十、预防
食盐碘化是目前公认的预防碘缺乏病的有效措施。
1.碘盐中的碘浓度。其影响因素有：①每日对碘的需要量以碘离子计算，公认的供给标准为150μg/d。②当地的缺碘程度可以通过尿碘来判断，正常尿碘应大于100μg/L。③每人每日食盐摄入量因地区、习惯而异，一般为6～20g，北方高于南方，平均10g。④烹调习惯。⑤食物中有无致甲状腺肿物质，如有则碘的供应量需提高。
2.碘盐中的含碘化合物。目前碘盐中所采用的碘化物有两种：碘化钾（KI）和碘酸钾（KIO），由于碘化钾在日光下、高温下、潮湿及酸性环境下易氧化或挥发而使碘丢失，因此世界多数国家都使用碘酸钾，后者不易挥发，在高温、潮湿条件下化学性质稳定。我国在历史上曾使用过碘化钾作为碘盐，从1989年起，根据专家建议，已改用碘酸钾[45]。
3.其他补碘方法用于特殊患者或特殊人群。补碘是一个长期而持久的防止措施，碘供不足或中断，则会使得到控制地区的碘缺乏病发生率回升，因此该病的防治过程中还需进行监测。
（1）碘化用水：即把碘化物按一定比例投放于供水系统，这种对限定地区的人群进行补碘，在泰国和意大利的西西里岛使用过，也收到了控制碘缺乏病的效果。由于饮用水仅占总供水量的1%～2%，因此全部供水系统内加碘显然是一种浪费。另一种办法是想饮用水中放入一种可以缓慢释放碘的缓释器，这在我国的某些地区使用过。例如，碘管碘化物，放入塑料管内，塑料管壁上有微孔；碘砖把碘酸钙放入高岭土中烧制成小砖块。把碘管或碘砖放入盛水容器中，缓释器中的碘可以微量、持久地进入水中，达到补碘作用[46]。
（2）碘化食品：多吃含碘食物，如紫菜、海带及海产品等。碘化糖果、碘化饼干、碘化酱油（包括鱼酱、豆酱等）等碘化食品在特定人群、特定地区可以发挥补碘作用。我国新疆、云南曾分别试用过碘化面粉、碘化大米，西藏还用碘化砖茶，由于藏民有每日饮奶茶习惯，而且喜用砖茶，因此在茶砖中加入碘化物也可以在大范围人群内进行补碘[47]。
（3）其他药物：复方碘口服溶液通常每日服用1滴，约0.06mL碘，连服30d，休息10d，而后可重复服用。这种办法费用低，使用简便，对小范围内的人群或暂不能推广碘盐的地方可以使用这种防治方法。碘化钾或碘酸钾片剂、糖丸、糖浆等制剂可用于孕妇、乳母和婴幼儿。孕妇（孕3个月以后）不宜服用碘油；婴幼儿没有合适的碘油剂型，这部分人群不愿意接受注射治疗，但是补碘治疗对他们又非常重要，足够的碘供应对下一代的智力发育至关重要，因此这些剂型是适宜的、可接受的。缺点是每天或间隔数日就需服用，不宜在大量人群中推广[48]。
4.碘油肌肉注射。适于在一定地区一次性大剂量补碘，碘剂缓慢释放，安全有效，可作为暂时性辅助措施。但并不适于很大规模预防，注射引起疼痛、局部硬结，也不经济。碘油含碘量约40%。对于0～12个月的婴儿最适宜的剂量为0.5mL，2年注射1次。1～10岁的儿童1.0mL，2.5年注射1次。11～48岁的成人，注射1.0mL时3年注射1次，注射2.0mL时4年注射1次。偶尔也有过敏者。
虽然甲状腺肿的病因和临床诊断已经比较清晰，但在单纯性甲状腺肿的治疗领域，目前仍存在诸多有待解决的问题：①碘缺乏所致的地方性甲状腺肿可通过补碘使其发病率明显降低，但是已患病者的甲状腺肿大仍不能得以完全恢复，相关的具体机制还有待于系统研究。②散发性高碘性甲状腺肿除限碘外，是否可给予抗氧化剂来促进其恢复尚未明确。③病程较长的散发性甲状腺肿，通过调整碘摄入量及补充甲状腺素治疗效果常常并不明显，有效的治疗手段还有待探索及研究[49]。
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