【碘和(he)甲(jia)狀(zhuang)腺】加碘鹽好還是無碘鹽好？碘和(he)甲(jia)狀(zhuang)腺炎、甲(jia)亢的關系

一、碘是制造甲狀腺激素的原料

碘(dian)是(shi)人(ren)體(ti)(ti)(ti)必(bi)需的(de)(de)(de)(de)(de)一種微量(liang)元(yuan)素(su)，它(ta)在(zai)我(wo)們身體(ti)(ti)(ti)中(zhong)(zhong)的(de)(de)(de)(de)(de)含量(liang)雖然(ran)少到只有(you)50毫克，僅為(wei)鐵含量(liang)的(de)(de)(de)(de)(de)八(ba)十分(fen)之一，但對維持(chi)人(ren)體(ti)(ti)(ti)中(zhong)(zhong)一些(xie)決定性的(de)(de)(de)(de)(de)新(xin)陳代謝卻是(shi)十分(fen)必(bi)要(yao)(yao)的(de)(de)(de)(de)(de)。碘(dian)和甲(jia)(jia)(jia)狀(zhuang)(zhuang)腺(xian)(xian)(xian)(xian)的(de)(de)(de)(de)(de)關(guan)系最為(wei)密切。甲(jia)(jia)(jia)狀(zhuang)(zhuang)腺(xian)(xian)(xian)(xian)具(ju)有(you)超強(qiang)和獨特(te)的(de)(de)(de)(de)(de)攝碘(dian)能(neng)力，能(neng)將(jiang)食物中(zhong)(zhong)50%的(de)(de)(de)(de)(de)碘(dian)吸收(shou)入內，環(huan)境中(zhong)(zhong)的(de)(de)(de)(de)(de)放射性碘(dian)大部分(fen)也被甲(jia)(jia)(jia)狀(zhuang)(zhuang)腺(xian)(xian)(xian)(xian)所(suo)吸收(shou)。碘(dian)在(zai)甲(jia)(jia)(jia)狀(zhuang)(zhuang)腺(xian)(xian)(xian)(xian)組(zu)織(zhi)中(zhong)(zhong)的(de)(de)(de)(de)(de)濃度比起(qi)其(qi)他(ta)器官(guan)和組(zu)織(zhi)要(yao)(yao)高出數(shu)千倍。碘(dian)是(shi)制(zhi)造甲(jia)(jia)(jia)狀(zhuang)(zhuang)腺(xian)(xian)(xian)(xian)激(ji)(ji)(ji)(ji)素(su)的(de)(de)(de)(de)(de)原料，它(ta)對人(ren)體(ti)(ti)(ti)的(de)(de)(de)(de)(de)作(zuo)用就是(shi)通過甲(jia)(jia)(jia)狀(zhuang)(zhuang)腺(xian)(xian)(xian)(xian)激(ji)(ji)(ji)(ji)素(su)來(lai)實現的(de)(de)(de)(de)(de)。甲(jia)(jia)(jia)狀(zhuang)(zhuang)腺(xian)(xian)(xian)(xian)激(ji)(ji)(ji)(ji)素(su)可(ke)以(yi)促(cu)進大腦和體(ti)(ti)(ti)格的(de)(de)(de)(de)(de)生長發育(yu)；維持(chi)人(ren)體(ti)(ti)(ti)重(zhong)要(yao)(yao)器官(guan)的(de)(de)(de)(de)(de)功能(neng)和活力，如保證心率在(zai)每分(fen)鐘70次左(zuo)右(you)，保證心肌收(shou)縮的(de)(de)(de)(de)(de)力量(liang)；維持(chi)身體(ti)(ti)(ti)的(de)(de)(de)(de)(de)恒溫狀(zhuang)(zhuang)態等(deng)，還與(yu)人(ren)體(ti)(ti)(ti)其(qi)他(ta)各種組(zu)織(zhi)和細胞(bao)正常活動息息相關(guan)。我(wo)們飲食中(zhong)(zhong)碘(dian)攝入量(liang)的(de)(de)(de)(de)(de)變(bian)(bian)化(hua)，無論是(shi)過少還是(shi)過多，都可(ke)以(yi)直接或間接影響(xiang)甲(jia)(jia)(jia)狀(zhuang)(zhuang)腺(xian)(xian)(xian)(xian)。當(dang)甲(jia)(jia)(jia)狀(zhuang)(zhuang)腺(xian)(xian)(xian)(xian)出現疾病(bing)，甲(jia)(jia)(jia)狀(zhuang)(zhuang)腺(xian)(xian)(xian)(xian)激(ji)(ji)(ji)(ji)素(su)的(de)(de)(de)(de)(de)生成(cheng)異常，就會(hui)嚴重(zhong)危害人(ren)體(ti)(ti)(ti)健康。如甲(jia)(jia)(jia)狀(zhuang)(zhuang)腺(xian)(xian)(xian)(xian)激(ji)(ji)(ji)(ji)素(su)過多的(de)(de)(de)(de)(de)甲(jia)(jia)(jia)亢(kang)心率會(hui)很(hen)快(kuai)，甲(jia)(jia)(jia)狀(zhuang)(zhuang)腺(xian)(xian)(xian)(xian)激(ji)(ji)(ji)(ji)素(su)減(jian)少的(de)(de)(de)(de)(de)甲(jia)(jia)(jia)減(jian)心率會(hui)變(bian)(bian)慢(man)，血(xue)壓也會(hui)隨之變(bian)(bian)化(hua)，胃腸蠕(ru)動也會(hui)相應的(de)(de)(de)(de)(de)過快(kuai)或緩慢(man)等(deng)等(deng)。

