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The addition of iodine to salt or drinking water is credited with the reduction or elimination of cretinism and goiter, although cretinism still remains a serious problem in many rural sections of China. Only in the early twentieth century did scientists discover the relationship of cretinism with lack of iodine and thyroid deficiency. As the variety of food sources dramatically increased in Europe and North America and the populations became less completely dependent on locally grown food, the prevalence of endemic goiter diminished. In Switzerland, where the soil is poor in iodine, cases of cretinism were abundant and even considered hereditary.
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More mildly affected inland areas of Europe and North America in the nineteenth century were referred to as “goiter belts.” The degree of iodine deficiency was milder and manifested primarily as thyroid enlargement rather than severe mental and physical impairment. In the late eighteenth and early nineteenth centuries, several travellers and physicians described alpine cretinism from a medical perspective, often attributing the cause to “stagnant air” in mountain valleys or “bad water.” The earliest Alpine mountain climbers sometimes came upon whole villages of cretins. It was described by ancient Roman writers and often depicted by medieval artists. In the past, endemic cretinism due to iodine deficiency was especially common in areas of southern Europe around the Alps. The addition of iodine compounds to table salt or water represents the first attempt to provide nutrient supplementation via “fortification” of common foods. Both conditions have led to public health campaigns of iodine administration in many countries.
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Iodine deficiency also causes goiter, the gradual enlargement of the thyroid gland. The condition is characterized by short stature, delayed bone maturation and puberty, infertility, neurological impairment and cognitive impairment ranging from mild to severe. Iodine deficiency in utero and during growth can result in cretinism, a condition of severely stunted physical and mental growth due to prolonged nutritional deficiency of iodine or from untreated congenital deficiency of thyroid hormones (hypothyroidism). Iodine is essential to normal growth and development. In the brain, iodine is found in the choroid plexus, the area on the ventricles of the brain where cerebrospinal fluid (CSF) is produced, and in the substantia nigra, an area associated with Parkinson’s disease. While the thyroid gland contains the body’s highest concentration of iodine, the salivary glands, brain, cerebrospinal fluid, gastric mucosea, breasts, ovaries and a part of the eye also concentrate iodine. It forms the basis of thyroid hormones and plays many other roles in human biochemistry.