Advertisement

Iodine Deficiency

  • Michael Bruce ZimmermannEmail author
Chapter

Abstract

Iodine deficiency early in life impairs cognition and growth, but iodine status is also a key determinant of thyroid disorders in adults. Severe chronic iodine deficiency increases risk for goiter and hypothyroidism. In contrast, compared to areas of adequate iodine intake, mild and moderate iodine deficiency in populations increases nodularity and thereby risk of hyperthyroidism, particularly in older adults. Increasing iodine intakes in populations leads to a small increase in the incidence of subclinical hypothyroidism. The link between iodine intake and thyroid autoimmunity is complex; prospective surveys have reported mild increases in the occurrence of thyroid autoimmunity with antibodies at a low titer after salt iodization. There is no strong evidence that ranges of dietary iodine intake are linked to thyroid cancer incidence; however, correction of iodine deficiency may shift subtypes toward less malignant forms. Thus, ensuring adequate, but not excessive, population iodine intake is an important component of preventive health care to reduce thyroid disorders.

Keywords

Iodine Deficiency Excess Iodized salt Urinary iodine Hypothyroidism Hyperthyroidism Goiter Nodules Thyroid cancer Thyroid autoimmunity Thyroid antibodies 

References

  1. 1.
    Zimmermann MB, Jooste PL, Pandav CS. Iodine-deficiency disorders. Lancet. 2008;372(9645):1251–62.PubMedPubMedCentralGoogle Scholar
  2. 2.
    World Health Organization, United Nations Children’s Fund, International Council for the Control of Iodine Deficiency Disorders. Assessment of iodine deficiency disorders and monitoring their elimination. A guide for programme managers. 3rd ed. Geneva: World Health Organization; 2007.Google Scholar
  3. 3.
    Aburto N. Effect and safety of salt iodization to prevent iodine deficiency disorders: a systematic review with meta-analyses. In submission 2014.Google Scholar
  4. 4.
    Zimmermann MB, Andersson M. Assessment of iodine nutrition in populations: past, present, and future. Nutr Rev. 2012;70(10):553–70.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Zimmermann MB. Symposium on ‘geographical and geological influences on nutrition’: iodine deficiency in industrialised countries. Proc Nutr Soc. 2010;69(1):133–43.PubMedPubMedCentralGoogle Scholar
  6. 6.
    The Iodine Global Network. Global iodine scorecard and map. Zurich: The Iodine Global Network; 2016. http://www.ign.org/scorecard.htm. Accessed 15 Nov 2016.Google Scholar
  7. 7.
    Zimmermann MB. Iodine deficiency. Endocr Rev. 2009;30(4):376–408.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Rasmussen LB, Ovesen L, Bulow I, et al. Relations between various measures of iodine intake and thyroid volume, thyroid nodularity, and serum thyroglobulin. Am J Clin Nutr. 2002;76(5):1069–76.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Thomson CD, Woodruffe S, Colls AJ, Joseph J, Doyle TC. Urinary iodine and thyroid status of New Zealand residents. Eur J Clin Nutr. 2001;55(5):387–92.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Vejbjerg P, Knudsen N, Perrild H, et al. Thyroglobulin as a marker of iodine nutrition status in the general population. Eur J Endocrinol. 2009;161(3):475–81.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Studer H, Ramelli F. Simple goiter and its variants—euthyroid and hyper-thyroid multinodular goiters. Endocr Rev. 1982;3(1):40–61.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Knudsen N, Bulow I, Jorgensen T, Laurberg P, Ovesen L, Perrild H. Comparative study of thyroid function and types of thyroid dysfunction in two areas in Denmark with slightly different iodine status. Eur J Endocrinol. 2000;143(4):485–91.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Meng F, Zhao R, Liu P, Liu L, Liu S. Assessment of iodine status in children, adults, pregnant women and lactating women in iodine-replete areas of China. PLoS One. 2013;8(11):e81294.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Chopra IJ, Hershman JM, Hornabrook RW. Serum thyroid hormone and thyrotropin levels in subjects from endemic goiter regions of New Guinea. J Clin Endocrinol Metab. 1975;40(2):326–33.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Delange F, Hershman JM, Ermans AM. Relationship between the serum thyrotropin level, the prevalence of goiter and the pattern of iodine metabolism in Idjwi Island. J Clin Endocrinol Metab. 1971;33(2):261–8.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Delange F, Camus M, Ermans AM. Circulating thyroid hormones in endemic goiter. J Clin Endocrinol Metab. 1972;34(5):891–5.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Stevenson C, Silva E, Pineda G. Thyroxine (T4) and triiodothyronine (T3): effects of iodine on the serum concentrations and disposal rates in subjects from an endemic goiter area. J Clin Endocrinol Metab. 1974;38(3):390–3.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Patel YC, Pharoah PO, Hornabrook RW, Hetzel BS. Serum triiodothyronine, thyroxine and thyroid-stimulating hormone in endemic goiter: a comparison of goitrous and nongoitrous subjects in New Guinea. J Clin Endocrinol Metab. 1973;37(5):783–9.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Dumont JE, Ermans AM, Maenhaut C, Coppee F, Stanbury JB. Large goiter as a maladaptation to iodine deficiency. Clin Endocrinol. 1995;43(1):1–10.Google Scholar