二、缺碘會導致呆小癥和大脖子病

碘(dian)可以(yi)說是(shi)(shi)(shi)人(ren)(ren)體(ti)惟一的(de)(de)(de)(de)智力(li)元素，平時(shi)我們(men)見到(dao)(dao)的(de)(de)(de)(de)智力(li)低下和先天畸形兒(er)形成(cheng)的(de)(de)(de)(de)原因，很多(duo)就(jiu)是(shi)(shi)(shi)由于缺(que)(que)碘(dian)。國際醫(yi)學界的(de)(de)(de)(de)檢測結果顯示(shi)，人(ren)(ren)類智力(li)的(de)(de)(de)(de)損(sun)害中有80％是(shi)(shi)(shi)因為缺(que)(que)碘(dian)導(dao)致的(de)(de)(de)(de)。碘(dian)在(zai)人(ren)(ren)的(de)(de)(de)(de)一生(sheng)(sheng)中都(dou)起著不可忽視的(de)(de)(de)(de)作(zuo)用，那么什么時(shi)段人(ren)(ren)最需要(yao)碘(dian)呢？孕期的(de)(de)(de)(de)前三個(ge)月是(shi)(shi)(shi)胎兒(er)腦發(fa)育(yu)時(shi)期，同時(shi)新生(sheng)(sheng)兒(er)0歲到(dao)(dao)2歲是(shi)(shi)(shi)腦細胞發(fa)育(yu)最快，也(ye)是(shi)(shi)(shi)最好(hao)的(de)(de)(de)(de)時(shi)段，占人(ren)(ren)一生(sheng)(sheng)智力(li)發(fa)展(zhan)的(de)(de)(de)(de)90％以(yi)上，此(ci)時(shi)碘(dian)營養(yang)是(shi)(shi)(shi)否正常，決定著智力(li)發(fa)育(yu)的(de)(de)(de)(de)關(guan)鍵，若在(zai)這時(shi)缺(que)(que)碘(dian)，哪怕是(shi)(shi)(shi)輕(qing)微缺(que)(que)，都(dou)會造(zao)成(cheng)不同程度的(de)(de)(de)(de)智力(li)損(sun)害，而(er)這種損(sun)害卻是(shi)(shi)(shi)終(zhong)生(sheng)(sheng)不可逆轉(zhuan)的(de)(de)(de)(de)。兒(er)童碘(dian)缺(que)(que)乏引起的(de)(de)(de)(de)甲減，還有一個(ge)明(ming)顯的(de)(de)(de)(de)特征就(jiu)是(shi)(shi)(shi)身材特別(bie)矮小，所以(yi)被稱之為“呆小癥(zheng)”。

