Lo ngại tình trạng ăn thiếu iốt, Bộ Y tế ra nghị định 09/2016/NĐ-CP và hướng dẫn từ 15-3-2017, các doanh nghiệp chế biến thực phẩm đều phải sử dụng muối có bổ sung iốt vào tất cả thành phẩm để bảo đảm sức khoẻ cho cộng đồng.
IV. LỜI MỞ
Các nhà sản xuất cho rằng, việc thay muối có iốt này sẽ làm tăng giá thành, chất lượng sản phẩm giảm vì hương vị, màu sắc.v.v…. Nhưng về lãnh vực dinh dưỡng và y học thì sao ?
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)
![JOD BASEDOW 1B](data:image/jpeg;base64,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)
II. TỔNG QUAN VỀ TUYẾN GIÁP
Tuyến giáp hình chữ H, dạng cái giáp nằm ở cổ, ngay dưới thanh quản và trước khí quản. Đây là tuyến nội tiết lớn nhất, quan trọng nhất vì hormone tuyến giáp chi phối nhiều quá trình chuyển hóa trong cơ thể con người.
Các hormone tuyến giáp có nhiều tác dụng quan trọng trong cơ thể con người:
(1) Tăng chuyển hóa chung của cơ thể. Do đó, khi cường giáp thì chuyển hoá cơ bản (basal metabolism rate BMR) tăng cao, ngược lại khi suy giáp thì BMR giảm thấp.
(2) Thúc đẩy phát triển, trưởng thành về thể chất lẫn tinh thần,
(3) Tác dụng lên chuyển hóa carbohydrate, lipid và protein,
(4) Tác dụng trên các hệ thống tim mạch, hô hấp, tiêu hóa, thần kinh, nội tiết, sinh dục…Do đó, trẻ bị suy giáp trong thời kỳ bào thai và những năm đầu sau sinh sẽ bị bệnh đần độn (cretinism), lùn và chậm, trì trệ thần kinh; người cường giáp thường kèm theo bệnh tim mạch, đái tháo đường…
III. IỐT VI CHẤT TỐI CẦN CHO TUYẾN GIÁP
Có nhiều hormone tuyến giáp, quan trọng nhất là Triiốtothyronine (T3) và thyroxine (T4). Tất cả các hormone tuyến giáp này được sinh tổng hợp từ axit amin tyrosin và iốt. Để sự tổng hợp đầy đủ lượng hormone T3, T4 cần thiêt, cơ thể cần từ 150-200 µg (microgam) iốt mỗi ngày.
![JOD BASEDOW 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)
Hầu hết, gần 99%, iốt do thức ăn, nước uống đem vào cơ thể đều được tuyến giáp bắt giữ để tổng hợp các hormone. Sau khi hoạt động, iốt dư thừa và từ thoái hóa hormone sẽ được thải ra thận, chỉ một ít được tế bào tuyến giáp tái sử dụng.
IV. ĐÁNH GIÁ THỪA THIẾU IỐT THẾ NÀO ?
Có ba cách đánh giá lượng mức iốt (iodine bilan) cung cấp cho cơ thể con người đầy đủ hay chưa là:
1. Đánh giá bướu giáp trên lâm sàng
Bình thường, với chế độ ăn đầy đủ iôt, tuyến giáp có thể tích 16-18 cm3. Lớn hơn số đo này là bị bướu cổ. Thầy thuốc lâm sàng dựa vào độ lớn phân bướu cổ ra 4 độ : (1) độ IA: một thùy tuyến giáp to hơn 1 đốt ngón cái của bệnh nhân, sờ nắn được; (2) độ IB: khi người bệnh ngửa đầu ra sau, nhìn thấy tuyến giáp to, nổi cục và có thể sờ nắn được; (3) độ II: tuyến giáp to, bướu nhìn thấy được ở tư thế bình thường, và (4) độ III: tuyến giáp phì đại, bướu lớn làm biến dạng cổ.
