Iodine Deficiency

What is iodine?

Iodine, a relatively rare element, is a member of a class of chemical elements known as halogens and has many important roles in the body. However, it can be crowded out by other toxic halogens which compete with each other for receptor and binding sites in the body.^1,2 The other halogens are:³

• Bromine – used in agriculture, sanitation and fire retardants as well as an alternative to chlorine in swimming pools
• Chlorine – used in swimming pools
• Fluorine – in water as fluoride; found in soil
• Astatine – radioactive chemical element ⁴

What’s the difference between iodine and iodide?

Some people get confused about iodine and iodide.  Iodide is the state of iodine when it bonds with another element, such as potassium. In this form, iodine can be ingested or applied topically.

Iodine and iodide are actually different expressions of the same element. Iodides represent a safe form of iodine for ingestion.⁵ When you purchase iodine from the local drug store, it’s usually an iodide solution. This combination allows the body to absorb and use it safely. Dietary iodine also occurs naturally as an iodide, such as potassium iodide or sodium iodide (i.e. as in salt).

Where is iodine found?

Iodine containing compounds are extracted from the ashes of burnt seaweed and found in salty oil well brines, Chilean saltpetre, seawater and solid rocks that form when seawater evaporates.  Seaweed concentrates large amounts of iodine from ocean water and it is also found in some types of soil.⁶             

Why do we need it?

Iodide plays an important role in regulating the activity of the thyroid gland. It is found in every cell of the body and is stored in particularly high concentrations in the thyroid gland, whilst large amounts are also stored in the salivary glands, the cerebrospinal fluid, the brain, the mucus membrane layer of the stomach, the choroid plexus (four sets of branching vessels in the brain where cerebrospinal fluid is produced), the breasts, the ovaries, and the ciliary body of the eye.⁷

Iodine deficiency is associated with goitre and hypothyroidism; in England, this is sometimes known as Derbyshire Neck. Babies born with severe thyroid function deficiency which is left untreated for several months may be at risk of growth failure – thyroid hormones influence growth from birth up to age 20 – and permanent mental retardation (cretinism).⁸

The Society for Endocrinology stated:

“Young women of child-bearing age are the most susceptible to the adverse effects of iodine-deficiency and even mild deficiency may have an impact on the developing brain of foetuses and young children. It can also cause goitre. According to the World Health Organisation, iodine-deficient communities have IQs up to 13.5 points lower than similar but iodine-sufficient communities.” ⁹

A 2011 study of the iodine status of 14 to 15 year old school girls in the UK concluded that the UK, like Australia and the USA, is now iodine-deficient. ^10,11 Young women of child bearing age are the group most susceptible to the adverse effects of iodine deficiency. Nearly 70% of the samples were below 100ug/L and 18% of samples showed very low iodine levels below 50μg/L. The researchers considered this finding to be of huge public health importance, since mild iodine deficiency impairs cognition in children and severe iodine deficiency reduces IQ by 10 to 15 points.

Dr Mark Vanderpump, one of the authors of the research article on iodine states, ‘One cup of milk contains about half the amount of iodine needed per day. A possible explanation for our findings may be that teenage girls are drinking less milk and are less likely to have milk and cereal for breakfast. The solution could be to add iodine to the salt used in products such as bread as has been done in for example Denmark.’ The same could be said of young children who are not now given free milk at school and adults, who think that drinking milk is fattening.

In response to the Lancet article, the Department of Health’s Scientific Advisory Committee on Nutrition asked for a review of the current evidence ¹⁰ that some degree of iodine deficiency might affect some groups within the UK population.  They agreed that, “the issue of iodine intakes is of considerable public health significance, although the Committee is cautious in drawing conclusions on current evidence due to the limitations of the available data,” ¹²

Iodine has a number of roles to play in the body ^13,14

• It is essential for the production of thyroid hormones ¹⁵
• Iodine mitochondrion-mediated apoptosis (programmed cell death) ¹⁶
• Iodine, together with thyroid hormones, has a monitoring and surveillance role, finding and destroying abnormal cells (like pre-cancer cells). Iodine also has an antioxidant and an anti-free-radical action ¹⁶
• Iodine has a protective and preventative effect against helicobacter pylori, the bacterium that lives in the stomach and causes ulcers and stomach cancer ¹⁷
• Iodine is needed during pregnancy and lactation for the health of the baby ¹⁸
• Iodine is a powerful antiseptic and may be used in complete safety. It works even in high dilutions.¹⁹

How much do people need?

The World Health Organisation, The United Nations Children’s Fund (UNICEF), and the International Council for the Control of Iodine Deficiency Disorders (ICCIDD) give the following recommended daily intake of iodine.²⁰

Can you have too much iodine?