缺(que)碘(dian)(dian)(dian)性疾(ji)病(bing)在成人身上則主(zhu)要(yao)是出(chu)現(xian)(xian)甲(jia)狀(zhuang)(zhuang)腺(xian)(xian)腫(zhong)大、結節，即老(lao)百姓平時所說的(de)(de)“大脖子(zi)病(bing)”。這種(zhong)病(bing)往往有(you)區域性，主(zhu)要(yao)是由于環境中如土壤、水、食物中缺(que)碘(dian)(dian)(dian)，甲(jia)狀(zhuang)(zhuang)腺(xian)(xian)中含(han)碘(dian)(dian)(dian)量(liang)減(jian)少，機體為適用(yong)這種(zhong)缺(que)碘(dian)(dian)(dian)狀(zhuang)(zhuang)態(tai)，以(yi)維持正(zheng)常(chang)的(de)(de)甲(jia)狀(zhuang)(zhuang)腺(xian)(xian)功能而發生代償性甲(jia)狀(zhuang)(zhuang)腺(xian)(xian)腫(zhong)大。我(wo)國曾經是缺(que)碘(dian)(dian)(dian)性疾(ji)病(bing)高(gao)發國家之(zhi)一。為了(le)預(yu)防(fang)碘(dian)(dian)(dian)缺(que)乏疾(ji)病(bing)，國家從1994年開始實行(xing)食鹽(yan)加(jia)碘(dian)(dian)(dian)，取(qu)得了(le)明(ming)顯的(de)(de)成效。現(xian)(xian)在缺(que)碘(dian)(dian)(dian)引起的(de)(de)呆小癥在我(wo)國已消除(chu),地方(fang)性甲(jia)狀(zhuang)(zhuang)腺(xian)(xian)腫(zhong)也(ye)基(ji)本得到(dao)控(kong)制。相(xiang)反由其(qi)他原因(yin)引起的(de)(de)甲(jia)狀(zhuang)(zhuang)腺(xian)(xian)病(bing)卻在增加(jia)。正(zheng)因(yin)為如此(ci)，大家對碘(dian)(dian)(dian)缺(que)乏疾(ji)病(bing)的(de)(de)警惕性放松(song)了(le)。但對缺(que)碘(dian)(dian)(dian)地區和人群(qun)(qun)來說，光靠其(qi)他含(han)碘(dian)(dian)(dian)食物補碘(dian)(dian)(dian)難已保證人體需求量(liang)，胎兒和嬰幼兒將(jiang)是最先(xian)受(shou)到(dao)危害的(de)(de)人群(qun)(qun)，碘(dian)(dian)(dian)缺(que)乏病(bing)也(ye)將(jiang)會卷(juan)土重來。

三、食物補碘最為可靠和安全

人(ren)體的(de)(de)碘80%-90%來源于食(shi)(shi)物和(he)飲(yin)水。一般情況下，我們通(tong)(tong)過日常飲(yin)食(shi)(shi)如碘鹽和(he)海(hai)產品(pin)就(jiu)能(neng)滿足身體內碘的(de)(de)需求。普(pu)通(tong)(tong)成人(ren)每天需要約100-150微克(ke)碘。我們食(shi)(shi)用的(de)(de)碘鹽加(jia)碘量為20-50mg/kg，即20-50μg/g，按這個(ge)標準計(ji)算，每天吃(chi)4~5克(ke)碘鹽，碘的(de)(de)量就(jiu)已經達標，吃(chi)得咸的(de)(de)人(ren)就(jiu)有(you)可(ke)能(neng)超標。

有關衛生部門也提出，所謂“服碘超標”與大家飲食中鹽的(de)過量(liang)有(you)一(yi)定關系。除了(le)碘(dian)(dian)(dian)鹽以外(wai)，食(shi)物中海(hai)(hai)產(chan)品、肉類、水(shui)中都含(han)有(you)一(yi)定量(liang)的(de)碘(dian)(dian)(dian)元素(su)。特別是海(hai)(hai)產(chan)品大多為高碘(dian)(dian)(dian)食(shi)物。海(hai)(hai)產(chan)品中的(de)碘(dian)(dian)(dian)是陸地植物的(de)幾倍甚(shen)至幾十倍。比如(ru)我們吃的(de)海(hai)(hai)帶，其碘(dian)(dian)(dian)含(han)量(liang)每千克就有(you)10毫克。紫菜、蝦皮(pi)等也(ye)屬(shu)于含(han)碘(dian)(dian)(dian)排行前列的(de)食(shi)品。碘(dian)(dian)(dian)也(ye)可以隨(sui)藥物進(jin)入體內。如(ru)西(xi)藥的(de)碘(dian)(dian)(dian)片、華素(su)片，中藥的(de)海(hai)(hai)藻、昆(kun)布、海(hai)(hai)浮石等，做CT等檢查(cha)的(de)造影劑等，都含(han)有(you)一(yi)定量(liang)的(de)碘(dian)(dian)(dian)。

