Chandra AK et al. Goitrogenic content of Indian cyanogenic plant foods and their in vitro anti-thyroidal activity. Indian J Med Res. 2004;119(5):180-185.
• Chandra AK et al. Role of bamboo-shoot in the pathogenesis of endemic goiter in Manipur, north East India. Endocr Pract. 2013;19(1):36-45.
• Doerge DR, Sheehan DM. Goitrogenic and estrogenic activity of soy isoflavones. Environ Health Perspect. 2002;110(Suppl 3):349-53.
• Dormitzer PR et al. Anomalously low endemic goiter prevalence among Efe pygmies. Am J Phys Anthropol. 1989;78:527-531.
• Ferreira AC et al. Inhibition of thyroid type 1 deiodinase activity by flavonoids. Food Chem Toxicol.2002;40(7):913-917.
• Fruzza AG et al. Unawareness of the effects of soy intake on the management of congenital hypothyroidism. Pediatrics. 2012;130:e699–e702.
• Gaitan E. Goitrogens in food and water. Ann Rev Nutr. 1990;10:21-39.
• Grayson RR. Factors influencing thyroidal I-131 uptake. Am J Medicine. 1960;28(3):397-415.
• Greer MA. Goitrogenic substances in food. Am J Clin Nutr. 1957;5(4):440-444.
• Hakkinen SH et al. Influence of domestic processing and storage on flavonol contents in berries. J Agric Food Chem. 2000;48(7):2960-2965.
• Iodine. Monograph. Altern Med Rev. 2010;15(3):273-278.
• Ioku K et al. Various cooking methods and the flavonoid content in onion. J Nutr Sci Vitaminol. 2001; 47: 78-83.
• Leung AM, Braverman LE. Iodine-induced thyroid dysfunction. Curr Opin Endocrinol Diabetes Obes.2012;19(5):414-419.
• Messina M, Redmond G. Effects of soy protein and soybean isoflavones on thyroid function in healthy adults and hypothyroid patients: a review of the relevant literature. Thyroid. 2006;16(3):249-258.
• Sathyapalan T et al. The effect of soy phytoestrogen supplementation on thyroid status and cardiovascular risk markers in patients with subclinical hypothyroidism: a randomized, double-blind crossover study. J Clin Endocrinol
Metab. 2011;96(5): 1442-9.
• Shukla S, Gupta S. Apigenin: a promising molecule for cancer prevention. Pharm Res. 2010;27:962–978.
• Teas J et al. Seaweed and soy: companion foods in Asian cuisine and their effects on thyroid function in American women. J Med Food. 2007;10(1):90-100.
• Vanderpas J. Nutritional epidemiology and thyroid hormone metabolism. Ann Rev Nutr. 2006;26:293–322.
• Xiao, CW. Health effects of soy protein and isoflavones in humans. J Nutr. 2008;138:1244S–1249S.