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 cringe whenever I hear of anyone being put solely on iodine without the extra nutritional co-factors needed for the iodine to effectively do its job in the body. These include taking adequate amounts of selenium and some may even need salt loading to counteract the detoxifying effects of the iodine. On the other hand, some Hashimotos patients don’t at all do well on it. We are all individual.
Hi,
I have Hashimotos and my doc put me on Iodine. I was worried because it took me 22 years to finally get my thyroid on the right track and lose the 30 pounds I gained in one month during the beginning of the struggle- I was worried this would flip something. And it has. I’ve been following Weight Watchers, exercising over an hour a day and still gaining weight at close to a pound every two days. Did a little research and it looks like this might be connected. So I’m taking a break from the iodine and seeing what happens. Hopefully that will be the ticket. I wish people would see the Hashimoto plus iodine issues. Thank you for your info.
Hello Chris-
I have had thyroid cancer and subsequent thyroidectomy. I was treated with low dose RAI.
Would there be any benefits for me to take iodine supplements? Should I avoid iodine rich items?
I presently take a high does of artificial T4 to keep me hyperthyroid, ie suppressing the thyroid cells.
Thank you,
Nancy
Dr. Kresser,
I am 54 y/o young –active/athletic–have had increasing debilitating fatigue, weight gain, vision changes, tremors/tingling/swelling feet and hands, excessive hair loss, bad neck pain, etc. for several years and think I’ve touched bottom line. Recent tests have shown High TSH, High Cortisol, 3 Thyroid Nodules, Vitamin D deficiency and 398 blood level Iodine (normal range 52-109). One endocrinologist told me “all older women have this and there’s nothing wrong with me”. Another Internal Med Doctor who is also in Alternative Med/Interest in Vitamins started me in Armour Thyroid immediately–at least I feel she listens and is genuinely concerned. But what does this High Blood Iodine could mean??
I had started taking Iodoral and after these results I stopped and I am taking Armour Thyroid, Vitamin B-100, Vitamin D and Bio Id Hormones.
What could be the cause of High Iodine? Is it pointing to a root problem that has not been diagnosed?
Thank you for any direction you can give.
G
I am not a doctor and in no way am an expert, but …. It seems to me that if you are not able to take iodine into your cells…..let’s say you have a bunch of bromide that is hogging up the space where iodine is supposed to go….what is it going to do? It is going to hang out in your blood and not get used. It is very important to rid your body of this bromide or whatever it is that is blocking your pathway to your thyroid. These pathways are so important and a reason many of us struggle even on high doses of thyroid meds. My doctor has me on NAC, you can google it and see if it is something you might like to try or something like it. Also, selenium in the form of L-selenomethionine is absolutely important for your body. I take the maximum dose 400mcg a day, this helps me in so many ways. Most people start at 100 mcg and adjust that up to 200 mcg a day, I have hashi’s and need the extra, not everybody does. Keep in mind that selenium helps convert T4 to T3 and that could make you need less thyroid meds, it did for me.
http://www.cheeseslave.com/cherry-angiomas-iodine-and-bromide-detox/
What are people’s thoughts with Bromide. I think when I started Iodine supp 135microgram a day I started getting more of these. The body ridding itself of increased Bromide. Has Bromide got a role in Hashi?
I think at Stop the thyroid Madness the reason Iodine doesn’t work by itself is because your suppossed to take selenium at the same time… http://www.stopthethyroidmadness.com/selenium/
cheers, DavidM
This is what our laboratory website says about the non-loading 24 hr urine collection for iodine levels:
Iodine concentration is a marker of recent intake and does not necessarily confirm insufficiency. So I guess the challenge would be the one to do. Makes sense to me.
Can anyone tell me if there is more than one way to test the iodine level? I asked my doc if she’d order one for me and she said yes but it appears not to be an Iodine loading test as has been mentioned. It is however a 24 hour iodine test. I’m suppose to collect urine in a 24 hour period but I’m not to take the iodine before hand. Is that a different test?… and more importantly, is the one Chris suggests a more accurate way of testing?
