Iodine Supplementation

  • Peter N. TaylorEmail author
  • Onyebuchi E. Okosieme


Iodine is essential for thyroid hormone production. Many areas of the world are at least mild-moderately iodine deficient with some regions still severely iodine deficient. Iodine supplementation, particularly through universal salt iodization, can be an extremely effective and relatively inexpensive method of correcting iodine deficiency. The benefits of correcting iodine insufficiency, particularly in pregnant women and children, can have dramatic positive effects on childhood cognitive development and other key outcomes such as growth. While the benefits of correcting iodine deficiency in severely iodine deficient regions are clear, the evidence for correcting mild-moderate iodine deficiency is less robust. Iodine supplementation requires careful introduction and monitoring to prevent over-replacement, which would mitigate against any benefits.


Iodine Supplementation Salt Fortification Pregnancy Deficiency 


  1. 1.
    Baumann F. Ueber das normale Vorkommen von Jod im Thierkörper. Z Physiol Chem. 1896;21:319–30.CrossRefGoogle Scholar
  2. 2.
    Marine D, Kimball OP. The prevention of simple goiter in man. J Lab Clin Med. 1917;3:40–8.Google Scholar
  3. 3.
    Hetzel BS. Iodine deficiency disorders (IDD) and their eradication. Lancet. 1983;2(8359):1126–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Walker SP, Wachs TD, Gardner JM, Lozoff B, Wasserman GA, Pollitt E, et al. Child development: Risk factors for adverse outcomes in developing countries. Lancet. 2007;369(9556):145–57.CrossRefPubMedGoogle Scholar
  5. 5.
    Horton S. The economics of food fortification. J Nutr. 2006;136(4):1068–71.PubMedGoogle Scholar
  6. 6.
    Monahan M, Boelaert K, Jolly K, Chan S, Barton P, Roberts TE. Costs and benefits of iodine supplementation for pregnant women in a mildly to moderately iodine-deficient population: a modelling analysis. Lancet Diabetes Endocrinol. 2015;3(9):715–22.CrossRefPubMedGoogle Scholar
  7. 7.
    Zimmermann MB, Jooste PL, Pandav CS. Iodine-deficiency disorders. Lancet. 2008;372(9645):1251–62.CrossRefPubMedGoogle Scholar
  8. 8.
    Zimmermann MB. Iodine deficiency. Endocr Rev. 2009;30(4):376–408.CrossRefPubMedGoogle Scholar
  9. 9.
    The Lancet Diabetes Endocrinology. Iodine deficiency in the UK: grabbing the low-hanging fruit. Lancet Diabetes Endocrinol. 2016;4(6):469.CrossRefPubMedGoogle Scholar
  10. 10.
    Volzke H, Caron P, Dahl L, de Castro JJ, Erlund I, Gaberscek S, et al. Ensuring effective prevention of iodine deficiency disorders. Thyroid. 2016;26(2):189–96.CrossRefPubMedGoogle Scholar
  11. 11.
    Dunn JT. Iodine should be routinely added to complementary foods. J Nutr. 2003;133(9):3008s–10s.PubMedGoogle Scholar
  12. 12.
    Kaganov B, Caroli M, Mazur A, Singhal A, Vania A. Suboptimal micronutrient intake among children in Europe. Nutrients. 2015;7(5):3524–35.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Taylor P, Vaidya B, Taylor P, Vaidya B. Iodine supplementation in pregnancy: Is it time? Clin Endocrinol. 2016;85:10–4.CrossRefGoogle Scholar
  14. 14.
    Andersson M, de Benoist B, Delange F, Zupan J. Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the Technical Consultation. Public Health Nutr. 2007;10(12a):1606–11.PubMedGoogle Scholar
  15. 15.
    Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev. 1997;18(3):404–33.CrossRefPubMedGoogle Scholar
  16. 16.
    Zhang H, Lv S, Mu Z, Li W, Zhang X, Wang Y, et al. Iodised salt contribution to iodine nutrition status of pregnant and lactating women. Br J Nutr. 2015;114(1):126–33.CrossRefPubMedGoogle Scholar
  17. 17.
    WHO, UNICEF, ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination. 3rd ed. Geneva: World Health Organisation; 2007.Google Scholar
  18. 18.
    Azizi F. Iodized oil: its role in the management of iodine deficiency disorders. Int J Endocrinol Metab. 2007;5(2):91–8.Google Scholar
  19. 19.
    Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21(10):1081–125.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3(2):76–94.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, et al. Management of thyroid dysfunction during pregnancy and postpartum: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(8):2543–65.CrossRefPubMedGoogle Scholar
  22. 22.
