Thailand’s Low Iodine Levels Lowers IQs

"The WHO placed a red card on every province in Thailand for Iodine Deficiency Disorders (IDD). For the first time ever province of an entire country has been certified as deficient in IDD which brings down the IQ scores of an entire population by 10-15% and is a leading cause of miscarriages, mental retardation and other severe effects," said Ivan Schifffer, a research biologist living in Pattaya.

This is not a new problem and one of the problems is a lack of selenium in the soil destroyed by pesticides and other agrochemicals. This causes some plants to produce low levels of sodium and chlorine which combine as sodium chloride containing natural iodine.

Iodine Deficiency Disorders (IDD) in Thailand can be traced back to ancient times. Gout was recognized by villagers many years ago, the historical evidence of which can be seen in ancient mural paintings at Wat Phumin, Nan Province that depict a crying woman with gout.

The first reports of IDD in the northeastern and northern regions of Thailand, which were situated in the countries goiter belt, appeared in 1953. In 1965 a pilot project of salt iodization was initiated in Phrae, and in 1968 was expanded into a national program relocated in Bangkok. In 1988, a survey of IDD incidence was conducted in 14 provinces of the upper north, as well as Loei province in the northeast, which revealed a first reported IDD prevalence rate of 12%.

In 1989 the Ministry of Public Health launched a Campaign Program for IDD Control including 14 provinces in the north and Loei province in the northeast. In 1991, the IDD survey was expanded to 24 provinces in the northeastern and the central region, which revealed that these provinces were IDD endemic areas as well. Consequently, the campaign program for IDD control was expanded to cover these provinces in 1993. Subsequently, in 1995, the area of operations was increased to nationwide coverage.

The goiter rate in school children has been used as an IDD indicator to assess the IDD situation in Thailand. Visith Chavasit, director of Mahidol University's Institute of Nutrition, said a short-term solution was to add iodine to iron and folate supplement tablets for pregnant women and babies aged up to five years.

Iodized salt is a major measure to increase iodine intake. The Food and Drug Administration under the Ministry of Public Health has passed the Notification of the Ministry of Public Health No. 153/1994, that edible salt must have an iodine content of not less than 30 parts per million.

Iodized drinking water is a minor measure to increase iodine intake in people in endemic areas. This is done by dropping 2 drops of concentrated iodine solution into 10 liters of drinking water to produce 200 micrograms in 1 liter of drinking water.

The iodized oil measure has been implemented in remote areas with over 20 percent IDD prevalence, which have difficulty in accessing to iodized salt and drinking water. Iodized oil is distributed only to target group populations including women of reproductive age, pregnant women and school children.

4.1 Iodized fish sauce

4.2 Iodine fortification in instant noodles

4.3 Iodine fortification of other food items, e.g. dried banana and chicken eggs

To strengthen the knowledge and awareness of IDD, a Communication Campaign has been carried out continuously since 1989. Printed materials and media have been produced and distributed to the public as part of this campaign.

The National Committee on IDD was established in 1991 with HRH Princess Maha Chakri Sirindhorn as Chairperson. The committee members comprise high ranking officials and distinguished persons from relevant agencies and NGOs.

The following are some achievements accrued through the close collaboration of these groups:

● Iodized machine produced by the Technical College under the Department of Vocational Education of Ministry of Education.

● Financial and material support from Redd Barna and UNICEF.

● IDD control in hilltribes under the Princess Mother Medical Volunteer Foundation.

● IDD control in school children in Border Patrol Police schools through the Royal Initiatives of HRH Princess Maha Chakri Sirindhorn.

● Instant noodles fortified with iodine, vitamin A and iron.

● National Campaign on IDD Elimination on the occasion of the 50th Anniversary of His Majesty the King’s Accession to the Throne, organized jointly by Ministry of Interior, Ministry of Public Health and the Thai Red Cross Society.

To maintain this achievement several measures must be considered and implemented:

However, the production and sale of iodized salt must be increased. All salt producers must produce iodized salt to insure full coverage in all areas.

The Ministerial notification may be modified to be able to control and standardize the quality of iodized salt production and packaging.

Research and development should continue to be conducted in order to expand methods of fortifying iodine in other foods. Moreover, studies of iodine fortification in animal feed must be strengthened since people can obtain iodine from fish and the meat and milk of animals fed with iodized salt.

Cooperation among relevant agencies is essential for the success of the IDD program and should be continued and encouraged.

Surveillance of IDD is established by the application of the total goitre rate as a parameter. However, other indicators, e.g., coverage of iodized salt, quality of iodized salt on sale in the market, rate of implementation of other iodine vehicles, TSH level in newborn, urine iodine levels in risk groups, and ultrasonic volumetric application, must be applied as IDD parameters.

The topmost aim of the IDD program is to reinforce the need for sustaining IDD elimination to ensure that IDD will not be a public health problem any longer. To achieve this aim, various measures, both major and supportive, must be effectively implemented. An effective and sensitive monitoring system must be applied for accurate and prompt IDD assessment. Close cooperation from relevant agencies is needed so that coordination and operation will be harmonious and in the same direction to achieve the ultimate goal together.

The daily iodine requirement for an adult has been estimated at 150 micrograms a day.

Less than a teaspoonful of the mineral is needed to meet the life-long requirements of an individual.

Yet iodine deficiency remains a public health problem in some parts of the world, including Thailand, said Samlee Plianbangchang, regional director of the WHO's Southeast Asia regional office.

The WHO recommended member countries follow the so-called universal salt iodization (USI) standard by adding iodine to all salt for human and animal consumption.

However, the process of making salt was still a problem, particularly among small-scale salt manufacturers.