This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here.
In a previous article I showed why, when used alone, thyroid hormone replacement often fails. In this post I’ll explain why optimizing your iodine intake is so crucial, and why both too little and too much iodine can be harmful.
Iodine deficiency is the most common cause of hypothyroidism worldwide. Once researchers realized this, health authorities around the world began adding iodine to table salt.
This strategy was effective in correcting iodine deficiency. But it had an unanticipated—and undesired—effect. In countries where iodine has been added to table salt, the rates of autoimmune thyroid disease have risen. The following is just a sample of studies around the world demonstrating this effect:
Why does this happen? Because increased iodine intake, especially in supplement form, can increase the autoimmune attack on the thyroid. Iodine reduces the activity of an enzyme called thyroid peroxidase (TPO). TPO is required for proper thyroid hormone production.
On the other hand, restricting intake of iodine can reverse hypothyroidism. In one study, 78% of patients with Hashimoto’s regained normal thyroid function with iodine restriction alone.
In the study above where rats developed goiter while receiving excess iodine, when they were given adequate selenium they did not develop the goiter.
Other studies have shown that selenium protects against the effects of iodine toxicity and prevents the triggering and flaring of autoimmune disease that excess iodine without selenium can cause.
In my practice I always test for both iodine deficiency and Hashimoto’s when a patient presents with hypothyroid symptoms. If they are iodine deficient, I will start them on a trial of iodine and selenium together. In most cases, patients see a significant improvement. In a minority of cases, they cannot tolerate supplemental iodine even with adequate selenium intake.
Unfortunately, the blood test for iodine that your doctor might run is not very accurate. The best way to determine iodine status is with a 24-hour urine loading test. This involves taking a large dose of iodine and collecting your urine for 24 hours afterward. If you are iodine deficient, you’ll retain more of the ingested iodine than you should and the level of iodine excreted in the urine will be lower than expected. The two labs I recommend for this test are Doctor’s Data and Hakala.
That said, if your doctor or health care practitioner won’t order these tests, you can simply begin an iodine protocol. This involves starting with a low dose of iodine (I start my patients with kelp tablets that contain 325 mcg of iodine per tablet) and increasing very slowly over time. As I’ve described in this article, it’s crucial that you also take 200 mcg of selenium per day during this protocol to protect against the potentially adverse effects of iodine supplementation, especially if you have autoimmune thyroid disease.
Physicians that specialize in treating hypothyroidism with iodine (such as Dr. Abraham and Dr. Brownstein) suggest doses as high as 50 mg per day may be necessary to restore iodine levels in those that are deficient. I have used doses this high in my practice, but it’s imperative that patients build up to such high doses very slowly, and I don’t recommend doing it without the supervision of a clinician experienced with iodine treatment. Be aware that high doses of iodine can lead to a transient increase in TSH levels, which can be mistakenly interpreted as a sign of hypothyroidism.
Finally, it’s important to keep in mind that a minority of patients with Hashimoto’s confirmed by biopsy (the gold standard) never test positive for thyroid antibodies. This is probably because their immune systems are so depressed they can no longer produce antibodies. If you have a combination of hyper- and hypothyroid symptoms, I would still suspect Hashimoto’s even if your thyroid antibody tests are normal. It’s wise to be cautious with iodine if you have any signs of autoimmune thyroid disease, even without a confirmed diagnosis.
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I have hashimotos and when I took iodine drops my goiter swelled, endo informed me only option surgical removal of thyroid. I quit taking iodine, quit glutin and my thyroid shunk, it’s almost been a year and my goiter is gone
My blood test showed 6.5 TSH.. I quit all grains and currently take 50 mgs of lugos per day. i have no hypothyroid symptoms whatsoever.
In the study quoted I think that saying 78% of Hashimotos hypothyroid patients were returned to a normal state from reduction in iodine intake is an inaccurate conclusion. Consider that 55% of the controls (who did not change their Iodine intake) also saw their hypothyroid condition returned to normal . Would not this indicate that only 23% actually got any benefit from reduction of Iodine? Considering this and the very small size of this study it would appear that more research needs to be done before drawing any concrete conclusions..
The more important question would be WHY did those 55% spontaneously recover? Something must have changed . If someone had looked closer into all details of diet, exercise, and lifestyle perhaps something more important could have been discovered.
Hello,
I must admit that I have not read all posts in this discussion which is fascinating. I confess that I have very little experience or knowledge compare to many here.
