Goiter, goiter everywhere

The results of the recent Heart Scan Blog poll are in.

The question:

Do you used iodized salt?

The responses:

Yes, I use iodized salt every day
94 (28%)

Yes, I use iodized salt occasionally
56 (16%)

No, I do not use any iodized salt
41 (12%)

No, I use a non-iodized salt (sea salt, Kosher)
126 (37%)

No, I use a non- or low-sodium substitute
15 (4%)

Thanks for your responses.

If only 28% of people are regular users of iodized salt, that means that the remainder--72%--are at risk for iodine deficiency if they are not getting iodine from an alternative source, such as a multivitamin or multimineral.

Even the occasional users of salt can be at risk. The common perception is that occasional use is probably sufficient to provide iodine. This is probably not true and not just because of the lower quantity of ingestion. Occasional users of salt tend to have their salt canister on the shelf for extended periods. The iodine is then lost, since iodine is volatile. In fact, iodine is virtually undetectable four weeks after a package is opened.

In my office, now that I'm looking for them much more systematically and carefully, I am finding about 2 people with goiters every day. They are not the obvious grotesque goiters of the early 20th century (when quack therapies like the last post, the Golden Medical Discovery, were popular). The goiters I am detecting are small and spongy. Yesterday alone I found 5 people with goiters, one of them visible to the eye and very distressing to the patient.

It seems to me that iodine deficiency is more prevalent than I ever thought. It is also something that is so simple to remedy, though not by increasing salt intake. Kelp tablets--cheap, available--have been working quite well in the office population. My sense is that the Recommended Daily Allowance of 150 mcg per day for adults is low and that many benefit from greater quantities, e.g., 500 mcg. What is is the ideal dose? To my knowledge, nobody has yet generated that data.

Thyroid issues being relatively new to my thinking, I now find it incredible that endocrinologists and the American Thyroid Association are not broadcasting this problem at the top of their lungs. This issue needs to be brought to the top of everyone's attention, or else we'll have history repeating itself and have goiters and thyroid dysfunction galore.

For more on this topic, see the previous Heart Scan Blog post, "Help keep your family goiter free."

Comments (25) -

  • kris

    5/20/2009 1:36:55 PM |

    Here is the list of over 20 publications about iodine consumption, trials, findings etc. the normal intake may be between 6 to 12.5 mg. it depends on the individual. when i started taking iodine, i took 50 mg a day for a week before i felt any uneasiness. now one drop of lugol's iodine every second day and i can feel it. according to these studies some vitamins along with iodine play major role in coping with iodine.  

  • Andrew

    5/20/2009 1:46:23 PM |

    What's your opinion of potassium salt?  I've been using an iodized mixture of sodium and potassium chloride lately, and it seems to be working well.

  • Anna

    5/20/2009 3:20:08 PM |

    I use sea salt that contains iodine naturally.  I also eat a little seaweed a couple of times a week.  Is this sufficient?  Who knows, I guess.  I definitely do not have any trace of a goiter.  I eat fish, too, and live on the East Coast, so I assume I'm okay.

  • StephenB

    5/20/2009 4:25:04 PM |

    The full text of the article "Iodine: deficiency and therapeutic considerations" (Altern Med Rev 13 (2): 116–27. PMID 18590348) published last year can be found here.

    From that article: "The safety of therapeutic doses of iodine above the established safe upper limit of 1 mg is evident in the lack of toxicity in the Japanese population that consumes 25 times the median intake of iodine consumption in the United States. Japan’s population suffers no demonstrable increased incidence of autoimmune thyroiditis or hypothyroidism."


  • Anna

    5/20/2009 7:12:55 PM |

    This is the second time in a week the volatility of iodine has come to my attention.  I'm wondering now about the iodine content in the dried kelp and sea vegetable I have in my cupboards.  Anyone have any idea how stable that iodine is?

  • Lena

    5/20/2009 9:49:59 PM |

    What do you reckon about "Celtic" salt (unprocessed sea salt)? I know there's a lot of websites out there granting it near-magical health properties, about which I am extremely skeptical, however it does have a notable amount of minerals in it (about 8% I believe) whereas regular salt is refined to 99.99% purity. So it seems if you switched to using that kind of salt in your diet (including avoiding processed food which uses pure salt) it may have some benefit. It does contain iodine naturally, too.

    I'm taking Lugol's solution too, about 10 drops a day. My iodine was measured at "<1" by the lab four months ago.

    Australian readers should note that Australian soil has an extremely low iodine content (it's official), so our food is unlikely to be a source of pretty much any iodine at all. A case where being a "localvore" won't help your health.