  20. 20.
    Dumont JE, Ermans AM, Bastenie PA. Thyroid function in a goiter endemic. 5. Mechanism of thyroid failure in Uele endemic cretins. J Clin Edocrinol Metab. 1963;23(9):847–53.Google Scholar
  21. 21.
    Yu X, Fan C, Shan Z, et al. A five-year follow-up study of goiter and thyroid nodules in three regions with different iodine intakes in China. J Endocrinol Investig. 2008;31(3):243–50.Google Scholar
  22. 22.
    Chen ZX, Xu WM, Huang YM, et al. Associations of noniodized salt and thyroid nodule among the Chinese population: a large cross-sectional study. Am J Clin Nutr. 2013;98(3):684–92.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Laurberg P, Jorgensen T, Perrild H, et al. The Danish investigation on iodine intake and thyroid disease, DanThyr: status and perspectives. Eur J Endocrinol. 2006;155(2):219–28.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Vejbjerg P, Knudsen N, Perrild H, et al. Effect of a mandatory iodization program on thyroid gland volume based on individuals’ age, gender, and preceding severity of dietary iodine deficiency: a prospective, population-based study. J Clin Endocrinol Metab. 2007;92(4):1397–401.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Krejbjerg A, Bjergved L, Pedersen IB, et al. Iodine fortification may influence the age-related change in thyroid volume: a longitudinal population-based study (DanThyr). Eur J Endocrinol. 2014;170(4):507–17.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Lombardi FA, Fiore E, Tonacchera M, et al. The effect of voluntary iodine prophylaxis in a small rural community: the Pescopagano survey 15 years later. J Clin Edocrinol Metab. 2013;98(3):1031–9.Google Scholar
  27. 27.
    Laurberg P, Pedersen KM, Hreidarsson A, Sigfusson N, Iversen E, Knudsen PR. Iodine intake and the pattern of thyroid disorders: a comparative epidemiological study of thyroid abnormalities in the elderly in Iceland and in Jutland, Denmark. J Clin Endocrinol Metab. 1998;83(3):765–9.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Krohn K, Fuhrer D, Bayer Y, et al. Molecular pathogenesis of euthyroid and toxic multinodular goiter. Endocr Rev. 2005;26(4):504–24.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Carle A, Pedersen IB, Knudsen N, et al. Epidemiology of subtypes of hyperthyroidism in Denmark: a population-based study. Eur J Endocrinol. 2011;164(5):801–9.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Yang F, Shan Z, Teng X, et al. Chronic iodine excess does not increase the incidence of hyperthyroidism: a prospective community-based epidemiological survey in China. Eur J Endocrinol. 2007;156(4):403–8.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Martino E, Safran M, Aghinilombardi F, et al. Environmental iodine intake and thyroid-dysfunction during chronic amiodarone therapy. Ann Intern Med. 1984;101(1):28–34.PubMedGoogle Scholar
  32. 32.
    Elnagar B, Eltom M, Karlsson FA, Ermans AM, Gebre-Medhin M, Bourdoux PP. The effects of different doses of oral iodized oil on goiter size, urinary iodine, and thyroid-related hormones. J Clin Endocrinol Metab. 1995;80(3):891–7.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Bourdoux PP, Ermans AM, Mukalay wa Mukalay A, Filetti S, Vigneri R. Iodine-induced thyrotoxicosis in Kivu, Zaire. Lancet. 1996;347(9000):552–3.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Delange F, de Benoist B, Alnwick D. Risks of iodine-induced hyperthyroidism after correction of iodine deficiency by iodized salt. Thyroid. 1999;9(6):545–56.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Burgi H, Kohler M, Morselli B. Thyrotoxicosis incidence in Switzerland and benefit of improved iodine supply. Lancet. 1998;352(9133):1034.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Vejbjerg P, Knudsen N, Perrild H, et al. Lower prevalence of mild hyperthyroidism related to a higher iodine intake in the population: prospective study of a mandatory iodization programme. Clin Endocrinol. 2009;71(3):440–5.Google Scholar
  37. 37.
