Screening patients for iodine deficiency
Iodine deficiency means the thyroid gland cannot produce certain hormones, which are, however, vital for specific bodily functions. An ultrasound examination of the thyroid makes it possible to detect inadequate supplies at an early stage. "ThyroMobils" have been on the road on five continents, serving as mobile doctors' offices since 1993. "M - The Explorer Magazine" met up with one in Cologne.
It takes just three minutes. The physician, Dr. Amir Sabet, coats his patient's throat with a gel before carefully moving the ultrasound transducer into place above it. On the monitor, Dr. Joachim Schwab's thyroid gland appears. Schwab is a department head for Cologne's district government. His responsibilities include environmental protection and occupational health and safety, and today he's setting a good example: "We invited the ThyroMobil to our health days," he says as he rises from the examination table and lets the physician explain his diagnosis.
The ThyroMobils - there are currently three - have been on the road since 1993. Christian Schintag from Merck is responsible for their deployment. "The idea originally arose when we wanted to collect data on iodine deficiency and related thyroid problems," recalls Schintag, a certified biologist and health care economist.
Important micrograms
Deficiency illnesses in industrialized countries? Yes, they occur, at least when we're talking about the trace element iodine. Iodine was first isolated in 1811, from the ashes of marine algae. The body requires between 150 and 200 micrograms of this element daily in order to produce the thyroid hormones. These hormones control oxygen consumption and heat production, and affect many other bodily functions - from growth to the central nervous system. If there is insufficient iodine, the first signs of a thyroid problem often soon follow, including swollen eyelids, or a feeling of fatigue and lack of motivation.
As the illness progresses, a goiter - referred to as a "struma" by physicians - can develop. It's the clearest, most visible result of iodine deficiency, which is the cause of nine out of ten goiter cases. The only effective preventive measure against iodine deficiency is to provide supplements of the element. But that isn't always easy in a normal diet. The last ice age washed the element out and into the sea. As a result, most natural foods are low in iodine, except for seafood, fish, and algae.
"People who don't eat enough fish and don't use an iodine-enriched table salt may find their thyroids are deficient in iodine," says Schintag. It's up to the ThyroMobils to detect this problem. The vehicles are mobile physicians' offices built on the basis of Mercedes 3120 vans - including air conditioning and a refrigerator - and they are equipped with everything needed to thoroughly screen about 120 people a day.
Patients waiting in front of ThyroMobil

Cooperation with health insurance companies and physicians
The ThyroMobil is supported by the German health insurer Barmer, which is also convinced of the efficacy of such screening. "The on-site examinations are carried out by qualified, local physicians," adds Schintag. Around 45,000 patients have already been screened in this way since 1993. The figure refers to examinations worldwide, as ThyroMobils have been on the road on all five continents and in more than 35 countries during this period.
Schintag is well aware that the vehicle has an unbeatable advantage, especially in exotic locations: "The key factor is that we can reach children, and adults, in very remote areas." Merck has donated one of the ThyroMobils, which cost about €80,000 each, to WHO for use in Africa. The health organization also recognizes this screening.
As we talk, the waiting line continues to stretch through the courtyard of the Cologne district government complex. Dr. Schwab, the department head, is just leaving the van with his report: "It doesn't hurt, of course, and afterwards you have a feeling of security." He knows he can relax. The ultrasound scan has revealed neither iodine deficiency nor any other abnormalities of his thyroid. "We tend to find something in almost half of all cases," says Schintag, who sees to it that around 7,200 patients pass through "his" ThyroMobil every year.
This is what makes it possible to detect thyroid illnesses due to iodine deficiencies at an early stage. "Together with Barmer, we want to use the ThyroMobil to contribute to raising patients' awareness, so that they take the initiative before a disorder becomes chronic," adds Schintag. It is the only way to reduce the number of thyroid operations performed as a consequence of iodine deficiency, currently about 100,000 a year.
That's why the ThyroMobils are on the road worldwide, and why they are met everywhere with the same enthusiasm Dr. Schwab showed in commenting on his examination: "Professional diagnosis and competent consultation - I felt every bit as well cared for in the ThyroMobil as in a physician's office."
ThyroMobil in Peru

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