Iodine deficiency and thyroid disorders

Zimmermann, Michael B; Boelaert, Kristien

doi:10.1016/s2213-8587(14)70225-6

Cited by 930Thyroid Disorders and TreatmentsThyroid Cancer Diagnosis and TreatmentThyroid and Parathyroid Surgery

Iodine deficiency and thyroid disorders

Zimmermann, Michael B, Boelaert, Kristien·2015·The Lancet Diabetes & Endocrinology

DOI 10.1016/s2213-8587(14)70225-6

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Abstract

Iodine deficiency early in life impairs cognition and growth, but iodine status is also a key determinant of thyroid disorders in adults. Severe iodine deficiency causes goitre and hypothyroidism because, despite an increase in thyroid activity to maximise iodine uptake and recycling in this setting, iodine concentrations are still too low to enable production of thyroid hormone. In mild-to-moderate iodine deficiency, increased thyroid activity can compensate for low iodine intake and maintain euthyroidism in most individuals, but at a price: chronic thyroid stimulation results in an increase in the prevalence of toxic nodular goitre and hyperthyroidism in populations. This high prevalence of nodular autonomy usually results in a further increase in the prevalence of hyperthyroidism if iodine intake is subsequently increased by salt iodisation. However, this increase is transient because iodine sufficiency normalises thyroid activity which, in the long term, reduces nodular autonomy. Increased iodine intake in an iodine-deficient population is associated with a small increase in the prevalence of subclinical hypothyroidism and thyroid autoimmunity; whether these increases are also transient is unclear. Variations in population iodine intake do not affect risk for Graves' disease or thyroid cancer, but correction of iodine deficiency might shift thyroid cancer subtypes toward less malignant forms. Thus, optimisation of population iodine intake is an important component of preventive health care to reduce the prevalence of thyroid disorders.

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Serum TSH is higher in areas of both overt and partial iodine deficiency.
“Serum TSH is, thus, higher in areas of both overt and partial iodine deficiency [8], very high in neonates [9], variable during pregnancy according to gestation [10], increasing at high age [11] and higher in some genetic population groups such as Ashkenazy Jews [12].”
From Risks of suboptimal and excessive thyroid hormone replacement across ages (2023) · cites this paper as [8]
Assay variability, potential interference with rheumatoid factors or heterophilic antibodies, occasional cases of macro-TSH, the age-related shift towards higher TSH concentrations in older iodine-sufficient patients, and obesity may affect this population-based sample to an extent.
“Furthermore, assay variability, potential interference with rheumatoid factors or heterophilic antibodies, occasional cases of macro-TSH, the observed age related shift towards higher TSH concentrations in older iodine sufficient patients, and obesity may affect this population based sample to an extent.45 46 47 48”
From Thyroid replacement therapy, thyroid stimulating hormone concentrations, and long term health outcomes in patients with hypothyroidism: longitudinal study (2019) · cites this paper as [47]
Consumers exposed to excessive amounts of iodine may be at increased risk of thyroid cancer.
“In addition, consumers exposed to excessive amounts of iodine may be at increased risk of thyroid cancer [79,80].”
From Current Status and Future Trends in Removal, Control, and Mitigation of Algae Food Safety Risks for Human Consumption (2022) · cites this paper as [79]