I was given a herbal tincture containing a herb called Ashwaganda which I took over a period of time. I noted that intially I began to lose hair, after time most of my facial hair dissappeared too. I beleive that I went Hyper due to the supplements (Solgar VM75 which containes potassium iodide) and the herbal tincture. My body went through some trauma- I feel my thyroid enlarging when I take simple herbal teas, I can’t tolerate vitamin D, or iron, or indeed any medication.
My hair is fine and is still falling out, eyebrows are barely exisitent. Please can someone please explain what happened to my thyroid, I believe I damaged it by consuming supplements and more importantly Ashwaganda known to cause Thyroidoxicosis. (I did not know this at the time).
Will I ever recover, please can someone tell me why I can’t tolerate essential Vitiamin D and iron which I so badly need. (My thyroid enlarges, the result is dreadful ear pain, extreme heat, I feel as though my head could explode). No doctor will believe me when I tell them this and I am told that I have nothing wrong with me. Blood tests are always normal but I am ill!
Apologies for posting this here, I just wondered if some kindly soul could advise.
It’s been a pretty frightening experience!
Supplements have to be treated with caution!
Kind Regards
Hi Dr. Chris . I have a question regarding to gliadin and its role in causing autoimmune disease ( thyroid hypothyroidism). We already know that gluten causes leaky gut syndrome and in consequences thyroid dysfunction . As You mention in article (http://chriskresser.com/the-gluten-thyroid-connection ) once this gluten protein enters bloodstream through the leaky gut lining antibodies starts to attack thyroid. My question is ; can we expect ours antibodies to stop attacking the thyroid once the gut lining is healed and on condition that we will be gluten free for more than 6 months even if we eat a little bit of gluten ? or if antibodies will still attack thyroid due to( antibodies memory of that particular protein ) even if some gluten is consumed but the gut lining is well healed ?
Yes, I have the same question!
Hi PIT
No one’s answered your question but since gluten causes leaky gut through the action of zonulin, it would be pointless consuming gluten to any degree I suspect. I envisage eating a bit of gluten will rark up the thyroid antibodies as well as other anti-gluten antibodies.
Heather, are you sure that it is the iodine that caused your thyroid to go hyper? Could be other causes. Also, for those who struggle with bromide detox, there is a salt loading protocol that one can follow to help address this. I’ve found some interesting and helpful iodine info on the ‘Breast Cancer Choices’ site. The info there is harmonious with everything Chris relates regarding the taking of iodine. For those who struggle with thyroid, I understand that managing it can seem like running the gauntlet. I have Hashimotos and have been finding my way too.
What form of iodine is this article referring to? Potassium iodine? I didn’t see it mentioned.
http://www.bodybio.com I watched that video and its obvious that the balance of all minerals are needed to heal the body. Too much of any one will get the body out of balance. Selenium is the balance that is most mentioned but it still seems we are looking at the most misunderstood part of medicine. The problem is experts run the show and they will kill us are proving there POINT !!!
Hello,
Is it possible to reverse hypothyroidism from taking too high a dose of iodine for too long?
I took iodoral 12.5 mg daily for a year and have now developed an under active thyroid.
I don’t want to go down the lifetime medication road unless absolutely no other option. Please help!!
I also suffer from adrenal fatigue due to suffering 2 deaths in a year and various other stressors. I am taking an adrenal support for this.
Thank you
Heather
The problem might have been you were taking iodine without the required accompanying nutrients (selenium, magnessiu and Vit C)
Hi Chris,
I was diagnosed with Hashimoto’s during my 1st pregnancy, that was 17 years ago. I was on Levoxyl for 13 years + antidepressants and suffered from terrible PMS. My vit D levels were low as well as B12 and cortisol was very low. I have now been on Naturethroid the past 4 years and lots of vitamins. I know my gut is messed up have been gluten free for 4 years but now going Paleo. I am taking a vitamin pack supplement called Propax with NT factor. The ingredients say it contains 18.75 mcg of iodine. Should I stop taking this supplement because of the iodine?
Thanks. I love your website and the wealth of information.
My God!….reading all this makes me wonder how extremely difficult it is to try to balance this curse! I might as well just give it up. There’s gotta be something simpler than this. I vote for a find the cure for thyroid disease cause….it’s hell!! Someone’s gotta figure this darn thing out!
Evon, my sentiments exactly! I haven’t found one person where I live (Wash DC area) who comes remotely close to a true understanding of the thyroid and immune system. I have Graves and Hashi’s and a multi-nodule goiter, plus chronic Lyme disease. The online blogs, books, studies and doctors all say something different from each other. Elaborate testing is referred to but then I try to get my doctors to do it and they are clueless. Then even with the standard thyroid tests there are different opinions in how to interpret them. Who is right? How do you know which direction to head in? One person says you’ll never get well without iodine, another says it’s the worst thing you could take. I’ve had the greatest improvements in how I feel by simply following a Paleo/GAPS type diet and detoxing. So, when in doubt, heal the gut and eat the way the body was designed to eat. The rest of this is crazy-making.