For some people, iodine or iodine-containing products may worsen autoimmune thyroid problems such as Hashimoto’s and Graves’ disease, and cause enlargement of the thyroid (goitre).²¹  On the other hand, some healthcare professionals believe that a high iodine intake, such as seen in Japanese women, can largely prevent breast cancer.²

If you are thinking of taking iodine supplements, consider having your levels measured to see if you have an actual deficiency.  Once you start supplementing, watch out for any symptoms that develop.

What medications contain iodine?

You need to look carefully at any medications you take as Iodine is found in a number of these.

Also, studies have shown that exposure to iodinated contrast media used for Xray investigations such as angiograms, CT scans and MRI scans is associated with the subsequent development of thyroid disease. ^22,23

Be aware, too, that some people have adverse reactions to iodine.^24,25,26

Table of medications and supplements that contain iodine

How is iodine deficiency tested?

Iodine deficiency can be tested for in various ways:

Skin patch test

Enough Iodine Tincture (mixture of iodine and potassium iodide) is placed on a cotton ball to paint a two-inch circle in a soft place of your body such as your inner thigh or upper arm.  If the painted area has disappeared after an hour, your body is seriously deficient in iodine.  If the painted area is still there after four hours, your body is not deficient in iodine. However, there is no evidence that this test is a reliable test on humans.²⁷

Urine test

A urine iodine test is most often used in research studies looking into iodine deficiency and is accepted as a good marker of very recent dietary iodine intake²⁰ although there are some controversies over this test. ²⁸

Nutritional supplements and medication may affect the result (they may contain iodine) so you should check with your doctor whether they should be discontinued before the test.  Non-essential supplements should be discontinued 48 hours before the test.

It is also essential that you don’t drink an excessive amount of fluids for 24 hours before the test as this may affect the result.²⁹

Iodine loading test

In an iodine loading test, iodine sufficiency is determined by comparing the amount of Iodine taken to the amount excreted in the urine.³⁰ After ingesting a specified oral dose of iodine, urine is collected for 24 hours and iodide levels are then measured. Because taking iodine is not good for certain people, you should always discuss having this test with your healthcare practitioner.

If the body has sufficient iodine, most of the ingested iodine will be excreted in the urine.  The more deficient in iodine the body is, the less iodine will be excreted in the urine. Whole body iodine sufficiency is reached when 90% or more of the ingested amount is excreted in the urine.

The 24 Hour iodine loading test is not available on the NHS in the UK but is available via Regenerus Laboratories. However, there is some evidence that this test does not provide a realistic assessment of an individual’s whole body iodine sufficiency or deficiency due to flaws in the methodology and the use of an arbitrary excretion cut-off point.^31,32

Blood test

Iodine levels can also be measured by means of a blood test. However, some doctors feel that this isn’t as good as a urinary test ³³ and urine testing seems to be the favoured test for research.

Will my doctor do an iodine test?

It is quite likely that your NHS GP will not do a test because the Department of Health advisers state that you should be able to get all the iodine you need by eating a varied and balanced diet.³⁴

What if I am deficient?

If your doctor has confirmed that you are deficient, there are several options but you do need to be careful because too much supplementation can cause problems. You could try increasing your iodine levels by eating foods that contain iodine before you try supplementation.

Dietary Sources of Iodine

Iodine is found in the following foods ³⁵:

 **Depending on the season, higher value in winter

It’s also found in iodized salt, sea salt, seaweed, kelp, foods that contain carrageen, agar-agar, algin or alginate, many prepared and/or cured meats (ham, bacon, sausage, corned beef), dried fruit, margarine, canned vegetables, commercial bakery products, chocolate, molasses, soy products, any vitamins or supplements that contain iodine, FD&C red dye #3, cereals – wheat etc, (depending on how much iodine was in the soil where they were grown).

However, if this is not possible for you to eat these foods or you remain deficient there are iodine supplements available:

• Kelp tablets (seaweed) – available from most health shops.
• Iodized salt – available from some supermarkets.
• Potassium Iodide tablets – available only on prescription.
• Lugol’s Iodine – a solution of elemental iodine and potassium iodide in water used on the skin as an antiseptic. Can be toxic if too much is taken.
• Nascent Iodine – iodine in an atomic form rather than a molecular form and supposedly more bioavailable. No research articles could be found on this product.

The Department of Health advise that “you should be able to get all the iodine you need by eating a varied and balanced diet. If you take iodine supplements, don’t take too much as this could be harmful. Taking 0.5mg or less a day of iodine supplements is unlikely to cause any harm.”

There is a lot of controversy over the use of iodine.³⁶ You need to research well before you consider which action to take. Talk to your doctor if you are not sure what dosage to take for deficiency.

Read more in-depth information about the thyroid and iodine.

