Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Iodine Deficiency Medication

  • Author: Stephanie L Lee, MD, PhD; Chief Editor: George T Griffing, MD  more...
 
Updated: Dec 16, 2015
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Medications used in iodine deficiency include antithyroid agents (potassium iodide) and thyroid products (levothyroxine).

Next

Antithyroid Agents

Class Summary

Iodine deficiency has been treated at a population level by several methods, including voluntary use of iodized salt, iodine supplementation in bread and water, and oral/intramuscular administration of iodized oil. The simplest and least expensive treatment is to have the patient purchase and use iodized salt.

Potassium iodide (SSKI)

 

Potassium iodide is an option in industrialized counties. Absorption from the gastrointestinal tract is rapid and complete. The skin and lungs also can absorb iodine. Iodine equilibrates in extracellular fluids and is specifically concentrated by the thyroid gland.

Previous
Next

Thyroid Products

Class Summary

Thyroid hormone, L-thyroxine, may be used to treat iodine deficiency, because the chemical content of iodine is approximately 60% by weight.

Levothyroxine (Synthroid, Levothroid, Levoxyl)

 

Levothyroxine (L-T4) is generally effective in treating iodine deficiency. It is a considerably more expensive preparation than other forms of iodine (eg, iodized salt), especially when its cost is combined with the added expense of measuring TSH levels to assure that the supplemental L-T4 has not resulted in iatrogenic hyperthyroidism.

Alternatively, thyroid hormone therapy has been used with caution to shrink the goiter of iodine deficiency. An L-T4 dose is chosen that maintains the TSH in the lower part of the reference range. TSH levels should be monitored carefully to avoid thyrotoxicosis due to autonomous nodules in the iodine deficiency goiter.

Previous
 
Contributor Information and Disclosures
Author

Stephanie L Lee, MD, PhD Associate Professor, Department of Medicine, Boston University School of Medicine; Director of Thyroid Health Center, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center; Fellow, Association of Clinical Endocrinology

Stephanie L Lee, MD, PhD is a member of the following medical societies: American College of Endocrinology, American Thyroid Association, Endocrine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Elizabeth N Pearce, MD, MSc Associate Professor of Medicine, Boston Medical Center, Boston University School of Medicine

Elizabeth N Pearce, MD, MSc is a member of the following medical societies: American Association of Clinical Endocrinologists, American Thyroid Association, Endocrine Society, Massachusetts Medical Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: consulted for Scientific Consulting Company GmbH; advisory board for Endocrine Advisor Website; Member of the Management Council of the Iodine Global Network.

Sonia Ananthakrishnan, MD Assistant Professor of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston University School of Medicine

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Acknowledgements

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS Professor of Medicine (Endocrinology, Adj), Johns Hopkins School of Medicine; Affiliate Research Professor, Bioinformatics and Computational Biology Program, School of Computational Sciences, George Mason University; Principal, C/A Informatics, LLC

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Nutrition, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, American Society for Bone and Mineral Research, Endocrine Society, and International Society for Clinical Densitometry

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
  1. Zimmermann MB, Jooste PL, Pandav CS. Iodine-deficiency disorders. Lancet. 2008 Oct 4. 372 (9645):1251-62. [Medline].

  2. Pearce EN, Andersson M, Zimmermann MB. Global iodine nutrition: Where do we stand in 2013?. Thyroid. 2013 May. 23(5):523-8. [Medline].

  3. Liu L, Wang D, Liu P, Meng F, Wen D, Jia Q, et al. The relationship between iodine nutrition and thyroid disease in lactating women with different iodine intakes. Br J Nutr. 2015 Sep 14. 1-9. [Medline].

  4. Zimmermann MB. Iodine deficiency in pregnancy and the effects of maternal iodine supplementation on the offspring: a review. Am J Clin Nutr. 2009 Feb. 89(2):668S-72S. [Medline].

  5. WHO Secretariat, 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 Dec. 10(12A):1606-11. [Medline].

  6. Delange F. Optimal iodine nutrition during pregnancy, lactation and neonatal period. Int J Endocrinol Metab. 2004. 89:3851.

  7. Azizi F, Smyth P. Breastfeeding and maternal and infant iodine nutrition. Clin Endocrinol (Oxf). 2009 May. 70(5):803-9. [Medline].

  8. Pearce EN, Pino S, He X, Bazrafshan HR, Lee SL, Braverman LE. Sources of dietary iodine: bread, cows' milk, and infant formula in the Boston area. J Clin Endocrinol Metab. 2004 Jul. 89(7):3421-4. [Medline].

  9. Hollowell JG, Staehling NW, Hannon WH, et al. Iodine nutrition in the United States. Trends and public health implications: iodine excretion data from National Health and Nutrition Examination Surveys I and III (1971-1974 and 1988-1994). J Clin Endocrinol Metab. 1998 Oct. 83(10):3401-8. [Medline]. [Full Text].