Hello Dr.Chris :
I hope you are well ,
I am a female ( 48 years old ) , I have thyroid problems that
The doctor removed a part of the thyroid & asked me to go with radioactive iodine
Therapy , but I find it very terrible consequences , &I did not want to proceed with it ,
I read about Nascent iodine , my question is :
Is this Nascent iodine compensate or equivalent to the Radioactive Iodine ?
Also I have read about that taking Iodine without Selenium is not correct,
Have a nice day ,
Linda,
I started having swallowing issues last spring and went to my doctor telling him it was my thyroid. He poo-pooed the idea since I was already on 60 mg of armour thyroid. After getting to the point where I couldn’t swallow anything without choking, my chiropractor suggested using iodine supplementation. Within 3 days my symptoms were almost gone. I currently take 50 mg per day just to be able to swallow without choking. You need to re-examine your supposed facts on iodine. A good website is http://www.iodine4health.com.
I developed an under active thyroid from only taking 12.5 mg of iodral for a year. Prior to that my thyroid was fine. There is a wealth of evidence that supports the onset of hashimotos with taking too much iodine and I am living proof. It over stimulates hydrogen peroxide in the thyroid cell causing inflammation. Please be cautious.
That was because you weren’t taking the recommended supplemental selenium (~200 mcg x day).
Well this MD says otherwise, and that the studies were interpreted wrong. I guess no one really knows for sure.http://www.newsmaxhealth.com/headline_health/iodine_study_misinterpret/2012/01/27/430557.html
Excellent article, Zach. Thanks for posting.
I will offer here what I have found to be true, as one with hypothryroidism, and after years of self-directed research, many many lab tests, and trial and error with different meds and modalities.
I believe and have found that iodine supplementation in far higher doses than the RDA , but somewhat lesser quantities than Brownstein suggests, can be safe and healing for the entire system.
As an example, blood work shows that I do not have Hashimotos/autoimmune hypothyroidism, though my thyroid is inflamed and I have higher than normal TSH levels. I have tried everything under the sun to cure and heal my low thryroid “naturally,” including Armour and Naturethroid, which were a bomb for me because the balance of t3 and t4 in them is known to be incompatible with the t3/t4 levels in humans, which can cause rapid heart rate.
Without a low-dose of non-generic Synthroid, my body just shuts down. I must take this.
Yet, this is still not enough to restore overall wellness.
I have been diagnosed by urine analysis to be BORDERLINE low iodine, and this result coincides with the fact that my hypothyroidism is, by lab numbers, mild, even though I become ill and non-functional without thryroid medication.
When I add 6.25 milligrams of combination iodine (Tri-iodine), everything changes for the better-sleep, weight, mood, overall health. Just iodine, which I have tried, is not enough, and neither are thyroid meds alone. I believe that I could take up to about 10mg, and still see good results without consequence.
I do believe the doses of iodine that Brownstein suggests may be too much for some people, and here’s why. If a person takes “too much” iodine, it can actually sweep the “good T4” out of the system, along with the toxins. Perhaps this is why people who take the higher doses-12.5-50mg. of iodine that Brownstein suggests- sometimes have elevated TSH and increased hypo symtoms.
Edgar Cayce sugggests taking iodine for hypothyroidism, and he also recommended (in my words) that taking iodine in a cycled pattern is the key to treatment, as it allows the body to increase T4 and T3 production, and to rest (on no iodine days) to absorb and retain it.
This has absolutely worked for me, without fail or side effects.
I have had hashimoto’s since 1987 and have always taken Levoxyl. I had been vegetarian since 1982, until a year and a half ago, when I started eating fish because I stopped eating grains, soy and dairy. I ate so much fish! A couple of months ago, I began to have heart palpitations unless I stopped my Levoxyl. After a month of no Levoxyl, my TSH was 100. Now I’m back on Levoxyl, but if I eat fish regularly, I have irregular, racing and pounding heartbeats again. I also had a chest rash after a scan using iodine contrast and I had red streaks up my arm after taking an iodine supplement about a year ago. This was prescribed by a dr after an iodine loading test. Do I need to just avoid fish and all iodine forever?
