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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What if you are taking Iosol iodine not potassium iodine?
Iosol also contains iodide in the form ammonium iodide.
Excess iodine intake can cause an autoimmune thyroiditis that bears all the characteristics of Hashimoto’s. However, in animal studies this occurs only if selenium is deficient or in excess. Similarly, in animal studies very high iodine intake can exacerbate a pre-existing autoimmune thyroiditis, but only if selenium is deficient or in excess.
With optimal selenium status, thyroid follicles are healthy, goiter is eliminated, and autoimmune markers like Th1/Th2 ratio and CD4+/CD8+ ratio are normalized over a wide range of iodine intake. It seems that optimizing selenium intake provides powerful protection against autoimmune thyroid disease, and provides tolerance of a wide range of iodine intakes.
In the next post in this series (Iodine and Hashimoto’s Thyroiditis, Part 2, May 26, 2011), we’ll transition from animals to humans. Does epidemiological evidence suggest that these animal findings are transferable to humans?
http://perfecthealthdiet.com/2011/05/iodine-and-hashimotos-thyroiditis-part-i/
Dr. Kresser:
Thank you for most informative article, wish I would have seen it when you first wrote it! In 2010 my GP put me on Synthroid, .5 and after 3 months with no relief from symptoms, put me on .88. I asked for Armour Thyroid because I had seen Stop the Thyroid Madness. Doc flat out refused. Went to a Univ. of Texas Endocrinologist and she refused, too. She referred me back to MD Anderson as I had had a skin cancer tumor removed (Dec. 2010) and have intestinal metaplasia in my stomach which can lead to stomach cancer. I went to an alternative doc in Katy, Texas for a LOT of money and prescribed his own version of Armour for me. Didn’t notice a lot of relief. Finally found a doc on my insurance then that would prescribe Armour. Did it for 8 weeks and then asked to switch to Naturethroid .65 mg twice a day. Then in November, Doc said my numbers weren’t low enough so he recommended two pills in the morning and one in the afternoon. I backed it down to 1.5 since my heart rate was staying elevated. I had tried Kelp Iodine last year but then stopped when I heard that it can be a problem for Hashi patients. I think my adrenals are taxed, too. They Katy doc had me on cortisol for six months and I loved the way I felt energized on it but didn’t want to stay on it indefinitely. It sounds like you are not completely endorsing Iodine supplementation? I want to try it if it is beneficial for me. Can you give me some direction on Iodine recommendations and adrenal testing? Thank you and God bless you!
Dr. Kessler,
Thank you for giving your input on this obviously controversial topic. I have Hashi’s and continually have positive results from treatment (Synthroid, Levo, Armour, etc…) followed by declining mood, health, etc… So I knwo my immune dysfunction is probably severe. Here’s my question(s)
1. I considered that I might be hyper sensitive to iodine, and that I might be better if I tried to remove it from my diet (dairy, kale, iodized salt, processed foods) My diet is actually quite ‘healthy’ – mostly organic, not a lot of sugar, etc… If I did that, would I be at risk to develop goiter?
2. Would a better solution be adding Selenium to counteract dietary iodine?
3. What are the drawbacks to taking a Selenium supplement?
Thanks!
Chris,
Thanks so much for your help!
Here’s my problem: I was diagnosed hypothyroid and my doctor recommended iodine supplementation. I started last week at one drop per day in water, of Iosol. By day 4 or 5 (which was my last day on the stuff!) I felt so dizzy and started having a really strong pulse. A couple of days later, panic, “clicking” in my ear, and heart palpitations. I still get the heart palpitations, and it has been six days off of the Iosol! Can you please tell me if these symptoms can truly be related to too much iodine? I realize that I may not have even been deficient and wonder if, even in just 4 or 5 drops of Iosol, I overdosed? Can you also tell me when symptoms may end? Magnesium seems to help the heart palpitations but should I also take selenium? I’d appreciate any advice you have, and I thank you!
Personally, I would NOT take SynCrap for all the money in china…..I’ve been taking Armour since 2002 after a 10 yr depression struggle where I thought all along I had a sluggish thyroid….
I take Iosol drops daily and when I have slacked off, I would get breast pain and tenderness…
Can you get to an Integrative MD and get on the right track?
Sorry. Date correction. (Dec. 24, 13 – not 2014)
In Nov 2013 I started Lugols 2% 1 drop orally on and off. About every other day. Sometimes I’d just use a couple drops topically instead. — I had been having some seperate issues unrelated prior to starting Lugols, so I went to the doctor for bloodwork for that issue on Nov 21st. — I was shocked when he said I was hypoT. #633.
