Consequences of excess Iodine

Karthik Balachandran

February 13,2015

Karthik Balachandran

Consequences of excess Iodine

February 13,2015

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Background

RDA of iodine is 150 g/day

Tolerable upper level of 1100 g/day
Excess :
Children-Urinary iodine > 300 g/day
Pregnant women- Urinary iodine > 500 g/day

Karthik Balachandran

Consequences of excess Iodine

February 13,2015

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Measures of iodine excess

Dried blood spot thyroglobulin concentration

4-40 g/dl indicates iodine suciency in children 514 years old

Karthik Balachandran

Consequences of excess Iodine

February 13,2015

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Thyroidal adaptation to excess iodine

Wol-Chaiko eect

Mechanism
Inhibitory eect of intrathyroidal iodolactones, iodoaldehydes and/or
iodolipids on thyroid peroxidase activity

Karthik Balachandran

Consequences of excess Iodine

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Thyroidal adaptation to excess iodine

Wol-Chaiko eect

Mechanism
Inhibitory eect of intrathyroidal iodolactones, iodoaldehydes and/or
iodolipids on thyroid peroxidase activity
Reduced intrathyroidal deiodinase activity as a result of the increased
iodine load might also contribute to decreased synthesis of thyroid
hormones

Karthik Balachandran

Consequences of excess Iodine

February 13,2015

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Wol-Chaiko eect

Karthik Balachandran

Consequences of excess Iodine

February 13,2015

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Wol-Chaiko eect : Aftermath

Reduction of NIS levels in 24 hours

Reduced intake - less inhibitory substances
Impaired follicular cell - thyroid dysfunction

Karthik Balachandran

Consequences of excess Iodine

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Susceptible patients

Autoimmune thyroid disease

History of surgery I 131 or antithyroid drug therapy for Graves disease
Subacute thyroiditis
Postpartum thyroiditis
Type 2 amiodarone-induced thyrotoxicosis (AIT) hemithyroidectomy
IFN therapy
Concomitant use of potential goitrogens, such as lithium

Karthik Balachandran

Consequences of excess Iodine

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Iodine induced hyperthyroidism

Jod-Basedow phenomenon
Nontoxic or diuse nodular goiter
Latent Graves disease
Long standing iodine deficiency

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Consequences of excess Iodine

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Sources of Iodine excess

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Consequences of excess Iodine

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Iodine supplementation

Iodized oil
Water supply
Crop irrigation
Animal fodder
Salt
Bread iodophors
Micronutrient biscuits

Karthik Balachandran

Consequences of excess Iodine

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Drawbacks

Increased risk of hypothyroidism

Increased risk of papillary carcinoma of thyroid

Karthik Balachandran

Consequences of excess Iodine

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Dietary sources

Dairy products
Seaweed - mainly in Japan
Iodized salt

Karthik Balachandran

Consequences of excess Iodine

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Vitamins and supplements

Congenital hypothyroidism caused by ingestion of excess maternal

iodine tablets during pregnancy

Discrepancy b/w measured and labelled values
American Thyroid Association recommends against ingestion of an

iodine or kelp daily supplement containing > 500g iodine for all
individuals, except for certain medical indications

Karthik Balachandran

Consequences of excess Iodine

February 13,2015

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Karthik Balachandran

Consequences of excess Iodine

February 13,2015

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