Thank you
Have you tried unrefined salt supplementation as recommended in Dr. Guy Abraham’s Iodine Protocol? You could be very toxic in bromine, as I was, in which case the salt would be needed to eliminate the bromide driven out off tissues by the iodine. You might even need the more aggressive salt loading procedure in addition to the normal salt supplement.
Did your loading test include a bromide test?
The salt resolved my own bromine toxicity very nicely.
I was recently told that I am hypothyroid. I am researching to figure out everything that is happening to me – if that is even possible! I had 2 CT Scans with iodine contrast over a 4 month period – each time I would get 2 golf ball size knots on each side at the front of my neck. It did not happen immediately but 1-2 days after the scans and they were painful. I have had CT Scans with iodine contrast in the past with no reaction afterwards.
Chris:
Very good post as always. Thank you.
In those individuals with deiodinase deficiencies, like me, are characterized with very high FT4, low FT3, low TSH and high RT3. Adding a small 500 mcg dose of iodine raised my T4 even higher (above normal range) and made me feel even worse than without iodine supplementation. My theory is that the excess FT4 produced from iodine supplementation is dumped as RT3 as it cannot convert to FT3 and only further exaggerates my hypothyroid symptoms. Are theses dots connected in a logical sequence?
The only treatment that is helped me is Cytomel.
Hi!
I Wonder, how is your t3- only treatment going?
Kind regards
Irene
Your articles on the thyroid are excellent and informative. I find the “iodine controversy” interesting. Articles with “anti-iodine” sentiment inevitably refer to Hashimoto’s, but not everyone who is hypothyroid has Hashimoto’s or any other autoimmune condition.
It’s also common to reference older studies or look at epidemiological studies, but rarely does someone acknowledge how much the clinical landscape has changed over the last 30-50 years.
Rarely do I hear anyone acknowledge how much chronic halogen exposure from ubiquitous toxic chlorine and fluoride might play a role in thyroid issues and necessitate higher iodine intake to compensate for it.
While many people believe that vegetables are “universally good for us,” Americans, especially health conscious Americans, probably eat more goitrogenic vegetables and soy than Americans from a few generations ago: broccoli, cabbage, arugula, kale, etc, not to mention lacto-fermented vegetables that don’t alter their goitrogenic tendencies. These anti-nutrients block iodine usage by the thyroid, so another interesting question is how eating a “super healthy” or vegan/vegetarian diet with high amount of goitrogenic anti-nutrients might necessitate more compensatory iodine intake.
Finally, I never hear practitioner’s discuss the real issue of global nuclear meltdown events like Fukushima on the thyroid health of their patients. UC Berkeley reports on radioactive elements found in rainwater, dairy milk, vegetables, etc found massive increases in the level of these toxic elements in our water and food supply post-Fukushima. This means that west coast populations like San Francisco and Berkeley were exposed to very high levels of nuclear fallout. How do these kind of events change our need for healthy forms of iodine? The reactors are still putting out significant amounts of radiation to this day – largely ignored by our politicians and global media.
So, with all of the above taken into consideration, what constitutes healthy and adequate iodine intake??
If a typical American consumes between 2-6mg of fluoride a day – a toxic halogen that will bind to iodine receptors – can 150mcg of iodine be adequate to compensate for that? What is a therapeutic iodine dose for someone who is hypothyroid or borderline hypothyroid, but is not suffering from an autoimmune thyroid condition?
Given the substantially different clinical landscape that exists today, I think it is a bit knee-jerk to be paranoid about iodine consumption, given our modern chronic exposure to other toxic halogens, as well as radioactive iodine. Surely some people do poorly with even small amounts of iodine, but let’s not throw the baby out with the bathwater. It may be that some people do need substantially more iodine while others (Hashimoto’s patients, etc) do not.
Sean Carson, L.Ac.
GLOBAL /CONCERN for CHILDREN…: If Fluoride is a toxic halogen that binds to iodine receptors, and chlorine may play a role in thyroid issues, it sounds like nearly everyone in industrialized countries is at risk for Hypothyroidism from the water supply alone. Can children have Hypothyroidism? If so, are the possible symptoms different than you might see in adults? We have been considering a reverse osmosis system for drinking water. Now I’m convinced it is a must. If anyone knows how young someone can be to have hypothyroidism, please comment! Thanks.
I have hypothyroidism and started supplementing with 500 mcg iodine (had also been eating Brazil nuts). Started having strange things happening with my heart (skipped beats, pounding, racing). Decreased to 300 mcg, still had heart symptoms. Stopped supplementing and two weeks later had elevated tsh, but normal t4 and t3. Heart symptoms went away at that time. Now, if I have more than 2 pinches of sea salt a day my heart symptoms come back. Any idea of what might be happening?
