iv. javaxiSvilis saxelobis Tbilisis saxelmwifo universiteti

xelnaweris uflebiT

l a S a u C a v a

ioddeficitis epidemiologiuri maCveneblebi da farisebri jirkvlis

paTologiebis gavrceleba skolis periodis asakis bavSvebSi

d i s e r t a c i a

doqtoris akademiuri xarisxis mosapoveblad

medicinaSi

10.02.2015 w.

 

1  

avtoris stili daculia

 

sadisertacio naSromi Sesrulebulia

 

Sps “endokrinologiis erovnul instituti”-Si

 

 

 

samecniero xelmZRvaneli - medicinis mecnierebaTa doqtori, profesori

elene giorgaZe

 

 

Tbilisi 2015 weli

2  

sarCevi

pirobiTi aRniSvnebi da Semoklebebi _____________________________4

Sesavali _______________________________________________________5

Tavi 1. literaturis mimoxilva ________________________________ 18

1.1 ioddeficitis ganmarteba da misi arsi

1.2 ioddeficitis epidemiologia

1.3 ioddeficiti, rogorc socialur-ekonomiuri problema

1.4 ioddeficitTan dakavSirebuli daavadebebi

1.5 ioddeficitis diagnostikis kriteriumebi

1.6 ioddeficitis profilaqtika da mkurnaloba

1.7 ioddeficitTan dakavSirebuli daavadebebis profilaqtika da

mkurnaloba

1.8 ioddeficiti, rogorc medicinis aqtiuri sakiTxi

Tavi@2. gamokvlevis masala da meTodebi ------------------35

Tavi 3. gamokvlevis Sedegebi -----------------------------------------46

Tavi 4. gamokvlevis Sedegebis ganxilva ----------------------66

daskvnebi-------------------------------------------------------------------------------69

rekomendaciebi___________________________________70

gamoyenebuli literaturis sia ------------------------------------71

3  

pirobiTi aRniSvnebi da Semoklebebi

1. smi –sxeulis masis indeqsi

2. TSH – Tireotropli hormoni

3. Ft3 – Tavisufali triiodTironini

4. Ft4 – Tavisufali tetraiodTironini (Tiroqsini)

5. AntiTPO – antisxeulebi peroqsidazas mimarT

6. TG – Tireoglobulini

7. (ICCIDD) - ioddeficitis kontrolis saerTaSoriso sabWo

8. WHO - jandacvis msoflio organizacia

9. UNICEF -gaerTianebuli erebis bavSvTa fondi

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4  

Sesavali

iodis deficiti warmoadgens sazogadoebrivi jandacvis erT-erT mTavar

problemas, radgan is aris mTavari mizezi farisebri jirkvlis

daavadebebis ganviTarebaSi. ioddeficiti SeiZleba manifestirebuli

iqnas fiziologiuri ganviTarebis yvela saferxurze. [1,2]

skolis asakis da pubertatis periodi aris ioddeficitis Sedegebis

manifestaciis yvelaze xSiri periodi, kerZod difuzurad gadidebuli

farisebri jirkvali, subklinikuri Tireoiduli disfunqcia (xSirad

hipoTireoidizmi, iSviaTad hiperTireoidizmi) [3,28,31] da darRveuli

mentaluri funqcia, aseve Seferxebuli fizikuri ganviTareba xSir

SemTxvevaSi dakavSirebulia nervuli sistemis paTologiebTan, romelic

gamowveulia ioddeficitiT.

ioddeficits aqvs mravali seriozuli gverdiTi efeqtebi, maT Soris,

rogorebicaa: kretinizmi, kvanZovani Ciyvi, darRveuli kognitiuri

funqciebi, zrdis Seferxeba, mkvdarSobadoba da a.S., aRniSnuli

darRvevebis simZime damokidebulia, iodis ukmarisobis xarisxze,

ioddeficits aqvs mniSvnelovani gavlena adamianis zrda-ganviTarebaze,

bolo aTwlelulis ganmavlobaSi, msoflio masStabiT, mniSvnelovani

progresi SeimCneva ioddeficitis prevenciasa da mkurnalobaSi, rasac

adasturebs, bolo wlebSi, ramodenime placebo-randomizirebuli kvleva,

[4,5,70] romlebic swavlobdnen iod CanacvlebiTi Terapiis gavlenas

adamianis organizmze [6,83].

iodi miekuTvneba egreT wodebul kvebis esenciur mikroelements, anu

iseTs, romelsac organizmi TviTon ver warmoqmnis da saWoroa misi

miwodeba gare samyarodan. is gavrcelebulia gare samyaroSi (niadagSi,

zRvaSi) iodidis saxiT. iodidis ionebi iJangeba mzis sxivis saSualebiT

aqrolebad atomur iodad. yovelwliurad 400 aTasi tona iodi qroldeba

zRvisa da okeanebis zedapiridan. zRvaSi iodis koncentracia Seadgens

50-60 mkg/l, xolo haerSi – 0,7 mkg/m3.atmosferodan iodi kvlav brundeba

niadagSi wvimasTan erTad sadac misi koncentracia meryeobs 1,8-8,5 mkg/l.

5  

amgvarad, iqmneba mankieri wre, magram iodis dabruneba niadagSi xdeba

Zalian nela da SedarebiT naklebi raodenobiT[7,8]. iodis Semcveloba

niadagSi Zalian meryeobs ( 50-9000 mkg/kg) da rogorc wesi swored, rom

niadagSia misi deficiti. aqden gamomdinare, mcenareebi, romlebic

izrdeba aseT niadagSi., Raribia iodiT (10 mkg/kg mSrali masisa

SedarebiT im mcenareebTan , romlebic izrdeba aradeficitur pirobebSi,

sadac iodis Semcveloba Seadgens 1000 mkg/kg mSrali masisa), xolo

adamianebi da cxovelebi, romlebic ikvebebian aseTi mcenareebiT,

ganicdian iodis deficits da maT uviTardebaT ioddeficituri

daavadeebebi [9130,131].

ioddeficiti miiCneva endemur paTologiad, rodesac misi maCvenebeli

10%-s aRemateba populaciaSi. 1993 wlis monacemebiT aziis qveynebSi

skolis periodis bavSvTa asakSi misi gavrceleba Seadgenda: nepali 44%,

koreis respublika 15%, Sri-lanka 14%, tailandi 12%, bangladeSi 11%,

indoeTi 9%, monRoleTi 7% (WHO [5]).

jandacvis msoflio organizaciis 1999 wlis monacemebiT 191 qveynidan

130-s aqvs ioddeficitTan dakavSirebuli problemebi, 20 maTganis mier

aRniSnuli problema aRmofxvrili iqna prevenciuli RonisZiebebis

saSualebiT, daaxloebiT 172 milioni anu 12% samxreT da CrdiloeT

aziisa arian daavadebuli farisebri jirkvlis sxvadasxva paTologiiT

xolo 41%-s aqvs gazrdili riski daavadebis ganviTarebis, romelTac

SesaZlebelia qondeT mosazRvre ioddeficituri statusi, aRniSnuli

problemis gamo bolo periodSi aqtiurad mimdinareobs prevenciuli

RonisZiebebi [21,38,41]. msoflioSi ramodenime qveyana miCneulia, rogorc

gansakuTrebuli ioddeficituri zona, magram aRniSnuli sabolood

Seswavlili araris. msoflio populaciis 50% miCneulia, rom cxovrobs

ioddeficitur zonaSi [5,6,21]. ioddeficiti XX saukunis bolos da XXI

saukunis dasawyisSi warmogvidga, rogorc msoflio sazogadoebriv-

socialuri problema. 1999 wlis maCveneblebiT msoflio populaciis 38.4

%-Si 130 qveynidan damaxasiaTebelia ioddeficituri mdgomareoba, aqedan

daaxloebiT 700 milionSi, rac warmoadgens populaciis 12.6 %-s

6  

aReniSneba farisebri jirkvlis paTologia, xolo 1994 wlis monacemebiT

43 milion adamians, ioddeficitis Sedegad ukve ganviTarebuli aqvs

mentaluri cvlilebebi, xolo rac Seexeba evropas is miCneulia

saSualo ioddeficitur regionad, endemuri Ciyvis aRwera evropaSi

xdeboda mxolod mTian regionebSi [6,45,57].

niadagSi ioddeficitis mTavari mizezebi SeiZleba iyos wyaldidoba,

Zlieri wvima, miwisZvra, rac mizezia niadagidan mikro-makroelementebis

gamorecxvisa. maRalmTian regionSi andebSi, himalaiSi aRniSnulis gamo

aris ioddeficitis gavrcelebis maRali maCvenebeli, amasTanave

aRniSnuli fiqsirdeba iseT regionebSi sadac aris xSiri wyaldidobebi,

magaliTad indoeTsa da bangladeSSi mdinare gangis sanapiroze,

aRniSnuli midamoebSi endemuri ioddeficiti damaxasiaTebelia wyalsa

da sakvebSi[3,4,99]. jandacvis msoflio organizaciis mier rekomendebulia

Cvil bavSvTa asakSi da 5 wlamde asakis bavSvebSi 90 mkg iodi dReSi, 6-12

wlamde asakSi _ 120 mkg, 12 wlis zemoT 150 mkg dRis ganmavlobaSi, xolo

orsulobis da laqtaciis periodSi 200-250 mkg dRe-RameSi (WHO).

ioddeficiti asocirebulia endemur CiyvTan da hipoTireoidizmTan,

xolo orsulobis SemTxvevaSi asocirebulia kretinizmTan, neonatalur

da CvilbavSvTa sikvdilobasTan, garda amisa msubuqad gamoxatulma

ioddeficitma SeiZleba gamoiwvios farisebri jirkvlis gadideba da

swavlaSi CamorCena bavSvTa asakSi, RniSnuli mdgomareobebi SeiZleba

daamZimos rkinis da selenis naklebobam [10,11,12,20]

xSirad endemuri Ciyvis gamovlineba xdeba SemTxveviT, farisebri

jirkvlis palpatoruli an ultrabgeriTi kontroliT. klinikurad

gamoixateba jirkvlis zomieri difuzuri gadidebiT an kvanZovani

warmonaqmnis (erTi an mravali) arsebobiT da xSirad misi funqciis

daqveiTebiT (hipoTireozis niSnebiT) vlindeba [14,108]:

bavSvebSi, ufro xSirad pubertatuli periodis gogonebSi _

zomieri difuzuri gadidebiT,

reproduqciuli asakis pirebSi.

7  

mozrdilebSi- difuzuri gadidebis fonze viTardeba erTeuli

an mravlobiTi kvanZovani warmonaqmnebi. romlebic mniSvnelovan zomebs

aRweven da irgvliv mdebare organoebze zewolas iwveven [63,67].

kvanZovani Ciyvi ioddeficitur kerebSi gacilebiT ufro xSirad

ganicdis malignizacias da ufro agresiuli mimdinareoba aqvs vidre

sxva teritoriebze [5,13].

iodis deficiti zrdis onkologiur daavadebaTa risks, upirveles

yovlisa endokrinuli da reproduqciuli sistemis mimarT[10].

epidemiologiuri gamokvlevebi gviCvenebs, rom iodis arasakmarisi

raodenoba sakvebSi zrdis farisebri jirkvlis folikuluri simsivnis

risks. xSirad farisebri jirkvlis simsivne vlindeba endemur

regionebSi, sadac mosaxleoba daavadebulia kvanZovani CiyviT[11].

regionebi, sadac Warbad moixmaren iods, naklebad gvxvdeba farisebri

jirkvlis agresiuli folikuluri da anaplastiuri karcinomebi. xSirad

gvxvdeba keTilTvisebiani papilaruli karcinomebi [10,12,74]. endemuri

regionebi, romlibic radiaqtiuri iodiT arian dabinZurebuli,

gaZlierebulia farisebri jirkvlis dasxiveba radiaqtiuri iodiT

[15,16,17]. bavSvebi da mozardebi, romlibic dasxivdnen Cernobilis

afeTqebis Semdeg, iodis ukmarisobis pirobebSi mcxovrebTa farisebri

jirkvlis simsivnis riski gaizarda orjer im pirebTan SedarebiT,

romlebic cxovrobdnen iodis normaluri moxmarebis pirobebSi [12,110,128].

Cernobilis afeTqebis Sedegad gaizarda ricxvi farisebri jirkvlis

agresiuli papilaruli karcinomebis im bavSvebSi romlebic cxovrobdnen

ioddeficitur regionebSi _ belorusia da ukraina, magaram ara

poloneTSi, sadac mimdinareobda farTomasStaburi iodiT profilaqtika

[115,116]. iodis deficiti, farisebri jirkvlis gadideba, hipoTireozi,

aratoqsiuri Ciyvi, Tireoiditi asocirdeba ZuZus kibo ganviTarebis

riskTan. gamokvlevebi gviCvenebs rom iodis deficiti sakvebSi zrdis

winamdebare jirkvlis kibos ganviTarebis risks[121,122,123,124,125]. iodis

deficiti regionebSi zrdis kuWis kiboTi sikvdilianobis risksac

[10,119,120].

