Poulton, Miriam; (1997) Iodine deficiency in the Northern Punjab of Pakistan. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

A study was conducted in a remote, mountainous area of the northern Punjab of Pakistan, where women's access to health care is particularly difficult. Against a background of iodine deficiency, supplementation camps were held in 16 villages and almost 1500 women were given oral iodised poppy seed oil. Baseline blood samples, taken at the camps, revealed a high degree of biochemical hypothyroidism, with low serum thyroxine (T4) and/or high serum thyrotropin (TSH), although serum triiodothyronine (T3) was generally maintained at normal levels. The changes in thyroid hormone levels, usually associated with pregnancy, were modified in this population, as pregnancy exerted a further stress on the thyroid gland, already functioning under conditions of iodine deficiency. Iodine deficiency poses a particular threat to the developing foetus and interviews with women indicated high rates of foetal wastage and infant mortality, although it was not possible to establish a causal link with iodine deficiency or thyroid hormone aberrations. Following supplementation, blood-sampling of non-pregnant women, attending follow- up clinics, indicated that serum T4 levels had increased while serum TSH levels decreased, with little effect on serum T3 levels. The proportion of women experiencing biochemical hypothyroidism thus decreased. Although some women experienced short-term biochemical hyperthyroidism, there was no clinical evidence of thyrotoxicosis. This study highlights the urgent need for promotion and marketing of iodised salt in this area, with particular emphasis on influencing the male household heads and community leaders. In addition, it is suggested that baseline assessment of iodine deficiency and monitoring of control programmes, including the introduction of iodised salt, is best done through measurement of a combination of T4 and TSH.

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