Iodine deficiency and prevalence of iodine deficiency diseases in the Tula region: current status and ways to solve the problem

The lack of systemic mass iodine prophylaxis in the Russian Federation is the main reason for the annual increase in the inci dence of thyroid pathologies throughout the country. Despite the set of measures aimed at implementing the Strategy for Improving the Quality of Food Products in the Russian Federation (RF) until 2030, approved by the RF Government Decree of 29.06.2016 No. 1364, including providing for the supply of iodized salt to retail organizations, food units of healthcare institu tions, kindergartens, schools and other institutions, the prevalence of thyroid pathologies in the regions remains high. The arti cle presents the results of the study assessing the severity of iodine deficiency and the prevalence of thyroid pathology among the population of the Tula region, conducted by specialists of the “Endocrinology research center” of the Ministry of Health of Russia together with the Ministry of Health of the Tula Region. BACKGROUND : The relevance of research on the assessment of iodine status and the study of the structure of thyroid pathol ogy among residents of certain territories of the Russian Federation, which are characterized by natural iodine deficiency and past technogenic radiation contamination, is associated with the need to clarify the mechanisms of development of thyroid pathology, including comorbid conditions, and will allow the implementation of scientifically justified preventive measures. AIM: To conduct a comprehensive study to assess the current iodine sufficiency of the population of the Tula region — an area affected by the Chernobyl nuclear power plant accident in 1986, analyze the actual prevalence and structure of thyroid pathol ogy compared to official statistics, and formulate conclusions about necessary preventive measures. MATERIALS AND METHODS : During the study in the Tula region, 589 people were examined, including 303 school-age chil dren (7–11 years old) and 286 adults (18 years and older). The epidemiological part of the study was conducted among the child population using the cluster method in three districts of the region (Tula — 90 children, Arsenyevsky district — 118 children, Yasnogorsky district — 95 children) and included: collection of anamnesis and questionnaires, measurement of anthropomet ric indicators (height, weight), examination by an endocrinologist with palpation of the thyroid gland, thyroid ultrasound with volume calculation, determination of iodine concentration in urine, examination of samples of table salt from households for the presence of iodine in them. A cross-sectional cohort survey of the adult population was conducted from June 8 to 10, 2022, in three districts of the Tula region: Yasnogorsk (n=79), Arsenyevsky (n=70), Shchekinsky (n=137) and included: collection of anamnesis and questionnaires, examination by an endocrinologist, thyroid ultrasound, determination of thyroid-stimulating hormone (TSH) and thyroid peroxidase antibodies (TPO-AT) in the blood serum, as well as a study of samples of table salt from households for the presence of iodine. RESULTS: According to the results of the epidemiological study in the Tula region, mild iodine deficiency (ID) was established (median urinary iodine (mUI) — 69.1 μg/l, share of diffuse goiter in children according to ultrasound data — 8.5%), with the allocation of the Arsenyevsky district, in which the mUI of 41.5 μg/l indicates moderate ID and a large proportion of goiter in children was detected — 13.5%. The share of households in the Tula region using iodized salt is very low — 18.5%. The results of the examination of the adult population of the Tula region confirmed the high prevalence of thyroid pathology in the region (ultrasound signs of structural changes in the thyroid gland were detected in 52.8% of those examined), which is mostly rep resented by nodular forms of goiter (76.8%). The combination of ultrasound signs of autoimmune and nodular thyroid pathol ogies occurs in 11.3% of cases of the overall prevalence of structural changes in the thyroid gland. When comparing with the data from previously conducted expeditions, a negative dynamics has been noted in the form of an increase in the prevalence of diseases of the thyroid glands detected by ultrasound in the study areas, from 26% in 1995 to 65–85.7% in 2022. CONCLUSION : Monitoring of the epidemiological situation in the Tula region has demonstrated a persisting inadequate level of iodine sufficiency among the population, which is reflected in the increasing prevalence of thyroid diseases and indicates the inefficiency of episodic measures for preventing iodine deficiency disorders (IDD). Taking into account the ecological status of the region, from the standpoint of medical and social significance, it is extremely important for regional health authorities to take urgent measures, namely, the development and implementation of a regional target program for the prevention of IDD with an emphasis on mass prevention using iodized salt.