Theo Tổ chức Y tế Thế giới WHO, phương pháp “nhìn sờ” thủ công này sai số rất lớn đến 40%, đánh giá 10 ca sai hết 4, nên từ những năm 90 của thế kỷ trước WHO đã khuyến cáo nên dùng máy siêu âm để đo kích thước tuyến giáp. Với máy siêu âm 2D và cách tính Guter Kunst R, nhân viên y tế nhanh chóng xác kích thước tuyến giáp.
Theo nghiên cứu của TS.BS Trần Bá Thoại, thể tích tuyến giáp trung bình của ngừoi Việt Nam là 16 ± 2 cm3.
2.Nồng độ iốt trong muối ăn
Với các mức quy định sau
– Muối không có i-ốt: hàm lượng iốt trong muối dưới 5 ppm (hoặc 50mcg/10gam)
– Muối có i-ốt nhưng không đủ tiêu chuẩn phòng bệnh khi nồng độ i-ốt từ 5 ppm đến dưới 15 ppm
– Muối iốt đủ tiêu chuẩn phòng bệnh: hàm lượng iốt trong muối từ 15 ppm đến 50 ppm (hoặc từ 150 mcg/10 gr đến 500 mcg/10gr)
– Muối có hàm lượng iốt cao: Hàm lượng iốt trong muối trên 50 ppm
3. Nồng độ iốt trong nước tiểu
Vì lượng iôt thải ra trong nước tiểu tỷ lệ thuận với lượng iôt đưa vào cơ thể, các chuyên gia của Tổ chức Y tế thế giới WHO đưa ra cách tính mức độ ăn iốt trong một cộng đồng bằng cách tính thông qua số đo trung bình lượng iốt thải ra trong nước tiểu hàng ngày.
Qua nồng độ iôt nước tiểu, chúng ta có các mức cung cấp iôt sau:
– Thiếu i-ốt nặng: iốt nước tiểu dưới 20 mcg/l.
– Thiếu i-ốt trung bình: iốt nước tiểu từ 20 mcg/L đến dưới 50 mcg/L.
– Thiếu i-ốt nhẹ: iốt từ 50 mcg/dl đến dưới 100 mcg/l
– Đủ iốt lý tưởng: iốt nước tiểu từ 100 mcg/dl đến dưới 200 mcg/L
– Đủ i-ổt ở mức cao:iốt nước tiểu từ 200 mcg/dl đến dưới 300 mcg/L
– Thừa i-ốt: nồng độ iốt trong nước tiểu trên 300 mcg/l
Theo chương trình phòng chống bệnh do thiếu iốt thế giới (iodine dèiciency diseases) IDD, ở những quốc gia có bilan iốt thấp hoặc có tỷ lệ bướu giáp đơn thuần cao, muối ăn nên được pha thêm iốt với tỷ lệ NaI/NaCl là 1/100,000.
V. THIẾU IỐT: BƯỚU GIÁP ĐƠN, SUY GIÁP
Iốt là thành phần cấu tạo của hormone giáp. Do đó, thiếu iốt sẽ tạo ra những bệnh lý ở tuyến giáp:
1* Bướu giáp đơn, bướu giáp địa phương:
![](data:image/jpeg;base64,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)
Khi bị thiếu iốt, tuyến giáp bù trừ bằng cách phì đại để tăng khả năng bắt giữ iốt. Trong giai đoạn còn bù lúc đầu, bướu giáp tuy lớn nhưng chức năng vẫn còn bình thường thể hiện qua nồng độ T3, T4 bình giáp.
2* Suy giáp:
Nếu thiếu hụt iốt kéo dài, tuyến giáp sẽ không có nguyên liệu để tổng hợp đủ các hormone gây ra suy giáp.
Vì là một tuyến nội tiết quan trọng, chi phối nhiều chu trình, hệ thống trong cơ thể, nên suy giáp có nhiều ảnh hưởng như mệt mỏi, buồn ngủ, trí nhớ bị giảm sút, suy tim, suy hô hấp…Đặc biệt, suy giáp do thiếu iốt sẽ rất nghiêm trọng với phụ nữ mang thai hay đang cho con bú, và trẻ sơ sinh như thai chết lưu, sẩy thai, dị tật bẩm sinh; trẻ sẽ bị đần độn, phát triển thể lực và trí tuệ yếu kém. WHO đánh giá rằng trẻ bị thiếu iốt dù nhẹ cũng làm giảm 13,5 điểm IQ và khả năng học tập lao động thấp sau này.
