6 Iodine Deficiency

Suggested citation: Endocrine Society. Endocrine Facts and Figures: Thyroid. First Edition. 2015.

6.1    Prevalence and Incidence

In 2013, the US was included among the 111 countries identified as having sufficient iodine intake defined by a national or subnational median urinary iodine (UI) concentration of 100–299 mcg/L in school-aged children.144 The proportion of the US population with UI lower than 100 mcg/L was 17% according to the 2013 International Council for Control of Iodine Deficiency Disorders (ICCIDD) scorecard.145 Overall, the US is currently considered iodine sufficient. However, mild iodine deficiency may be present in pregnant US women and women of childbearing age.146

Sufficient population iodine intake as assessed by median urinary iodine was set in 1992 as 100 to 199 micrograms per liter for school-age children adults, with the exception of pregnant and lactating women. For that population, a median value of 150 to 249 micrograms per liter (mcg/L) signals adequate intake. Excessive intake for school-age children and adults was signaled by urinary concentration 300 mcg/L and higher, and for pregnant and lactating women, 500 mcg/L and higher.79

According to data in a one-third subsample of the NHANES 2005-2010 participants, the overall prevalence of low UI concentrations among 6- to 75-year-olds was 31.1% between 1988 and 1994. In 2001 and 2002, 38.0% of women aged 15 to 45 had urinary iodine concentrations of 100 mcg/L or lower.147

 

6.2    Demographic Differences

According to data in a one-third subsample of the NHANES 2005–2006 and 2009–2010 participants and in all 2007–2009 participants age 6 years and older, median UI concentration in 2009-2010 (144 mcg/L) was lower than in 2007-2008 (164 mcg/L). Non-Hispanic blacks had the lowest UI concentrations (131 mcg/L) compared with non-Hispanic whites or Hispanics (147 and 148 mcg/L, respectively). The median for all pregnant women in NHANES 2005–2006 was less than adequate (129 mcg/L; optimal is 150-249 mcg/L), whereas third trimester women had UI concentrations that were adequate (median UI 172 mcg/L).148 The demography of UI according to the NHANES 2009–2010 is reported in Tables 30 and 31.

 Table 30. Urinary iodine by age and sex in the US.
  IODINE LEVEL,1 mcg/L IODINE LEVEL CORRECTED FOR CREATININE LEVEL,1 mcg/g
AGE
     > 6 years 144 143
     6–11years 213 250
     12–19 years 131 117
     20-29 years 132 112
     30-39 years 132 114
     40-49 years 128 114
     50-59 years 136 147
     60–69 years 148 181
     > 70 years 182 239
SEX
    Male 147 149
    Female 134 150
    Females of childbearing age 124 117

Source: Caldwell et al. 2013146

 Table 31. Urinary iodine by race/ethnicity in the US.
RACE/ETHNICITY IODINE LEVEL,1 mcg/L IODINE LEVEL CORRECTED FOR CREATININE LEVEL,1 mcg/g
  Non-Hispanic white 147 149
  Non-Hispanic black 131 98
  All Hispanic 148 142

 Source: Caldwell et al. 2013146

Whereas fewer than 10% of households in the world in 1990 had access to iodized salt, by the year 2000, that percentage had increased to 68%. As a strategy for reducing mental retardation resulting from iodine deficiency, salt iodization also introduces the possibility of excessive intake of iodine if appropriate monitoring is not carried out. An evaluation of iodine levels in 35,233 schoolchildren at 378 sites of 28 countries has shown that many previously iodine deficient parts of the world now have median urinary iodine concentrations well above 300 mcg/L, which is excessive and carries the risk of adverse health consequences.149

 

6.3    Life Expectancy and Mortality

Elderly people, especially those living in iodine-deficient areas, are more prone to abnormal thyroid function. A 6-year study in a mildly iodine-deficient area of Italy showed all-cause mortality among persons with hyperthyroidism was 65% higher than in those with normal thyroid function.150

In severely iodine deficient areas, iodine deficiency has been documented to be an important etiological factor leading to poor fetal growth and development. Iodine is essential for physical growth and development of the central nervous system of the fetus. Some studies have shown that severe iodine deficiency in pregnant mothers leads to increased incidence of perinatal and infant child mortality.151

 

6.4    Diagnosis, Treatment, and Prescription Trends

Among 51 newborns, 26 who were diagnosed with congenital hypothyroidism due to severe iodine deficiency were treated with T4. The remaining 25 cases were given T4 plus 100 mcg/day of oral iodine. Free T3, free T4, TSH, thyroglobulin, thyroid volume, urine iodine, and breast milk iodine levels were measured in the first and third months of treatment, and the data were compared between the two groups. It was found that the addition of oral iodine to T4 treatment provided no benefit compared to treatment with T4 alone.152

The effect of the mandatory nationwide iodine fortification program in two areas of Denmark was measured in 2465 adults. Age-dependent differences in thyroid volume and enlargement had leveled out, suggesting that the previously observed increase in thyroid volume with age may have been caused by iodine deficiency.153

 

6.5    Health Outcomes Measures

In a double blind, randomized, placebo-controlled trial that recruited 241 breast-feeding mother-infant pairs between 2010 and 2011, median urinary iodine concentrations suggested iodine deficiency. The indirect supplementation group received one dose of 400 mg to the mother and placebo to the infant, and the direct supplementation group received one dose of about 100 mg iodine to the infant and placebo to the mother. Urinary iodine levels, breast milk iodine, mother and infant TSH, maternal and infant T4 and infant growth were measured at baseline (it was 35 mcg/L in mothers and 73 mcg/L in infants), and when the infants were 3, 6, and 9 months. The number of infants with thyroid hypofunction was lower in the indirect supplementation group than in the direct supplementation group. The infant groups did not differ in anthropomorphic measures, except that length-for-age Z score was slightly greater in the direct infant supplementation group. At 3 months and 6 months of age, median infant urinary iodine concentration in the indirect infant supplementation group was sufficient (>100 mcg/L), whereas infant urinary iodine concentration was sufficient only at 6 months in the direct supplementation group.154

Iodine supplementation during pregnancy or the peri-conceptional period in regions of severe iodine deficiency reduces risk of cretinism.155 A systematic review of studies on the impact of iodine supplementation on maternal and newborn thyroid function in regions of mild to moderate iodine deficiency noted the lack of controlled trials on infant neurodevelopment. However, gestational iodine supplementation reduced maternal thyroid volume and serum thyroglobulin. In some studies, it prevented a rise in serum TSH.156

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