8  

iods mniSvnelovani adgili uWiravs organizmis nivTierebaTa cvlaSi,

radgan Tireoidul hormonebi gamoiyeneba sxeulis TiTqmis yvela

ujredis regulaciaSi, maT Soris metabolozmis regulaciaSi da wonis

kontrolSi, radgan igi aqtiurad monawileobs cximis, rogorc energiisa

da siTburi wyaros gamoyenebaSi [118], aseve iodi mniSvnelovania sxva

endokrinuli jirkvlebisaTvis, esenia: Tirkmelzeda jirkvali,

saTesleebi, sakvercxeebi, pankreasi, Timusi da a.S.; [46,47,48] iodi aseve

monawileobs kuW-nawlavis traqtis funqcionirebaSi

garemos adgilobrivi Taviseburebebidan gamomdinare saqarTvelosaTvis

erT-erT mniSvnelovan problemas warmoadgens ioddeficiti, romelsac

arainfeqciur daavadebaTa Soris gavrcelebis, daavadebulTa da riskis

qveS myofTa raodenobis mixedviT erT-erTi mniSvnelovani adgili ukavia.

aRniSnuli daavadeba saqarTvelosaTvis yovelTvis warmoadgenda

problemas. XX saukunis bolos Catarebuli masobrivi gamokvlevebiT

saqarTveloSi dadegenili iqna endemuri teritoriebi, efeqturad

ganxorcielebulma iodis profilaqtikam mniSvnelovnad Seamcira

endemuri Ciyvis maCveneblebi, Tumca gasuli saukunis bolos

mniSvnelovnad moimata ioddeficitis maCvenebelma, rasac xeli Seuwyo

prevenciuli RonisZiebebis Sesustebam da amasTanave socialur-

ekonomiurma mdgomareobam. ioddeficitis roli endemuri Ciyvis

SemTxvevaSi mravalgzis iqna Seswavlili, magram arsebobs sxva mravali

faqtori, romelic monawileobs endemuri Ciyvis CamoyalibebaSi [142].

kvlevis mizania: Seswavlil iqnes saqarTveloში ioddeficitis

epidemiologiuri maCveneblebი, ioddeficitTan dakavSirebuli da sxva

etiologiiT gamowveulifarisebri jirkvlis daavadebebis

gavrcelebaskolis asakis periodis bavSvebSi da iodis Semcvelobis

Seswavla wyalsa da niadagSi. (ix. cxrili #1)

9  

cxrili #1: saqarTvelos regionebSi iodis Semcveloba wyalSi, niadagSi

da masTan dakavSirebuli Ciyvis gavrceleba 1997-2003 wlebi

dasaxlebuli

punqti

Ciyvis

sixSi

re (%)

iodis

Semcvelob

a niadagSi

mg/kg

(norma -

0.8-1.2)

iodis

Semcvelo

ba wyalSi

mg/l

(norma

>5)

barisaxo 52% 0.65 3.4

Satili 57% 0.27 2.7

duisi 62% 0.2 1.1

zemo alvani 51% 0.36

saCxere 63 % 0.34 1.22

WiaTura 56 % 0.2 0.9

zestafoni 35 % 0.45 1.5

ambrolauri 71 % 0.3 1.0

oni 69 % 0.18 2.5

cageri 70 % 0.2 0.5

lentexi 68 % 0.09

mestia 65 % 0.07

baTumiM 48 % 0.48

Suaxevi 65 % 0.066

10  

xulo 72 % 0.034

qeda 57 % 0.04

axalcixe 35 % 0.5

Telavi 51 % 0.36 1.6

yvareli 54 % 0.5 3.2

bodbe 32 % 0.8 3.25

ninowminda 34 % 0.72 2.97

sagarejo 31 % 0.6 1.0

Cailuri 30 % 0.7 3.5

lagodexi 41 % 0.6 2.6

gurjaani 35 % 2.0 2.7

gori 50 % 0.64 0.615

xaSuri 45 % 0.38 0.47

mcxeTa 30 % 0.9 2.2

axalgori 55 % 0.4 0.84

bolnisis

raioni, qveSi

4.2 % 1.6

kazreTi 60 % 1.1-1.6 5.25

Coxatauri 68 % 0.7 4.2

foTi 30 % 0.83 1.7

11  

zugdidi 55 % 1.48

senaki 48 % 1.4

12  

kvlevis amocanebi:

kvlevis miznebis gansaxorcieleblad daisaxa Semdegi amocanebi:

1. arsebuli monacemebis mixedviT ioddeficituri da

araioddeficituri regionebis SerCeva

2. saqarTvelos regionebis skolis periodis asakis bavSvebSi

farisebri jirkvlis palpatoruli gasinjva

3. palpatorulad farisebri jirkvlis struqturuli cvlilebis

SemTxvevaSi farisebri jirkvlis ultrabgeriTi diagnostireba

4. farisebri jirkvlis ultrabgeriTi diagnostirebis Sedegad

dadasturebuli daRvevis arsebobis SemTxvevaSi

Tireoidmastimulirebeli hormonis gansazRvra

5. farisebr jirkvalSi koloiduri CanarTebis arsebobis, mcire

moculobis an moculobiTi warmonaqmnis SemTxvevaSi Tavisufali

Tiroqsinis, Tavisufali tetraiodTironinis da/an antisxeulebis

gansazRvra peroqsidazas mimarT

6. farisebri jirkvlis daavadebebis gavrcelebis Seswavla bavSvTa

asakis populaciaSi

7. niadagSi da wyalSi arsebuli iodis Semcvelobis Seswavla da misi

korelacia daavadebis gavrcelebasTan saqarTvelos sxvadasxva

regionebSi

8. ioddeficitisa da anTropometriul maCveneblebs Soris

korelaciuri kavSiris dadgena

13  

naSromis mecnieruli siaxle

pirvelad iqneba naCvenebi saqarTvelos skolis periodis bavSvebSi

ioddeficituri epidemiologiuri maCveneblebi

saqarTvelos regionebis skolis periodis bavSvebSi farisebri jirkvlis

daavadebebis gavrcelebis maCveneblebi

ioddeficitTan anTropometriuli korelaciuri kavSiri skolis

periodis bavSvebSi

saqarTvelos regionebSi niadagsa da wyalSi iodis Semcveloba XXI

saukuneSi

saqarvelos regionebSi niadagsa da wyalSi iodis Semcvelobis

korelacia farisebri jirkvlis paTologiebTan, sxvadasxva regionis

skolis periodis bavSvebSi

14  

naSromis praqtikuli Rirebuleba

1. ioddeficiti dakavSirebulia organizmis zrda-ganviTarebasTan, rac

qmnis saxelmwifos sazogadoebriv-socialur-ekonomikur fons, radgan

ioddeficitma SesaZlebeli gamoiwvios kretinizmi, mkvdarSobadoba,

nervuli sistemis dazianebebi da sxva mniSvnelovani paTologiuri

cvlilebebi, rac iwvevs socialur-ekonomikur cvlilebasda saxemwifos

ganviTarebas uSlis xels, aRniSnuli kvleva xels Seuwyobs miRebul

iqnas informacia saqarTveloSi ioddeficitis mdgomareobis Sesaxeb

2. miRebuli informacia mogvcems saSualebas moxdes aqtiuri promocia

ioddeficitis da masTan dakavSirebuli daavadebebis,aseve, Tu ramdenad

mniSvnelovania prevenciuli RonisZiebebis gatareba aRniSnul

daavadebebTan dakavSirebiT

3. kvelevaSi arsebuli masala da miRebuli Sedegebi daexmareba

praqtikos eqimebs muSaobaSi, kerZod ioddeficitis da mis mier

gamowveuli farisebri jirkvlis daavadebis marTvaSi

15  

disertaciis dasacavad gasatani ZiriTadi debulebebi

1. arsebobs

korelaciuri kavSiri niadagSi da wyalSi iodis Semcvelobasa da

farisebri jirkvlis daavadebebs Soris

2. saqarTve

lo warmoadgens ioodeficitur regions

3. arsebobs

korelaciuri kavSiri ioddeficitsa da sxeulis masis inedqss Soris

4. ioddefi

citis aRmosafxvrelad araris sakmarisi mxolod iodizirebuli

mariliT profilaqtika

5. kaliumis

iodidiT profilaqtikuri Terapia efeqturia ioddeficituri daavadebis

profilaqtikisaTvis

6. ioddefi

citis dros swavlis xarisxi bavSvebSi ukukorelaciur kavSirSia

Tireotropul hormonTan

16  

publikaciebi:

1. Screening Study of Iodine Deficiency Status and Thyroid Diseases in Georgian Children -

Pediatric Research 2011 Vol: 0():399-399.

L Uchava; S Janjgava; E Giorgadze; K Asatiani; M Lomidze; M Korinteli; T Zerekidze; K

Mirianashvili; N Svani; A Malazonia

2. Severe obesity accompanied with subclinical hypothyroidism- Endocrine Abstracts (2009) 20

P56, Ketevan Asatiani, Shota Janjgava, Lasha Uchava, Marina Tsagareli,Nana Tsagareli

3. Lasha Uchava, Shota Janjgava, Elene Giorgadze, Ketevan Asatiani, Tamar Zerekidze and

Marina Lomidze, “Screening Study of Iodine Deficiency Status and Thyroid Diseases in

Georgian Children”. BMC Pediatrics

4. Lasha Uchava, “Screening Study of Iodine Deficiency Status in the republic of

Georgia”ჟურნალი“იnteleქtuali”.

5. თ.ზერეკიძე, შ.ჯანჯღავა, ლ.უჩავა, ქ.ასათიანი, ე.გიორგაძე

„ჰიპერლეპტინემიდაკარდიო–მეტაბოლურიმახასიათებლები.

ექსპერიმენტულიდაკლინიკურიმედიცინა, #4, 2014, გვ.57-63.

6. ლ.უჩავა, შ.ჯანჯღავა, ე.გიორგაძე, ქ.ასათიანი, თ.ზერეკიძე, მ.ლომიძე,

„საქართველოსიოდეფიციტურრეგიონებშიფარისებრიჯირკვლისდაავადებებისგავრ

17  

ცელებასკოლისასაკისბავშვებში. ექსპერიმენტულიდაკლინიკურიმედიცინა, #4, 2014,

გვ.63-70.

disertaciis moculoba da struqtura

1. diserta

cia warmodgenilia qarTul enaze; 82 gverdze; ZiriTadi nawili moicavs

70 gverds; Sedgeba 4 Tavisagan, Seicavs daskvnebs da praqtikul

rekomendaciebs;

2. gamoyene

buli literaturis sias (142 literaturuli wyaro), 11 cxrils, 21

grafiks, 1 suraTs da 1 Skalas.

literaturis mimoxilva

iodis deficiti warmoadgens sazogadoebrivi jandacvis erT-erT mTavar

problemas, radgan is aris mTavari mizezi farisebri jirkvlis

daavadebebisetiologiaSi. ioddeficiti SeiZleba ganviTardes

fiziologiuri ganviTarebis yvela saferxurze: mucladyofnis periodSi,

axalSobilebSi, Cvil bavSvTa asakSi, skolis periodis bavSvebSi,

pubertatul asakSi, zrdasrulebSi, orsulebsa da laqtaciis periodSi

myof qalebSi, romelic SesaZlebelia aRmofxvrili iyos iodis

adeqvaturi dozis miRebis SemTxvevaSi, magram miuxedavad amisa,

gamoyofilia maRali riskis mqone asakobrivi jgufebi, es aris muclad

yofnis periodi, bavSvebi 2 wlame asakSi, orsulebi da laqtaciis

periodSi myofi qalebi [1,3,83]. ioddeficitiT gamowveuli mentaluri

dazianebebi miekuTvneba maRali prevenciis mqone daavadebebs msoflioSi,

xolo skolis asaki da pubertatis periodi aris ioddeficitis

Sedegebis manifestaciis periodi, kerZod difuzurad gadidebuli

18  

farisebri jirkvali, subklinikuri Tireoiduli disfunqcia (xSirad

hipoTireoidizmi, iSviaTad hiperTireoidizmi) [129,130,131] da darRveuli

mentaluri funqcia, aseve Seferxebuli fizikuri ganviTareba xSir

SemTxvevaSi dakavSirebulia nervuli sistemis paTologiebTan, romelic

gamowveulia ioddeficitiT [100,101]. ioddeficitis Sedegad

ganviTarebuli farisebri jirkvlis paTologiebisas maRalia riski

garemoSi arsebuli radiaqtiuri nivTierebebis aTvisebas [126].

ioddeficits aqvs mravali seriozuli gverdiTi efeqtebi, maT Soris,

rogorebicaa: kretinizmi, kvanZovani Ciyvi, darRveuli kognitiuri

funqciebi, zrdis Seferxeba, mkvdarSobadoba da a.S., aRniSnuli

darRvevebis simZime damokidebulia, iodis ukmarisobis xarisxze,

ioddeficits aqvs mniSvnelovani gavlena adamianis zrda-ganviTarebaze,

bolo aTwlelulis ganmavlobaSiბ [61,62], msoflio masStabiT,

mniSvnelovani progresi SeimCneva ioddeficitis prevenciasa da

mkurnalobaSi, rasac adasturebs, bolo wlebSi, ramodenime placebo-

randomizirebuli kvleva, romlebic swavlobdnen iod CanacvlebiTi

Terapiis gavlenas adamianis organizmze [2]. iodis, rogorc deficits

aseve misi maRali done organizmSi SesaZlebelia gaxdes farisebri

jirkvlis daavadebis mizezi. iodi aris mTavari komponenti

triiodTironinis da Tiroqsinis warmoqmnisaTvis, amitom misi raodenoba

sakvebSi warmoadgens erT-erT mTavar komponents swori kvebis dros. ara

adeqvaturi iodis miReba iwvevs Tireoiduli hormonebis araswor

sinTezs, rac sabolood iwvevs hipoTireozs [132,133,134]. imisaTvis, rom

farisebrma jirkvalma daasinTeziros Tiroqsinis adeqvaturi raodenoba,

saWiroa farisebri jirkvlis mier aTvisebuli iyos organizmidan 52 mkg

iodi dRis ganmavlobaSi, mZime ioddeficiti viTardeba mas Semdgom

rodesac misi aTviseba mcirdeba 20 mkg-mde dRis ganmavlobaSi

iodi miekuTvneba egreT wodebul kvebis esenciur mikroelements, anu

iseTs, romelsac organizmi TviTon ver warmoqmnis da saWoroa misi

miwodeba gare samyarodan. is gavrcelebulia gare samyaroSi ( niadagSi,

zRvaSi) iodidis saxiT [2,3]. iodidis ionebi iJangeba mzis sxivis

19  

saSualebiT aqrolebad atomur iodad. yovelwliurad 400 aTasi tona

iodi qroldeba zRvisa da okeanebis zedapiridan. zRvaSi iodis

koncentracia Seadgens 50-60 mkg/l, xolo haerSi – 0,7 mkg/m3.

atmosferodan iodi kvlav brundeba niadagSi wvimasTan erTad sadac misi

koncentracia meryeobs 1,8-8,5 mkg/l. amgvarad, iqmneba mankieri wre, magram

iodis dabruneba niadagSi xdeba Zalian nela da SedarebiT naklebi

raodenobiT. iodis Semcveloba niadagSi Zalian meryeobs ( 50-9000 mkg/kg)

da rogorc wesi swored, rom niadagSia misi deficiti. aqden

gamomdinare, mcenareebi, romlebic izrdeba aseT niadagSi., Raribia

iodiT ( 10 mkg/kg mSrali masisa SedarebiT im mcenareebTan , romlebic

izrdeba aradeficitur pirobebSi, sadac iodis Semcveloba Seadgens 1000

mkg/kg mSrali masisa), xolo adamianebi da cxovelebi, romlebic

ikvebebian aseTi mcenareebiT, ganicdian iodis deficits da maT

uviTardebaT ioddeficituri daavadeebebi [28,31].

suraTi #1

20  

iodis koncentracia samel wyalSi damokidebulia iodis

kincentraciaze niadagSi. ioddeficitur regionebSi iodis koncentracia

wyalSi Seadgens daaxloebiT 2 mkg/l. wyali, rogorc wesi, ar

warmoadgens iodis ZiriTad wyaros. vinaidan sasmeli wyali Seicavs

iodis mcire raodenobas, ZiriTadad iods Cven vRebulobT sakvebidan

[73,78]. iodis yvelaze did raodenobas Seicavs zRvis Tevzi da zRvis

produqtebi (800-1000 mkg/kg), gansakurebiT yvelaze did raodenobas

Seicavs zRvis wyalmcenareebi. cnobilia, rom iodis did raodenobas

Seicavs zRvis kombosto (laminaria) Tevzis qoni, rZe [92,93,94], kvercxi,

xorci, cotas Seicavs – xili da bostneuli, garda ispanaxisa. unda

aRiniSnos, rom iodis Semcveloba meryeobs sezonidan sezonamde (rZis

produqtebi), erTi regionidan meoremde, kerZis momzadebis wesiT da

saerTod, is produqtebi, romlebsac Cven viyenebT sakvebSi Zalian

gaRaribebulia iodiT[3,68,70]. (ix suraTi #1)

ioddeficitis maxasiaTeblebad miiCneva: gadidebuli farisebri

jirkvlis moculoba, kvanZovani Ciyvis raodenobrivi mateba an farisebri

jirkvlis paTologiebis simravle, SardSi iodi an neonatalur plazmaSi

21  

momatebuli Tireoidmastimulirebeli hormonis done. ioddeficiti

miiCneva endemur paTologiad, rodesac misi maCvenebeli 10%-s aRemateba

populaciaSi. 1993 wlis monacemebiT aziis qveynebSi skolis periodis

bavSvTa asakSi misi gavrceleba Seadgenda: nepali 44%, koreis

respublika 15%, Sri-lanka 14%, tailandi 12%, bangladeSi 11%, indoeTi

9%, monRoleTi 7% (WHO [5]).