He gave he 50mcg Synthroid, which I didn’t take because I felt it was the iodine that induced this, and not a true reading. So, I thought maybe it was just going to take some time for my body to adapt to the iodine. I continued as I had been taking the Lugols for several more weeks until I noticed I started GAINING weight. So, I decided to stop the iodine completely (Dec 24, 13), and let it get out of my system and then get retested.
A couple days later I started itching ALL over my body – detox/die off? Iono. So I pressed on to get the iodine out of my system. I had headaches, and even some deep chest pains on right side of my chest. Well finally after 11 days w/ no iodine (I read that it takes about 10 days to get this completely out of the system), I went back for bloodwork (Jan. 3, 14). When my doctor retested me, OMG. My TSH was now higher 668! (Of course he increased Synthroid to 75mcg)
Ok, I don’t get this, I was taking low dose iodine and TSH was 633, I quit completely for 11 days and it’s 668? So, what’s going on?
Well, now I’m back trying to take the iodine. 3 drops topically. The itching stopped immediately. So did the chest pain and headache. But, I’ve gained weight and even at LOW calories intake of 1100-1200. I’m just stuck here weight wise. If I eat normally, I gain. Plus I’m COLD all the time. Low temps of 95.5-96.8 is average. What do you suspect is going on with me? Any thoughts at all? Should I begin the Synthroid? Press on with the iodine? Thanks for your time. Blessings.
I’m still confused as to whether Iodine can help treat hyperthyroidism. (graves disease) . There is much confusion between Hyperthyroidism( over active thyroid) and hypothyroidism (under active thyroid) believe me the treatments are completely opposite. Just ask my wife who was given the a hormone replacement drug instead of a hormone inhibitor drug. Neo-Mercazole. It nearly cost her her life.
Absolutely true.
I had a person at a health food store to prescribe something for hypo when I am hyper.
As has been commented numerous times, alternative as well as medical are not very knowledgeable about the thyroid issues.
iodine/potassium iodide is and was used long ago to treat both hypo and hyperthyroidism. Although it’s true that iodine is necessary for the formation of thyroid hormone, this doesn’t mean that everyone with hyperthyroidism should avoid iodine. First of all, remember that most people with hyperthyroidism have Graves’ Disease. And although this condition involves an excessive production of thyroid hormone, the reason for this is due to the autoimmune component. It’s the TSH receptor antibodies which stimulate or attack the TSH receptors, which in turn results in the overproduction of thyroid hormone. Giving someone iodine doesn’t mean the thyroid gland will produce even more thyroid hormone. In fact, in the past, medical doctors actually recommended Lugol’s solution as a treatment for hyperthyroidism and Graves’ Disease
so no. the health food practitioner isn’t the ignoramus. its you.
The Iodine Loading Test has been shown that it does not accurately show iodine levels, as iodine is also excreted in feces and sweat, and that iodine continues to be excreted beyond the 24 hour testing time. http://www.townsendletter.com/Jan2013/iodine0113.html
There are a lot of tecnical questions being asked, that quite frankly as a lay person I have no idea what they mean. I would like to ask some simple down to earth questions…. I am a 43 year old female, I have been on levothyroxine since shortly after the birth of my first son 21 years ago. Never experienced any problems, have had occational adjustments in dosages, no big deal, felt great.
For approx the past year I have been feeling awful. My thyroid labs were reviewed and my dose is up now to 225mcg. Still feeling awful, fatigue insomnia, SEVERE muscle aching, hair loss, intolerant to heat and cold, ect…all the wonderful symptoms that accompany hypothyroid patients.
However, my family physican is now leaning towards fibromyalgia and treating me for such. My confusion lies in the symptoms overlap and being so simular.
225mcg is a large dose, could my body possibly not be converting T4 into T3?
Recently i have added an iodine supplement (recieved from global health) to my plant based multivitamin (which contains plenty of the reccomended selenium) I have never seen an endocrinologist in my 21 years of treatment, never had an ultrasound (even though my mother had a goiter removed) and to my knowledge Im not aware if my T3 levels have ever been tested.
I guess…..I really just want to stop recieving the run around, and to be treated for the CORRECT condition and most of all to FEEL BETTER! Can you help me..Specialy pysicians are hard to find in my area, I live in rural nebraska.
There is a consensus in our international thyroid group that when our T3 is low, we tend to get fibromyalgia type symptoms. Many have gotten relief simply by raising their T3 levels. There can be a number of reasons why T3 levels drop, even for those who have had success taking T4 only medication for some time. The iodine could be a factor, or that your body is stressed in some new way and much of your T4 is actually being converted into Reverse T3. Low iron storage levels also cause this as well as sub-optimal liver health. I would suggest experimenting with dropping out the iodine and if that doesn’t help, get your free T4, free T3, Reverse T3 levels checked. There is a helpful math equation to work out the ratio between Reverse T3 and Free T3 since raw lab numbers tell very little. This can be found online via Google. I’d also test full iron panel to see what is going on there. For me my thyroid was affected also by hormones as I started into Peri-menopause, so recent changes could be related to other hormones too.