  • David

    5/20/2009 10:46:21 PM |

    I take Iosol iodine, which I get from iherb.com for $12 a bottle (http://bit.ly/6qLtp). Each drop has 1,830 mcg of iodine, and there are over 600 drops per bottle. Great price, and seems to be working well for me. My feet aren't nearly as cold as they used to be, and my usually low morning temperature has started increasing a bit, too.

  • k1wuk

    5/20/2009 11:11:47 PM |

    My sense is that goiter is the least of the problems with iodine deficiency.  Kris has pointed to the optimox link.  Optimox manufactures Iodoral which is iodine in convenient tablet form.  The liquid form, Lugol's Solution is available here: http://www.jcrows.com/iodine.html

    My sister began taking iodine supplements last year at my suggestion.  She had experienced 5 years of bad mammograms so she was delighted to have a flawless mammogram three months after starting iodine.  It seems that iodine is so important to the baby that breasts concentrate iodine as well as thyroid glands.  Fibrocystic breast disease seems to be the equivalent of goiter in breast tissue.

    She also reports better sleep, fresh moist skin, quicker reactions, more energy and most recently, iodine applied to poison ivy stopped the itch.  

    Dr Flechas reports here, http://iodine4health.com/disease/diabetes/flechas_diabetes.htm, that half of his diabetic patients are no longer diabetic when they get enough iodine.  The other half improve, needing less medication.  It seems to me that iodine should be the first step in treating diabetes of either form.

    Iodine deficiency is reported to be the number one preventable cause of mental retardation in the world.  Looking around, goiter is not the most visible evidence of iodine deficiency.

    Having read the papers at Optimox and others, iodine looks to be under appreciated and quite valuable.

  • Anonymous

    5/20/2009 11:20:12 PM |

    I cut out all salt from my 'nutritarian'-style diet a few weeks ago.  But as a result of reading this blog, I started taking 4 kelp tablets a day at about the same time. I'm thinking of taking even more tablets to try to help increase my low (according to the endocrinologists and this blog, not my doctor) thyroid numbers.

  • mongander

    5/21/2009 2:59:31 AM |

    I rarely use salt except when I make popcorn.  I do occasionally take an Iodoral and sometimes add a drop of aquarium Lugols iodine in my 7 gallon water jugs of thermal spring water.

    When I run in 90°+ weather I do take salt.  So far, at age 70, no goiter.

  • Anonymous

    5/21/2009 3:41:24 AM |

    You might want to let Michael Bloomberg know that cutting back on salt will increase iodine deficiency.  His health commissioner, Thomas Frieden, was picked to head the CDC.

  • Anonymous

    5/21/2009 1:07:58 PM |

    Remember to reduce bromine exposure which competes with iodine.

  • maxthedog

    5/21/2009 7:36:42 PM |

    Thanks for conducting the poll - very interesting.
    We use kosher and sea salt at home - about a year ago, this late realization (regarding iodine) led me to a bit of a panic, as my pregnant wife was nearing full term...  I was especially worried because I had been all along encouraging heavy broccoli consumption as well, and brassica vegetables are known to have goitrogenic properties (as do many other types of plants).  I then learned she was taking a multi-supplement that contained a fair amount of iodine. Whew.  Our 10 month old is doing great now, fortunately. Smile  
    We consume a fair amount of garlic and seafood as well, though I don't really know what the variance is when it comes to garlic's iodine content - presumably it depends quite a bit on the soil and water supply (Apparently, California garlic and broccoli assimilate a fair amount of selenium from the water used for irrigation, for instance).

  • Anna

    5/22/2009 12:28:23 AM |


    I'd love ot know if you have any more info on iodine and breast health.

  • Trinkwasser

    5/22/2009 1:23:41 PM |

    I checked the Lo-Salt I've been using since I decided I might not be getting enough potassium (a good guess as electrolytes came back spot on) and realise it is NOT iodised.

    Not a problem personally I suspect as I eat plenty of fish and shellfish but I'm now trialling various seaweeds, sea vegetables etc. Even without a deficiency these are tasty!

    Goiter is not common in the UK AFAIK, nowhere near as common as hypothyroid. However when young my father was hyperthyroid, which damaged his heart before being treated. Didn't stop the tough old goat from living into his eighties, but in retrospect I believe he may well have become hypothyroid in later life as a result of the operation (not diagnosed), and probably also became Type 2 (not diagnosed)in his last years.

    Probably wouldn't have lengthened his life but diagnosis and treatment would certainly have improved the quality a lot. All power to you for continuing your posts on these issues. They will suffice until Endocrine System SP1 is released.