VI. THỪA IỐT BỊ CƯỜNG GIÁP DO IỐT, JOD-BASEDOW
Thừa iốt sẽ gây ra tác dụng Jod-Basedow (hội chứng, hiện tượng Jod-Basedow). Hội chứng được đặt tên theo từ gốc tiếng Đức “Jod” có nghĩa là iốt ghép với Basedow là tên của bác sĩ Karl Adolph von Basedow, người đầu tiên mô tả bệnh lý này. Đây là hội chứng cường giáp sau khi dùng quá thừa iốt, như ăn quá nhiều, dùng thuốc có iốt (thuốc chống loạn nhịp tim amiốtarone, thuốc cản quang có chứa iốt để chụp phim quang tuyến X trong chẩn đoán hình ảnh y khoa).
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)
Hội chứng Jod-Basedow thường xuất hiện ở bệnh nhân bị bướu giáp đơn do thiếu iốt (simple goiter) di chuyển đến một vùng địa lý giàu iốt, hay được bổ sung iốt quá liều. Bản thân những người bị bệnh Basedow, bướu cổ đa nhân độc hoặc các dạng u tuyến giáp khác cũng có nguy cơ bị Jod-Basedow khi họ uống thêm nhiều iốt. Tác dụng Jod-Basedow hầu như không xảy ra ở những người có tuyến giáp hoàn toàn bình thường.
Ở những người đã có sẵn các bất thường tuyến giáp, một sự gia tăng iốt dù rất nhỏ cũng có thể khơi mào Jod-Basedow điển hình khiến tuyến giáp tăng hoạt động mà không còn sự kiểm soát của tuyến yên. Trong một số trường hợp, hiện tượng Jod-Basedow là trái ngược với hiệu ứng Wolff-Chaikoff, ức chế hormon tuyến giáp trong giai đoạn ngắn khi cho một lượng iốt tương đối lớn vào cơ thể.
VII. ĐÔI ĐIỀU BÀN LUẬN
Thiếu iốt là một mối quan tâm sức khỏe cộng đồng, đặc biệt đối với phụ nữ mang thai, trẻ sơ sinh, trẻ mới biết đi và trẻ nhỏ. Ở lứa tuổi này, thiếu hụt iốt kéo dài dẫn đến tổn thương não không hồi phục và chậm phát triển tâm thần.
Với sự giúp đỡ của Quỹ Nhi đồng Liên Hiệp Quốc UNICEF, năm 1992, Dự án Phòng chống bướu cổ đã chính thức được triển khai trên lãnh thổ Việt Nam. Đến năm 2005, chúng ta đã cơ bản hoàn thành kiểm soát các rối loạn thiếu iốt (Iodine Deficiency Diseases, IDD), với độ bao phủ muối i-ốt đủ tiêu chuẩn phòng bệnh đạt 92% ; mức i-ốt niệu trung vị đạt 122 µg/l và tỷ lệ bướu cổ trẻ em 3,6 %. Nhưng năm 2008, Bệnh viện Nội tiết trung ương tiến hành điều tra lại, tỷ lệ sử dụng muối iốt chỉ còn 33,7 %. Do đó, bộ Y tế ban hành nghị định 09/2016/NĐ-CP và hướng dẫn quy định là từ 15-3-2017, các doanh nghiệp sử dụng muối có tăng cường iôt trong chế biến thực phẩm.
Hai điều lưu ý: (1) Có nhiều nguồn cung iốt cho cơ thể như từ thức ăn, nước uống, nên việc bổ sung iốt vào trong muối ăn không phải là nguồn duy nhất, (2) Việc thừa iốt sẽ gây ra cường giáp Jod-Basedow, cũng nguy hiểm không kém suy giáp. Chính vì điều trị cường giáp khó khăn hơn suy giáp rất nhiều, cho nên hiện đã có xu hướng biến cường giáp Basedow thành suy giáp để điều trị dễ dàng hơn bằng cách cho uống hormone thyroxine (T4) hàng ngày!