jandacvis msoflio organizaciis 1999 wlis monacemebiT 191 qveynidan

130-s aqvs ioddeficitTan dakavSirebuli problemebi, 20 maTganis mier

aRniSnuli problema aRmofxvrili iqna prevenciuli RonisZiebebis

saSualebiT, daaxloebiT 172 milioni anu 12% samxreT da CrdiloeT

aziisa arian daavadebuli farisebri jirkvlis sxvadasxva paTologiiT

xolo 41%-s aqvs gazrdili riski daavadebis ganviTarebis, romelTac

SesaZlebelia qondeT mosazRvre ioddeficituri statusi, aRniSnuli

problemis gamo bolo periodSi aqtiurad mimdinareobs prevenciuli

RonisZiebebi [6,21,40]. msoflioSi ramodenime qveyana miCneulia, rogorc

gansakuTrebuli ioddeficituri zona, magram aRniSnuli sabolood

Seswavlili araris. msoflio populaciis 50% miCneulia, rom cxovrobs

ioddeficitur zonaSi [21,45,57]. ioddeficiti XX saukunis bolos da XXI

saukunis dasawyisSi warmogvidga, rogorc msoflio sazogadoebriv-

socialuri problema. 1999 wlis maCveneblebiT msoflio populaciis 38.4

%-Si 130 qveynidan damaxasiaTebelia ioddeficituri mdgomareoba, aqedan

daaxloebiT 700 milionSi, rac warmoadgens populaciis 12.6 %-s –

aReniSneba farisebri jirkvlis paTologia, xolo 1994 wlis monacemebiT

43 milion adamians, ioddeficitis Sedegad ukve ganviTarebuli aqvs

mentaluri cvlilebebi, xolo rac Seexeba evropas is miCneulia

saSualo ioddeficitur regionad, endemuri Ciyvis aRwera evropaSi

xdeboda mxolod mTian regionebSi, 1980-iani wlebis maCveneblebis

mixedviT umetes regionebSi damaxasiaTეbeli iyo ioddeficituri

maCvenebeli wina wlebisgan gansxavebiT (Gutekunst & Scriba). 1997 wlis

kvlevis mixedviT, sadac monawileobda evropis 26 qveyana saSualo da

mZime ioddeficiti gamoxatuli iyo mraval regionSi, rac dramatuli

22  

Sedegi iyo iodizirebuli marilis promociis Sewyvetis [80], romelic 5-7

wlis ganmavlobaSi ar gamoiyeneboda am qveynebSi [36,37,39]. 1999 wels

jandacvis msoflio organizaciis (WHO), gaerTianebuli erebis bavSvTa

fondis (UNICEF) da ioddeficitis kontrolis saerTaSoriso sabWos mier

(ICCIDD) reportirebuli iqna Semdegi monacemebi: dasavleT da

centraluri evropis 18 qveyanaSi SeimCneoda ioddeficiti, 275 milion

adamianSi, romelic warmoadgens mosaxleobis 31.6 %-s fiqsirdeboda

ioddeficiti, xolo 130 milions anu mosaxleobis 15 %-s qonda

farisebri jirkvlis daavadeba [6,38, 41,42,57].

niadagSi ioddeficitis mTavari mizezebi SeiZleba iyos wyaldidoba,

Zlieri wvima, miwisZvra, rac mizezia niadagidan mikro-makroelementebis

gamorecxvisa. maRalmTian regionSi andebSi, himalaiSi aRniSnulis gamo

aris ioddeficitis gavrcelebis maRali maCvenebeli, amasTanave

aRniSnuli fiqsirdeba iseT regionebSi sadac aris xSiri wyaldidobebi,

magaliTad indoeTsa da bangladeSSi mdinare gangis sanapiroze,

aRniSnuli midamoebSi endemuri ioddeficiti damaxasiaTebelia wyalsa

da sakvebSi [3,99]. jandacvis msoflio organizaciis mier rekomendebulia

Cvil bavSvTa asakSi da 5 wlamde asakis bavSvebSi 90 mkg iodi dReSi, 6-12

wlamde asakSi _ 120 mkg, 12 wlis zemoT 150 mkg dRis ganmavlobaSi, xolo

orsulobis da laqtaciis periodSi 200-250 mkg dRe-RameSi. amerikis

medicinis institutis mier mowodebulia Semdegi sqema: 90 mkg iodi 8

wlamde asakSi, 120 mkg 9-13 wlis bavSvebSi, 150 mkg mozrdilebSi da

araorsulebSi, 220 mkg orsulebSi da 290 mkg iodi laqtaciis periodSi

(WHO). iodis moTxovnileba orsul qalebSi izrdeba, radgan izrdeba

Tiroqsini produqcia, imisaTvis, rom SenarCunebuli iyos mTeli

orsulobis dros euTireoiduli mdgomareoba, radgan ioddeficiti

orsulobis dros iwveves nayofis neiro-motoruli sistemis ganviTarebis

paTologiebs. iodi da farisebri jirkvlis hormonebi orsulobis dros

nayofSi uzrunvelyofen somatur zrdas da pasuxismgeblebi arian

ramodenime organos da organoTa sistemebis ganviTarebaze,

gansakuTrebiT maTi roli aisaxeba nervul sistemaze, isini

23  

uzrunvelyofen mielinizacias da nervuli ujredebis diferenciacias,

Tavis tvinis momwifebas da mTavari fiziologiuri procesebis

momwifebas [4].

ganviTarebad qveynebSi sakvebi produqtebi Seicavs cianogenur

glukozidazas, romelic SeiZleba gardaiqmnas Tavisufal cianidad,

cianidi ki TavisTavad konvertirdeba Tiocianidad, romelic TavisTavad

warmoadgens Ciyvis maprovocirebel faqtors, rac aixsneba imiT, rom

Tiocianidi blokavs iodis aTvisebas farisebr jirkvalSi. umetes

SemTxvevaSi ioddeficitis mizezi aris sakvebismieri iodis nakleboba,

romelic umetes SemTxvevaSi upiratesad gamoixateba cxovrebis im

periodSi, rodesac izrdeba iodisadmi organizmis moTxovnileba, kerZod

pubertatuli periodi, laqtaciis da orsulobis periodi, aseve

ioddeficitis mizezi SeiZleba gaxdes, SardiT iodis gaZlierebuli

gamoyofa (nefrozuli sindromi), TiroqsinSemboWavi globulinis maRali

done, romelic damaxasiaTebelia hiperestrogenizmis da oraluri

kontracefciis miRebis dros, selenis da rkinis dabali done sisxlis

plazmaSi, latenturi Tireoiduli enzimebis deficiti da autoimunuri

Tireoiduli procesebi [6,38].

seleni aris mTavari komponentifermentebisaTvis (mag.: 1-deiodinaza),

romlebic uzrunvelyofen da akatalizeben Tiroqsinis(T4-is)gardaqmnas

(T3-ad)triiodTironinad [84,85,98]. aqedan, gamomdinare iodis da selenis

kombinirebuli deficiti iwvevs miqsedemuri Ciyvis ganviTarebas, selenis

dabali done aRiniSnebaavstraliaSi, egvipteSi da axal zelandiaSi,

xolo maRali Semcveloba venesuelaSi, romelic aseve arRvevs farisebri

jirkvlis funqcias da iwvevs producirebuli triiodTironinis

formirebas Tiroqsinad [8,9,58].

Tireoiduli hormonebis metabolizmis darRvevebi, aseve SesaZlebeblia

gamoiwvios rkinis deficitma organizmSi, radgan pirveli ori nabiji

Tireoiduli hormonebis sinTezisaTvis katalizdeba Tiroperoqsidazas

mier, romelic aris rkinadamokidebuli enzimi, aRniSnulis gamo rkinis

24  

deficiti iwvevs triiodTironinis da Tiroqsinis daqveiTebas sisxlis

plazmaSi da amcirebs tiroqsinis gardaqmnas triiodTironinad, rac

iwvevs Tireoidmastimulirebeli hormonis koncentraciis matebas

sisxlSi, aRniSnulidan gamomdinare iodis metabolizmis dros

rkinadeficituri anemiis mqone pacientebSi iodCanacvlebiT Terapia

naklebefeqturia 30 kvirianma dakvirvebam aCvena, rom rkinadeficituri

anemiis mqone pacientebSi farisebri jirkvlis paTologia gamoxatuli

iyo 64%-Si, xolo rkinis normaluri donisas sisxlSi, mxolod 12%-Si,

aRniSnuli kvlevis dros rkina CanacvlebiTi Terapiis gziT miRweuli

iqna Semdegi: kombinirebuli Terapia iodisa da rkinis CanacvlebiTi

Terapiis fonze farisebri jirkvlis daavadebebi mcirdeboda ufro

swrafad vidre mxolod iodis preparatebiT Canacvlebis fonze[8,11,34,43].

ioddeficiti asocirebulia endemur CiyvTan da hipoTireoidizmTan,

xolo orsulobis SemTxvevaSi asocirebulia kretinizmTan [63,64,65,67],

neonatalur da CvilbavSvTa sikvdilobasTan, garda amisa msubuqad

gamoxatulma ioddeficitma SeiZleba gamoiwvios farisebri jirkvlis

gadideba da swavlaSi CamorCena bavSvTa asakSi, აRniSnuli mdgomareobebi

SeiZleba daamZimos rkinis da selenis naklebobam [9,65]. ioddeficitis

gamovlineba SeasaZlebelia moxdes cxovrebis nebismier etapze. (ix.

cxrili #2)

xSirad endemuri Ciyvis gamovlineba xdeba SemTxveviT, farisebri

jirkvlis palpatoruli an ultrabgeriTi kontroliT. klinikurad

gamoixateba jirkvlis zomieri difuzuri gadidebiT an kvanZovani

warmonaqmnis (erTi an mravali) arsebobiT da xSirad misi funqciis

daqveiTebiT (hipoTireozis niSnebiT) [108]vlindeba:1. bavSvebSi, ufro

xSirad pubertatuli periodis gogonebSi _ zomieri difuzuri

gadidebiT, 2. reproduqciuli asakis pirebSi, 3. mozrdilebSi difuzuri

gadidebis fonze viTardeba erTeuli an mravlobiTi kvanZovani

warmonaqmnebi. romlebic mniSvnelovan zomebs aRweven da irgvliv

mdebare organoebze zewolas iwveven.kvanZovani Ciyvi ioddeficitur

25  

kerebSi gacilebiT ufro xSirad ganicdis malignizacias da ufro

agresiuli mimdinareoba aqvs vidre sxva teritoriebze[20].

cxrili #2:ioddeficitur daavadebaTa gamovlinebis speqtri

sicocxlis periodi potenciuri darRvevebi

nayofi

aborti, mkvdradSobadoba,

Tandayolili anomaliebi,

momatebuli perinataluri

sikvdilianoba,

endemiuri nevrologiuri

kretinizmi:

gonebriviCamorCeniloba,

yrumunjoba, spastiuri diplegia,

sielme;

endemuri miqsedematozuri

kretinizmi

axalSobili

neonataluri Ciyvi

manifestirebuli an subklinikuri

hipoTireozi

bavSvebi da mozardebi

endemuri Ciyvi

iuveniluri hipoTireozi

fizikuri da gonebrivi

ganviTarebis darRveva

mozardebi

Ciyvi da misi garTulebebi:

hipoTireozi,

gonebrivi CamorCeniloba,

unayofoba,

iodinducirebuili Tireotoqsikozi,

endemuri kretinizmiT daavadebuli

bavSvis dabadebis riski

26  

yvela asaki

radiaqtiuri iodis STanTqmis

momateba birTvuli katastrofebis

dros,

kognituri funqciis darRveva

kretinizmi _ kretinizmi es aris mentaluri darRveva, romelic

SekavSirebuli sxva nervul da somatur darRvevebTan, ise SeiZleba

mimdinareobdes ori saxiT: nevrologiuri da miqsedematozuri.

nevrologiuri kretinizmisaTvis damaxasiaTebelia, mentaluri CamorCena,

yru-munjoba, siarulis darRveva da spastiuroba, magram ara

hipoTireoidizmi,[13] mis mizezad miCneulia orsulobisas dedis

organizmSi arsebuli hipoTireoidizmi, postnataluri euTireoiduli

mdgomareobT, xolo miqsedemuri kreatinizmis dros damaxasiaTebelia

mentaluri CamorCena, dabali simaRle da hipoTireoidizmi, es aris

Sedegi orsulobis gvian periodSi ganviTarebuli ioddeficitisa,

romelic grZeldeba postnatalur periodSic. aRniSnuli Sedegebi

damaxasiaTebelia, maSin rodesac mikroelemnt iodis aTviseba farisebri

jirkvlSi daqveiTebulia 25 mkg-mde dRis ganmavlobaSi [14,26,107,109]

ioddeficitTan aseve dakavSirebulia, iseTi problemebi rogorebicaa

zrdis da mentaluri Cvevebis ganviTareba, romlis Sefaseba da

diferencireba SesaZlebelia, mxolod bavSvTa asakSi 2,5 wlis zemoT. 9-

dan 15 wlamde bavSvebis dakvirvebam aCvena, rom ioddeficitis mqone

bavSvebi, swavlobdnen SedarebiT naklebad da hqondaT naklebi

motivacia, gansxvavebiT bavSvebisgan, romelTac ar hqondaT

ioddeficituri statusi[15,34]. 18 kvlevis meta-analizma aCvena, rom

kognitiuri da fsiqo-motoruli ganviTarebis qula 13,5_iT naklebi iyo

araioddeficituri bavSvebisgan gansxvavebiT, gonebrivi SesaZleblobebi

Sefasebuli iqna gonebrivi ganviTarebis koeficientis (IQ) mixedviT,

romelic gaiara 2214 bavSvma [16,35,29]. kognitiuri funqciebis Seswavlisas

dafiqsirda Semdegi problema, ucnobi iyo daqveiTebuli gonebrivi

SesaZleblobebi dakavSirebuli iyo mucladyofnis periodTan Tu bavSvTa

27  

asakSi ganviTarebul ioddeficitTan, garda amisa espaneTis provinciaSi

Seswavlili iqna skolis periodis bavSvebSi SardSi iodis koncentracia,

bavSvebSi sadac SardSi iodis koncentracia 100 mkg/l-ze dabali iyo

saSualo gonebrivi ganviTarebis koeficienti iyo 96,4, xolo bavSvebSi,

romelTac iodis SEmcveloba SardSi aRemateboda 100 mkg/l-ze gonebrivi

ganviTarebis koeficienti Seadgenda 99-s [23]. avstraliaSi Seswavlil

iqna orsulobis periodSi iodis Semcveloba SardSi, orsulebSi sadac

iodis eqskrecia SardSi 150 mkg/l-ze naklebi iyo, maT bavSvebSi

SeimCneoda daqveiTebuli metyvelebis unari, SedarebiT orsulebisa

romelTac SardSi iodis sekreia iyo 150 mkg/l-ze meti [21,22]. am kvlevaSi

gamoricxuli iqna ioddeficitis regionaluri faqtori, radgan SardSi

iodis eqskrecia skolis asakis bavSvTa periodSi Seadgenda 108 mkg/l-ze,

aqedan gamomdinare, aRniSnuli mentaluri cvlilebebi dakavSirebuli

iqna orsulobis dros arsebul ioddeficitTan [30,32,33]. amas garda

orsulobis dros arsebuli ioddeficitiT gamowveuli inteleqtualuri

darRvevebi Seuqcevadia, gansxvavebiT postnatalur periodSi

ganviTarebuli ioddeficitisgan, romelic ganicdis regresirebas iodis

an Tiroiduli hormonebis Canacvlebisas, rac dasturdeba albaneTsi

Catarebuli kvlevis Sedegad, sadac monawileobda 310 bavSvi, romelTac

eZleodaT iodis preparati an placebo, iodiT CanacvlebiT Terapiaze

myof bavSvebSi sarwmunod gaumjobesda Tireoiduli funqcia da

kognitiuri testebis Sesrulebis unari[24,25,27].