    Moleti M, Lo Presti VP, Campolo MC, Mattina F, Galletti M, Mandolfino M, et al. Iodine prophylaxis using iodized salt and risk of maternal thyroid failure in conditions of mild iodine deficiency. J Clin Endocrinol Metab. 2008;93(7):2616–21.CrossRefPubMedGoogle Scholar
  23. 23.
    Moleti M, Di Bella B, Giorgianni G, Mancuso A, De Vivo A, Alibrandi A, et al. Maternal thyroid function in different conditions of iodine nutrition in pregnant women exposed to mild-moderate iodine deficiency: An observational study. Clin Endocrinol. 2011;74(6):762–8.CrossRefGoogle Scholar
  24. 24.
    Bath SC, Walter A, Taylor A, Wright J, Rayman MP. Iodine deficiency in pregnant women living in the South East of the UK: The influence of diet and nutritional supplements on iodine status. Br J Nutr. 2014;111(9):1622–31.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Mohd-Shukri NA, Duncan A, Denison FC, Forbes S, Walker BR, Norman JE, et al. Health behaviours during pregnancy in women with very severe obesity. Nutrients. 2015;7(10):8431–43.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Gushurst CA, Mueller JA, Green JA, Sedor F. Breast milk iodide: reassessment in the 1980s. Pediatrics. 1984;73(3):354–7.PubMedGoogle Scholar
  27. 27.
    Seibold-Weiger K, Wollmann H, Rendl J, Ranke M, Speer C. Iodine concentration in the breast milk of mothers of premature infants. Zeitschrift fur Geburtshilfe und Neonatologie. 1999;203(2):81–5.PubMedGoogle Scholar
  28. 28.
    Pretell EA, Moncloa F, Salinas R, Kawano A, Guerra-Garcia R, Gutierrez L, Beteta L, Pretell J, Wan M 1969 Prophylaxis and treatment of endemic goiter in Peru with iodized oil. J Clin Endocrinol Metab 29:1586–95.Google Scholar
  29. 29.
    Nøhr SB, Laurberg P, Børlum KG, Pedersen KM, Johannesen PL, Damm P, Fuglsang E, Johansen A 1994 Iodine status in neonates in Denmark: regional variations and dependency on maternal iodine supplementation. Acta Paediatrica 83:578–82.Google Scholar
  30. 30.
    Bouhouch RR, Bouhouch S, Cherkaoui M, Aboussad A, Stinca S, Haldimann M, et al. Direct iodine supplementation of infants versus supplementation of their breastfeeding mothers: a double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol. 2014;2(3):197–209.CrossRefPubMedGoogle Scholar
  31. 31.
    Pharoah PO, Buttfield IH, Hetzel BS. Neurological damage to the fetus resulting from severe iodine deficiency during pregnancy. Lancet. 1971;1(7694):308–10.CrossRefPubMedGoogle Scholar
  32. 32.
    Pharoah PO, Connolly KJ. A controlled trial of iodinated oil for the prevention of endemic cretinism: a long-term follow-up. Int J Epidemiol. 1987;16(1):68–73.CrossRefPubMedGoogle Scholar
  33. 33.
    Thilly CH, Swennen B, Moreno-Reyes R, Hindlet J-Y, Bourdoux P, Vanderpas JB. Maternal, fetal and juvenile hypothyroidism, birth weight and infant mortality in the etiopathogenesis of the IDD spectra in Zaire and Malawi. In: Stanbury J, editor. The Damaged Brain of Iodine Deficiency: Cognitive, Behavioral, Neuromotor and Educative Aspects. New York: Cognizant Communication; 1994.Google Scholar
  34. 34.
    Cao XY, Jiang XM, Dou ZH, Rakeman MA, Zhang ML, O'Donnell K, et al. Timing of vulnerability of the brain to iodine deficiency in endemic cretinism. N Engl J Med. 1994;331(26):1739–44.CrossRefPubMedGoogle Scholar
  35. 35.
    O'Donnell KJ, Rakeman MA, Zhi-Hong D, Xue-Yi C, Mei ZY, DeLong N, et al. Effects of iodine supplementation during pregnancy on child growth and development at school age. Dev Med Child Neurol. 2002;44(2):76–81.CrossRefPubMedGoogle Scholar
  36. 36.
    Pretell E, Caceres A. Impairment of mental development by iodine deficiency and its correction. A retrospective view of studies in Peru the damaged brain of iodine deficiency. New York: Stanbury JB; 1994. 187–91 p.Google Scholar
  37. 37.