  • kris

    5/22/2009 6:10:49 PM |


    Here are few links to dr. david derry's answer to patients(in case you haven't found it your self). My wife had painted lugol's iodine externally for breast lumps, with unbelievable results only after applying it twice. she was having hard time sleeping on one side. her mother passed away few years ago with Breast cancer. just being extra careful now.


  • Leslie

    5/22/2009 9:54:39 PM |

    My endo told me to avoid iodine because it exacerbates goiter in hypothyroid.  Also, those of you who know nursing mothers, PLEASE be aware of this risk:

    from pubmed:
    1: Hypothyroidism in a breast-fed preterm infant resulting from maternal topical iodine exposure.
    Smith VC, Svoren BM, Wolfsdorf JI.
    Pediatr. 2006 Oct;149(4):566-7.
    PMID: 17011335 [PubMed - indexed for MEDLINE]

    2: Transient hypothyroidism in a breastfed infant after maternal use of iodoform gauze.
    L'Italien A, Starceski PJ, Dixit NM.
    J Pediatr Endocrinol Metab. 2004 Apr;17(4):665-7.
    PMID: 15198299 [PubMed - indexed for MEDLINE]

    3: Early childhood caries: an overview with reference to our experience in California.
    DenBesten P, Berkowitz R.
    J Calif Dent Assoc. 2003 Feb;31(2):139-43. Review.
    PMID: 12636318 [PubMed - indexed for MEDLINE]

    4: Transient neonatal hypothyroidism during breastfeeding after post-natal maternal topical iodine treatment.
    Casteels K, Pünt S, Brämswig J.
    Eur J Pediatr. 2000 Sep;159(9):716-7. No abstract available.
    PMID: 11014479 [PubMed - indexed for MEDLINE]

    5: [Iodine antiseptics are not harmless]
    Arena Ansotegui J, Emparanza Knörr JI.
    An Esp Pediatr. 2000 Jul;53(1):25-9. Review. Spanish.
    PMID: 10998400 [PubMed - indexed for MEDLINE]

    6: The newborn should be protected from dangerous transient induced hypothyroidism.
    López-Sastre JB, Rivas-Crespo MF.
    Acta Paediatr. 1995 Oct;84(10):1211. No abstract available.
    PMID: 8563243 [PubMed - indexed for MEDLINE]

    7: [Thyroid function disturbances in an infant following maternal topical use of polydine]
    Rakover Y, Adar H.
    Harefuah. 1989 May 10; 116(10):527-9. Hebrew.
    PMID: 2792927 [PubMed - indexed for MEDLINE]

    8: Topical iodine, breastfeeding, and neonatal hypothyroidism.
    Delange F, Chanoine JP, Abrassart C, Bourdoux P.
    Arch Dis Child. 1988 Jan;63(1):106-7. No abstract available.
    PMID: 3348642 [PubMed - indexed for MEDLINE]

  • kris

    5/23/2009 2:32:32 AM |

    here is another study from the same site search. i just copied the whole paragraph.

    1: Public Health Nutr. 2007 Dec;10(12A):1600-1.Click here to read Links
        Iodine nutrition of pregnant and lactating women in Hong Kong, where intake is of borderline sufficiency.
        Kung AW.

        Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.

        OBJECTIVE: To describe the iodine nutrition of pregnant and lactating women in Hong Kong, where intake is of borderline sufficiency.DESIGN: Review of cross-sectional and prospective studies.SETTING: China, Hong Kong Special Administrative Region (SAR).SUBJECTS: Pregnant and lactating women.RESULTS: Studies of pregnant women in Hong Kong SAR have revealed an increase in the urinary iodine (UI) concentration as pregnancy advances. A significant percentage of women had a sub-normal serum thyroid hormone concentration at full term. Although iodine is concentrated by the mammary gland, 19% of all mothers had low iodine concentrations in their breast milk. The moderate correlation between the concentrations of iodine in breast milk and urine suggests that an adequate maternal urinary iodine concentration cannot reliably indicate that an infant is getting enough iodine in breast milk. Therefore, some breast-fed infants may still be at risk of low iodine intake, and additional iodine supplements, other than salt iodisation, would be warranted in this population.CONCLUSIONS: The currently recommended intake of iodine through universal salt iodisation may not be adequate for pregnant and lactating women, and supplementation during pregnancy and lactation should be further considered in light of the latest recommendations.

    here is another one.

    1: J Am Coll Nutr. 2004 Apr;23(2):97-101.Click here to read Links
        Maternal thiocyanate and thyroid status during breast-feeding.
        Dorea JG.

        Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brazil.