subklinikuri nevrologiuri defeqti – optiamluri iodiT CanacvlebiTi

Terapia orsul qalebSi uzrunvelyofs nayofis srulfasovan

Camoyalibebas da ganviTarebas, romelic dasturdeba Semdegi kvlevebis

safuZvelze, qalebi saSualo an msubuqi ioddeficitiT an msubuqi

hipoTireoziTromlebic imyofebodnen CanacvlebiT Terapiaze 200-300 mkg

iodi dRis ganmavlobaSi orsulobis adreuli periodidan [29], SemdgomSi

bavSvTa nevrologiuri ganviTarebis statusi iyo bevrad ukeTesi vidre

im bavSvebisa, romlis dedebic ar iyvnen CanacvlebiT Terapiaze. meore

28  

klinikurad mniSvnelovani manifestacia ioddeficitis aris

sazogadoebaSi integracia [7,18,19].

ioddeficiti zrdis neonatalur an CvilbavSvTa sikvdilobas, aRniSnuli

SesaZlebelia Semcirebuli iqnas 50 %-iT, Tu orsulobis dros moxdeba

swori dozirebiT iodis preparatiT CanacvlebiTi Terapia [16,17]. gvineaSi

dafiqsirebuli iqna perinataluri sikvdilobis orjer ufro meti

maCvenebeli, im orsul qalebSi, romleTac Tavisufali Tiroqsinis

maCvenebeli hqondaT daqveiTebuli, aRniSnulis meqanizmi sabolood

Seswavlili araris, magram savaraudoa, rom monawileobs ramodenime

faqtori erTdroulad, romelTa Soris moiazreba imunuri sistemis

problema da infeqciuri daavadebebis mimarT dabali rezistentoba

[23,106,109].

endemuri Ciyvi aris pirveli mniSvnelovani gamovlineba ioddeficitis

dros, iodis dabali aTviseba iwvevs triiodTironinisa da Tiroqsinis

sinTezis daqveiTebas, rac SemdgomSi iwvevs Tireoidmastimulirebeli

hormonis sekreciis zrda, romlis mizanic aris, rom aRadginos

triiodTironinisa da Tiroqsinis normaluri done,

Tireoidmastimulirebeli hormonis maRali done iwvevს Tireoiduli

ujredebis gamravlebas, rac iwvevs farisebri jirkvlis moculobaSi

zrdas. aRniSnuli meqanizmis Sedegad viTardeba farisebri jirkvlis

difuzurad gadideba [10,12]. umetes SemTxvevaSi viTardeba difuzuri

Ciyvi, magram zogierT SemTxvevaSi damaxasiaTebelia kvanZovani

warmonaqmnebis warmoSoba, romlis mizezic gaxlavT Tireoidul

folikulebSi proliferaciuli ubnebis arseboba, aRniSnulis gamo

ioddeficitur regionebSi bavSvebsa da mozardTa asakSi

damaxasiaTebelia difuzuri Ciyvi, xolo xangrZlivi periodis

ganmavlobaSi mimdinare ioddeficitis dros damaxasiaTebelia kvanZovani

Ciyvis arseboba. ioddeficiti iwvevs Tireoidul folikulur ujredebSi

replikaciebs, rac zrdis Sans Tireotropuli hormonis receptoris

genis mutaciis da iwvevs Tireotropul hormon damoukidebel zrdas

[70,71,72], rac aseve iwvevs garkveuli ujredebis damoikidebel

29  

funqcionirebas, aRniSnulidan gamomdinare mosalodnelia

hiperTireoidizmis gamovlineba, radgan eseTi ujredebi moklebuli arian

Tireotropuli hormonis kontrols, amitom iodTerapiis Canacvlebis

SemTxvevaSi mosalodnelia hiperTireozis ganviTareba[74,76,77].

tradiciulad endemuri Ciyvis gamovlena xdeba palpaciis meSveobiT,

magram bolo periodSi aqtiurad gamoiyeneba ultrabgeriTi kvlevis

meTodi, romelic iZleva saSualebas, zustad iqnes daTvlili farisebri

jirkvlis moculoba da Seswavlili iqnas misi struqtura, rac bolo

wlebis ganmavlobaSi erT-erT mTavar diagnostikur meTodad

Camoyalibda. ioddeficitur regionebSi farisebri jirkvlis saSualo

moculoba yvela asakobriv jgufSi ufro metia, vidre iodiT gajerebul

regionSi, ioddeficitur regionSi mcxovrebTaTvis farisebri jirkvlis

moculoba sxvadasxvaa asakis, sqesis da sxeulis moculobis mixedviT.

farisebri jirkvlis moculoba amerikasa da evropiaSi mcxovrebTaTvis

TiTqmis erTia, miuxedavad imisa, rom amerikisagan gansxvavebiT evropis

ramodenime qveyanaSi ufro metadaa gamoxatuli ioddeficiti. mraval

individSi endemurad gadidebuli difuzuri Ciyvi warmoadgens mxolod

esTetikur problemas, magram mozrdilTa asakSi man SeiZleba miaRwios

Zalian didi zomebs, rac iwvevs traqeis an saylapavis kompresias, aseve

mosalodnelia avTvisebian simsivned gadagvareba [75,77].

iodis deficiti zrdis onkologiur daavadebaTa risks, upirveles

yovlisa endokrinuli da reproduqciuli sistemis mimarT.

epidemiologiuri gamokvlevebi gviCvenebs, rom iodis arasakmarisi

raodenoba sakvebSi zrdis farisebri jirkvlis folikuluri simsivnis

risks. xSirad farisebri jirkvlis simsivne vlindeba endemur

regionebSi, sadac mosaxleoba daavadebulia kvanZovani CiyviT. regionebi,

sadac Warbad moixmaren iods, naklebad gvxvdeba farisebri jirkvlis

agresiuli folikuluri da anaplastiuri karcinomebi. xSirad gvxvdeba

keTilTvisebiani papilaruli karcinomebi. endemuri regionebi, romlibic

radiaqtiuri iodiT arian dabinZurebuli [110,111,126,127,128], gaZlierebulia

farisebri jirkvlis dasxiveba radiaqtiuri iodiT. bavSvebi da

30  

mozardebi, romlibic dasxivdnen Cernobilis afeTqebis Semdeg, iodis

ukmarisobis pirobebSi mcxovrebTa farisebri jirkvlis simsivnis riski

gaizarda orjer im pirebTan SedarebiT, romlebic cxovrobdnen iodis

normaluri moxmarebis pirobebSi [10,75,76]. Cernobilis afeTqebis Sedegad

gaizarda ricxvi farisebri jirkvlis agresiuli papilaruli

karcinomebis im bavSvebSi romlebic cxovrobdnen ioddeficitur

regionebSi _ belorusia da ukraina, magaram ara poloneTSi, sadac

mimdinareobda farTomasStaburi iodiT profilaqtika. iodis deficiti,

farisebri jirkvlis gadideba, hipoTireozi, aratoqsiuri Ciyvi,

Tireoiditi asocirdeba ZuZus kibo ganviTarebis riskTan [112,113,114].

gamokvlevebi gviCvenebs rom iodis deficiti sakvebSi zrdis winamdebare

jirkvlis kibos ganviTarebis risks. iodis deficiti regionebSi zrdis

kuWis kiboTi sikvdilianobis risksac [136,139]. evoluciis procesSi

adamianma gamoimuSava adaptaciis unari iodis Semcvelobis Semcirebaze

wyalsa da sakvebSi. iodis moxmarebis dRe_Ramuri norma Seadgens 150-200

mkg, aqedan 100mkg-mde dRe-RameSi xmardeba Tireoiduli hormonebis

sinTezs.

ioddeficitis Sedegad gamowveuli hipoTireoidizmebi dReisobiT

naklebadaa gavrcelebuli, mozrdilebs aqvT tipiuri manifestirebuli

hipoTireoidizmis suraTi da umetes SemTxvevaSi difuzurad gadidebuli

farisebri jirkvali [13,15]. momavali ganviTarebisaTvis mucladyofnisa

da Cvilobis dros mniSvnelovania, rom ioddeficitis mkurnaloba

Catardesdroulad da dozireba iyos sworad SerCeuli, radgan Tavidan

aviciloT nevuli wnulebis demielinizacia nayofSi[14].

iods mniSvnelovani adgili uWiravs organizmis nivTierebaTa cvlaSi,

radgan Tireoidul hormonebi gamoiyeneba sxeulis TiTqmis yvela

ujredis regulaciaSi, maT Soris metabolozmis regulaciaSi da wonis

kontrolSi, radgan igi aqtiurad monawileobs cximis, rogorc energiisa

da siTburi wyaros gamoyenebaSi, aseve iodi mniSvnelovani sxva

endokrinuli jirkvlebisaTvis, esenia: Tirkmelzeda jirkvali,

saTesleebi, sakvercxeebi, pankreasi, Timusi da a.S.; [46,47,48,131] iodi aseve

31  

monawileobs kuW-nawlavis traqtis funqcionirebaSi, radgan misi

garkveuli raodenoba aris saWiro sanerwyve jirkvlis

funqcionirebisaTvis da kuWis wvenis warmoqmnisaTvis, iodi aqtiurad

monawileobs imunuri sistemis funqcionirebaSi [86,135], monawileobas

Rebulobs antibaqterialur, antiparazitul da antisimsivnur imunur

pasuxSi. [49,50,51,52] naCvenebi iqna, rom iodis maRali dozireba

gamoyenebuli iqnas farisebri jirkvlis simsivneebis samkurnalod, mas

gaaCnia antioqsidanturi moqmedebac [91,140]. 1960 wels rodesac iodis

SeTviseba iyo SedarebiT maRali filtvis simsivnis maCvenebeli iyo 1:20,

xolo dReisaTvis aris 1:8 da yovelwliurad izrdeba 1%-iT. jandacvis

msoflio organizaciis mier naCvenebi iqna, rom ioddeficiti

mniSvnelovan rols asrulebs uSvilobis ganviTarebaSi, iodis

naklebobis gamo SeiZleba ganviTardes menstrualuri ciklis darRvevebi,

adreuli menopauza da sakvercxeebis daavadebebi, xolo mamakacebSi

SesaZloa gamoiwvios winamdebare jirkvlis daavadebebi [53,54,55,56]

iodis Semcvelobis gansazRvrisaTvis organizmSi sadiagnostikod

gamoiyeneba SardSi iodis eqskreciis gansazRvra, farisebri jirkvlis

zoma, Tireotropuli hormoni da Tireoglobulini. SardSi iodis

eqskreciis gansazRvra iZleva informacias organizmSi amJamad arsebuli

iodis Sesaxeb, xolo farisebri jirkvlis zoma, Tireotropuli hormoni

da Tireoglobulini Tveebis an wlebis informacias iodis statusis

Sesaxeb organizmSi [44,79].

SardSi iodis eqskrecia – gastro-intestinaluri sistemiT SeTvisebuli

iodis daaxloebiT 90% gamoiyofa Sardis gziT organizmidan [135,137,138].

ioddeficituri regionis dasadgenad SardSi iodis gansazRvra

populaciaSi xdeba 24 saaTiani Sardis SegrovebiT, sadac iodis

gansazRvra xdeba ara yvela individSi aramed brma SerCeviT[46,87,88]. Tu

iodis Semcveloba SardSi Seadgens 50-99 mkg/l-s iTvleba msubuq

ioddeficitur zonad, 20-49 mkg/l saSualod, xolo 20 mkg/l-s qvemoT

mZime ioddeficitur zonad [6,89,90]. (ix. cxrili #3)

32  

cxrili #3: ioduriis mixedviT gamoyofen iodis deficitis klinikuri

gamovlinebis sam xarisxs:

xarisxi msubuqi saSulo mZime

Ciyvi -

gvxvdeba

populaciaSi

10-30%

50%-mde

100%

saSualod

ioduria

5 - 9,9

mkg%

2 - 4,9

mkg%

2 mkg%-ze

naklebi

hipoTireozi

da kretinizmi

ar aris

SesaZloa

iyos

hipoTireo

zi

kretinizmis

SemTxvevebi

1-dan 10%-mde

(ICCIDD)

plazmaSi Tireotropuli done aris maCvnebeli ioddeficitis statusis,

rogorc neonatalur skriningul programaSi, aseve mogvianebiT

periodSic [102]. regionSi ioddeficituri statusi dgindeba mxolod im

SemTxvevaSi Tu Tireotropuli hormonis done metia 5.0 mIU/L xolo

neonatalur periodSi samjer aRemateba am maCvenebels. skolis asakis

bavSvebSi Tireotropul hormonTan erTad aucilebeli gakeTebuli iyos

Tiroqsinis Semcvelobac plazmaSi, radgan nanaxi iyos subklinikuri

hipoTireozi [48,49].