    Fierro-Benitez R, Cazar R, Stanbury JB, Rodriguez P, Garces F, Fierro-Renoy F, et al. Effects on school children of prophylaxis of mothers with iodized oil in an area of iodine deficiency. J Endocrinol Investig. 1988;11(5):327–35.CrossRefGoogle Scholar
  38. 38.
    Pharoah PO, Ellis SM, Ekins RP, Williams ES. Maternal thyroid function, iodine deficiency and fetal development. Clin Endocrinol. 1976;5(2):159–66.CrossRefGoogle Scholar
  39. 39.
    DeLong GR, Leslie PW, Wang SH, Jiang XM, Zhang ML, Rakeman M, et al. Effect on infant mortality of iodination of irrigation water in a severely iodine-deficient area of China. Lancet. 1997;350(9080):771–3.CrossRefPubMedGoogle Scholar
  40. 40.
    Chaouki ML, Benmiloud M. Prevention of iodine deficiency disorders by oral administration of lipiodol during pregnancy. Eur J Endocrinol. 1994;130(6):547–51.CrossRefPubMedGoogle Scholar
  41. 41.
    Semba RD, de Pee S, Hess SY, Sun K, Sari M, Bloem MW. Child malnutrition and mortality among families not utilizing adequately iodized salt in Indonesia. Am J Clin Nutr. 2008;87(2):438–44.PubMedGoogle Scholar
  42. 42.
    Koutras DA, Christakis G, Trichopoulos D, Dakou-Voutetaki A, Kyriakopoulos V, Fontanares P, et al. Endemic goiter in Greece: Nutritional status, growth, and skeletal development of goitrous and non goitrous populations. Am J Clin Nutr. 1973;26(12):1360–8.PubMedGoogle Scholar
  43. 43.
    Zimmermann MB, Jooste PL, Mabapa NS, Mbhenyane X, Schoeman S, Biebinger R, et al. Treatment of iodine deficiency in school-age children increases insulin-like growth factor (IGF)-I and IGF binding protein-3 concentrations and improves somatic growth. J Clin Endocrinol Metab. 2007;92(2):437–42.CrossRefPubMedGoogle Scholar
  44. 44.
    Qian M, Wang D, Watkins WE, Gebski V, Yan YQ, Li M, et al. The effects of iodine on intelligence in children: a meta-analysis of studies conducted in China. Asia Pac J Clin Nutr. 2005;14(1):32–42.PubMedGoogle Scholar
  45. 45.
    Bautista A, Barker PA, Dunn JT, Sanchez M, Kaiser DL. The effects of oral iodized oil on intelligence, thyroid status, and somatic growth in school-age children from an area of endemic goiter. Am J Clin Nutr. 1982;35(1):127–34.PubMedGoogle Scholar
  46. 46.
    Shrestha RM. Effect of iodine and iron supplementation on physical, psychomotor and mental development in primary school children in Malawi [Doctoral Thesis]. Wageningen Agricultural University; 1994.Google Scholar
  47. 47.
    Huda SN, Grantham-McGregor SM, Tomkins A. Cognitive and motor functions of iodine-deficient but euthyroid children in Bangladesh do not benefit from iodized poppy seed oil (Lipiodol). J Nutr. 2001;131(1):72–7.PubMedGoogle Scholar
  48. 48.
    Isa ZM, Alias IZ, Kadir KA, Ali O. Effect of iodized oil supplementation on thyroid hormone levels and mental performance among Orang Asli schoolchildren and pregnant mothers in an endemic goitre area in Peninsular Malaysia. Asia Pac J Clin Nutr. 2000;9(4):274–81.CrossRefPubMedGoogle Scholar
  49. 49.
    Taylor PN, Okosieme OE, Dayan CM, Lazarus JH. Therapy of endocrine disease: impact of iodine supplementation in mild-to-moderate iodine deficiency: systematic review and meta-analysis. Eur J Endocrinol/Eur Fed Endocr Soc. 2013;170(1):R1–R15. doi: 10.1530/EJE-13-0651.CrossRefGoogle Scholar
  50. 50.
    Antonangeli L, Maccherini D, Cavaliere R, Di Giulio C, Reinhardt B, Pinchera A, et al. Comparison of two different doses of iodide in the prevention of gestational goiter in marginal iodine deficiency: a longitudinal study. Eur J Endocrinol/Eur Fed Endocr Soc. 2002;147(1):29–34.CrossRefGoogle Scholar
  51. 51.