I had an iodine challenge a.k.a. urinary iodine loading test. It works like this:
In more recent times a “24-hour iodine/iodide load test” has become a useful analysis for practitioners. A specified oral dose of iodine/iodide is given and urine is collected for the subsequent twenty-four hours. The Doctor’s Data, Inc. “load” report format leads the industry by permitting the practitioner to obtain individualized results based upon any oral dosage deemed appropriate for a given patient. The test is based on the concept that the body has specific and saturable mechanisms to take up iodine/iodide. When maximal retention is attained, the percentage of an iodine/iodide load that is retained decreases and the percentage urinary excretion increases. The percentage excretion is calculated by dividing the patient’s mg/24-hour iodine results by the oral iodine/iodide dosage (mg) provided on the requisition form by the practitioner, then multiplied by 100. The iodine excretion value represents iodine plus iodide oxidized to iodine. The load test requires a complete twenty-four hour urine collection.
I think my result was about 25mg indicating a severe iodine deficiency. Going on iodine at a small dose of 6mg every 2 days caused my thyroid antibodies to rise. I’ve taken a bottle of selenium tablets over a month and will see if the antibodies drop. So far, not really. I’m monitoring the antibodies monthly.
Thanks Honora,
That’s a good excerpt from Doctor’s Data. It doesn’t tell me if the traditional test, that doesn’t do the iodine loading before hand, is as accurate nor if it will give me the information that Chris is talking about. I’m guessing that the loading test is better but I need to know why before I ask my doctor is she’s willing to request it instead of the traditional test.
Do you know? Thanks for taking the time to reply.
Can anyone explain which type of iodine test to do? Chris referred to the 24 hour urine test…that you take 50 mg of iodine at the beginning of. I’ve read through this whole thread to try to get clarity on exactly what test to ask for. I’ve read of one called an iodine loading test
My doc was willing to order and iodine test for me but it looks like they will just be measuring the iodine in my urine (24 hours of it) without taking the iodine before hand. Is that going to be as effective a measure?
In my case my T3 is normal but my TSH is about a 5.97, on doctor says stay where I am with my meds, not to unbalance my T3, another doctor says I need to get my TSH number down????????
Hello just came across this thread. Two yrs ago diagnosed with hashimotos. Tsh 150. Yes 150!!! I have been treated with tirosint but sometimes I still have symptoms of hypo. Swollen face is the worst some days. Tsh now 0.77. Negative for cushings disease. No need for t3 and t4 as per endo I convert on my own. What is making me so swollen???
I did a 24 urine test and my uptake was 38%. I have hoshimotos and just found out I was pregnant. Can I start supplementing with 12.5mg of iodoral? My doctor said it was fine but I am curious of your opinion?
P.S. I’m also taking 3-4 Brazil nuts per day for selenium, and a trace mineral supplement (Schindele’s Minerals). I’m being treated by a natural practitioner with acupuncture and a herbal tincture which includes motherwort, bugleweed, hops, lemon balm and St. John’s wort. I had all my vitamins and minerals tested, and there are no deficiencies.
Hello Kate,
You might want to check out Dr. Mercola’s website. He references studies done on hypothyroidism which shows that not only too little iodine can lead to hypothyroidism, but also amounts of over 400mcg per day can ironically lead to hypothyroidism. Like you, I am also taking 4 Brazil nuts a day for selenium (2 morning and 2 evening) along with NAC to counteract muscle wasting caused by Celiac Disease. I’ve just started taking Royal Maca Root powder today for boosting thyroid function the natural way. All cofactors should be there in whole foods such as this and the amount of natural iodine per level tablespoon is about 50mcg. Dosing only twice a day with a delicious smoothie should fit me right into the correct amount of iodine to go with my selenium-rich nuts each day without adverse side effects. Maca should never be taken in its raw form, but only in its Royal (sun-dried) form so that harmful enzymes are neutralized as well as bacteria and yeasts. I find it interesting that Maca root can also cause goiters if an iodine deficiency is present in the individual. That’s actually what brought me to this article/site in the first place since I was doing research on it. However, if maca root is taken with the proper selenium supplements such as what is found in Brazil nuts in high amounts (never take supplements with sodium selenite or selenite in them-they are highly toxic varieties of selenium and will destroy your endocrine system) then the goiters never occur due to the glutathione that selenium helps produce to detox the thyroid of free radicals when hormones are being produced. I think cross references like this one can help us all determine from a practical point of view what the truth is about antioxidant cofactors when the science seems to prove very little beyond the controversy of clinical trials going seemingly opposite directions.