I start to wonder if taking Iodine as I do, about 10-12mg per day, is the right thing to do…I deal with Hashi and had numbers as high as 841 over the years, but recent labs showed 84. So this is good in the whole scheme of where I’ve been……I take 120mg Armour daily, take selenium daily, Vit D3 and K2 and Vit C.
And feel I’m ok….when I skip Iodine and I’ve done that but no more, I get breast pain and tenderness….
Iodine has to go to so many places in our body. A friend just told me “our” integrative MD told her to get off Iodine she’s been taking for a couple of years on my suggestion. I think she is wrong to go off the Iodine and she is a pretty strict vegan to boot.
Its amazing how the importance of iodine has been so quieted. Iodine is found in every cell in your body and is very critical to a healthy thyroid. With the thyroid problems increasing, especially in woman, one would think that the studies on iodine would be the focus. Like the studies that prove that every person with a thyroid disease or disorder has an iodine deficiency!
According to the World Health Organization’s Department of Nutrition for Health and Development, iodine deficiency is a public health problem in 54 countries. The CDC states that iodine deficiency is one of the four major deficiency diseases in the world and the easiest to correct. Yet information about the importance of iodine has yet to hit the mainstream media!
http://www.globalhealingcenter.com/?a_aid=528d5efe5749d
I’ve read that Hashimoto’s doesn’t always show up on blood tests. My results were negative, but no cause has been found since I was first diagnosed almost 18 years ago. I tried taking iodide recently, just 12.5mgs/day, and I started to have negative symptoms show up in skin and hair. Any advice?
http://www.ncbi.nlm.nih.gov/m/pubmed/23521369/
I wanted to drop this pubmed article here for information’s sake.
Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review.
AuthorsStamatakis E,et al. Show allJournal
Eur J Clin Invest. 2013 May;43(5):469-75. doi: 10.1111/eci.12074. Epub 2013 Mar 25.
Affiliation
Department of Epidemiology and Public Health, University College London, London, UK. [email protected]
Abstract
BACKGROUND: Expenditure on industry products (mostly drugs and devices) has spiraled over the last 15 years and accounts for substantial part of healthcare expenditure. The enormous financial interests involved in the development and marketing of drugs and devices may have given excessive power to these industries to influence medical research, policy, and practice.
MATERIAL AND METHODS: Review of the literature and analysis of the multiple pathways through which the industry has directly or indirectly infiltrated the broader healthcare systems. We present the analysis of the industry influences at the following levels: (i) evidence base production, (ii) evidence synthesis, (iii) understanding of safety and harms issues, (iv) cost-effectiveness evaluation, (v) clinical practice guidelines formation, (vi) healthcare professional education, (vii) healthcare practice, (viii) healthcare consumer’s decisions.
RESULTS: We located abundance of consistent evidence demonstrating that the industry has created means to intervene in all steps of the processes that determine healthcare research, strategy, expenditure, practice and education. As a result of these interferences, the benefits of drugs and other products are often exaggerated and their potential harms are downplayed, and clinical guidelines, medical practice, and healthcare expenditure decisions are biased.
CONCLUSION: To serve its interests, the industry masterfully influences evidence base production, evidence synthesis, understanding of harms issues, cost-effectiveness evaluations, clinical practice guidelines and healthcare professional education and also exerts direct influences on professional decisions and health consumers. There is an urgent need for regulation and other action towards redefining the mission of medicine towards a more objective and patient-, population- and society-benefit direction that is free from conflict of interests.
© 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by Blackwell Publishing Ltd.
PMID 23521369 [PubMed – indexed for MEDLINE]
Full text: Blackwell Publishing
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Guidelines, editors, pharma and the biological paradigm shift.
Health is wealth: considerations to european healthcare.
How to develop cost-conscious guidelines.
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The medical expenditure panel survey: a national information resource to support healthcare cost research and inform policy and practice.
Hi everyone. Just wanted to say thank you to everyone for offering such great feedback on a very difficult topic. I apologize if this has been posted in the past, and I missed it, but has anyone read this article (or the studies referenced in it) on the need for iodine and selenium to be taken at the same time or have any comments on it?
http://perfecthealthdiet.com/category/nutrients/iodine-and-selenium/
And secondly, it appears that Hashimoto’s is predominantly found in women. Could it be that estrogen dominance or a failure to detoxify estrogen properly is contributing to the problem?
http://www.dannyroddy.com/main/2012/3/12/hashimotos-disease-excess-estrogen-in-disguise.html
Chris talks about both of these phenomena, but it seems like the “iodine vs. no iodine” debate gets a lot of the attention.
