Roland Gartner
Ludwig-Maximilians University, Munich , GermanyPresentation Title:
Iodine deficiency and its critical role during pregnancy
Abstract
Thyroid hormones are particularly important for optimal neurocognitive development. Fortunately, severe iodine deficiency during pregnancy had become less all over the world due to the continuous efforts to introduce universal salt iodization (USI). However, in most European countries as well as Saudi Arabia and the United Arab Emirates, the use of iodized salt in households is voluntary, and therefore mostly insufficient. Pregnant women have an approximately 50% higher iodine requirement compared to non-pregnant women due to increased thyroid hormone production, increased renal iodine clearance and transplacental transmission of iodine to the fetus.
Especially during the early pregnancy, hypothyroxinemia, a sign for low iodine storage in the thyroid might affect the optimal development of the offspring. There are many studies that clearly demonstrate that if the mother from the first day of pregnancy on has not enough iodine stored in her thyroid, the ability of reading, logic thinking and memory of the child is significantly lower compared to sufficient iodine intake of the mother. Accordingly, the recommendations for mean iodine intake during the whole pregnancy is 250 µg/ day. Many observational studies and two meta-analyses revealed that subclinical hypothyroidism and hypothyroxinemia in mothers are associated with indicators of intellectual disability in the offspring. In a large prospective epidemiologic study it could be shown that the children of mothers living in an area with sufficient iodine intake had mean of 12 IQ points more than the children of mothers with a mean iodine intake < 100 µg at the age of 12 years.
As a consequence, all woman that want to get pregnant have to be screened for TSH and FT4, and if FT4 is in the low normal range, an iodine supplementation with 150 µg/day already before conception should be started, and continued through the whole pregnancy and breastfeeding period. Even women with autoimmune thyroiditis can be supplemented, without any risk to induce thyroid dysfunction.
Biography
Roland Gärtner started his scientific training in the laboratories of the LMU in Munich, developed radioimmune assays for several hormones, isolated and characterizes thyroxine-binding globulin. In parallel did his education in internal medicine, final exam 1985, afterwards training in Endocrinology and Diabetes and achieved the European Recognition of Quality in Endocrinology Diabetes and Metabolism. He completed his PhD 1987 about the investigations on thyroid cell growth, growth regulation, iodine metabolism, and goiter involution in rats and isolated intact porcine thyroid follicles ex vivo. He recognized the important role of selenium in normal thyroid cell metabolism, initiated clinical trials on autoimmune thyroiditis as we as the effect of selenium in sepsis patients. He is member of the Editorial Boards of J Trace Elements in Medicine and Biology, Thyroid Reseach and Experimental and Clinical Endocrinology and Diabetes, is member of several scientific associations, and has more than 200 publications, 30 book chapters and 25 invited lectures in international conferences. He was the German representative on ICCIDD of the WHO, and is leading the German task force on iodine deficiency since 1996. Currently he is practicing in a private clinic as well as in Dubai Medwin Clinic.
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