    Teng W, Shan Z, Teng X, et al. Effect of iodine intake on thyroid diseases in China. N Engl J Med. 2006;354(26):2783–93.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Carle A, Laurberg P, Pedersen IB, et al. Epidemiology of subtypes of hypothyroidism in Denmark. Eur J Endocrinol. 2006;154(1):21–8.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Pedersen IB, Laurberg P, Knudsen N, et al. An increased incidence of overt hypothyroidism after iodine fortification of salt in Denmark: a prospective population study. J Clin Endocrinol Metab. 2007;92(8):3122–7.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Li N, Jiang Y, Shan Z, Teng W. Prolonged high iodine intake is associated with inhibition of type 2 deiodinase activity in pituitary and elevation of serum thyrotropin levels. Br J Nutr. 2012;107:674–82.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Vagenakis AG, Braverman LE. Adverse effects of iodides on thyroid-function. Med Clin N Am. 1975;59(5):1075–88.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Szabolcs I, Podoba J, Feldkamp J, et al. Comparative screening for thyroid disorders in old age in areas of iodine deficiency, long-term iodine prophylaxis and abundant iodine intake. Clin Endocrinol. 1997;47(1):87–92.Google Scholar
  43. 43.
    Pedersen IB, Knudsen N, Jorgensen T, Perrild H, Ovesen L, Laurberg P. Thyroid peroxidase and thyroglobulin autoantibodies in a large survey of populations with mild and moderate iodine deficiency. Clin Endocrinol. 2003;58(1):36–42.Google Scholar
  44. 44.
    Andersen S, Iversen F, Terpling S, Pedersen KM, Gustenhoff P, Laurberg P. Iodine deficiency influences thyroid autoimmunity in old age—a comparative population-based study. Maturitas. 2012;71(1):39–43.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Boukis MA, Koutras DA, Souvatzoglou A, Evangelopoulou A, Vrontakis M, Moulopoulos SD. Thyroid-hormone and immunological studies in endemic goiter. J Clin Endocrinol Metab. 1983;57(4):859–62.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Kahaly GJ, Dienes HP, Beyer J, Hommel G. Iodide induces thyroid autoimmunity in patients with endemic goiter: a randomised, double-blind, placebo-controlled trial. Eur J Endocrinol. 1998;139(3):290–7.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Latrofa F, Fiore E, Rago T, et al. Iodine contributes to thyroid autoimmunity in humans by unmasking a cryptic epitope on thyroglobulin. J Clin Endocrinol Metab. 2013;98(11):E1768–E74.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Bulow Pedersen I, Knudsen N, Carle A, et al. A cautious iodization program bringing iodine intake to a low recommended level is associated with an increase in the prevalence of thyroid autoantibodies in the population. Clin Endocrinol. 2011;75(1):120–6.Google Scholar
  49. 49.
    Li YS, Teng D, Shan ZY, et al. Antithyroperoxidase and antithyroglobulin antibodies in a five-year follow-up survey of populations with different iodine intakes. J Clin Endocrinol Metab. 2008;93(5):1751–7.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Zimmermann MB, Galetti V. Iodine intake as a risk factor for thyroid cancer: a comprehensive review of animal and human studies. Thyroid Res. 2015;18(8):8.  https://doi.org/10.1186/s13044-015-0020-8.Google Scholar
  51. 51.
    Peterson E, De P, Nuttall R. BMI, diet and female reproductive factors as risks for thyroid cancer: a systematic review. PLoS One. 2012;7(1):e29177.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Feldt-Rasmussen U. Iodine and cancer. Thyroid. 2001;11(5):483–6.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Harach HR, Escalante DA, Onativia A, Lederer Outes J, Saravia Day E, Williams ED. Thyroid carcinoma and thyroiditis in an endemic goiter region before and after iodine prophylaxis. Acta Endocrinol. 1985;108(1):55–60.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Lind P, Langsteger W, Molnar M, Gallowitsch HJ, Mikosch P, Gomez I. Epidemiology of thyroid diseases in iodine sufficiency. Thyroid. 1998;8(12):1179–83.PubMedPubMedCentralGoogle Scholar
  55. 55.
    Besic N, Hocevar M, Zgajnar J. Lower incidence of anaplastic carcinoma after higher iodination of salt in Slovenia. Thyroid. 2010;20(6):623–6.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol. 2013;2013:965212.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Franceschi S, Preston-Martin S, Maso LD, et al. A pooled analysis of case-control studies of thyroid cancer. IV. Benign thyroid diseases. Cancer Cause Control. 1999;10(6):583–95.Google Scholar
  58. 58.
    Grais IM, Sowers JR. Thyroid and the heart. Am J Med. 2014;127:691–8. (Epub ahead of print).PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Human Nutrition LaboratoryInstitute of Food, Nutrition, and Health, ETH ZurichZurichSwitzerland

Personalised recommendations