    Romano R, Jannini EA, Pepe M, Grimaldi A, Olivieri M, Spennati P, et al. The effects of iodoprophylaxis on thyroid size during pregnancy. Am J Obstet Gynecol. 1991;164(2):482–5.CrossRefPubMedGoogle Scholar
  52. 52.
    Pedersen KM, Laurberg P, Iversen E, Knudsen PR, Gregersen HE, Rasmussen OS, et al. Amelioration of some pregnancy-associated variations in thyroid function by iodine supplementation. J Clin Endocrinol Metab. 1993;77(4):1078–83.PubMedGoogle Scholar
  53. 53.
    Nohr SB, Jorgensen A, Pedersen KM, Laurberg P. Postpartum thyroid dysfunction in pregnant thyroid peroxidase antibody-positive women living in an area with mild to moderate iodine deficiency: is iodine supplementation safe? J Clin Endocrinol Metab. 2000;85(9):3191–8.CrossRefPubMedGoogle Scholar
  54. 54.
    Glinoer D, De Nayer P, Delange F, Lemone M, Toppet V, Spehl M, et al. A randomized trial for the treatment of mild iodine deficiency during pregnancy: maternal and neonatal effects. J Clin Endocrinol Metab. 1995;80(1):258–69.PubMedGoogle Scholar
  55. 55.
    Liesenkotter KP, Gopel W, Bogner U, Stach B, Gruters A. Earliest prevention of endemic goiter by iodine supplementation during pregnancy. Eur J Endocrinol/Eur Fed Endocr Soc. 1996;134(4):443–8.CrossRefGoogle Scholar
  56. 56.
    Santiago P, Velasco I, Muela JA, Sanchez B, Martinez J, Rodriguez A, et al. Infant neurocognitive development is independent of the use of iodised salt or iodine supplements given during pregnancy. Br J Nutr. 2013;110:1–9.CrossRefGoogle Scholar
  57. 57.
    Velasco I, Carreira M, Santiago P, Muela JA, Garcia-Fuentes E, Sanchez-Munoz B, et al. Effect of iodine prophylaxis during pregnancy on neurocognitive development of children during the first two years of life. J Clin Endocrinol Metab. 2009;94(9):3234–41.CrossRefPubMedGoogle Scholar
  58. 58.
    Ma ZF, Skeaff SA. Thyroglobulin as a biomarker of iodine deficiency: a review. Thyroid. 2014;24(8):1195–209.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Berbel P, Mestre JL, Santamaria A, Palazon I, Franco A, Graells M, et al. Delayed neurobehavioral development in children born to pregnant women with mild hypothyroxinemia during the first month of gestation: the importance of early iodine supplementation. Thyroid. 2009;19(5):511–9.CrossRefPubMedGoogle Scholar
  60. 60.
    Rebagliato M, Murcia M, Alvarez-Pedrerol M, Espada M, Fernandez-Somoano A, Lertxundi N, et al. Iodine supplementation during pregnancy and infant neuropsychological development: INMA mother and child cohort study. Am J Epidemiol. 2013;177:944–53.CrossRefPubMedGoogle Scholar
  61. 61.
    Murcia M, Rebagliato M, Iniguez C, Lopez-Espinosa MJ, Estarlich M, Plaza B, et al. Effect of iodine supplementation during pregnancy on infant neurodevelopment at 1 year of age. Am J Epidemiol. 2011;173(7):804–12.CrossRefPubMedGoogle Scholar
  62. 62.
    Zimmermann MB, Connolly K, Bozo M, Bridson J, Rohner F, Grimci L. Iodine supplementation improves cognition in iodine-deficient schoolchildren in Albania: a randomized, controlled, double-blind study. Am J Clin Nutr. 2006;83(1):108–14.PubMedGoogle Scholar
  63. 63.
    Gordon RC, Rose MC, Skeaff SA, Gray AR, Morgan KM, Ruffman T. Iodine supplementation improves cognition in mildly iodine-deficient children. Am J Clin Nutr. 2009;90(5):1264–71.CrossRefPubMedGoogle Scholar
  64. 64.
    Hynes KL, Otahal P, Hay I, Burgess JR. Mild iodine deficiency during pregnancy is associated with reduced educational outcomes in the offspring: 9-year follow-up of the gestational iodine cohort. J Clin Endocrinol Metab. 2013;98(5):1954–62.CrossRefPubMedGoogle Scholar
  65. 65.
    Okosieme OE, Marx H, Lazarus JH. Medical management of thyroid dysfunction in pregnancy and the postpartum. Expert Opin Pharmacother. 2008;9(13):2281–93.CrossRefPubMedGoogle Scholar
  66. 66.
