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Prevention and treatment of endemic iodine-deficiency goiter by iodination of a municipal water supply

par Squatrito, Sebastiano;Vigneri, Riccardo;Runello, Filippo;Ermans, André Marie ;Polley, R.D.;Ingbar, Sidney S.H.
Référence The Journal of clinical endocrinology and metabolism, 63, 2, page (368-375)
Publication Publié, 1986

Article révisé par les pairs

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Résumé :

A recently described method for the prevention and treatment of endemic iodine deficiency and goiter, introduction of iodine into a public water supply, was tested in Troina a town of about 13, 000 inhabitants in northeast Sicily. There, before initiationof the program, a goiter endemic of moderate severity was present, as evidenced by goiterprevalence of 55% in school children. Iodine deficiency in nongoitrous adults was indicated by daily urinary iodine excretion of 40.7 ± 2.6 μg (mean ± SE) and 24-hthyroid radioiodine uptake of 50.8 ± 2.4%. Iodination of the water supply was initiated in November 1979 using a stream-splitting device that diverts a controlled fractionof the total water flow to a canister containing iodine crystals, where the water becomessaturated with iodine (˜300 mg/liter) before returning to the main stream. Except for a 15-month interruption during which governmental authorization of the programwas being reconfirmed, treatment of the water has continued to the present time, initially at a level of 81 ± 25 μg/liter (mean ± SD) and since resumption at a level of 46.5 ± 5 μg/liter. Iodination of the water was followed by a prompt and marked reduction in goiter prevalence, and by improvement in biochemical indices of iodine deficiency. By April 1983, overall goiter frequency in school children had declined to 6.1%, and large goiters (WHO Grade 2) had virtually disappeared. By January 1984, daily urinary iodine excretion had increased to 85.6 ± 6.5 (SEM) μg and radioiodine uptake had decreased to 40.7 ± 4.7%. Serum thyroid-related hormone concentrations were as follows (pretreatment vs. November-December 1983): T4 5.8 ± 0.3 vs. 8.4 ± 0.3 μgdl; T3 1.6 ± 0.05 us. 1.2 ± 0.06 ng/ml; TSH, 3.7 ± 0.2 us. 2.2 ± 0.1 μU/ml; all changes being statistically significant. By late 1983, serum T4 T3 and TSH values in Troina were almost identical to those in Catania, a community in which iodine deficiency is not present (goiter prevalence in school children, 2.2%). In contrast, in Troina serum T4 concentrations were significantly higher and serum TSH concentrations were significantly lower than those in Maniaci, a iodine-deficient town near Troina, in which the water was not iodinated. Iodinated water was well tolerated by the population of Troina, and no adverse effectsof water iodination, including any increase in the frequency of hyperthyroidism, was observed. At present prices, the cost of the water iodination program in Troina would be approximately 4 cents (U.S.) per person per year. We conclude that iodination of public watersupplies is highly efficacious, safe, and cost-effective, and where applicable, affords promise in the prophylaxis and treatment of endemic iodine deficiency and goiter,. © 1986 by The Endocrine Society.