        Cyanogenic glucosides are naturally present in plant foods especially in staple foods (cassava) consumed by millions of people in tropical countries. Most traditional processing methods are effective in detoxifying such goitrogens to safe levels of consumption. Nevertheless, residual cyanide (CN) is rapidly metabolized to thiocyanate (SCN) by existing metabolic pathways. There are concerns that goitrogens may reach the nursing infants through breast feeding or cow's milk based formulas. SCN adverse effects are commonly observed in relation to cigarette smoking. Breast-feeding is effective in protecting infants from anti-thyroid effects of eventual or habitual maternal exposure to CN exposure in food (cassava) or recreation habits (cigarette smoking). SCN goitrogenic effects occur secondary to iodine deficiency in special circumstances of high consumption of incomplete detoxified cassava and insufficient protein intake. Only during inadequate protein nutrition can SCN aggravate endemic iodine-deficient disorders (IDD).

    More and more one reads about these, more and more it becomes a muddy and confusing subject.
    despite the fact that we have all sorts of studies and experts to educate people, all it takes is few drug profit driven experts studies to confuse the less money spending route.
    Please read this
    "The Wolff-Chaikoff Effect"
    "crying wolf".
    Please don't take me wrong. i am not trying to contradict the studies that you have posted here. i am merely trying to show as to what else is available out there.

  • TedHutchinson

    5/23/2009 9:10:04 AM |

    The Safe and Effective Implementation of Orthoiodosupplementation In Medical Practice

    This section had me laughing out loud. Much the same applies to the use of effective amounts of D3.
    Medicoiodophobes suffer from: A) a split personality which results in iodophobia within the orthoiodosupplementation range previously used safely and successfully in medical practice and iodophylia for megadoses of iodide (up to 12 gm/day); B) double standards, which render those physicians intolerant to the minor side effects of the inorganic forms and extremely tolerant to the severe side effects of the radioactive and organic forms; C) amnesia pertaining to the inorganic, non-radioactive forms when making therapeutic decisions; D) confusion, attributing the severe side effects of organic iodine-containing drugs to inorganic iodine/iodide; and E) an altered state of consciousness, allowing doublethink, doublespeak, and contradictory logic to become acceptable. Although the factors involved in medical iodophobia are still unknown, decreased cognition seems involved. Since low iodine intake is associated with intellectual impairment, deficiency of this essential element cannot be ruled out, and if present, would create a self-perpetuating phenomenon. Needless to say, medical iodophobia is contagious and can be transmitted to patients and other physicians (iatrogenic iodophobia). Medical iodophobia will remain a syndrome until the causes are discovered and effective therapy implemented. It is very likely however, that medical iodophobia will eventually be classified as an iodine-deficiency disease.

  • Anne

    5/23/2009 11:33:53 AM |

    My endo told me not to take iodine because he said living in the UK, it being an island, people here get enough iodine from their diets.

    He also said that because I eat a lot of fish (once or twice per day) that gives me additional iodine.

    He said some of his German patients take iodine against his wishes (must be a popular supplement among Germans), and if they are pregnant it's really bad for the fetus.


  • kris

    5/23/2009 7:37:08 PM |

    according to Dr. david derry,"Fish of the great lakes still shows Goiter formation".
    So even fish's origin is important. apart from fluoride in the tooth paste and fluoride added municipal water which depletes us from iodine. never mind chlorine in the water and bromine in the food and many other goods around us, helps to deplete iodine.

  • Anna

    5/24/2009 7:10:45 PM |

    I wonder about the huge amount of food that is imported into the UK from distant locations One can't assume enough iodine universally throughout the UK based on UK soil content.

  • Anne

    5/25/2009 8:12:10 AM |

    Kris - you should eat sea fish and shell fish.

  • kris

    5/25/2009 7:03:50 PM |

    Thank you for your advise.
    now i am eating sea fish twice a week. but iodine is must for me. my mother's right side elbow and knee was in bad shape for 35 years. The knee joint was so bad that the joint would come off of it's position. we had to learn our to self to place it back. as usual, she went to many doctors but no help. she is vegetarian all her life. about six months ago she started applying lugol's iodine externally on the knee. she was applying religiously 3 times a day for 2 weeks on and one week off. at the end of the two weeks application, the knee would look like war zone. after about month and half, the knee starting to look like normal knee. now she is able to walk about mile and a half every day on the tread mill. she also been taking 3 drops a day internally too. i personally believe in more iodine than we can find in our the food.

  • Anonymous

    7/31/2009 2:43:32 AM |

    "Breast Cancer and Iodine" by Dr David M. Derry, Canada