    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.CrossRefPubMedGoogle Scholar
  67. 67.
    Zimmermann MB. Iodine requirements and the risks and benefits of correcting iodine deficiency in populations. J Trace Elem Med Biol Organ Soc Miner Trace Elem (GMS). 2008;22(2):81–92.CrossRefGoogle Scholar
  68. 68.
    Laurberg P, Bulow Pedersen I, Knudsen N, Ovesen L, Andersen S. Environmental iodine intake affects the type of nonmalignant thyroid disease. Thyroid. 2001;11(5):457–69.CrossRefPubMedGoogle Scholar
  69. 69.
    Cerqueira C, Knudsen N, Ovesen L, Perrild H, Rasmussen LB, Laurberg P, et al. Association of iodine fortification with incident use of antithyroid medication – a Danish nationwide study. J Clin Endocrinol Metab. 2009;94(7):2400–5.CrossRefPubMedGoogle Scholar
  70. 70.
    Burgi H, Kohler M, Morselli B. Thyrotoxicosis incidence in Switzerland and benefit of improved iodine supply. Lancet. 1998;352(9133):1034.CrossRefPubMedGoogle Scholar
  71. 71.
    Doufas AG, Mastorakos G, Chatziioannou S, Tseleni-Balafouta S, Piperingos G, Boukis MA, et al. The predominant form of non-toxic goiter in Greece is now autoimmune thyroiditis. Eur J Endocrinol/Eur Fed Endocr Soc. 1999;140(6):505–11.CrossRefGoogle Scholar
  72. 72.
    Mazziotti G, Premawardhana LD, Parkes AB, Adams H, Smyth PP, Smith DF, et al. Evolution of thyroid autoimmunity during iodine prophylaxis – the Sri Lankan experience. Eur J Endocrinol/Eur Fed Endocr Soc. 2003;149(2):103–10.CrossRefGoogle Scholar
  73. 73.
    Teng W, Shan Z, Teng X, Guan H, Li Y, Teng D, et al. Effect of iodine intake on thyroid diseases in China. N Engl J Med. 2006;354(26):2783–93.CrossRefPubMedGoogle Scholar
  74. 74.
    Okosieme OE. Impact of iodination on thyroid pathology in Africa. J Royal Soc Med. 2006;99(8):396–401.CrossRefGoogle Scholar
  75. 75.
    Leung AM, Avram AM, Brenner AV, Duntas LH, Ehrenkranz J, Hennessey JV, et al. Potential risks of excess iodine ingestion and exposure: statement by the american thyroid association public health committee. Thyroid. 2015;25(2):145–6.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Shi X, Han C, Li C, Mao J, Wang W, Xie X, et al. Optimal and safe upper limits of iodine intake for early pregnancy in iodine-sufficient regions: a cross-sectional study of 7190 pregnant women in China. J Clin Endocrinol Metab. 2015;100(4):1630–8.CrossRefPubMedGoogle Scholar
  77. 77.
    Bartalena L, Bogazzi F, Braverman LE, Martino E. Effects of amiodarone administration during pregnancy on neonatal thyroid function and subsequent neurodevelopment. J Endocrinol Investig. 2001;24(2):116–30.CrossRefGoogle Scholar
  78. 78.
    Pedersen KM, Laurberg P, Nohr S, Jorgensen A, Andersen S. Iodine in drinking water varies by more than 100-fold in Denmark. Importance for iodine content of infant formulas. Eur J Endocrinol/Eur Fed Endocr Soc. 1999;140(5):400–3.CrossRefGoogle Scholar
  79. 79.
    WHO UNICEF International Council for the Control of Iodine Deficiency Disorders. Assessment of iodine deficiency disorders and monitoring their elimination. 3rd ed. Geneva: World Health Organization; 2007.Google Scholar
  80. 80.
    Pearce EN. Iodine deficiency in pregnant women in the UK: the costs of inaction. Lancet Diabetes Endocrinol. 2015;3(9):671–2.CrossRefPubMedGoogle Scholar
  81. 81.
    Zhou SJ, Skeaff SA, Ryan P, Doyle LW, Anderson PJ, Kornman L, McPhee AJ, Yelland LN, Makrides M. The effect of iodine supplementation in pregnancy on early childhood neurodevelopment and clinical outcomes: results of an aborted randomised placebo-controlled trial. Research Support, Non-U.S. Gov’t England 1745–6215. Trials. 2015;16:563. doi:  10.1186/s13063-015-1080-8.

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© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Thyroid Research GroupCardiff University, C2 Link, University Hospital WalesCardiffUK

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