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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Hi Chris,
I’ve had hastimoto since 1998 and I have been taking bio identical thyroid meds for about 3 years and before that armour. Six months ago my blood tests showed that I had a very low iodine reading, along with b12 and deficient selenium levels, b2 and b6. My doctor increased my dosage of tsh, t4 and t3. I took iodine supplement for 3 months a levels were normal at the next test tsh went up from 3.13 to 4.14 and t3 went from 80 to 65. Then 3 months another blood test (I had stopped taking the iodine supplement) and my iodine levels were very low again and my tsh level went down to .34 and t3 51 t4 1.0. I’m taking the iodine supplement ( 12.5 every other day) again along with selenium as recommended. Don’t my levels sound hyper? My doctor has increased my dosage again and I’m worried that I will be hyper. Your thoughts?
PS: I also added 4 grams of krill/purified fish oil. I have also cut way back on vegetable oils and have raw nuts (two brazil nuts a day for selenium; almonds, walnuts, sesame seeds etc.) each day and lots of dark greens. And I try to keep foods basic. Not a lot of packaged chemical filled foods.
Another thyroid group told me Almonds are goitrogenic, so I avoid almonds a lot now. Check that out.
I wonder how high phytates are in brazil nuts and whether the selenium is actually available to you or bound by the phytates?
Dr. Kressler and other respondents: very interesting message board. And always learn something from everyone’s experience.
I’m not qualified to speak on anything but I do want to add. It’s real important to address thyroid issues with a Dr.’s oversight. I was diagnosed with Hashi’s in 1978. Ignored the significance of it. Just didn’t understand. Consequently I spent my youth very very tired. In 1996 I could hardly make it through a day. Never connected it with Hashi’s. My husband insisted I go in to see what was wrong as I had to sleep all the time. If my memory serves me right, I was tested for thyroid and it came back a score of 18.5. Something like that. They immediately put me on thyroid medication and advised if I failed to take it I could go into a comma they couldn’t bring me out of. I can not tell you the immediate improvement in my whole quality of life.
What I do want to say is that Dr. Kressler makes a very important point. If you have tried all the right things to correct your thyroid condition its real important to remember that deficiencies in other areas are so important to investigate. The body needs a lot of things we sometimes are deficient in…and for decades. Sometimes deficient since utero. Namely Vitamin D levels. It can cause havoc as I found out. Also B levels, very important. I keep my Vitamin D level at 65 and my B12 as close to 800 as possible and I feel so good now! I think of all the years I just pushed myself to raise a family, never miss work and always running on empty. Don’t just look at thyroid, the body needs a lot of things we don’t get in modern life. I suspect most of us are really low in D levels and B12. I get myself down below the 31st latitude during the winter as often as I can. I think it is essential for good health. That has been my experience. To good health!
Agreed on Vit D. See Dr Holick’s views/research into this. Apparently us humans can’t get enough from diet alone, and we need more during the winter months (due to low light levels). I also was deficient in vit d (tested at a UK NHS lab).
Also, look into Vit C. I’m taking massive dosages at 10k grams (not mg!) daily. Starting to feel slightly better in myself. Worth reading: Vitamin C: The Real Story, by Hickey/Saul. Again, humans cannot produce this although most animals can.
Had a friend who took massive doses of vitamin C and died from it. Tragic!
Oxidation has it’s uses but too much is harmful. That’s why the body uses ant-oxidants to quench oxidants after they’ve played their part. Cyanates, think isothiocyanates and almonds with cyanic glycosides,
become cyanide in the presence of vitamin C.
Dr Kresser,
I just had a serum iodine test done and my reading came back at 398mcg. What would be your suggestion on what to do next?