Tireoglobulinis koncentracia aris sensitiuri maCvenebeli

Tireotripuli hormonis aqtivobisa da farisebri jirkvlis

hiperplaziis. Tireoglobulinis koncentracia ufro maRalia

Tireotropuli hormonis koncentraciaze bavSvTa asakSi [59,60],

farisebri jirkvlis saerTo moculoba aris erT-erTi mniSvnelovani

diagnostikuri meTodi ioddeficitis dros, Tumca is ar asaxavs

33  

realurad ioddeficitis simZimis xarisxs. farisebri jirkvlis

moculoba SeiZleba nanaxi iyos xeliT palpaciisas, Tumca

ultrabgeriTi diagnostika iZleva srulfasovan pasuxs [81].

farisebri jirkvlis diagnostirebisaTvis aseve SeasZlebelia

gamoyenebuli iyos ionizirebuli iodis CarTvis meTodi, Tumca misi

gamoyeneba sxvadasxva mizezebis gamo araxelsayrelia, aseve ar

gamoiyenaba triiodTironinisa da Tiroqsinis koncentraciis gansazRvra

SratSi, radgan umetes SemTxvevaSi isini normis farglebSia

garemos adgilobrivi Taviseburebebidan gamomdinare saqarTvelosaTvis

erT-erT mniSvnelovan problemas warmoadgens ioddeficiti, romelsac

arainfeqciur daavadebaTa Soris gavrcelebis, daavadebulTa da riskis

qveS myofTa raodenobis mixedviT erT-erTi mniSvnelovani adgili ukavia.

aRniSnuli daavadeba saqarTvelosaTvis yovelTvis warmoadgenda

problemas. XX saukunis bolos Catarebuli masobrivi gamokvlevebiT

saqarTveloSi dadegenili iqna edndemuri teritoriebi, efeqturad

ganxorcielebulma iods profilaqtikam mniSvnelovnad Seamcira

endemuri Ciyvis maCveneblebi, Tumca gasuli saukunis bolos

mniSvnelovnad moimata ioddeficitis maCvenebelma, rasac xeli Seuwyo

prevenciuli RonisZiebebis Sesustebam da amasTanave socialur-

ekonomiurma mdgomareobam. ioddeficitis roli endemuri Ciyvis

SemTxvevaSi mravalgzis iqna Seswavlili, magram arsebobs sxva mravali

faqtori, romelic monawileobs endemuri Ciyvis CamoyalibebaSi, razec

miuTiTebs is faqti, rom efeqturad Catarebuli iodiT profilaqtikis

miuxedavad ar moxda endemuri kerebis srulad aRmofxvra, garda amisa

endemuri Ciyvis gavrceleba yvela endemur regionSi ar aris

ukuproporciuli iodis SemcvelobasTan garemoSi, miuxedevad amisa

msoflioSi Catarebuli mravali kvleva ar iZleva srul informacias

yvela im faqtoris Sesaxeb, romelic iwvevs ioddeficitsa da endemur

Ciyvs [142].

34  

Tavi 2: kvlevis masalebi da meTodebi

2.1 kvlevis masalebis da meTodebis zogadi daxasiaTeba

2007 wlis ivnisidan 2013 wlis martis CaTvliT skrininguli kvlevis

farglebSi Seswavlili iqna 52328 skolis periodis asakis bavSvi.

skriningi, es aris farulad mimdinare daavadebebze im pirTa

gamokvleva, romlebic ar iTvlebian daavadebulad. dReisaTvis klinikur

epidemiologiaSi mkafiod aris rekomendebuli skriningis organizaciis

mecnieruli principebi, rogorc wesi skriningisaTvis gamoiyeneba iafi,

martivi, arainvaziuri diagnostikuri procedurebi, romelTav amave dros

aqvT maRali mgrZnobeloba [141].

aRniSnulidan gamomdinare skrininguli kvlevis dros bavSvebs

utardebodaT Semdegi gamokvlevvebi [79]:  

1. farisebri jirkvlis palpatoruli gasinjva

2. farisebri jirkvlis ultrabgeriTi kvleva

3. Tireoidmastimulirebeli hormonis gansazRvra sisxlis SratSi

4. antisxeulebi peroqsidazas mimarT

5. SerCeviTad Tavisufali Tiroqsinis da Tavisufali triiodTironinis

gansazRvra

6. anTropometriuli monacemebi (simaRle, wona, sxeulis maisis indeqsi)

7. moswavleTa da maswavlebelTa kiTxvari

aRniSnuli kvlevebis Catareba moxda “endokrinologiis erovnul

institutSi”.

35  

8. skrininguli kvlevis farglebSi saqarTvelos sxvadasxva regionSi nanaxi

iqna iodis Semcveloba miwisa da wylis nimuSebSi, romelic aRebuli iyo

wesebis sruli dacviT da gagzavnil iqna Stutgardis laboratoriaSi.

pacientebi aRniSnuli kvlevisaTvis winaswar SerCeul iqnen

saqarTvelos regionebis skolebSi, farisebri jirkvlis daavadebebis

profilaqtikuri gasinjvis dros, sadac bavSvebSi farisebri jirkvlis

gasinjva pirvel etapze xdeboda palpatorulad, Tu farisebri jirkvlis

moculoba xeliT gasinjvisas iyo difuzurad gadidebuli an

fiqsirdeboda struqturuli cvlilebebi, am SemTxvevaSi bavSvebis

Semdgomi skriningi xorciledeboda ultrabgeriTi kvleviT da

endokrinologiis erovnuli institutis bazaze ukeTdebodaT

Tireotropuli hormonis gansazRvra, im SemTxvevaSi Tu garda

difuzurad gadidebuli farisebri jirkvlisa xdeboda aRmoCena sxva

struqturuli cvlilebebis, bavSvebs utardebodaT damatebiTi kliniko-

laboratoriuli diagnostika. kvlevis gamoricxvis kriteriumebi iyo:

Tireotropuli hormonis darRveuli done anamnezSi, farisebri

jirkvlis paTologiebis mkurnaloba, anamnezSi rkinadeficituri anemia

2.2kvlevis kiTxvari:

moswavleebis gamokiTxva xdeboda specialuri kiTxvaris saSualebiT.

kiTxvari iyo martivi, ise rom pacients Tavad SeeZlo misi Sevseba.

kiTxvari Sedgeboda 1 gverdis da 10 kiTxvisgan. kiTxvaridan miviReT

Semdegi saxis informacia: demografiuli maCveneblebi (mag: asaki, sqesi

da a.S.), daavadebis anamnezi da medikamentebi, ioddeficitisaTvis

damaxasiaTebeli simptomebis arseboba da gonebrivi aTvisebis unar-

Cvevebi [103,104,105]

2.3 fizikaluri gamokvleva:

36  

2.3.1farisebri jirkvlis palpacia, wona, simaRle, sxeulis masis indeqsi:

fizikaluri kvlevis pirveli safexuri iyo pacientebis awonva da

simaRlis gansazRvra fexsacmelebis da qurTukis gareSe. pacientebis

asawonad viyenebdiT saswors – ТВЕС; wonas gamovsaxavdiT kilogramebSi

(kg). saswori gamiznulad iyo arCeuli, vinaidan wonida 0,2-200 kg-mde

wonis farglebSi. simaRlis gansazRvrisTvis viyenebdiT simaRlis sazoms

– Seca 240 meqanikur sazoms; simaRles gamovsaxavdiT metrebiT (m).

sxeulis masis indeqsis (s.m.i.) (Quetelet indeqss) gamosaTvlelad viyenebdiT

formulas (213): wona (kg)/simaRlis² (m²). s.m.i.-is mixedviT gamovyaviT 4

jgufi. (ixileT cxrili #4,5 da Skala #1)

cxrili #4

jgufi s.m.i.-is maCvenebeli saxelwodeba

I 18.5 – 24.9 normaluri wona

II 25 – 29.9 Warbo wona

III 30 – 34.9 simsuqne I xarisxi

IV 35 – 39.9 simsuqne II xarisxi

V 40 – 44.9 simsuqne III xarisxi

VI ≥ 45 morbiduli simsuqne

cxrili #5:cximis gadanawilebis procentuli maCveneblebi bavSvebSi,

Skalis mixedviT

woniTi kategoria maCvenebeli procentebSi

wonis deficiti naklebi 5 procentze

normaluri wona 5-dan 85 procentamde

Warbi wona 85-dan 95 procentamde

37  

simsuqne 95 procentis toli an meti

Skala #1

38  

39  

farisebri jirkvlis palpacia - subieqturi, magram yvelaze ekonomiuri

meTodia, ris gamoc mosaxerxebelia ioddeficitur kerebSi skrininguli

kvlevebis Casatareblad.

dgindeba gadidebis xarisxi da kvanZis (kvanZebis) arseboba.

msofliosjandacvis organizaciis monacemebis mier SemuSavebuli

klasifikacia palpatorul monacemebs emyareba da aqvs diagnostikuri

Rirebuleba. (ix. cxrili #6)

cxrili #6

xarisxi aRweriloba

0 Ciyvi ar aris (f.j. wilis zoma ar aRemateba gamosakvlevi

piris ceris distaluri falangis zomas)

I

Ciyvi palpirebadia, magram ar SeimCneva kisris normaluri

mdebareobisas (f.j.-is TvalsaCino gadidebas adgili ar

aqvs). masve miekuTvneba kvanZovani warmonaqmnebi, romlebic

ar iwveven f.j.-is gadidebas

II Ciyvi kargad Cans kisris normaluri mdebareobis drosac

2.3.2ultrabgeriTi kvleva: zustdeba jirkvlis moculoba, misi

struqtura, kvanZis (kvanZebis) arseboba da misi xasiaTi: cista, fibrozi,

kalcifikacia.

ultrasonografiulad endemuri Ciyvis diagnozi dasturdeba

mozrdilebSi (18 welze zeviT) Tu qalebSi farisebri jirkvlis

moculoba aRemteba 18ml, xolo mamakacebSi 25ml-s;

bavSvebSi mizanSewonilia farisebri jirkvlis saerTo moculobis

normativebis gamoyeneba, romelic gaTvlilia sxeulis zedapiris

farTobis mixedviTan asakobrivi jgufebis mixedviT.(ix cxrili #7,8)

40  

cxrili #7: farisebri jirkvlis moculobis normebi sxeulis zedapiris

farTobis mixedviT

sxeulis

zedapiris

farTobi

0,8 0,9 1,0 1,1 1,2 1,3 1,4 1,5 1,6 1,7

gogonebi 3,4 4,2 5,0 5,9 6,7 7,6 8,4 9,3 10,2 11,1

biWebi 3,3 3,8 4,2 5,0 5,7 6,6 7,6 8,6 9,9 11,2

(Zimmerman M.B,.et.al. 2001 WHO/ICCIDD)

cxrili #8: farisebri jirkvlis zomebi asakobrivi jgufis mixedviT

(ml)

asaki

(weli)

biWebi gogonebi

6 5,4 4,9

7 5,7 6,3

8 6,1 6,7

9 6,8 8,0

10 7,8 9,3

11 9,0 9,8

12 10,4 11,7

13 12,0 13,8

14 13,9 14,9

15 16,0 15,6

41  

2.4 venuri sisxlis nimuSi:

venuri sisxlis nimuSis aReba xdeboda 10-12 saaTis SimSilis Semdeg

dilis 9:00-11:00 saaTis SualedSi; aRebuli nimuSis nawili inaxeboda 4ºC-

ze. TiToeuli pacientisTvis vsazRvravdiT Tireotropuli hormonis

dones da rig SemTxvevebSi Tavisufal Tiroqsins, Tavisufal

triiodTironins da antisxeulebs peroqsidazas mimarT.  

SratSihormonebis dones vsazRvravdiT DRG formis ELISA nakrebiT, rac

aris fermentiT moniSnuli imunosorbentuli kvleva dafuZvnebuli

sendviCis principze.kvlevis arsi mdgomareobs SemdegSi: mikrosinjara

ifareba monoklonuri antisxeuliT, romelic mimarTulia hormonis

molekulis antigenuri ubnisken. Semdeg emateba pacientis sisxlis

nimuSi, romelsac ereva is koniugatis xsnari, romelic Seicavs

fermentiT moniSnul antisxeuls da aris anti-hormonuli antisxeuli,

koniugirebuli biotinTan. zemoa RniSnulis Sedegad warmoiqmneba

sendviC-kompleqsi.mikrosinjaris gamorecxvis Semdeg rCeba mxolod

SekavSirebuli koniugati.meore inkubaciuri safexuris dros,

peroqsidazasfermentuli kompleqsi ukavSirdeba biotin-anti-hormonul

antisxeulebs. SekavSirebuli kompleqsis raodenoba proporciulia

nimuSSi hormonis koncentraciis.substratis dasxmis Semdeg miRebuli

Seferilobis intensivoba pirdapirproporciulia pacientis sisxlis

SratSi hormonis koncentraciis.hormonebis sazom erTeulad viyenebdiT:

Tireotropuli hormoni mLU/L, Tavisufali Tiroqsini ng/dlda

Tavisufali triiodTironinispg/ml, xolo antisxeulebi peroqsidazas

mimarT sazom erTeulad viyenebdiT U/ml-s. (ix. cxrili #9)

42  

cxrili #9: farisebri jirkvlis hormonebis normebi asakobrivi

jgufebis mixedviT

norma Norm

axalSobilebi 1,73-6,30

pg/ml

6 dRe-3 Tve 1,95-6,04

pg/ml

4-12 Tve 2,15-5,83

pg/ml

1-6 weli 2,41-5,50

pg/ml

7-11 weli 2,53-5,22

pg/ml

Tavisufali triiodTironini FT3

12-20 weli 2,56-5,01

pg/ml

axalSobilebi 0,86-2,49

ng/dl

6 dRe-3 Tve 0,89-2,20

ng/dl

4-12 Tve 0,92-1,99

ng/dl

1-6 weli 0,96-1,77

ng/dl

7-11 weli 0,97-1,67

ng/dl

12-20 weli 0,98-1,63

ng/dl

Tavisufali Tiroqsini FT4

zrdasrulebi 0.80-2,00

ng/dl

Tireotropuli hormoni

TSH

axalSobilebi 0,70-15,2

mlu/l

43  

io

dd

efi

ci

tu

ri

sta

tu

sis

de

fin

ici

a

xde

bo

da

Tu

bav

Sve

bSi

fiq

sir

deb

od

a

di

fuzurad gadidebuli farisebri jirkvali da maRali an normis

farglebSi arsebuli Tireoidmastimulirebeli hormoni, asakis

6 dRe-3 Tve 0,72-11,0

mlu/l

4-12 Tve 0,73-8,35

mlu/l

1-6 weli 0,70-5,97

mlu/l

7-11 weli 0,60-4,84

mlu/l

12-20 weli 0,51-4,30

mlu/l

zrdasruli 0,27-4,2

mlu/l

55-87 weli 0,5-8,9 mlu/l

axalSobilebi <117 U/ml

6 dRe-3 Tve <47 U/ml

4-12 Tve <32 U/ml

1-6 weli <13 U/ml

7-11 weli <18 U/ml

12-20 weli <26 U/ml

antisx. peroqsid. mimarT

anti –TPO antibodies

zrdasrulebi <34IU/ml

axalSobilebi 25-307 ng/ml

6 dRe-3 Tve 20-228 ng/ml

4-12 Tve 18-125 ng/ml

1-6 weli 9,0-67 ng/ml

7-11 weli 5,1- 43

ng/ml

12-20 weli 2,6-36 ng/ml

Tireoglobulini

Thyroglobulin

zrdasrulebi 1,4-78 ng/ml

44  

gaTvaliswinebiT an farisebri jirkvlis normaluri saerTo moculobis

fonze darRveuli Tireoidmastimulirebeli hormonis done.

antisxeulebiperoqsidazas mimarT _ autoimunuri Tireoiditis

gamosaricxad.

