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Iodine Deficiency Treatment &

Management
Updated: Oct 14, 2017
Author: Stephanie L Lee, MD, PhD; Chief Editor: George T Griffing, MD more...

TREATMENT

Approach Considerations
Treatment of iodine deficiency

Correction of an individual's iodine deficiency should be instituted at a level recommended by the

US Institute of Medicine (IOM) and the World Health Organization (WHO). In a nonpregnant adult,
150 mcg/day is sufficient for normal thyroid function.

Consultation with an endocrinologist should be considered when the etiology of thyroid

abnormalities is unclear. Thyroidectomy may be indicated for patients with compressive symptoms
of a large goiter.

Prevention

At a population level, iodine deficiency disorder (IDD) can be prevented by the iodization of food
products or the water supply. In practice, this is usually achieved by iodization of salt. An alternative
in some developing countries has been the periodic injection of iodized oil supplements. [14, 18]

Iodine treatment-related hyperthyroidism

The primary complication of iodine therapy for IDD is the development of hyperthyroidism. This
may occur, especially in patients older than 45 years, because of the hyperfunctioning areas of
autonomy that tend to develop in patients with long-standing iodine-deficient goiters. [27]

A Danish study investigating the incidence of hyperthyroidism associated with Denmark's iodine
fortification program found that, based on the incident use of antithyroid medication in various parts
of the country, the incidence of hyperthyroidism was greater among persons who had suffered from
moderate iodine deficiency than it was among those who had had only a mild deficiency. [28] In the
moderately deficient population, the incident use of antithyroid medication increased the most in
persons younger than 40 years or older than 75 years. Four years after iodine fortification began,
the incidence of hyperthyroidism apparently began to decline, returning to prefortification rates in
most population groups by the end of 6 years.

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Sources of Iodine Replacement

Iodine replacement should be based on the recommendations of IOM and WHO. In an adult, 150
mcg/day is sufficient for normal thyroid function. Replacement of iodine is most easily achieved by
requesting that the patient use iodized salt in his or her cooking and at the table or an iodine-
containing daily multiple vitamin. Other dietary sources of iodine include milk, egg yolks, and
saltwater fish. Not all daily or prenatal multiple vitamins contain iodine, but those that do, typically
contain 150 mcg of iodine per tablet.

While a person who follows a vegan diet still might consume iodized salt, only 70% of salt sold from
US supermarket shelves currently is iodized. Other major sources of US dietary iodine are
saltwater fish, milk and milk products, and eggs. These food items are not included in a true vegan
diet. [29]

The Institute of Medicine (IOM) recommended dietary allowance (RDA) is 220 mcg/day of iodine for
pregnant women. Not all daily or prenatal multiple vitamins contain iodine, but those that do,
typically contain 150 mcg of iodine per tablet. The IOM recommends 290 mcg/day for lactating
women and 90-120 mcg/day for children aged 1-11 years. The adequate intake for infants is
110-130 mcg/day.

The American Thyroid Association and the Endocrine Society [30, 31] have recommended that
lactating women take vitamins containing 150 mcg of iodide daily to supplement their dietary intake
of iodide. This recommendation stems from NHANES reports of low individual maternal urinary
iodide concentrations in women of childbearing age and pregnant woment, although it is not clear
that lactating women in the United States are at risk for iodine deficiency. [32]

Infant formula is required by the FDA to contain minimum and maximum calorie-based iodine of 5
and 75 mcg/100 kcal. If an infant formula does not contain at least the minimum amount of each of
the nutrients required by the FDA, it is subject to recall. [33]

In developing countries, eradication of iodine deficiency has been accomplished by adding iodine
drops to well water or by injecting people with iodized oil.

Using highly concentrated pharmaceutical agents such as a saturated solution of potassium iodide
(SSKI), which has a concentration of 35,000-50,000 mcg/drop, is impractical and potentially
dangerous.

Treatment of Nontoxic Goiters Caused by Iodine Deficiency

Long-term dietary iodine replacement at levels recommended by IOM and WHO may decrease the
size of iodine-deficient goiters in very young children and pregnant women and is indicated for all
patients with iodine deficiency. [6] Generally, long-standing goiters associated with iodine deficiency
disorder respond with only small amounts of shrinkage after iodine supplementation, and patients
are at risk for developing hyperthyroidism. Patients do not routinely require specific therapy unless
the goiter is large enough to cause compressive symptoms (eg, tracheal obstruction, thoracic inlet
occlusion, hoarseness).

Levothyroxine

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Iodine Deficiency Treatment & Management: Approach Considerations,... https://emedicine.medscape.com/article/122714-treatment

Exogenous levothyroxine (L-T4) can also be used to decrease goiter size but generally is not
effective in adults and older children. Supplemental L-T4, when added to the T3 and T4 secretion by
the autonomous nodules in the endemic goiter, may cause thyrotoxicosis. Long-term L-T4 therapy
that results in the suppression of the TSH level to below-normal levels may have deleterious effects
on cardiac and bone health; therefore, L-T4 therapy is no longer routinely administered to patients
with goiter.

Radioactive iodine

Radioactive iodine (iodine-131 [131I]) has been used, primarily in Europe, to decrease thyroid
volume in patients with euthyroid goiters (40-60% volume reduction). In the United States, 131I is
the most common treatment for toxic multinodular goiters associated with hyperthyroidism. Risks
associated with 131I therapy include permanent hypothyroidism.

Surgery

The standard of care for large goiter associated with obstructive symptoms such as dough, stridor,
and dysphagia is thyroidectomy. If the goiter extends into the anterior mediastinum, surgery is the
recommended treatment even without obstructive symptoms. After the surgery, the patient will
need levothyroxine replacement therapy.

Guidelines
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