I think that it’s easy enough for a drug company with a special interest to fund a clinical trial with a bent on proving whatever they have to in order to keep their profits safe. But the real proof is in the real world outcome of patients who were suffering and now are much improved or perhaps cured (if we’re allowed to use that word). I also think it’s a crime that we’re not allowed to use the word “cure” for anything but a drug, yet drugs don’t cure anything. They only “treat” the ailment while causing other health issues (so-called side effects) which in turn require another drug to treat according the western medical doctors. It’s a vicious cycle until either they have all our money or we end up dead from the preponderance of side effects.
Thanks for your helpful answer!
Hi Chris, I was very happy to find this series of articles! I have had Grave’s disease since January, and your article “The Gluten-Thyroid Connection” was one of the first things I found. I immediately stopped eating gluten, because gluten intolerance runs in my family and I figured it would help. After reading Dr. Brownstein’s book I also started taking iodine at a very low level (150mcg), and began to build up slowly. However, now that I’m up to 600mcg I have started to feel worse again, and now I’ve read this article I wonder if it’s the same for Grave’s disease as it is for Hashimoto’s? Got my lab results back today, TSH .02, Free T4 36, Free T3 14. I also had my iodine level tested (in blood serum), and the result was 97; I don’t even know what that means! Help! I’ve lived in Switzerland since 1994, where Bromides were banned in 1993; I also have always eaten as much organic food as possible and almost never drink soda; so I guess it’s possible I have over-iodined myself. On the other side, there are people taking 50mg with no bad effects! I’m confused.
http://goo.gl/XaIo4
This may answer the questions you need answered. I also highly recommend the books The Iodine Crisis by Lynn Farrow, Iodine by David Brownstein, and Stop the Thyroid Madness by Janie Bowthorpe
Read those three books and the Iodine supplementation guide and you’ll have a much better understanding. The Yahoo Iodine and IodineOT discussion groups are also great resources.
http://breastcancerchoices.org/ipractitioners.html
http://www.stopthethyroidmadness.com/how-to-find-a-good-doc/
These might also be of use as well.
Good luck in finding your path to health. The Iodine level you had tested won’t tell you much of anything. Its better to get a Iodine spot and loading test along with a bromide load test from Hakala labs.
More details are in the supplement guide I linked at the start.
Jonathan,
The first link no longer works. Do you know of an alternative available now?
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Hi
I enjoy researching alternative healing as a hobby and many times I run into your articles. I recently read your article on iodine and thyroids. My first question would be, is doing an iodine deficiency test on the skin an effective test to see if a person is low on iodine? I’ve done a lot of research on iodine and I realize that taking too much or taking it without selenium could harm the thyroid. I’m making 5% Lugol’s Iodine. So here is the dosage I’m running by you to see if its ok…If I the iodine on my skin is gone in less then 4-6 hours and I’m low on iodine then i’ll take 1-4 drops of iodine (4 drops is 25mg of iodine) once a day with 200 mcg of selenium and 500 mg of tyrosine…is that a safe dosage for thyroid problems?