對(dui)普通百姓來說(shuo)，食(shi)用(yong)(yong)(yong)碘(dian)(dian)鹽和(he)平(ping)時食(shi)用(yong)(yong)(yong)一(yi)些(xie)海產是補碘(dian)(dian)最有效(xiao)可(ke)靠的(de)(de)(de)(de)(de)方法，也是我國繼續防治(zhi)碘(dian)(dian)缺(que)乏(fa)疾(ji)病的(de)(de)(de)(de)(de)基本措(cuo)施。除缺(que)碘(dian)(dian)的(de)(de)(de)(de)(de)重點地區外，一(yi)般地方的(de)(de)(de)(de)(de)妊娠和(he)哺乳婦女、嬰幼兒等特殊人(ren)群也是碘(dian)(dian)營(ying)養重點關(guan)注的(de)(de)(de)(de)(de)對(dui)象(xiang)。懷孕(yun)(yun)時碘(dian)(dian)需求量比平(ping)常(chang)要增(zeng)加50％左右，則應適(shi)當多吃海產品來補充。孕(yun)(yun)婦在補充碘(dian)(dian)時，如查尿碘(dian)(dian)含量低于100微克／升(sheng)尿，則要加大碘(dian)(dian)鹽攝入或服用(yong)(yong)(yong)碘(dian)(dian)丸(wan)，但必須在醫生的(de)(de)(de)(de)(de)指導下，采(cai)用(yong)(yong)(yong)正確劑量進行補充，以防止攝碘(dian)(dian)過高。由于中(zhong)老年婦女是甲狀腺疾(ji)病的(de)(de)(de)(de)(de)高發人(ren)群，則不(bu)宜吃過多的(de)(de)(de)(de)(de)海帶等含碘(dian)(dian)食(shi)物(wu)，以免(mian)誘(you)發甲狀腺疾(ji)病。

