Iodized oil in the prevention of endemic goiter and cretinism.

Abstract

The introduction of the use of iodized oil for the control of goiter resulted from the observation of the persistence of lipiodol in the chest after use in bronchography. This observation led to the introduction of iodized oil injection as a public health measure in New Guinea. Subsequent follow-up revealed that the injection was effective in the prevention of goiter. In a controlled trial in the Western Highlands carried out between 1966-1970 it was found that endemic cretinism could be prevented provided iodized oil was given before pregnancy. The Papua New Guinea studies provided the basis for the use of iodized oil in regions and countries where the distribution of iodized salt is not a practical measure. This discussion of the use of iodized oil in the prevention of endemic goiter and cretinism reviews the following: dispersal and excretion of iodized oil; trials of the use of iodized oil for control of endemic goiter in Papua New Guinea Argentina Brazil Ecuador Peru and Zaire; trials of the use of iodized oil in the prevention of cretinism in New Guinea Ecuador Peru and Central Africa; and the cost of iodized oil prophylactic programs. The use of iodized oil has proved to be effective in reducing the frequency of endemic goiter in reducing the size of established goiters and in preventing the appearance of goiter among persons at risk. Under currently existing economic conditions iodized oil programs can be implemented at a cost of approximately 7-9 US cents/person/year of protection. Evidence exists that major neuromotor physical and psychological deficits which are found in association with endemic goiter are prevented providing iodized oil is given before conception. There are virtually no complications attendant upon the administration of iodized oil except that occasional persons with large nodular goiters may develop thyrotoxicosis. When this has happened the condition responds to routine medical measures. In several large programs this complication has not been recognized. It may be minimized by restriction to those under age 40. In sum iodized oil appears to provide effective safe and economically sound prophylaxis against endemic goiter and related disabilities in those situations where iodization of salt is not feasible for economic or social reasons. Oral administration of iodized oil has been used as an alternative to intramuscular injection and would significantly reduce the cost of an iodized oil program.