July - September 2005, Volume 1, Issue 3

Toma A, Diaconu B, Gheorghiu M, Sava N, Nedelcu L, Trifanescu R, Sava M, Barbos D, Coculescu M

Persistence of neurological cretinism in old endemic goiter areas of the Carphatians

Acta Endo (Buc) 2005, 1 (3): 311-324
doi: 10.4183/aeb.2005.311

The subCarpathian areas of Arges county are now characterized by a moderate endemia of iodine deficiency disorders (IDD) due to salt iodization. However, we found some cases of endemic cretinism (EC), that is the major expression of anomalies in the physical and intellectual development caused by a severe iodine deficiency. There are presented 5 patients, 4 men and 1 woman, with neurological endemic cretinism (NEC) (n=2) and mixed forms of the disease (n=3), coming from 2 old endemic areas (medium urinary iodine excretion in the studied patients 20.8 g/day), diagnosed and treated in outpatients clinics or in hospitals. Four patients are members of the same family. The age of the patients is between 36 and 84 years old, the average age being 69. The intellectual capacity was assessed by using the Wechsler and Raven tests, the average intelligence quotient (IQ) value was of 20.8 points ? 1.47. The thyroid volumes (TV) were estimated by palpatory method and by ultrasonography and were between 8.7-200 ml. TSH values in studied patients ranged between 3.8-26 IU/ml and free T4 ranged between 0.272-1.22 ng/dl. Aggregation of more cases of endemic cretinism in the same family suggests the occurrence of some genetic factors. In conclusion, the old age (over 70 years old) of 4 cretins shows they are remnants of the old IDD endemia. However, there is also an isolated case of middle age (36 years old) suggesting an inadequate iodine intake, despite a law regarding salt iodization which has been operating since 1962. More attention to the universal salt iodization and to consumption of iodized salt in the rural areas is necessary.

Keywords: neurological endemic cretinism, IDD, subCarpathian area

Correspondence: Mihail Coculescu, Institute of Endocrinology, 36 Bd. Aviatorilor, 011863, Bucharest, Romania, e-mail: m.coculescu@uni-davila.ro