2.5 punqciuri biofsia - Tu gamovlinda 1_1,5sm-ze meti diametris erTi an

meti kvanZovani warmonaqmni, punqtatis aReba xdeba saeWvo eqogenobis

mqone warmonaqmnidan.

Tu arc erTi kvanZi arxasiaTdeba avTvisebiani ultrabgeriTi

niSnebiT, aRiniSneba mxolod konglomeratuli warmonaqmnebi da msgavsi

eqo-struqtura - mizanSewonilia punqtatis aReba yvelaze didi

kvanZidan.(ix. cxrili #10)

cxrili #10: punqciuri biofsiis Sedegebi

yvelaze xSiri daskvna savaraudo daskvna

koloidur-proliferaciuli

Ciyvi,

autoimunuri Tireoiditi,

farisebri jirkvlis kibo;

folikuluri neoplazia

(adenoma);

2.6saeWvo SemTxvevebSi scintigrafia saWiroa Catardes:

1. farisebri jirkvlis funqciuri avtonomiis gamosaricxad;

2. Tu Tireotropuli hormonis maCvenebeli normis farglebSia;

3. punqciuri biofsiiT miRebulia savaraudo pasuxi: `saeWvo~ an

~folikuluri neoplazia~;

4. gansakuTrebiT saSualo da xandazmul asakSi;

2.7 iodis gansazRvra wyalsa da niadagSi:

45  

wylisa da niadagis Segroveba xdeboda laboratoriis mier

mowodebuli specialur konteinerebSi, Segrovili masala laboratoriis

moTxovni Sesabamisad miwodebul iqna yvela regionidan masalis

Segrovebidan araumetes 3 dRisa, masala gagzavnil iqna Stutgardis

laboratoriaSi da misi analizis Catareba ganaxorciela profesorma

Robert oTenbergerma DIN 38 405-D 33 meToduri protokolis mixedviT

2.8 masalis statistikuri analizi:

monacemebis mowodeba moxda saSualo±standartuli deviaciiT (sd)

mudmivi variabelisaTvis da n (%) kategoriuli variabelisTvis.

klinikuri maxasiaTeblebis Sedareba xdeboda erTgzis ANOVA-Ti mudmivi

variabelisTvis da Chi‐sqaure  an  Fisher-is zusti testi kategoriuli

variabelisTvis. Speatman-is korelacia Catarda TiToeuli asakisaTvis,

raTa dagvedgina kavSiri ioddeficitur regionebSi farisebri jirkvlis

paTologiebis gavrcelebis kavSiri niadagSi da wyalSi iodis

Semcvelobis maCvenebels Soris. zogadi xazobrivi modelis analizi

gamoviyeneT, rom gamogvevlina kavSiri Tireotropuli hormonis donesa

da farisebri jirkvlis paTologiis gavrcelebas Soris asakTan da

wonasTan mimarTebaSi. amas garda, logistikuri regresiis modeli

gamoviyeneT, raTa gamogvekvlia kavSiri Tireotropuli hormonis donesa

da farisebri jirkvlis paTologiebs Soris, niadagsa da wyalSi iodis

SemcvelobasTan, asakTan, sqesTan da s.m.i.-Tan misadagebis Semdeg.

statistikuri analizisTvis gamoviyeneT SPSS 20.0 versia (SPSS,  Inc., Chicago, 

IL). P‐value < 0.05 iqna arCeuli, rogorc statistikurad sarwmuno.

Tavi 3: gamokvlevis Sedegebi

46  

 

kvlevaSi monawileoba miiRo 52 328 saqarTvelos regionebSi skolis periodis

asakis bavSvebma.aqedan 25 193 iyo biWi, xolo 27 135 iyo gogo (ix. grafiki #2).

da CautardaT Semdegi kvlevebi (ix. grafiki #1):

1. farisebri jirkvlis palpatoruli gasinjva - 52 328 bavSvi

2. farisebri jirkvlis ultrabgeriTi kvleva – 23 638 bavSvi

3. Tireoidmastimulirebeli hormonis gansazRvra sisxlis SratSi – 7 258

bavSvi

4. antisxeulebi peroqsidazas mimarT – 2 125 bavSvi

5. SerCeviTad Tavisufali Tiroqsinis da Tavisufali triiodTironinis

gansazRvra – 2 143 bavSvi

6. anTropometriuli monacemebi (simaRle, wona, sxeulis maisis indeqsi) _

7 258 bavSvi

7. moswavleTa da maswavlebelTa kiTxvari 7 258 bavSvi da 235

maswavlebeli.

grafiki #1

47  

grafiki #2

48  

49  

saqarTvelos sxvadasxva regionebSi Seswavlili iqna 52 328 skolis periodis

asakis bavSvi (ix. grafiki #3,4), saidanac paTologiuri cvlilebebi

dafiqsirda5 426 bavSvSi,(ix. grafiki #5,6)aqedan difuzurad gadidebuli Ciyvi

aReniSneboda 4 403 bavSvs (ix. grafiki #7,8), xolo sxva paTologiebi 1 023

bavSvs (ix. grafiki #9), kerZod: kvanZovani Ciyvi – 27 (ix. grafiki #10,11),

toqsiuri Ciyvi – 18 (ix. grafiki 12,13) autoimunuri Tireoiditi – 675 (ix.

grafiki #14,15), hipoTireozi – 303 (ix. grafiki 16,17).

grafiki #3

50  

grafiki #4

51  

grafiki

#5

52  

 

53  

grafiki #6

54  

grafiki #7

55  

grafiki #8

56  

grafiki #9

57  

grafiki #10

58  

grafiki #11

59  

grafiki #12

60  

grafiki #13

61  

grafiki #14

62  

grafiki #15

63  

grafiki #16

64  

grafiki #17

65  

wyalsa da niadagSi gamovlenil iqna iodis Semcveloba (ix. cxrili #11)

aseve, gamovlenil iqna sarwmuno korelaciuri kavSiri farisebri jirkvlis

paTologiebsa da iodis dabal dones Soriswyalsa da niadagSi. (ix. grafiki

# 18)

cxrili #11

რაიონები  paTologia წყალი  ნიადაგი 

p-value

TianeTi 195 0.006 0.5 

<0.001 

samtredia 371 0.02 0.5 

<0.001 

gori 650 0.007 0.4 

<0.001 

Telavi 532 0.02 0.2 

<0.001 

rusTavi 151 0.025 0.4 

<0.001 

marneuli 355 0.005 0.1 

<0.001 

ambrolauri 211 0.01 0.1 

<0.001 

gurjaani 360 0.03 0.3 

<0.001 

bolnisi 277 0.02 0.2 

<0.001 

66  

grafiki #18

67  

aseve, gamovlinda dadebiTi korelaciuri kavSiri sxeulis masis indeqssa

da Tireotropul hormons Soris. (ix. grafiki #19)

grafiki #19

maswavlebelTa kiTxvaris mixedviT, romelic iTvaliswinebda

ioddeficituri mdgomareobis mqone bavSvebis SedarebiT Sefasebas

araioddeficitis mqone bavSvebTan da romlis maqsimaluri qula

Seadgenda 10-s. miRebulma Sedegebma aCvena, rom ioddeficitis mqone

bavSvebi saSualod 2-3 quliT CamorCebodnen swavlis xarisxSi (aTviseba,

damaxsovreba, gadmocemis unari) klasSi sxva bavSvebTan SedarebiT. (ix.

grafiki #20)

68  

grafiki #20 

kaliumis iodidiT profilaqtikuri Terapiam, aCvena daaxloebiT 2 %-iT

daqveiTeba ioddeficitis maCveneblis. (ix. grafiki 21)

grafiki #21:

69  

Tavi 4: gamokvlevis Sedegebis ganxilva

ioddeficitis prevalensi sakvlev populaciaSi Seadgenda 10,37 %-s.

rogorc biWebSi, ise gogonebSi,iodis dabali done wyalsa da niadagSi

asocirdeboda ioddeficitis gazrdil riskTan, rasac adasturebs, is

faqti, rom regionebSi sadac SeimCneva gansakuTrebiT dabali done

niadagsa da wyalSi fiqsirdeboda endemuri Ciyvis maRali maCveneblebi,

kerZod eseTi dasaxlebuli punqtebi gaxldaT: TianeTi, samtredia,

sagarejo, marneuli, ambroaluri, lagodexi, dedofliswyaro, axmeta,

kaspi, barisaxo, Satili, axalcixe da bolnisi. am regionebSi

ioddeficitis fonze damaxasiaTebeli iyo ioddeficitis klasikuri

simptomatika, rogoricaa endemuri Ciyvi, iuveniluri hipoTireozi,

fizikuri da gonebrivi ganviTarebis darRveva, Ciyvi da misi

garTulebebi: hipoTireozi, iodinducirebuili Tireotoqsikozi.

ioddeficiturad regioni iqna miCneuli radgan, janmo-s mixedviT

ioddeficituria regioni sadac endemuri Ciyvis da masTan dakavSirebuli

daavadebebis raodenoba aRemateba 10 %-s.

saqarTvelos regionebis skolis periodis asakis bavSvebSi farisebri

jirkvlis palpatorulma gasinjvam aCvena, rom ioddeficitur regionebSi

perioduli profilaqtikuri gasinjvebi iZleva safuZvels raTa

adreulad gamovlenili iqnas ioddeficituri mdgomareoba. kvlevam

aCvena, rom gasul wlebTan SedarebiT mniSvnelovnad SeimCneva

gaumjobeseba ioddeficituri mdgomareobis, Tumca saqarTvelos

garkveuli regionebi mainc rCeba, rogorc endemuri zona.

kvlevis dros nanaxi iqna, aramxolod ioddeficituri endemuri Ciyvi

aramed, iseTi mniSvnelovani farisebri jirkvlis daavadebebi,

rogorebicaa: kvanZovani Ciyvi, autoimunuri Tireoiditi, mkveTrad

gamoxatuli hipoTireozi da toqsiuri Ciyvi. aRniSnuli daavadebebi

saerTo populaciis 2 %-ze zemoT iyo nanaxi: TianeTSi, samtrediaSi,

abaSaSi, ambrolaurSi, sagarejoSi, lagodexSi, barisaxoSi da SatilSi.

70  

rac gvaZlevs imis safuZvels, vivaraudoT, rom aRniSnuli daavadebebi

dakavSirebulia ioddeficitTan, radgan umetes regionebSi SeimCneva

iodis deficiti wyalsa da niadagSi.

kvlevis Sedegebma aCvena, rom iodizirebuli mariliT ioddeficitis

profilaqtikuri RonisZieba efeqturi, magram arasakmarisia, radgan

srulad iqnes aRmofxvrili ioddeficituri mdgomareoba regionSi, rasac

adasturebs 1997-2003 wlebSi maRalmTian regionebSi Catarebuli kvlevis

Sedegebis Sedareba dRevandel maCveneblebTan, romlis mixedviTac Tu

1997-2003 wlebSi ioddeficitis maCvenebeli 57 %-dan daqveiTda 39 %-mde,

dReisobiT is Seadgens 10.37 %-s, miuxedavad 1997-2003 wlebSi

ioddeficitis mkveTri Semcirebisa, rac warmoedgenda 18 %-s 2004 wels

prezidentis #466 brZanebiT saqarTvelos parlamens gaegzavna Semdegi

daskvna:

“ miuxedavad gaweuli Zalisxmevisa ioddeficitis problema jerjerobiT

isev mwvavea da amis mizezia is, rom saqarTveloSi am etapze realurad

ver moxerxda farTomasStabiani profilaqtika – xarisxiani

iodizirebuli mariliT momaragebis politikis gatareba, romelic

dargTaSorisi kordinaciis problemur sakiTxs warmoadgens.

cnobilia, rom farisebri jirkvlis paTologiis winaaRmdeg brZolisa da

profilaqtikis yvelaze iaffasiani da efeqturi meTodi, mosaxleobis

yvela asakobrivi jgufisaTvis warmoadgens iodizirebuli marilis

gamoyeneba.

saqarTvelos finansTa saministros sabaJo departamentis monacemebiT,

1998 wels qveyanaSi importirebuli iyo 1744 tona, 1999 wels – 1414 t,

xolo 2001 wels 10 000 tonaze meti iodizirebuli marili, naTlad Cans,

rom profilaqtikis mizniT 1999-2001 wlebSi qveyanaSi importirebuli da

mosaxleobis mier moxmarebuli iodizirebuli marilis raodenoba

Zalzed dabalia da arasakmarisi. amasTan erTad moxmarebuli

iodizirebuli marilis sakmaod didi raodenoba ar akmayofilebda

saxelmwifo standartebs.

71  

usistemod da araorganizebulad xdeba qveynis qalaqebisa da raionebis

mosaxleobis iodizirebuli mariliT momarageba. Tu erT raionSi Sedis

ramodenime tona meore raionSi Seitaneba mxolod aTeuli kilogrami da

rac mTavaria, misi Rirebuleba sxvadasxvaa da miuwvdomelia mosaxleobis

yvela fenisaTvis.

sakiTxi metad rTulia da iTxovs dargTaSoris damatebiT RonisZiebebis

gatarebas, maT koordinacias umaRles doneze”

miuxedavad saqarTvelos saxelmwifo programisa, romelic

kanonmdeblobiT iTvaliswinebs bazarze, mxolod iodizirebuli marilis

gamoyenebas da amoqmedda 2007 wels saqrTveloSi mainc rCeba endemuri

kerebi.

kvlevis Sedegebze dayrdnobiT, SeiZleba vivaraudoT, rom ioddeficitur

regionebi midrekilia sxeulis masis matebisaken, rac dadasturda

kvlevis SedegebiT da gviCvena, rom Tireotropuli hormonis donis

matebisas imatebs sxeulis wonac, aRniSnulidan gamomdinare SegviZlia

vivaraudoT, rom ioddeficiti warmoadgens erT-erT mizezs Warbi wonis

ganviTarebaSi.

aseve, maswavleblis kiTxvaris Sedegebis analizis mixedviT irkveva,

rom moswavleebs romelTac daudgindaT ioddeficiti SedarebiT dabali

aqtivoba aqvT swavlasa da unarCvevebSi sxva klasis moswavleebisgan

gansxvavebiT, rac gvaZlevs imis safuZvels vTqvaT, rom ioddeficiti

pirdapir korelaciaSi bavSvis gonebriv ganviTarebasTan da

unarCvevebTan, rac mizezia mosaxleobis inteleqtualuri potencialis

daqveiTebis.

