Guidelines Summary

World Health Organization

The World Health Organization (WHO) recommended dietary allowance
(RDA) of iodine is as follows [3] :
 Adults and adolescents - 150 mcg/day
 Pregnant and lactating women - 250 mcg/day
 Children aged 6-12 years - 120 mcg/day
 Infants to 6 years - 90 mcg/day
The WHO notes that although a reduction in the intake of salt to less than 5
g/day, on average, is needed to reduce cardiovascular risk, individuals still
consume about 10 g/day, most from household salt used for home cooking
and at the table. Therefore, the WHO strongly recommends all food-grade
salt should be fortified with iodine as a safe and effective strategy for the
population-based prevention and control of iodine deficiency disorders.
Additional recommendations include the following:
 Monitoring of salt intake and iodine intake is needed to adjust salt
iodization as necessary to ensure that individuals consume sufficient
iodine despite reduction of salt intake.
 Iodized salt should be used universally after the age of 1 year. Infants
and young children are assumed to be covered via breast milk or
iodine-enriched infant formula milk.
 Since pregnant women have a higher daily iodine requirement of 250
mcg/day, other interventions such as iodine supplementation could be
considered if iodine inadequacy is found
Iodine Deficiency Prevention During Pregnancy
The following organizations have issued guidelines for the managment of
thyroid dysfunction during pregnancy, which include recommendations for
management of iodine deficiency:
 Endrocrine Society (ES)
 American Thyroid Association (ATA)
 European Thyroid Association (ETA)
The Endocrine Society (ES) guidelines offer the following
recommendations for iodine nutrition during pregnancy [30] :
 Women of childbearing age should have an average iodine intake of
150 μg/day. Prior to conception, during pregnancy, and while
breastfeeding, women should increase their intake to 250 μg/day.
 Iodine intake during pregnancy and breastfeeding should not
exceed 500 μg/day.
 Once-daily prenatal vitamins should contain 150–200 μg iodine in the
form of potassium iodide or iodate. Supplementation should be
started before conception.
  Breastfeeding mothers should maintain a daily intake of 250 μg of
iodine to ensure that breast milk provides 100 μg of iodine per day to
the infant.
The American Thyroid Association (ATA) guidelines concur with the ES
guidelines and include the following additional recommendations [31] :
 There is no need to initiate iodine supplementation in pregnant
women who are being treated for hyperthyroidism or who are taking
LT4.
 Excessive doses of iodine exposure during pregnancy should be
avoided, except in preparation for the surgical treatment of Graves
disease.
 Clinicians should carefully weigh the risks and benefits when ordering
medications or diagnostic tests that will result in high iodine exposure.
The European Thyroid Association (ETA) recommends daily iodine intake
during pregnancy, and lactation should be at least 250 μg and should not
exceed 500 µg. Iodine intake should be supplemented with 150 μg of
iodine/day, beginning prior to conception and continuing through
lactation. [34]