Theo tôi, Bộ Y tế cần lưu ý hai việc:
(1) một là Khảo sát, điều tra chính xác mức sử dụng iốt (bilan iốt) của người dân bằng cách định lượng iôt nước tiểu hơn là đánh giá qua tỷ lệ bướu cổ. Đánh giá bướu cổ dựa trên lâm sàng sai số quá lớn; đánh giá qua siêu âm khá phức tạp, hơn nữa thiếu iôt chỉ là một trong rất nhiều nguyên nhân gây tuyến giáp lớn, và
(2) hai là Cần lưu ý lượng iốt cho vào thực phẩm công nghiệp, đặc biệt là thực phẩm để xuất khẩu ra nước ngoài, iốt có thể làm thay đổi màu sắc, mùi vị của sản phẩm cũng như cơ sở chế biến phải tốn kém hơn trong việc ghi nhãn, đăng ký thành phần…..
VIII. TÀI LIỆU THAM KHẢO
[1] Bộ Y tế ban hành văn bản về muối iốt trái ý kiến Thủ tướng
https://suckhoe.vnexpress.net/tin-tuc/suc-khoe/bo-y-te-ban-hanh-van-ban-ve-muoi-iot-trai-y-kien-thu-tuong-3644126.html
[2] Bổ sung muối iốt: Doanh nghiệp kêu trời, bộ bảo cứ làm đi
http://tuoitre.vn/bo-sung-muoi-iot-doanh-nghiep-keu-troi-bo-bao-cu-lam-di-1349803.htm
[3] Bộ Y tế yêu cầu doanh nghiệp chế biến sử dụng muối iốt
http://phunuonline.com.vn/suc-khoe/yeu-cau-doanh-nghiep-che-bien-su-dung-muoi-iot-bo-y-te-thuc-hien-trai-y-kien-thu-tuong-111083/
[4] Bức xúc quy định dùng muối I-ốt: DN hỏi thẳng Bộ Y tế
http://toquoc.vn/y-te/buc-xuc-quy-dinh-dung-muoi-iot-dn-hoi-thang-bo-y-te-231460.html
[5]Thyroid function and diseases
https://books.google.com.vn/books?id=mXeKCwAAQBAJ&pg=PA145&lpg=PA145&dq=iốtBasedow+disease+?&source=bl&ots=peVrXbR5py&sig=7SJipI9osFd02CP_jzKwrd4Stqw&hl=en&sa=X&ved=0ahUKEwiNsrP-lY3XAhXIf7wKHQx2BsMQ6AEINjAD#v=onepage&q=iốtBasedow%20disease%20%3F&f=false
[6] Iodine-induced thyroid dysfunction
https://www.uptodate.com/contents/iốtine-induced-thyroid-dysfunction
[7] Iodine and Hyperthyroidism
https://www.globalhealingcenter.com/natural-health/iốtine-and-hyperthyroidism/
[8] Can too much iodine cause hypothyroidism?
https://www.pathologystudent.com/?p=3064
[9] Biện pháp phòng chống các rối loạn thiếu i-ốt
http://www.benhviennoitiettrunguong.com.vn/content/item/option/tt-t-ct/parent/phuong-phap-phong-chong-roi-loan-thieu-i-ot
[10] Tình hình sử dụng muối i-ốt và thu nhận i-ốt của phụ nữ có con dưới 5 tuổi năm 2008-2009
http://benhviennoitiettrunguong.com.vn/content/item/option/tt-t-ct/parent/ket-qua-dieu-tra-su-dung-muoi-iot-p1
[11] Chương trình phòng chống các rối loạn do thiếu i-ốt ở Việt Nam
https://www.unicef.org/vietnam/vi/Final_IDD_VN_email_version.pdf
[12] Thừa iode bị cường giáp
http://dantri.com.vn/suc-khoe/thua-iot-coi-chung-bi-cuong-giap-basedow-20171029051015287.htm
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