Hi shelly, Did you figure out what was happenning, I had the same thing happenning to me, but it was because of 150mcg iodine in a prenatal supplement, I previously could use iodized salt, but after the supplement I had increased heart rate and other symptoms, I stopped supplement and iodized salt and the problem fixed, after a few weeks if I try using iodized salt the same symptoms are coming back.
Can you please tell me if you have figured out something, as I want to travel overseas and they don’t have anything but iodised salt there.
Hi! Did you find why That was happening ? I have exactly the same symptoms !
Kind regards
Irene
I am not sure, I consulted many doctors, my TSH levels are normal, but I don’t feel normal anymore. I am suffering from horrible insomnia even after I have stopped the iodised salt. I was never like this before. Sometimes I still get heart racing, but don’t know why. This could be biggest mistake of my life taking an iodine supplement and it was in a prenatal supplement, it was no mistake of mine, I feel horrible now.
Keep me updated of how you’re going.
Hello.
What happend to me was: My doctor gave me thyroxine because of elevated TSH, but I soon stopped the medication, after 3 weeks perhaps. I Didnt feel well, quite bad actually. After That I have Been having increased heart rate and heart palps at times, increased hair loss and other symptoms, so I found out it was due to iodine in the foods: egg yolks, yoghurt, fish and seafood, sushi, etc. I stopped eating everything That contains iodine. I felt much much better! I also dont use salt on My food, the response to salt isnt as bad as before but there are still some increased heart rate. I tried 50 mcg iodine with selenium two days ago, it did not go well! It was only 50 mcg and I got the heart palps back plus some increased heart rate but it will go away in some days. During these days I have also Been having insomnia, and not so cheerful as usual, more anxious and cranky :/ 🙂 but not too bad.
My thyroid hormones are all within range but they show a puituitary pattern, low tsh and low t4 and t3, chronic stress. Both T4 and t3 was higher before and I Didnt have these symptoms. I am following K. Datiz Protocol now… I think it helps 🙂
Is your hormones at the same level as before ? Because I think i have always Been sensitive to iodine, but now since ny hormones are low(but within range) they are more sensitive to iodine. I think I am on the border so it’s easy to give me hypothyroid symptoms.
Kind regards
Irene
So are you hypothyroid or hyperthyroid now, because increased heart rate and all those are symptoms of hyperthyroidism, so if you stop salt and everything do you become hypo. What sort of treatment are you going to take now?
So does it mean you can’ t take iodine or iodine rich products all your life now?
I had elevated TSH before, in Feb. Because I took iodine 400mcg everyday. I believe. I was only drowsy, and cold, did not have any other symptoms. Both t3 and t4 were in upper ranges.
I dont believe I was hyperthyroid because I Didnt Get warm, or Anything like That. I was dizzy, I Get dizzy everytime .. probably lower blood pressure. I have already low blood pressure, but I dont usually have any dizziness. With lower blood pressure, your heart rate increases. Iam on no treatment, only better lifestyle. Trying to fix whatever with supplements etc.
Kind regards
Irene
Maybe your calcium and/or magnesium are to low now. It’s described in the book The iodine crisis. Take e Calcium-magnesium supplement with the iodine and hopefully it will go better
It may be the Brazil nuts. All you need is two. Are you sure you don’t mean mg for iodine? You would be taking too much if mg. I wonder if you could be detoxing Bromine. You might want to take Methamazole from physician while working on your nutrient program. What did your doctor say?
A popular anti-inflammatory is Bromelain… Does that convert to Bromide or Bromine ?
Hey Chris
Great articles! Good work.. I was wondering if you (or anyone else for that matter) could guide me as to what I should do.. The thing is I had my thyroid tests done 3 times over the past year.. All 3 times, my T3 and T4 results were within range, however, the TSH fluctuated quite a bit. The first time, my TSH came at 9 (tht was really high!).. I didn’t go to a doc but someone recommended I have fish oil so I had that continuously. After 3 or 4 months, my TSH dropped to normal range and was at 4.0. I stopped having fish oil after that and in the recent test that I got done (4 months later), my TSH came in at 4.628. I’m 27 years old and as per the reports, the normal band for TSH at my age is 0.4-4.2
Can you or anyone please guide as to what I should do? I don’t want to go to the docs cause my friends were saying they’ll prolly give me a medicine for life :/ Also, is and can one’s TSH level fluctuate this much within a year? And did the fish oil actually benefit or was it mere coincidence?