Author Topic: In Somalia! The cause of Hypothyroidism is under research.  (Read 5752 times)

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Offline SOYDA

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In Somalia! The cause of Hypothyroidism is under research.
« on: March 28, 2008, 05:23:04 PM »
In Somalia! The cause of Hypothyroidism is under research.

Hypothyroidism is caused by any structural and functional derangement that interferes with the production of adequate level of thyroid hormones.
There is primary and secondary forms depending on whether the disease arises from intrinsic abnormality in the thyroid gland or results from pituitary or hypothalamus diseases.

Clinical features.
The clinical picture is different whether the hypothyroidism develops in early childhood or in adults and older children.
Cretinism is hypothyroidism that develops in the infancy or early childhood. It is common in the mountainous areas of Africa, India and China where dietary iodine deficiency is endemic. It is less frequent in the present days due to widespread supplementation of foods with iodine.
In rare occasions cretinism may result from inborn errors in the metabolism e.g. enzyme deficiency that interferes with the biosynthesis of the normal level of the hormones.

The clinical manifestations of the cretinism are: impaired development of the skeletal system and CNS with mental retardation, short stature, coarse facial features, a protruding tongue and umbical hernia. The severity of the disease depends on the age of onset.
Normally, the maternal T4 and T3 cross the placenta and are critical to the fetal brain development. If the maternal hypothyroidism begins before the development of the fetal thyroid gland, metal retardation is severe. But if the maternal hypothyroidism develops late in the pregnancy after the fetal thyroid is well formed normal fetal brain development occurs.

Iodine deficiency is common in the mountainous areas. The patient may be euthyroid or hypothyroid depending on the severity of the iodine deficiency. The hyperthyroidism is due to TSH stimulation of the gland which produces goiter in the face of continuing iodine deficiency.

- Children may not show classic clinical features of hypothyroidism. There is often slow growth rate, poor school performance and arrest of pubertal development.
- Young women may not show obvious signs of hypothyroidism and should be excluded in all the patients with oligo-amenorrhea, menorrhagia, infertility or hyperprolectinemia.
- In elderly patients, the signs of the hypothyroidism may be indistinguishable from the signs of the normal aging.

Lab tests
Serum TSH is the test of choice. High level of TSH confirms primary hypothyroidism. A low total or free T4 confirm the hypothyroidism and its measurement is important because the hypothyroidism from the hypothalamic or pituitary origin the TSH may be low or normal.
   Other tests are:
   -presence of anemia normochromic-microcystic.
   - serum asparte level is increased due to liver or muscular metabolic disturbance.
   - hypercholesterolemia
   - hyponatremia due to increase in ADH secretion and impaired free water clearance.

Replacement therapy with thyroxin  (I.e. T4) is given for life. The starting dose depends on the severity of the deficiency, the age of the patient, the fitness and cardiac performance.
In the young fit patients 100 ug/daily is suitable while 50 ug/daily increased to 100 ug /daily after 2 weeks is more appropriate for small and old patients. In patients with ischemic heart disease, the starting dose is usually 25 ug/daily increased cautiously controlling the heart function with ECG.
The adequacy of the replacement should be assessed clinically and with thyroid function tests after at least 6 weeks on a steady dose.
The aim of the treatment is to restore T4  and TSH to within the normal range. If the TSH remains high the T4 dose should be increased in increments of 25-50 ug and tests repeated 6 weeks later. The stepwise progression is continued until the TSH become normal.
Alternative views propone that the complete well-being of the patients is restored only when the T4 level is high-normal and TSH is slightly suppressed.

Really, if you visit the hospitals that in Mogadishu you will see many cases of Hypothyroidism, and always doctors said its due to iodine deficiency mainly, but I don’t think so, because we have large sea that is full of iodine, also we use salt with iodine, water with some times having iodination, so this matter needs research, so its something concerns you, me and every who in the medical field so if you get answer to it please display it and publish.

By Executive Director of Somali Young doctors Association   (SOYDA)

Dr. Abdiqani Sheikh Omar,

Offline Waxbaro!

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Re: In Somalia! The cause of Hypothyroidism is under research.
« Reply #1 on: March 29, 2008, 08:22:11 PM »
Dear SOYDA, I agree with you that such researches is very important especially to a country which lacks statistics and data for various important issues.

Iodine deficiency disorders (IDD)

A-Prevalence of goitre and urinary iodine level
In Somalia, no data are available on the prevalence of goitre or on the level of urinary iodine. Iodine deficiency is most probably a public health concern as access to iodized salt is extremely low (UNICEF, Somalia, Micronutrient supplementation).

B-Iodization of salt at household level
In 1999, a MICS survey revealed that less than 1% of all households where salt was tested used adequately iodized salt (UNICEF, 1999).

Source: Somalia Nutrition Profile – Food and Nutrition Division, FAO, 2005

Iodine element is a rich in the all sea food such as fish, shrimps, etc and easily available in Somalia. but Unfortunately Somali community has taboo not to eat the sea food due to ignorance of the balanced diet which is available in Somalia, although the country has the longest cost land in all the African nations.

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