Thank You,
I am currently suffering a bout of thyroiditis, no signs of antibodies so the endocrinologist thinks it is because I was taking iodine supplements for 3.5 years. Was up to 18.75 mg of iodine via Iodoral for about the last year and a half. Started very low and worked my way up very gradually. Felt that 18.75 was good for me, could tell it was too much if I took 25 or more. I am conflicted whether to believe it was indeed the iodine or other causes. Had a VERY stressful two weeks before it hit, not sleeping normal hours, not sleeping much at all. Then ate wheat and dairy the day before and day of the hyperthyroid’s first sign, which was a heart rate of over 135. Tried to use herbs (motherwort and bugleweed) rather than drugs but was back in the ER with a heart rate of over 190 and fibrillating all over the place. Now taking some beta blockers hoping, waiting for it to resolve. It’s been over a month. I am tempted to try using a VERY small amt of iodine for a couple of days and then lithium but not the huge doses recommended by the holistic doctor who uses 900 mg a day. Mainly just waiting it out but am quite dizzy a lot of the time lately, tired, and my muscles are catabolizing away. Any suggestions?! Thank you.
I have had my thyroid remove 15 years ago. They had never been able to get any of my levels straight . What are they doing wrong and what questions should I be asking. My body swings both ways and it is so hard for my family to understand what I am going though. Help!,
This is a very common problem, because not a lot was taught in the old days about treating hypothyroidism. But I saw a young doctor, fresh on the scene, and I guess they take more now in med. school. He told me to make very tiny incremental changes one way or the other, until you are euthyroid (neither hyper nor hypo). First of all, I use the 50 mcg. pill, and change my dose 1/4 pill per week at a time. Test after six weeks. By then you will have a good idea. Ten years ago the Association of Clinical Endocrinologists said the best spot for your TSH (if you are on a T4) is .2 – 2.0. I am very happy at 1.5. I
Hi Chris,
Are you concerned about the level of mercury and other heavy metals found in kelp — including the one you recommend?
http://www.sciencedirect.com/science/article/pii/0013932774900652
Thanks in advance,
Kelly
I am concerned that kelp naturally contains methyl bromide which is supposed to cause damage to the iodine symporter, as the bromine being of higher molecular weight displaces the iodine. Also a web site on seaweed consumption advised limiting all seaweed consumption to 2X per week because higher consumption was connected to incidence of papillary carcinoma of the thyroid.
While you’re at it don’t forget the high levels of Methyl Bromide, a toxin which is even found in sea salt at low levels but who is defining how low something needs to be to have negligible biological effect?
Dr. Kresser:
I recently took a 24 hour iodine loading test (Hakala Labs) and the results showed that I was iodine deficient (I excreted only 61% of the dose). I also excreted 3.15 mg of bromide, in which the lab technician commented that any amount above zero is of concern.
I want to start taking iodine but am cautious to take more than 6.25 – 12.5 mgs. If I do this, how much selenium would you recommend that I take (along with the iodine). I understand that these two supplements should be taken together, etc. Am I correct in thinking that supplemental iodine can act as a chelating agent for bromide and fluoride? By the way – I do have Hashimoto’s.
I appreciate your consideration,
Max
max,
did you hear anything back from the Dr. regarding how much selenium to take with the iodine? I’m in the same spot. Also have hoshimotos. I’m wondering if I get my blood tested and I come back low for iodine if that’s accurate at all. Any thoughts? I’m afraid to do the loading test.
Thanks 🙂
Most recommend 200 mcg (not mg) of selenium.
Brazil nuts vary in how much selenium they contain so you cannot be sure.
47 year old female, with Hashi. TPO in 200’s. Low end for T3. Mid for T4. TSH 1.2 or less. Thyroid Storm that nearly took my life 7 years ago. Have read all the books mentioned here. Took iodine loading test- was at 90% (how is THAT possible? I live in Michigan).
Current Protocol (established by me and not a doctor since no one would treat me at the time, tho just recently found endo willing to try to work with me):
6.25-12.5 mg Iodoral
Magnesium
Selenium (brewer’s yeast- good or bad?)