  10. Caldwell KL, Jones R, Hollowell JG. Urinary iodine concentration: United States National Health And Nutrition Examination Survey 2001-2002. Thyroid. 2005 Jul. 15(7):692-9. [Medline].

  11. Caldwell KL, Miller GA, Wang RY, Jain RB, Jones RL. Iodine status of the U.S. population, National Health and Nutrition Examination Survey 2003-2004. Thyroid. 2008 Nov. 18(11):1207-14. [Medline].

  12. Caldwell KL, Pan Y, Mortensen ME, Makhmudov A, Merrill L, Moye J. Iodine status in pregnant women in the National Children's Study and in U.S. women (15-44 years), National Health and Nutrition Examination Survey 2005-2010. Thyroid. 2013 Aug. 23(8):927-37. [Medline].

  13. Zimmermann MB, Aeberli I, Torresani T, et al. Increasing the iodine concentration in the Swiss iodized salt program markedly improved iodine status in pregnant women and children: a 5-y prospective national study. Am J Clin Nutr. 2005 Aug. 82(2):388-92. [Medline]. [Full Text].

  14. Bath SC, Steer CD, Golding J, Emmett P, Rayman MP. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet. 2013 Jul 27. 382(9889):331-7. [Medline].

  15. Williams GR. Neurodevelopmental and neurophysiological actions of thyroid hormone. J Neuroendocrinol. 2008 Jun. 20(6):784-94. [Medline].

  16. Zimmermann MB, Wegmuller R, Zeder C, et al. Rapid relapse of thyroid dysfunction and goiter in school-age children after discontinuation of salt iodization. Am J Clin Nutr. 2004 Apr. 79(4):642-5. [Medline]. [Full Text].

  17. Santiago-Fernandez P, Torres-Barahona R, Muela-Martínez JA, et al. Intelligence quotient and iodine intake: a cross-sectional study in children. J Clin Endocrinol Metab. 2004 Aug. 89(8):3851-7. [Medline]. [Full Text].

  18. Zimmermann MB, Moretti D, Chaouki N, et al. Development of a dried whole-blood spot thyroglobulin assay and its evaluation as an indicator of thyroid status in goitrous children receiving iodized salt. Am J Clin Nutr. 2003 Jun. 77(6):1453-8. [Medline]. [Full Text].

  19. Zimmermann MB, Aeberli I, Andersson M, Assey V, Yorg JA, Jooste P. Thyroglobulin is a sensitive measure of both deficient and excess iodine intakes in children and indicates no adverse effects on thyroid function in the UIC range of 100-299 µg/L: a UNICEF/ICCIDD study group report. J Clin Endocrinol Metab. 2013 Mar. 98(3):1271-80. [Medline].

  20. Krejbjerg A, Pedersen IB, Laurberg P. Can Elastography Predict Growth of Incidental Thyroid Nodules? A Pilot Two-Year Follow-Up Study. Ultrason Imaging. 2015 Sep 7. [Medline].

  21. Zimmermann MB. Iodine requirements and the risks and benefits of correcting iodine deficiency in populations. J Trace Elem Med Biol. 2008. 22(2):81-92. [Medline].

  22. Cerqueira C, Knudsen N, Ovesen L, et al. Association of iodine fortification with incident use of anti-thyroid medication - A Danish nationwide study. J Clin Endocrinol Metab. 2009 Apr 14. [Medline].

  23. Leung AM, Lamar A, He X, Braverman LE, Pearce EN. Iodine status and thyroid function of Boston-area vegetarians and vegans. J Clin Endocrinol Metab. 2011 Aug. 96(8):E1303-7. [Medline]. [Full Text].

  24. Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015 Apr. 3 (4):286-95. [Medline].

 
Previous
Next
 
Distribution of iodine deficiency in developing countries.
Typical endemic goiters in 3 women from the Himalayas, an area of severe iodine deficiency. Image courtesy of F. DeLange.
A man and 3 females (age range, 17-20 y) with myxedematous cretinism from the Republic of the Congo in Africa, a region with severe iodine deficiency. Image courtesy of F. DeLange.
Histologic sections from a normal thyroid and from an endemic goiter that was removed because of compressive symptoms. The normal thyroid (A) contains thyroid cells arranged in a monolayered sheet around a storage form of thyroid hormone, colloid, while the endemic goiter (B) shows intense hyperplasia with no colloid. Image courtesy of F. DeLange.
Table.
Iodine Deficiency None Mild Moderate Severe
Median urine iodine, mcg/L >100 50-99 20-49 < 20
Goiter prevalence < 5% 5-20% 20-30% >30%
Neonatal thyroid-stimulating hormone (TSH),



>5 IU/mL whole blood



< 3% 3-20% 20-40% >40%
Cretinism 0 0 + +
Adapted from the World Health Organization (WHO)/United Nations Children's Fund (UNICEF)/International Council for Control of Iodine Deficiency Disorders (ICCIDD).
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.