2013 wels ganmeorebiT gamokvleuli iqna 2010 wels ioddeficitur

regionad miCneuli erT-erTi raioni, sadac 2010 wlidan aqtiurad

mimdinareobda kaliumis iodidiT profilaqtikuri Terapia, kvlevis

Sedegma aCvena, rom aRniSnul arealSi daaxloebiT 2 %-iT iqna

daqveiTebuli ioddeficitis maCvenebli.

72  

daskvnebi: 

1. endemuri Ciyvi kvlav rCeba saqarTvelosTvis erT-erT umTavres

problemad, radgan misi maCvenebeli aRemateba saerTo populaciaSi 10

%-s

2. iodizirebuli mariliT CanacvlebiTma Terapiam Seamcira ioddficitis

maCveneblebi saqarTveloSi, magram is ar aRmoCnda sakmarisi

ioddeficitis sruli aRmofxvrisaTvis

3. Seswavlili raionebidan avadobis yvelaze maRali maCveneblebi

gvxvdeba: TianeTi (11 %), samtredia (10,5 %), sagarejo (11 %), marneuli

(15,4 %), ambrolauri (15,3 %), lagodexi (12,2 %), dedofliswyaro (12 %),

axmeta (11,6 %), kaspi (13 %), barisaxo (20,3 %), Satili (15,2 %), axalcixe

(11,4 %), bolnisi (13 %)

4. wyalsa da niadagSi arsebuli iodis nakleboba zegavlenas axdens

ioddeficitze da dadebiT korelaciaSi modis farisebri jirkvlis

paTologiebTan

5. ioddeficiti pirdapirproporciaulia swavlis xarisxis maCvenebelTan,

rac safuZvels warmoadgens mosaxleobis inteleqtualuri potencialis

daqveiTebisa

6. hipoTireozis mqone pacientebi midrekilebi arian Warbi wonisaken

7. kaliumis iodidiT CanacvlebiTi Terapia efeqturia ioddeficitis

profilaqtikasa da mkurnalobaSi ioddeficitur regionebSi

73  

rekomendaciebi

1. aucilebelia mosaxleobis momarageba iodizirebuli mariliT

2. sasurvelia profilaqtikuri Terapia skolis periodis bavSvebSi

Catardes kaliumis iodidiT, misi maRal efeqturobis gamo

3. rekomendebulia periodulad moxdes profilaqtikuri gasinjvebi

skolis periodis bavSvebSi, radgan Tavidan aviciloT ioddeficitis

Sedegad ganviTarebuli daavadebebi

74  

gamoyenebuliliteratura:

1. Walker SP, Wachs TD, Gardner JM, et al. Child development: risk factors for adverse outcomes

in developing countries. Lancet 2007; 369:145.

2. WHO Secretariat, Andersson M, de Benoist B, et al. Prevention and control of iodine deficiency

in pregnant and lactating women and in children less than 2-years-old: conclusions and

recommendations of the Technical Consultation. Public Health Nutr 2007; 10:1606.

3. Food and Nutrition Board Institute of Medicine. Dietary reference intake. Washington, DC:

National Academy Press, 2001.

4. ICCIDD, UNICEF, WHO. Assessment of iodine deficiency disorders and monitoring their

elimination. Geneva, World Health Organization, 2001.

5. Andersson M, Takkouche B, Egli I, et al. Current global iodine status and progress over the last

decade towards the elimination of iodine deficiency. Bull World Health Organ 2005; 83:518.

6. Delange F. Optimal iodine nutrition during pregnancy, lactation and the neonatal period. Int J

Endocrinol Metab 2004; 2:1.

http://ceecis.org/iodine/04a_consequences/01_preg/Delange_2004.pdf (Accessed on September

21, 2011).

7. Public Health Committee of the American Thyroid Association, Becker DV, Braverman LE, et

al. Iodine supplementation for pregnancy and lactation-United States and Canada:

recommendations of the American Thyroid Association. Thyroid 2006; 16:949.

8. Zimmermann MB, Wegmüller R, Zeder C, et al. The effects of vitamin A deficiency and vitamin

A supplementation on thyroid function in goitrous children. J Clin Endocrinol Metab 2004;

89:5441.

9. Kopp P, Kimura ET, Aeschimann S, et al. Polyclonal and monoclonal thyroid nodules coexist

within human multinodular goiters. J Clin Endocrinol Metab 1994; 79:134.

10. Tonacchera M, Agretti P, Chiovato L, et al. Activating thyrotropin receptor mutations are

present in nonadenomatous hyperfunctioning nodules of toxic or autonomous multinodular

goiter. J Clin Endocrinol Metab 2000; 85:2270.

75  

11. Zimmermann, MB, Molinari, L, Spehl, M, et al. Updated provisional WHO/ICCIDD reference

values for sonographic thyroid volume in iodine-replete school-age children. IDD Newsletter

2001; 17:12.

12. Cao XY, Jiang XM, Dou ZH, et al. Timing of vulnerability of the brain to iodine deficiency in

endemic cretinism. N Engl J Med 1994; 331:1739.

13. Pharoah PO, Connolly KJ. A controlled trial of iodinated oil for the prevention of endemic

cretinism: a long-term follow-up. Int J Epidemiol 1987; 16:68.

14. Qian M, Wang D, Watkins WE, et al. The effects of iodine on intelligence in children: a meta-

analysis of studies conducted in China. Asia Pac J Clin Nutr 2005; 14:32.

15. Boyages SC, Halpern JP, Maberly GF, et al. A comparative study of neurological and

myxedematous endemic cretinism in western China. J Clin Endocrinol Metab 1988; 67:1262.

16. DeLong GR, Leslie PW, Wang SH, et al. Effect on infant mortality of iodination of irrigation

water in a severely iodine-deficient area of China. Lancet 1997; 350:771.

17. Aghini Lombardi FA, Pinchera A, Antonangeli L, et al. Mild iodine deficiency during

fetal/neonatal life and neuropsychological impairment in Tuscany. J Endocrinol Invest 1995;

18:57.

18. van Mil NH, Tiemeier H, Bongers-Schokking JJ, et al. Low urinary iodine excretion during

early pregnancy is associated with alterations in executive functioning in children. J Nutr 2012;

142:2167.

19. Zimmermann MB. The adverse effects of mild-to-moderate iodine deficiency during pregnancy

and childhood: a review. Thyroid 2007; 17:829.

20. Pedersen KM, Laurberg P, Iversen E, et al. Amelioration of some pregnancy-associated

variations in thyroid function by iodine supplementation. J Clin Endocrinol Metab 1993;

77:1078.

21. Glinoer D, De Nayer P, Delange F, et al. A randomized trial for the treatment of mild iodine

deficiency during pregnancy: maternal and neonatal effects. J Clin Endocrinol Metab 1995;

80:258.

76  

22. Liesenkötter KP, Göpel W, Bogner U, et al. Earliest prevention of endemic goiter by iodine

supplementation during pregnancy. Eur J Endocrinol 1996; 134:443.

23. Romano R, Jannini EA, Pepe M, et al. The effects of iodoprophylaxis on thyroid size during

pregnancy. Am J Obstet Gynecol 1991; 164:482.

24. Antonangeli L, Maccherini D, Cavaliere R, et al. Comparison of two different doses of iodide in

the prevention of gestational goiter in marginal iodine deficiency: a longitudinal study. Eur J

Endocrinol 2002; 147:29.

25. Berbel P, Mestre JL, Santamaría A, et al. Delayed neurobehavioral development in children born

to pregnant women with mild hypothyroxinemia during the first month of gestation: the

importance of early iodine supplementation. Thyroid 2009; 19:511.

26. Velasco I, Carreira M, Santiago P, et al. Effect of iodine prophylaxis during pregnancy on

neurocognitive development of children during the first two years of life. J Clin Endocrinol

Metab 2009; 94:3234.

27. Henrichs J, Bongers-Schokking JJ, Schenk JJ, et al. Maternal thyroid function during early

pregnancy and cognitive functioning in early childhood: the generation R study. J Clin

Endocrinol Metab 2010; 95:4227.

28. Soriguer F, Millón MC, Muñoz R, et al. The auditory threshold in a school-age population is

related to iodine intake and thyroid function. Thyroid 2000; 10:991.

29. Bleichrodt N, Born MP. A metaanalysis of research on iodine and its relationship to cognitive

development. In: The damaged brain of iodine deficiency, Stanbury JB (Ed), Cognizant

Communication Corporation, New York 1994. p.195.

30. Bath SC, Steer CD, Golding J, et al. Effect of inadequate iodine status in UK pregnant women

on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents

and Children (ALSPAC). Lancet 2013; 382:331.

31. Santiago-Fernandez P, Torres-Barahona R, Muela-Martínez JA, et al. Intelligence quotient and

iodine intake: a cross-sectional study in children. J Clin Endocrinol Metab 2004; 89:3851.

77  

32. Hynes KL, Otahal P, Hay I, Burgess JR. Mild iodine deficiency during pregnancy is associated

with reduced educational outcomes in the offspring: 9-year follow-up of the gestational iodine

cohort. J Clin Endocrinol Metab 2013; 98:1954.

33. van den Briel T, West CE, Bleichrodt N, et al. Improved iodine status is associated with

improved mental performance of schoolchildren in Benin. Am J Clin Nutr 2000; 72:1179.

34. Zimmermann MB, Connolly K, Bozo M, et al. Iodine supplementation improves cognition in

iodine-deficient schoolchildren in Albania: a randomized, controlled, double-blind study. Am J

Clin Nutr 2006; 83:108.

35. de Benoist, B, McLean, E, Andersson, M. Iodine deficiency in 2007: Global progress since

2003. IDD Newsletter 2008; 4:3.

36. www.iccidd.org.

37. Pearce EN, Andersson M, Zimmermann MB. Global iodine nutrition: where do we stand in

2013? Thyroid 2013; 23:523.

38. Vitti P, Delange F, Pinchera A, et al. Europe is iodine deficient. Lancet 2003; 361:1226.

39. Andersson M, Karumbunathan V, Zimmermann MB. Global iodine status in 2011 and trends

over the past decade. J Nutr 2012; 142:744.

40. Vanderpump MP, Lazarus JH, Smyth PP, et al. Iodine status of UK schoolgirls: a cross-sectional

survey. Lancet 2011; 377:2007.

41. Caldwell KL, Pan Y, Mortensen ME, et al. Iodine Status in Pregnant Women in the National

Children's Study and in U.S. Women (15-44 Years), National Health and Nutrition Examination

Survey 2005-2010. Thyroid 2013; 23:927.

42. Pearce EN. U.S. iodine nutrition: where do we stand? Thyroid 2008; 18:1143.

43. Murray CW, Egan SK, Kim H, et al. US Food and Drug Administration's Total Diet Study:

dietary intake of perchlorate and iodine. J Expo Sci Environ Epidemiol 2008; 18:571.

44. Haddow JE, McClain MR, Palomaki GE, Hollowell JG. Urine iodine measurements, creatinine

adjustment, and thyroid deficiency in an adult United States population. J Clin Endocrinol

Metab 2007; 92:1019.

78  

45. Bourdoux P, Thilly C, Delange C, Ermans AM. A new look at old concepts in laboratory

evaluation of endemic goiter. In: Towards the Eradication of Endemic Goiter, Cretinism, and

Iodine Deficiency, Dunn JT, Pretell EA, Daza CH, Viteri FE (Eds), Pan American Health

Organization, Washington, DC 1986. p.115.

46. Brownstein, D., Iodine: Why You Need It: Why You Can’t Live Without It, MedicalAlternatives

Press, West Bloomfield, Michigan, 2006.

47. Beck, L., The Good, The Bad & The Ugly, Seminar Manual, 2006.

48. Iodine Nutrition – More Is Better, New England Journal of Medicine, Vol 354: pages2819-2821;

June 29, 2006.

49. Pelletier C., Doucet E., Imbeault P., Tremblay A., Associations between weight loss-induced

50. changes in plasma organochlorine concentrations, serum T3 concentration, and resting

metabolicrate, Toxicol Sci., 67 (1): 46-51, May 2002.

51. Abraham,G.E., The Original Internist, 11:17-36, 2004.

52. Abraham, G.E., Flechas, J.D., Hakala, J.C., The Original Internist, 9:30-41, 2002.

53. Abraham, G.E., The Original Internist, 11:(2) 29-38, 2004.

54. Abraham, G.E. Townsend Letter, 245:100-101, 2003.

55. Abraham, G.E., Flechas, J.D., Hakala, J.C., The Original Internist, 9:5-20, 2002.

56. Abraham, G.E., additional articles in The Original Internist, 2003 - 2008

57. Delange F. Neonatal screening for congenital hypothyroidism: results and perspectives. Horm

Res 1997; 48:51.

58. Zimmermann MB, Aeberli I, Andersson M, et al. Thyroglobulin is a sensitive measure of both

deficient and excess iodine intakes in children and indicates no adverse effects on thyroid

function in the UIC range of 100-299 μg/L: a UNICEF/ICCIDD study group report. J Clin

Endocrinol Metab 2013; 98:1271.

59. Vejbjerg P, Knudsen N, Perrild H, et al. Thyroglobulin as a marker of iodine nutrition status in

the general population. Eur J Endocrinol 2009; 161:475.

60. Lamberg BA, Haikonen M, Mäkelä M, et al. Further decrease in thyroidal uptake and

disappearance of endemic goitre in children after 30 years of iodine prophylaxis in the east of

Finland. Acta Endocrinol (Copenh) 1981; 98:205.

79  

61. Vejbjerg P, Knudsen N, Perrild H, et al. Effect of a mandatory iodization program on thyroid

gland volume based on individuals' age, gender, and preceding severity of dietary iodine

deficiency: a prospective, population-based study. J Clin Endocrinol Metab 2007; 92:1397.

62. Weng HX, Yan AL, Hong CL, et al. Uptake of different species of iodine by water spinach and

its effect to growth. Biol Trace Elem Res 2008; 124:184.

63. Benmiloud M, Chaouki ML, Gutekunst R, et al. Oral iodized oil for correcting iodine

deficiency: optimal dosing and outcome indicator selection. J Clin Endocrinol Metab 1994;

79:20.

64. Perrine CG, Herrick K, Serdula MK, Sullivan KM. Some subgroups of reproductive age women

in the United States may be at risk for iodine deficiency. J Nutr 2010; 140:1489.

65. Sullivan KM, Perrine CG, Pearce EN, Caldwell KL. Monitoring the iodine status of pregnant

women in the United States. Thyroid 2013; 23:520.

66. Laurberg P, Nøhr SB, Pedersen KM, Fuglsang E. Iodine nutrition in breast-fed infants is

impaired by maternal smoking. J Clin Endocrinol Metab 2004; 89:181.

67. Pearce EN, Leung AM, Blount BC, et al. Breast milk iodine and perchlorate concentrations in

lactating Boston-area women. J Clin Endocrinol Metab 2007; 92:1673.

68. Dunn JT. What's happening to our iodine? J Clin Endocrinol Metab 1998; 83:3398.

69. Martins MC, Lima N, Knobel M, Medeiros-Neto G. Natural course of iodine-induced

thyrotoxicosis (Jodbasedow) in endemic goiter area: a 5 year follow-up. J Endocrinol Invest

1989; 12:239.