Zinc
B2
B3
Multi vit
Omega 3
Calcium citrate
Pharmacy mix of Progesterone for estrogen dominance
D3 (2000-4000IU)
Alfalfa (to help with chronic inflammation)
Probiotics to help heal gut
Gluten free for 4 months
Dairy free for 6 months
1/4 grain of Armour (only on it for 6 weeks)
This will be a long process to see if improvements in overall health and symptoms are gained by the above protocol. Anyone have any comments? Thank you, Lauren
Just read that IL-6 can totally block, by itself, the conversion of T4 to active T3. Logically this blocking would have its limitations and possibly by increasing T3, as with Cytomel, this blocking can be superseded. In addition, Nettle tea, Chinese Skullcap, and Boswella or Boswellin( a trademark product with other inflammation suppressors like turmeric activated by black pepper) and Celery seed extract or safflower petals should help.
hi, I’ve been diagnosed with postpartum thyroiditis in June 2013 ( I had my baby in late January) at first I had dropped weight and was tired, had diarrhea and a heart rate of 120 ,my Dr put me on a 20 mg beta-blocker 3/ day….months have past and my blood test are each time slightly better but still in April 2014 I am still in the hyperthyroid phase, my heart rate is around 70 now , my weight is stabilized I even put on some pounds, …so I started taking selenium 200 and a tablet of kelp 325 a day ,2 months ago .the kelp has helped my energy levels but other then that , is it normal that it last so long 11 months and counting ? I am desperate to go back to normal .any advise? Please help
Hi Dr Chris,
My daughter was born with no thyroid and I’ve read that the thyroid gland is formed when a fetus is only 3 weeks old. Before falling pregnant I was taking Iodine supplement because I had been tested and found deficient. I knew there was a link with iodine and the thyroid so I wondered if you thought there was any chance the extra iodine I was taking could have been excessive for our baby in utero and caused her congenital hypothyroidism? It doesn’t matter either way as we have a beautiful baby girl but I would love to know if there was a link.
Thanks!
Hello! There are so many comments I admit I did not read through them all, so perhaps my question has already been answered but I will ask:
I was diagnosed as hypothyroid during my pregnancy 2 years ago (I had not been to a physician in almost 10 yrs prior, so who knows when it began). I have actually always been VERY thin my entire life, so the HYPO was a shock to me and myu doctors. I never thought I felt low-energy or tired–it came out of nowhere. My TSH was at a 7.0 however, adn without meds, that is where it ends up.
I began taking Armour once I found a doctor to precscribe (natural seems a better route). I am on 45 mg/day.
I recently bought some Iodine/Kelp drops (one drop = 100% DV). I read iodine rich foods help, so i bought the supplement. I take it daily at work. I noticed for the first week or so my stomach would hurt after drinking (like a shooting pressure pain) It’s not nearly so bad now. I never consulted my physician, just did on my own accord to try and help my thyroid from being aggravated. Should I take Selenium too? Or is the intake of iodine not ok??? Thanks so much!!!!
PS. If anything symptomwise: I have noticed mood changes/depression symptoms and have always suffered with adult acne. At first attributed to post-partum hormones, but now attribute to the thyroid. It has been awhile since I went “KOOKY” but it happens (also hard to draw the line between just being a woman! But I was NEVER like that before! Poor hubby!)
We’re all so unique, and it’s taken me many years to get where I am at 75 started on this issue in my early 50’s and didn’t get help for 10 long miserable years…..bad doc…..I knew nothing.
I stayed at 90mg Armour for 5 yrs and then moved myself slowly to 120mg where I’ve been for a few years….I learned to do my own up dosing, breaking off a piece of 60mg tab and upping every couple weeks or so… I was on a great thyroid support board too, whch i now closed. And a cooperative integrative MD who let me do my own updosing….
I take probably 10-12mg of Iosol daily, which is 6-7 drops or so in water….clean water…no tap water.
Selenium is a good antioxidant and I was takig 200-400mcg daily, now I’m dropping down to 200mcg daily…
Hashi numbers have dropped a lot for me.. Brazil nuts are high in selenium….you can eat a few of those per day.
So, it takes work and a cooperative doc, I’m not one who wanted to be at the doc all the time to get my dose changed….testing every time, etc…..
This is how I’ve been able to work with my old thyroid gland…..when I don’t take Iodine, I will get breast pains…..
I want to add a ‘good news’ story and it is that I was taking 1-2 drops Lugol’s for months and didn’t feel much from it. a health practitioner suggested I experiment with more, using the ‘taste test’. I did and worked up to taking 5 drops and with each raise to one more drop, I began to feel better and better. Six drops and the taste became objectionable, but the 5 drops sure do the trick giving me more energy, brain clarity. I’ll also add that I’m taking selenium and a salt/potassium drink daily, the salt which assists the iodine in heavy metal removal.