Thank-you
Hi,
I’ve had diagnosed Hashimoto’s Thyroiditis since I was 12 years old. There is a strong belief that I likely had this from birth or developed it much earlier than my diagnosis and it was only found at that time because I stopped growing at the size of a typical 6-8 year old or show any beginning signs of entering puberty. Once I started thyroid hormone replacement therapy I rapidly grew to a height commensurate with the other females in my family and after the growth slowed I went through puberty. I am now 41 and had been stable on the same dose of Levothyroxine since the time I was diagnosed, but now my labs are going crazy. On that stable dose of Levothyroxine, I have been undergoing testing nearly every two months due to these radical fluctuations. One test is severely underactive (TSH 49), the next test is severely overactive (TSH 0.001), the next severely underactive (TSH 66), the next severely overactive (TSH 0.004), etc. I take my Levothyroxine at the same time every morning, on an empty stomach and do not eat for at least 30 minutes. I take no other medications at the same time as my Levothyroxine and have always taken the same multivitamins in the evening after dinner. I was told by a reproductive endocrinologist, that I was seeing for fertility issues at one point, that eventually the antibodies associated with Hashimoto’s will kill off the thyroid all together. However, towards the end, the thyroid will fight for it’s life. In his explanation, he likened this to a car running out of gas. The car will go downhill, where it can contact small amounts of gasoline left in the tank and sputter back to life giving the car the ability to run again, meaning the thyroid will come back to life to certain extent, as it temporarily wins this tug of war for it’s life and kick out massive amounts of thyroid hormone, causing you to be overactive. Once the car starts going uphill, it cannot access the small amounts of gasoline in the tank and it will slow down or stop, meaning the antibodies start to win again, so it slows down and the thyroid hormones become inaccessible again causing you to be underactive. He said that this will usually continue until the thyroid dies off on it’s own and then a stable dose of thyroid replacement hormone can once again be found. Other patients undergo radioactive iodine treatment or surgical removal of the thyroid under a doctor’s recommendation or through the patients urging because the process is taking too long and the ups and downs get to be too much for the person or for the person’s system to handle and then a stable dose of thyroid replacement can once again be found. He said that most patients don’t reach this point in the course of Hashimoto’s because they don’t develop Hashimoto’s antibodies until later in their lives so they don’t have active Hashimoto’s for 30+ years. My regular endocrinologist did not disagree with any of these things or the reproductive endocrinologist’s explanation of it, but he refuses to suggest or let me undergo radioactive iodine treatment or surgical thyroid removal. My problem with this is that I don’t feel that I can continue to go through these rapid and extreme fluctuations for much longer. They are causing other health issues for me due to the fatigue, insomnia, hot and cold fluctuations and too many other things to mention. I have constant heart palpitations and recently had an abnormal EKG, which I need to have repeated as it is very different from my previous EKG’s performed before these fluctuations began. I believe this may be connected to the abnormal issues with my thyroid, as well. What could cause such radical shifts in TSH while on the same dosage, taken under the same conditions throughout the testing period? What are your experiences with patients who’ve had long term Hashimoto’s Thyroiditis and hormone antibodies? Does the explanation that the reproductive endocrinologist gave sound accurate? How does someone in my condition find a stable dose of thyroid replacement hormone? Have you heard of Hashimoto’s patients undergoing radioactive iodine treatment or surgical thyroid removal? What impact can long term, radical shifts in thyroid hormone have on the body or systems of a Hashimoto’s patient?
Thank you for any help you can offer in this area,
Fed up with 30+ years of Hashimoto’s Thyroiditis!
http://www.breastcancerchoices.org/iprotocol.html
http://www.breastcancerchoices.org/ipractitioners.html
http://www.stopthethyroidmadness.com/
I highly recommend that you read Iodine by David Brownstein and Stop the Thyroid Madness. I think they may be very helpful to you and your situation. With an Iodine Literate practitioner I think you could solve your problem.
Also the use of a hormone that isn’t T4 only may help as well which is why you might want to read Stop the Thyroid Madness.
Good luck
So sorry that you are experiencing such difficulty.
Have any of your doctors suggested that at 41 you may be going through peri-menopause which would cause the symptoms you are describing? Or if you are taking fertility medicines this could be throwing your thyroid, and adrenal system and other hormones into imbalance, too, which could produce the symptoms you are experiencing.