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2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum
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Hypothyroidism
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Thyroid disease in pregnancy: new insights in diagnosis and clinical management
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Trace Elements in Human Nutrition (II)—An Update
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Efficacy and safety of long-term universal salt iodization on thyroid disorders: epidemiological evidence from 31 provinces of mainland China.
Li, Y., Teng, D., Ba, J., Chen, B., Du, J., He, L., Lai, X., Teng, X., Shi, X., Li, Y., et al. (2020) · Thyroid · doi:10.1089/thy.2019.0067 · Cited by 359 · see citing works
Hypothyroidism
Chaker, L., Razvi, S., Bensenor, I. M., Azizi, F., Pearce, E. N., & Peeters, R. P. (2022) · Nature Reviews Disease Primers · doi:10.1038/s41572-022-00357-7 · Cited by 330 · see citing works
Global endocrinology: global perspectives in endocrinology: coverage of iodized salt programs and iodine status in 2020
Zimmermann, M. B., & Andersson, M. (2021) · European Journal of Endocrinology · doi:10.1530/eje-21-0171 · Cited by 231 · see citing works
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Thyroid replacement therapy, thyroid stimulating hormone concentrations, and long term health outcomes in patients with hypothyroidism: longitudinal study
Thayakaran, R., Adderley, N. J., Sainsbury, C., Torlinska, B., Boelaert, K., Šumilo, D., Price, M., Thomas, G. N., Toulis, K. A., & Nirantharakumar, K. (2019) · BMJ · doi:10.1136/bmj.l4892 · Cited by 138 · see citing works
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Reference intervals in the diagnosis of thyroid dysfunction: treating patients not numbers
Jonklaas, J., & Razvi, S. (2019) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(18)30371-1 · Cited by 100 · see citing works
Levothyroxine therapy in elderly patients with hypothyroidism
Effraimidis, G., Watt, T., & Feldt-Rasmussen, U. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.641560 · Cited by 60 · see citing works
Thyroid function across the lifespan: do age-related changes matter?
Walsh, J. P. (2022) · Endocrinology and Metabolism · doi:10.3803/enm.2022.1463 · Cited by 59 · see citing works
Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated?
Vigone, M. C., Capalbo, D., Weber, G., & Salerno, M. (2018) · Journal of the Endocrine Society · doi:10.1210/js.2017-00471 · Cited by 51 · see citing works
Current Status and Future Trends in Removal, Control, and Mitigation of Algae Food Safety Risks for Human Consumption
Wu, G., Zhuang, D., Chew, K. W., Ling, T. C., Khoo, K. S., Van Quyen, D., Feng, S., & Show, P. L. (2022) · Molecules · doi:10.3390/molecules27196633 · Cited by 51 · see citing works
Interpretation of thyroid function tests during pregnancy
Visser, W. E., & Peeters, R. P. (2020) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2020.101431 · Cited by 44 · see citing works
Determination of Total Iodine Content in Edible Seaweeds: Application of Inductively Coupled Plasma-Atomic Emission Spectroscopy
Milinovic, J., Rodrigues, C., Diniz, M., & Noronha, J. P. (2021) · Algal Research · doi:10.1016/j.algal.2020.102149 · Cited by 34 · see citing works
Risks of suboptimal and excessive thyroid hormone replacement across ages
Feldt-Rasmussen, U., Effraimidis, G., Bliddal, S., & Klose, M. (2023) · Journal of Endocrinological Investigation · doi:10.1007/s40618-023-02229-7 · Cited by 23 · see citing works
“Serum TSH is, thus, higher in areas of both overt and partial iodine deficiency [8], very high in neonates [9], variable during pregnancy according to gestation [10], increasing at high age [11] and higher in some genetic population groups such as Ashkenazy Jews [12].”
Background
A Procedure for the Quantification of Total Iodine by Inductively Coupled Plasma Mass Spectrometry, and Its Application to the Determination of Iodine in Algae Sampled in the Lagoon of Venice
Badocco, D., Di Marco, V., Piovan, A., Caniato, R., & Pastore, P. (2016) · Analytical Methods · doi:10.1039/c6ay02204a · Cited by 15 · see citing works

Authors: Zimmermann, M. B., & Boelaert, K.
Affiliations: ETH Zurich (CH)
University of Birmingham (GB)
ORCID: Zimmermann, Michael B
Boelaert, Kristien
Venue: The Lancet Diabetes & Endocrinology
Publisher: Elsevier BV
Published: 2015-04
Volume: 3
Issue: 4
Pages: 286-295
ISSN: 2213-8587 (ISSN-L)
DOI: 10.1016/s2213-8587(14)70225-6
OpenAlex: W1983353299
Cited by: 930
References: 92
Citations by year: 2026: 92 · 2025: 113 · 2024: 132 · 2023: 87 · 2022: 95 · 2021: 96 · 2020: 100 · 2019: 61 · 2018: 62 · 2017: 40 · 2016: 35 · 2015: 15
FWCI: 7.66
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet Diabetes & Endocrinology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords: iodine deficiency, thyroid dysfunction, goiter, hypothyroidism, hyperthyroidism, toxic nodular goiter, salt iodization, subclinical hypothyroidism, thyroid autoimmunity, Graves' disease, thyroid cancer, iodine intake, thyroid hormone synthesis, iodine recycling
MeSH terms: Deficiency Diseases, Food, Fortified, Goiter, Humans, Hyperthyroidism, Hypothyroidism, Iodine, Severity of Illness Index, Thyroid Neoplasms

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Iodine deficiency and thyroid disorders

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