Thanks again for any insights!
My question is this.. I no longer have a thyroid.. I take synthroid daily.. but my worry is if the SHTF and I couldn’t get medicine what could I take to replace it?? It seems that my 80 yearl old mother took iodine to treat her’s after her’s was removed, that was before Synthroid..I want to be able to treat myself if I cannot get my med if we have a economic shutdown or a depression hits us! Thank You!
Was wondering if u ever got a reply or found out something to use , I have also had a Full thyroidectomy back in 2010 and also am wondering if the shft hits what I can use ? What and how exactly amounts did your grandmother use ?
Good day Sir. I am a nutrition and dietetics student. I would like to ask what will be the cost and benefits if a high dosage of iodine is consumed as well as a low iodine is consumed. And what are the specific dosage of high and low iodine. Thank Sir and hoping for your reply 🙂
I have been diagnosed with hashimotos. I was wondering if getting hyponatremia from drinking too much water before during and after the London marathon could have led to the autoimmune response? That was in 2003 and was my first marathon. I have only done one other marathon in 2010 and it was after this that I was diagnosed with H after feeling very lethargic. Do you think long distance running or running general is still a suitable form of exercise for me or could it be putting too much pressure on my adrenal system and thyroid? I generally feel ok and am on 100mg of levothyroxine. I enjoy running but am not sure if it is doing me any good.I’m interested in your thoughts or anyone else’s. thanks
Hi Chris,
This is a really compelling article – I love how you’ve emphasized the importance of concurrent vitamin D and selenium with iodine supplementation.
I agree with you 100%. As a naturopath, I see on a daily basis that Iodine is so important, yet does carry significant risk if use is not monitored properly and if patients are not risked out for use. There are MANY times that I’ve seen patients come in with elevated TSH numbers as a result of using Iodine, perhaps most often in those with Hashimoto’s disease. As you’ve mentioned Chris, those with Hashi’s do need to be cautious as a general rule. And in some cases, a Hashi’s patient may actually be iodine deficient and require iodine.
In patients with goitre or who are iodine deficient, the proliferation of thyrocytes can cause hyperthyroidism to occur on beginning iodine supplementation. This effect is sometimes hard to avoid…however it managed properly, correcting iodine deficiency can provide great benefits to the patient. The patients I always look at as being much more risky are those who are iodine deficient, and who have pre-existing cardiovascular disease or angina. In these patients, a transient hyperthyroid state can be truly dangerous…and so much caution is warranted with supplementation.
We are currently using dried urine iodine testing in the clinic. It closely approximates the 24 hour urine iodine collection and is a lot simpler!
if you have a moment, I hope you might want to read my evidence -based blog post on iodine and hypothyroid/hashimoto’s in relation to fertility and pregnancy, which is my clinical focus. Iodine is a crucial nutrient (that must be administered with care, knowledge and caution)for all of human life, and most especially in the time of reproduction.
http://www.whitelotusclinic.ca/blog/dr-fiona-nd/iodine-and-hashimotos-fertility/
warmest regards,
Dr. Fiona McCulloch ND
Good day Mam. I am a nutrition and dietetics student. I would like to ask what will be the cost and benefits if a high dosage of iodine is consumed as well as a low iodine is consumed. And what are the specific dosage of high and low iodine. Thank you mam and hoping for your reply 🙂
Can anyone please help me.
I always used iodized salt and ate sea food without any problems , but I was planning a pregnancy so I brought a prenatal supplement with 150mcg iodine and 500mcg folic acid, After few days with 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.
I want to travel overseas and they don’t have anything but iodised salt there. I am also 10 weeks pregnant and this is worrying me a lot. Should I avoid iodine all my life because I’m getting hyper symptoms.
Anje5, You must give your body selenium for quite a while before starting iodine. This prepares the body for the iodine. Without it you will have the problems you speak of. I would definitely find a good doctor in your area that understands health, not just medicine. I have a functional medicine doctor who is also an OB/GYN. I find this is a good fit for me. Someone once told my Mom she was allergic to iodine, so we had no iodine in our home …..ever. By having a deficiency to iodine, it led me to many other problems. I now have hashimotos and struggle to stay well.
I needed iodine, your baby needs it…. you need it. You just have to make sure you are doing it correctly, make sure you are taking a good clean supplement of L-selenomethionine for a while before adding iodine to your routine. Also, make sure you chose a good grade iodine, look for a reputable company that uses good processes for their supplements. This you should do for every supplement you take, pregnant or not. Good luck with your baby.