I’m not a doctor, nor an expert. But I was diagnosed with Hashimoto’s six years ago (age 16) and I have been on Levoythyroxin that whole time. And I still feel terrible. Now, I don’t know if I feel bad from some other undiagnosed problem (I’ve been going to doctors for years trying to get a diagnosis for severe fatigue, being unrefreshed after excessive amounts of sleep, severe night sweats, and thin, weak hair.) Or if maybe my thyroid is not being treated properly. I am on a Vitamin D supplement, even though my deficiency was not brought to my attention for a couple years after my diagnosis, nor that it could be connected to my thyroid.. But I have never heard from any doctor to take other supplements as well, like Selenium. I just recently was looking for causes for my adult acne and found out that iodine can cause acne and that increased my desire to found out if I am taking an unhelpful medication. I also read that even if my thyroid levels are normal, with Hashimoto’s it doesn’t really matter if I am still feeling bad and have unresolved symptoms. So, I can’t make comment on what facts are true or false or any of that, but I can say that I have been taking a medication to fix my thyroid symptoms that happens to have iodine and that I can say 100 percent that I don’t feel well or that my thyroid problem has been helped at all!
Also, if these two sentences are true, I am flabbergasted as to why in the hell I am being treated with a medication that can do the exact opposite of what I was taking it for: ” Because increased iodine intake, especially in supplement form, increases 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.”
Also, I have found through the years and numerous doctors (some even at Mayo clinic) that doctors are very uninformative and do not share valuable information with their patient about their health or how to make themselves feel better.
I really think it would go a long way to helping you restore your health if you read Stop the Thyroid Madness by Janie Bowthorpe, Iodine by David Brownstein, and/or The Iodine Crisis by Lynn Farrow. I really enjoyed both the last two, but its up to you.
There may be people that actually feel wonderful on T4 only treatment like Levoythyroxin, but I haven’t seen those stories. Janie’s book is filled with patient stories where they used T4 only treatment exclusively and never felt a significant improvement. Their tests were better. The TSH test “improved”, but they still felt like crap.
Some other resources that may be useful in case you decide to supplement Iodine are at the following websites.
http://health.groups.yahoo.com/group/iodine/files/01%20NEW%20MEMBERS%20-%20READ%20FIRST/
This may require membership to get to the page though I don’t think so.
http://home.comcast.net/~jocy1/junk/The%20Guide%20to%20Supplementing%20with%20Iodine.pdf
In case it is the membership is free by the way you just have to request it. Great discussion group on Iodine.
tinyurl.com/iodine-references.com
This is also great.
Good luck
Jonathan
I just want to say that I am one person that was very much adversely affected by taking Iodoral. I have lost my thyroid gland because of taking 12.5 mg/day of that supplement.
I test negative to all the usual antibodies that most doctors test for, i.e., TPO, TgAb, etc. Little did I and my doctor know that II was hypothyroid due to the TSH Receptor antibodies (TRAb). He put me on Iodoral to help with my hypothyroidism. Within a month, my FT4 and FT3 starting climbing and kept on climbing. When I saw an endocrinologist, I was diagnosed with Graves’ disease. I now know that I’ve had TRAb all along.
The TSH Receptor Antibodies (TRAb) can be BLOCKING (TSBAb) causing hypothyroidism or STIMULATING (TSAb/TSI) causing hyperthyroidism (Graves’ disease) and it can switch between the two.
WARNING TO HYPOTHYROID PATIENTS CONSIDERING TAKING AN IODINE SUPPLEMENT: At the very least, you should get tested for the TSBAb via the TBII test. If you are positive, don’t take the iodine/iodide, it’s NOT worth the risk, believe me, it’s been hell having Graves’ disease.
Hi Chris,
I have Hashimoto’s disease and just started taking Iodine from a recommendation by Dr. Brownstein’s newsletter saying Americans don’t have enough iodine in their diet and the lack of iodine can cause cancer. If I take selenium with the iodine will that solve the problem? What if I continue to take Iodine what might happen?
Based upon the findings of research found in the following link
http://drsircus.com/medicine/iodine/iodine-rescue
this article and the title are somewhat misleading . To use a photo of table salt containing Iodide does not address the successful use of other forms of Iodine, especially the atomic (Nascent) form rather than the molecular form.
Robert
Their are different types of iodine. I believe salt company use low quality iodine in their products, also salt is chemically and heat treated, very low quality. Today many quality salts are available if you take the time to look for them, and yes they cost more. But their much healthier and they taste better, and I like pink Himalayan salt.