四、為防高碘，碘鹽在悄然變化

由于(yu)(yu)我國(guo)幅員廣闊，不(bu)(bu)同地(di)域之間水中(zhong)的(de)(de)(de)(de)含(han)碘(dian)(dian)(dian)(dian)(dian)(dian)量(liang)和(he)(he)居民(min)膳食結構不(bu)(bu)同，存(cun)在低(di)碘(dian)(dian)(dian)(dian)(dian)(dian)和(he)(he)高(gao)碘(dian)(dian)(dian)(dian)(dian)(dian)的(de)(de)(de)(de)地(di)區(qu)(qu)(qu)(qu)差(cha)。一般來說，缺碘(dian)(dian)(dian)(dian)(dian)(dian)的(de)(de)(de)(de)地(di)方(fang)山區(qu)(qu)(qu)(qu)多(duo)于(yu)(yu)平原(yuan)，內(nei)地(di)多(duo)于(yu)(yu)沿海。我國(guo)的(de)(de)(de)(de)高(gao)碘(dian)(dian)(dian)(dian)(dian)(dian)地(di)區(qu)(qu)(qu)(qu)則主要分布在黃河故道地(di)區(qu)(qu)(qu)(qu)，原(yuan)因是當地(di)的(de)(de)(de)(de)井水碘(dian)(dian)(dian)(dian)(dian)(dian)含(han)量(liang)過(guo)高(gao)。還有(you)的(de)(de)(de)(de)地(di)方(fang)屬于(yu)(yu)非(fei)缺碘(dian)(dian)(dian)(dian)(dian)(dian)地(di)區(qu)(qu)(qu)(qu)等等。國(guo)際上公認的(de)(de)(de)(de)碘(dian)(dian)(dian)(dian)(dian)(dian)研究成(cheng)果發現，碘(dian)(dian)(dian)(dian)(dian)(dian)的(de)(de)(de)(de)攝(she)入(ru)(ru)量(liang)與甲(jia)(jia)狀腺(xian)(xian)疾病(bing)的(de)(de)(de)(de)關系成(cheng)U字型的(de)(de)(de)(de)關系，即碘(dian)(dian)(dian)(dian)(dian)(dian)的(de)(de)(de)(de)攝(she)入(ru)(ru)量(liang)的(de)(de)(de)(de)過(guo)高(gao)與過(guo)低(di)都會導(dao)致(zhi)(zhi)甲(jia)(jia)狀腺(xian)(xian)疾病(bing)的(de)(de)(de)(de)增加。自從我國(guo)實(shi)行食鹽(yan)全(quan)部(bu)加碘(dian)(dian)(dian)(dian)(dian)(dian)，缺碘(dian)(dian)(dian)(dian)(dian)(dian)引起的(de)(de)(de)(de)地(di)方(fang)性甲(jia)(jia)狀腺(xian)(xian)腫病(bing)人減少，但對于(yu)(yu)原(yuan)來的(de)(de)(de)(de)碘(dian)(dian)(dian)(dian)(dian)(dian)營養狀態充足的(de)(de)(de)(de)人口來說，就存(cun)在著碘(dian)(dian)(dian)(dian)(dian)(dian)過(guo)量(liang)的(de)(de)(de)(de)危險。碘(dian)(dian)(dian)(dian)(dian)(dian)過(guo)量(liang)可(ke)以導(dao)致(zhi)(zhi)對健康不(bu)(bu)良影響(xiang)，包括碘(dian)(dian)(dian)(dian)(dian)(dian)致(zhi)(zhi)甲(jia)(jia)狀腺(xian)(xian)功能亢(kang)進癥(zheng)和(he)(he)自身免疫甲(jia)(jia)狀腺(xian)(xian)病(bing)等。進年(nian)來，“能不(bu)(bu)能吃(chi)(chi)碘(dian)(dian)(dian)(dian)(dian)(dian)鹽(yan)？”、“高(gao)碘(dian)(dian)(dian)(dian)(dian)(dian)地(di)區(qu)(qu)(qu)(qu)陪吃(chi)(chi)碘(dian)(dian)(dian)(dian)(dian)(dian)鹽(yan)”等一度成(cheng)為老(lao)百姓(xing)熱議的(de)(de)(de)(de)話題(ti)。

其實，為(wei)(wei)了(le)防(fang)止補碘(dian)(dian)(dian)(dian)(dian)過(guo)量(liang)，國(guo)(guo)(guo)家已采取了(le)因地(di)制宜的(de)政(zheng)策，我(wo)(wo)國(guo)(guo)(guo)從2000年起就已下調了(le)碘(dian)(dian)(dian)(dian)(dian)鹽濃度標準，鹽中(zhong)的(de)碘(dian)(dian)(dian)(dian)(dian)含(han)量(liang)已悄然“瘦身”。而且，在上(shang)海市等非(fei)碘(dian)(dian)(dian)(dian)(dian)鹽缺乏病(bing)流行區開始供應無碘(dian)(dian)(dian)(dian)(dian)鹽。我(wo)(wo)國(guo)(guo)(guo)衛生部(bu)門也組織專家進(jin)行了(le)大量(liang)調查，認(ren)為(wei)(wei)我(wo)(wo)國(guo)(guo)(guo)的(de)食(shi)鹽加碘(dian)(dian)(dian)(dian)(dian)屬于(yu)安全范圍(wei)。中(zhong)國(guo)(guo)(guo)營(ying)(ying)養(yang)學(xue)會制定(ding)的(de)《中(zhong)國(guo)(guo)(guo)居(ju)民(min)膳食(shi)營(ying)(ying)養(yang)素(su)參考攝(she)入(ru)量(liang)》里(li)，碘(dian)(dian)(dian)(dian)(dian)營(ying)(ying)養(yang)素(su)的(de)最高攝(she)入(ru)量(liang)為(wei)(wei)每天(tian)(tian)800毫(hao)克，攝(she)入(ru)量(liang)在這(zhe)一(yi)數(shu)字以(yi)下都是(shi)(shi)(shi)安全的(de)。如北京地(di)區居(ju)民(min)的(de)碘(dian)(dian)(dian)(dian)(dian)進(jin)食(shi)量(liang)平均在每天(tian)(tian)300毫(hao)克左右。現(xian)在無論是(shi)(shi)(shi)中(zhong)國(guo)(guo)(guo)還是(shi)(shi)(shi)全世(shi)界(jie)，甲(jia)狀腺疾病(bing)的(de)發(fa)病(bing)率都在增(zeng)加，其原因是(shi)(shi)(shi)多(duo)方(fang)面的(de)。當然，我(wo)(wo)們在防(fang)治碘(dian)(dian)(dian)(dian)(dian)缺乏疾病(bing)的(de)同時，一(yi)定(ding)要(yao)摒棄“補碘(dian)(dian)(dian)(dian)(dian)寧多(duo)勿少”的(de)錯誤觀點。