Iodine (and sea salt) do not remove heavy metals.
Dear Dr Chris,
I am one of the patients on the Dr Brownstein protocol and I have gone up from 12.5 mg of Iodoral to between 45-60 mg now and I think I am one of those minority patients that you mention who simply cant tolerate iodine even with selenium.
I have been on the protocol for 5 months now and despite a clean diet and so on I have felt unwell the whole time to the point where sometimes I need to spend a day or two in bed. My glands are up and I feel like I am fighting something even with protocols to cleanse my system.
I took the Iodine to battle chronic fatigue and massive systemic candida. Now I am scared to go off the protocol, despite feeling bad, as when I take two days off to detox, by the third day I am bed ridden with exhaustion – I cannot seem to suddenly drop the iodine and I am scared that I am trapped taking something that makes me worse! my hair is thinning and I am having crazy hormonal reactions and depression too.
Please Dr Chris could you let me know what you do with your patients who cannot tolerate the Iodine protocol?
thanks so much!
Naomi
I’m not Chris, but it sounds to me that perhaps your immune system is starting to work properly — that is, if you feel like you’re ‘fighting something’. Usually with ME/CFS we’re extremely disabled from viruses, bacteria, fungi, chemicals, etc., but our immune systems aren’t able to ‘fight’ and clear these infections…
Thanks for this brilliant information about iodine and it’s role / impact.
Many report that taking Anatabloc for chronic inflammation have knocked their Hashi out…..
I have a posting above on what I have done for Hashi and was taking Abloc from Jan-April 2013 and this too probably was part of knocking out Hashi, at least getting it down to 84 which is a low for me. I’m off Abloc now, but many report on this supp and TPO levels being dramatically reduced…..
I have just found out that I have Hashimoto’s Disease and am looking for as much info as I can. I knew that iodine was involved and not get what it all means – thank you.
I have hypothyroidism and believe that I am also sensitive to iodine. The first reason I believe that I am sensitive to iodine is that on a hiking trip I drank water containing iodine tablets and I was more swollen and sluggish than ever. Recently I ran out of my synthroid for almost 2 wks so I decided I would get an iodine supplement in the mean time. Which I was suppost to take 4 drops. I took two. I started feeling more sluggish. A couple days later I was put back on my medication. I took that 125 mcg of synthroid and one drop iodine, I became swollen mostly my face hands feet and legs, very cranky,confused feeling. Basically I feel better off my meds. What options do I have to treat my hypothyroidism? If anything? And how do I start this conversation w my Dr.?
Hi Tasha. Those symptoms you describe could have you been your body detoxing from your iodine use. I just started taking iodine (6.5 milligrams daily) and I’ve experienced some detox reactions (which is a good sign) but that’s why the companion nutrients are essential, especially selenium and unrefined salt. Also, vitamin C, magnesium and ATP cofactors. Definitely don’t just take iodine alone.
I have hashimoto’s (TPO/AB of 106, and TSH in the normal range, with T3 on the low end of normal and a T4 on the higher side of normal… but all normal). My doctor suggested I try a supplement called Thyroid Now, which has iodine in it (225 mcg). Should I take it? I am also on Selenomethionine (200 mg). I have been off of gluten since October and on an AIP Paleo diet for the past three weeks, which seems to have calmed my system down a lot.
Many panic when TSH rises as iodine consumption is commenced. This isn’t always a negative phenomenon. According to Dr. David Brownstein, this takes place as the body starts to produce more sodium-iodide symporter molecules (NIS). This is the body producing more of these molecules to enable more efficient transport of iodine into cells. NIS is stimulated by TSH so figures that if the body is in the process of moving more iodine into the cells, it will release more TSH in order to stimulate NIS. Dr. Brownstein points out that this is usually the case when iodine is commenced and Free T3 and Free T4 are in normal or optimal ranges.
yes my TSH increased to 2.9 from .8 while I started taking iodine rich food but then my doctor gave me more medication to bring TSH to less than 2.5. So how is the increase in TSH good ?