70. Roti E, Uberti ED. Iodine excess and hyperthyroidism. Thyroid 2001; 11:493.

71. Pedersen IB, Laurberg P, Knudsen N, et al. An increased incidence of overt hypothyroidism

after iodine fortification of salt in Denmark: a prospective population study. J Clin Endocrinol

Metab 2007; 92:3122.

72. Bülow Pedersen I, Laurberg P, Knudsen N, et al. Increase in incidence of hyperthyroidism

predominantly occurs in young people after iodine fortification of salt in Denmark. J Clin

Endocrinol Metab 2006; 91:3830.

80  

73. European Commission HaCPD-GSCoF, Opinion of the Scientific Committee on Food on the

tolerable upper level of intake of iodine, European Commission, Brussels (2002).

74. Dasgupta PK, Liu Y, Dyke JV. Iodine nutrition: iodine content of iodized salt in the United

States. Environ Sci Technol. 2008 Feb 15;42(4):1315-23.

75. Dasgupta PK, Liu Y, Dyke JV. Iodine nutrition: iodine content of iodized salt in the United

States. Environ Sci Technol. 2008 Feb 15;42(4):1315-23.

76. Gunton JE, Hams G, Fiegert M, McElduff A. Iodine deficiency in ambulatory participants at a

Sydney teaching hospital: is Australia truly iodine replete? Med J Aust. 1999 Nov 1;171(9):467-

70.

77. Hoption Cann SA. Hypothesis: dietary iodine intake in the etiology of cardiovascular disease. J

Am Coll Nutr. 2006 Feb;25(1):1-11.

78. Kapil U, Sharma TD, Singh P, Dwivedi SN, Kaur S. Thirty years of a ban on the sale of

noniodized salt: impact on iodine nutrition in children in Himachal Pradesh, India. Food Nutr

Bull. 2005 Sep;26(3):255-8.

79. Dunn JT. Seven deadly sins in confronting endemic iodine deficiency, and how to avoid them. J

Clin Endocrinol Metab. 1996 Apr;81(4):1332-5.

80. McClure RD. Goiter prophylaxis with iodized salt. Science. 1935 Oct 18;82(2129):370–1.

81. Darcan S, Goksen D. Consequences of iodine deficiency and preventive measures. Pediatr

Endocrinol Rev. 2003 Dec;1 Suppl 2:162-8; discussion 68-9.

82. Szybinski Z, Jarosz M, Hubalewska-Dydejczyk A, et al. Iodine-deficiency prophylaxis and the

restriction of salt consumption - a 21st century challenge. Endokrynol Pol. 2010 Jan-

Feb;61(1):135-40.

83. Zimmermann MB. Iodine deficiency. Endocr Rev. 2009 Jun;30(4):376-408.

84. Triggiani V, Tafaro E, Giagulli VA, et al. Role of iodine, selenium and other micronutrients in

thyroid function and disorders. Endocr Metab Immune Disord Drug Targets. 2009 Sep;9(3):277-

94.

81  

85. Bibbins-Domingo K, Chertow GM, Coxson PG, et al. Projected effect of dietary salt reductions

on future cardiovascular disease. N Engl J Med. 2010 Feb 18;362(7):590-9.

86. Titze J, Ritz E. Salt and its effect on blood pressure and target organ damage: new pieces in an

old puzzle. J Nephrol. 2009 Mar-Apr;22(2):177-89.

87. Caldwell KL, Jones R, Hollowell JG. Urinary iodine concentration: United States National

Health And Nutrition Examination Survey 2001-2002. Thyroid. 2005 Jul;15(7):692-9.

88. Wang GY, Zhou RH, Wang Z, Shi L, Sun M. Effects of storage and cooking on the iodine

content in iodized salt and study on monitoring iodine content in iodized salt. Biomed Environ

Sci. 1999 Mar;12(1):1-9.

89. Krajcovicova-Kudlackova M, Buckova K, Klimes I, Sebokova E. Iodine deficiency in

vegetarians and vegans. Ann Nutr Metab. 2003;47(5):183-5.

90. Smyth PP, Duntas LH. Iodine uptake and loss-can frequent strenuous exercise induce iodine

deficiency? Horm Metab Res. 2005 Sep;37(9):555-8.

91. Patrick L. Iodine: deficiency and therapeutic considerations. Altern Med Rev. 2008

Jun;13(2):116-27.

92. Baier-Anderson C, Blount BC, Lakind JS, Naiman DQ, Wilbur SB, Tan S. Estimates of

exposures to perchlorate from consumption of human milk, dairy milk, and water, and

comparison to current reference dose. J Toxicol Environ Health A. 2006 Feb;69(3-4):319-30.

93. Sanchez CA, Krieger RI, Khandaker N, Moore RC, Holts KC, Neidel LL. Accumulation and

perchlorate exposure potential of lettuce produced in the Lower Colorado River region. J Agric

Food Chem. 2005 Jun 29;53(13):5479-86.

94. Snyder SA, Pleus RC, Vanderford BJ, Holady JC. Perchlorate and chlorate in dietary

supplements and flavor enhancing ingredients. Anal Chim Acta. 2006 May 10;567(1):26-32.

95. Greer MA, Goodman G, Pleus RC, Greer SE. Health effects assessment for environmental

perchlorate contamination: the dose response for inhibition of thyroidal radioiodine uptake in

humans. Environ Health Perspect. 2002 Sep;110(9):927-37.

96. Available at: http://lpi.oregonstate.edu/infocenter/minerals/iodine/. Accessed July 18, 2011.

82  

97. Available at: http://emedicine.medscape.com/article/122714-overview. Accessed July 18, 2011.

98. Cann SA, van Netten JP, van Netten C. Hypothesis: iodine, selenium and the development of

breast cancer. Cancer Causes Control. 2000 Feb;11(2):121-7.

99. Nagataki S, Shizume K, Nakao K. Thyroid function in chronic excess iodide ingestion:

comparison of thyroidal absolute iodine uptake and degradation of thyroxine in euthyroid

Japanese subjects. J Clin Endocrinol Metab. 1967 May;27(5):638-47.

100. Canturk Z, Cetinarslan B, Tarkun I, Canturk NZ, Ozden M. Lipid profile and lipoprotein (a)

as a risk factor for cardiovascular disease in women with subclinical hypothyroidism. Endocr

Res. 2003 Aug;29(3):307-16.

101. Iqbal A, Jorde R, Figenschau Y. Serum lipid levels in relation to serum thyroid-stimulating

hormone and the effect of thyroxine treatment on serum lipid levels in subjects with subclinical

hypothyroidism: the Tromso Study. J Intern Med. 2006 Jul;260(1):53-61.

102. Fazio S, Palmieri EA, Lombardi G, Biondi B. Effects of thyroid hormone on the

cardiovascular system. Recent Prog Horm Res. 2004;59:31-50.

103. Canaris GJ, Steiner JF, Ridgway EC. Do traditional symptoms of hypothyroidism correlate

with biochemical disease? J Gen Intern Med. 1997 Sep;12(9):544-50.

104. Wartofsky L. Management of subclinical hyperthyroidism. J Clin Endocrinol Metab. 2011

Jan;96(1):59-61.

105. Kramer CK, Von Muhlen D, Kritz-Silverstein D, Barrett-Connor E. Treated hypothyroidism,

depressed mood, and cognitive function in old age: the Rancho Bernardo Study. Eur J

Endocrinol. 2009 Dec; 161(6):917-21

106. Zimmermann MB. Iodine deficiency in pregnancy and the effects of maternal iodine

supplementation on the offspring: a review. Am J Clin Nutr. 2009 Feb;89(2):668S-72S.

107. Verheesen RH, Schweitzer CM. Iodine deficiency, more than cretinism and goiter. Med

Hypotheses. 2008 Nov;71(5):645-8.

108. Laurberg P, Nohr SB, Pedersen KM, et al. Thyroid disorders in mild iodine deficiency.

Thyroid. 2000 Nov;10(11):951-63.

83  

109. Bretthauer EW, Mullen AL, Moghissi AA. Milk transfer comparisons of different chemical

forms of radioiodine. Health Phys. 1972 Mar;22(3):257-60.

110. Spitzweg C, Harrington KJ, Pinke LA, Vile JG, Morris JC. Clinical review 132: the sodium

iodide symporter and its potential role in cancer therapy. J Clin Endocrinol Metab 2001

Jul;86(7):3327-35.

111. Kilbane MT, Ajjan RA, Weetman AP, et al. Tissue iodine content and serum-mediated 125I

uptake-blocking activity in breast cancer. J Clin Endocrinol Metab. 2000 Mar;85(3):1245-50.

112. Topper YJ, Freeman CS. Multiple hormone interactions in the developmental biology of the

mammary gland. Physiol Rev 1980 Oct;60(4):1049-106

113. Eskin BA. Iodine and mammary cancer. Adv Exp Med Biol. 1977;91:293-304.

114. Smyth PP. Role of iodine in antioxidant defence in thyroid and breast disease. Biofactors.

2003;19(3-4):121-30.

115. Venturi S, Donati FM, Venturi A, Venturi M, Grossi L, Guidi A. Role of iodine in evolution

and carcinogenesis of thyroid, breast and stomach. Adv Clin Path. 2000 Jan;4(1):11-7.

116. Venturi S. Is there a role for iodine in breast diseases? Breast. 2001 Oct;10(5):379-82.

117. Stadel BV. Dietary iodine and risk of breast, endometrial, and ovarian cancer. Lancet. 1976

Apr 24;1(7965):890-1.

118. Many MC, Papadopolos C, Martin I, et al. Iodine induced cell damage in mouse hyperplastic

thyroid is associated with lipid peroxidation. In: Gordon A, Gross J, Hennemann G, eds.

Progress in Thyroid Research. New York, NY: Routledge; 1991:213-5.

119. Cohen M, Klein E, Kuten A, Fried G, Zinder O, Pollack S. Increased emotional distress in

daughters of breast cancer patients is associated with decreased natural cytotoxic activity,

elevated levels of stress hormones and decreased secretion of Th1 cytokines. Int J Cancer. 2002

Jul 20;100(3):347-54.

120. Inaudi P, Bernabei A, Gioffre W, et al. Plasma and cyst fluid levels of delta 5 and delta 4

steroid hormones in women with gross cystic breast disease. Clin Endocrinol (Oxf). 1987

Dec;27(6):643-8.

84  

121. Thornton LM, Andersen BL, Carson WE, 3rd. Immune, endocrine, and behavioral precursors

to breast cancer recurrence: a case-control analysis. Cancer Immunol Immunother. 2008

Oct;57(10):1471-81.

122. Smyth PP. The thyroid, iodine and breast cancer. Breast Cancer Res. 2003;5(5):235-8.

123. Smyth PP. Thyroid disease and breast cancer. J Endocrinol Invest. 1993 May;16(5):396-401.

124. Aceves C, Anguiano B, Delgado G. Is iodine a gatekeeper of the integrity of the mammary

gland? J Mammary Gland Biol Neoplasia. 2005 Apr;10(2):189-96.

125. Ziegler RG, Hoover RN, Pike MC, et al. Migration patterns and breast cancer risk in Asian-

American women. J Natl Cancer Inst. 1993 Nov 17;85(22):1819-27.

126. Garcia-Solis P, Alfaro Y, Anguiano B, et al. Inhibition of N-methyl-N-nitrosourea-induced

mammary carcinogenesis by molecular iodine (I2) but not by iodide (I-) treatment Evidence that

I2 prevents cancer promotion. Mol Cell Endocrinol. 2005 May 31;236(1-2):49-57.

127. Funahashi H, Imai T, Tanaka Y, et al. Suppressive effect of iodine on DMBA-induced breast

tumor growth in the rat. J Surg Oncol. 1996 Mar;61(3):209-13.

128. Shrivastava A, Tiwari M, Sinha RA, et al. Molecular iodine induces caspase-independent

apoptosis in human breast carcinoma cells involving the mitochondria-mediated pathway. J Biol

Chem. 2006 Jul 14;281(28):19762-71.

129. Kahaly GJ. Cardiovascular and atherogenic aspects of subclinical hypothyroidism. Thyroid.

2000 Aug;10(8):665-79.

130. Park YJ, Lee YJ, Choi SI, Chun EJ, Jang HC, Chang HJ. Impact of subclinical

hypothyroidism on the coronary artery disease in apparently healthy subjects. Eur J Endocrinol.

2011 Jul;165(1):115-21.

131. Haentjens P, Van Meerhaeghe A, Poppe K, Velkeniers B. Subclinical thyroid dysfunction

and mortality: An estimate of relative and absolute excess all-cause mortality based on time-to-

event data from cohort studies. Eur J Endocrinol. 2008 Sep;159(3):329-41.

132. Rizos CV, Elisaf MS, Liberopoulos EN. Effects of thyroid dysfunction on lipid profile. Open

Cardiovasc Med J. 2011;5:76-84.

85  

86  

133. Molnar I, Magyari M, Stief L. Iodine deficiency in cardiovascular diseases. Orv Hetil. 1998

Aug 30;139(35):2071-3.

134. Jung CH, Sung KC, Shin HS, et al. Thyroid dysfunction and their relation to cardiovascular

risk factors such as lipid profile, hsCRP, and waist hip ratio in Korea. Korean J Intern Med.

2003 Sep;18(3):146-53.

135. Venturi S, Venturi M. Iodine in evolution of salivary glands and in oral health. Nutr Health.

2009;20(2):119-34.

136. Abnet CC, Fan JH, Kamangar F, et al. Self-reported goiter is associated with a significantly

increased risk of gastric noncardia adenocarcinoma in a large population-based Chinese cohort.

Int J Cancer. 2006 Sep 15;119(6):1508-10.

137. Behrouzian R, Aghdami N. Urinary iodine/creatinine ratio in patients with stomach cancer in

Urmia, Islamic Republic of Iran. East Mediterr Health J. 2004 Nov;10(6):921-4.

138. Gulaboglu M, Yildiz L, Celebi F, Gul M, Peker K. Comparison of iodine contents in gastric

cancer and surrounding normal tissues. Clin Chem Lab Med. 2005;43(6):581-4.

139. Golkowski F, Szybinski Z, Rachtan J, et al. Iodine prophylaxis—the protective factor against

stomach cancer in iodine deficient areas. Eur J Nutr. 2007 Aug;46(5):251-6.

140. Kupper FC, Carpenter LJ, McFiggans GB, et al. Iodide accumulation provides kelp with an

inorganic antioxidant impacting atmospheric chemistry. Proc Natl Acad Sci U S A. 2008 May

13;105(19):6954-8.

141. m. gordelaZe, m. gumberiZe “Tandayolili hipoTireozis skriningi da

mkurnaloba axalSobilebSi” – 2011 weli

142. საქართველოს შრომის, ჯანმრთელობის და სოციალური დაცვის სამინისტროს

კლინიკური პრაქტიკის ნაციონალური რეკომენდაცია „ახალშობილებში

თანდაყოლილი ჰიპოთირეოზის სკრინინგი და მკურნალობა“ – 2010 წელი