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
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