五、甲狀腺疾病患者不宜補碘

高碘可誘(you)發(fa)甲(jia)(jia)(jia)狀腺疾病如甲(jia)(jia)(jia)亢、慢性甲(jia)(jia)(jia)狀腺炎、甲(jia)(jia)(jia)減、甚至(zhi)甲(jia)(jia)(jia)狀腺癌。已有這(zhe)些疾病的患(huan)者多(duo)食(shi)含碘類食(shi)物(wu)(wu)也可加重(zhong)疾病發(fa)展(zhan)。因此(ci)甲(jia)(jia)(jia)狀腺疾病患(huan)者平時不宜多(duo)吃含碘食(shi)物(wu)(wu)，特(te)別(bie)是甲(jia)(jia)(jia)亢患(huan)者，更要嚴格低碘飲食(shi)。

甲(jia)(jia)狀腺(xian)制造甲(jia)(jia)狀腺(xian)激素首先必須把血(xue)液中的(de)碘(dian)濃聚，平時可將(jiang)(jiang)血(xue)液中的(de)碘(dian)濃聚25-50倍，甲(jia)(jia)亢(kang)(kang)(kang)時可達350倍以上，生成釋放更多的(de)甲(jia)(jia)狀腺(xian)激素導致甲(jia)(jia)亢(kang)(kang)(kang)加重。醫學上將(jiang)(jiang)高(gao)碘(dian)引起的(de)甲(jia)(jia)亢(kang)(kang)(kang)稱為(wei)“碘(dian)甲(jia)(jia)亢(kang)(kang)(kang)”。

在最(zui)近(jin)衛生(sheng)(sheng)部公布的(de)使(shi)用碘(dian)(dian)制劑(ji)預(yu)防核輻射的(de)指導(dao)意見中，就(jiu)列出了(le)(le)8種(zhong)(zhong)甲狀(zhuang)腺(xian)相(xiang)關疾病不宜(yi)使(shi)用。特別值得(de)注意的(de)事，古代中醫治(zhi)療甲狀(zhuang)腺(xian)腫大的(de)方藥如海(hai)藻(zao)、昆布、四海(hai)舒郁丸、海(hai)藻(zao)玉壺湯(tang)中，都含有大量含碘(dian)(dian)植物(wu)，只適宜(yi)缺碘(dian)(dian)性甲狀(zhuang)腺(xian)腫這種(zhong)(zhong)類(lei)型，民間(jian)習用的(de)甲狀(zhuang)腺(xian)病多吃海(hai)帶也(ye)同樣如此。日本人(ren)(ren)也(ye)發(fa)現攝入高碘(dian)(dian)食(shi)物(wu)海(hai)藻(zao)，每天200毫(hao)克以后(hou)，就(jiu)有10%的(de)人(ren)(ren)發(fa)生(sheng)(sheng)了(le)(le)碘(dian)(dian)誘(you)發(fa)的(de)甲狀(zhuang)腺(xian)腫。我國醫學界學者(zhe)對慢性甲狀(zhuang)腺(xian)炎患(huan)者(zhe)的(de)甲狀(zhuang)腺(xian)功能進行(xing)調(diao)查也(ye)發(fa)現，高碘(dian)(dian)飲食(shi)患(huan)者(zhe)容易(yi)發(fa)生(sheng)(sheng)甲減。

補碘小貼士：

1、普通人群進食碘鹽和日常飲食即可達到碘營養的要(yao)求標準(zhun)。

2、缺碘地區和妊娠婦女、嬰幼兒二大人群要多補碘，多吃高碘食物。

3、甲狀腺(xian)病患(huan)者、中(zhong)老年婦女不宜多食(shi)含碘(dian)食(shi)物(wu)和藥物(wu)。