For more support check out our online community:
http://www.healthunlocked.com/thyroiduk

References

1. Galletti, P: Effect of fluorine on thyroidal iodine metabolism in hyperthyroidism . The Journal of Clinical Endocrinology & Metabolism October 1, 1958 vol. 18 no. doi: 10.1210/jcem-18-10-1102
   https://doi.org/10.1210/jcem-18-10-1102
2. Changes in Dietary Iodine Explains Increasing Incidence of Breast Cancer with Distand Involvement in Young Women
   Jay Rappaport
   J Cancer. 2017; 8(2): 174–177
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5327366/
3. Periodic Table
   Royal Society of Chemistry
   http://www.rsc.org/periodic-table/
4. Periodic Table
   Royal Society of Chemistry
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5. What is the difference in iodine and iodide?
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6. Extracting iodine from seaweed
   Royal Society of Chemistry
   http://www.rsc.org/learn-chemistry/resource/res00001915/extracting-iodine- from-seaweed?cmpid=CMP00006633
7. Iodine, Iodine metabolism and Iodine deficiency disorders revisited
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8. Goiter
   American Thyroid Association
   https://www.thyroid.org/goiter/
9. Society for Endocrinology
   New study suggests UK is now iodine-deficient. Press Release. 12 April 2011
   https://www.endocrinology.org/media/1129/2011-04-12_iodine.pdf
10. Vanderpump PJ; Lazerus J H, Smyth P P, Laurburgh P; Et Al; Iodine Status of UK Schoolgirls: a Cross Sectional Survey, The Lancet,
    Volume 377, Issue 9782, Pages 2007 – 2012, 11 June 2011
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60693-4/abstract
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12. Scientific Advisory Committee on Nutrition (SACN) Statement on Iodine and Health, February 2014
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13. Dr Barry Durrant-Peatfield, MB BS LRCP MRCS; The Great Thyroid Scandal and How to Survive it. Pp 131-135
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    Reinwein D, Durrer HA, Meinhold H.
    Horm Metab Res. 1981 Aug;13(8):456-9
    https://www.ncbi.nlm.nih.gov/pubmed/7327524
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    Department of Anthropology, PO Box 3050 STN CSC, University of Victoria, British Columbia, Canada V8W 3P5
    https://academic.oup.com/icb/article/49/2/155/641567#10960037
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    Carmen Aceves, Brenda Anguiano, and Guadalupe Delgado
    Thyroid. 2013 Aug; 23(8): 938–946
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752513/#__ffn_sectitle
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    Angela M. Leung, MD, MSc, Elizabeth N. Pearce, MD, MSc, and Lewis E. Braverman, MD
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    Vermeulen H1, Westerbos SJ, Ubbink DT.
    J Hosp Infect. 2010 Nov;76(3):191-9
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21. A Review: Radiographic Iodinated Contrast Mediia-Induced Thyroid Dysfunction
    Sun Y Lee; Connie M Rhee; Angela M Leung; Lewis E Braverman; Gregory A Brent; Elizabeth N Pearce
    The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 2, 1 February 2015
    https://academic.oup.com/jcem/article/100/2/376/2813118
22. Association Between Iodinated Contrast Media Exposure and Incident Hyperthyroidism and Hypothyroidism
    Connie M. Rhee, MD; Ishir Bhan, MD, MPH; Erik K. Alexander, MD; Steven M. Brunelli, MD, MSCE , Arch Intern Med. 2012;172(2):153-159. doi:10.1001/archinternmed.2011.677
    http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108674
23. Contrast Medium: Using Gadolinium or Iodine in Patients with Kidney Problems
    Author: Prof Stacy Goergen*
    Inside Radiology
    https://www.insideradiology.com.au/contrast-medium/
24. Adverse Reactions to Contrast Material
    Alexander Morzycki, Anuj Bhatia, Kieran J Murphy
    Canadian Association of Radiologists Journal: Volume 68, May 2017, 187-193
    https://www.sciencedirect.com/science/article/pii/S0846537116300432
25. Adverse Reactions to Iodinated Contract Media
    Wendy Bottinor, Pritam Polkampally, Ion Jovin
    International Journal of Angiology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3770975/
26. Adverse reactions to iodinated contrast media
    Morcos SK, Thomas HS
    Eur Radiol 2001;11(7):1267-75
    https://www.ncbi.nlm.nih.gov/pubmed/11471623
27. The Bioavailability of Iodine Applied to the Skin
    Guy E. Abraham, MD
    https://www.optimox.com/content/Iodine%20Research%20Resources/IOD23.pdf
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    Offie Porat Soldin
    Clin Biochem. 2002 Nov; 35(8): 575–579
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3637997/#!po=60.7143
29. Genova Diagnostics Patient Instruction Leaflet
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33. Comparing 4 Different Methods Of Iodine Testing
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34. SACN STATEMENT ON IODINE AND HEALTH – February 2014
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35. Association of UK Dietitian’s Fact Sheet on Iodine https
    https://www.bda.uk.com/resource/iodine.html
36. Validation of the Orthoiodosupplementation Program: A Rebuttal of Dr. Gaby’s Editorial on Iodine
    Guy E. Abraham, MDand David Brownstein, MD
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Dated updated: 24/04/24 (V1.6)
Review date: 24/04/27