Iodine deficiency is REAL 21. August 2009 William Davis (30) Like many health-conscious people, Kurt avoids salt. In fact, he has assiduously avoided salt ever since his heart attack back in 1995. Lately, Kurt had become tired, often for little or no reason. His thyroid panel:TSH 4.2 mIU/L (0.27-4.20)Free T3 1.74 pg/ml (2.50-4.30)Free T4 1.05 ng/dl (0.9-1.7)Kurt's TSH of 4.2 mIU/L is sufficient to increase LDL cholesterol by 20-30% and increase the (relative) risk for heart attack 3-fold. Kurt's thyroid was also palpably enlarged. While it was just barely visible--just a minor bulge in the neck (in the shape of a bowtie), it could be clearly felt when I examined him. I asked Kurt to add 500 mcg of iodine every day. Three months later, another thyroid panel showed:TSH 0.14 mIU/L (0.27-4.20)Free T3 2.50 pg/ml (2.50-4.30)Free T4 1.1 ng/dl (0.9-1.7)Kurt's thyroid function normalized to nearly ideal levels just with iodine replacement. (The free T3, while improved, remains low; an issue for another day!) I see this response with some frequency: low-grade goiter and apparent hypothyroidism (low thyroid function) that responds, at least partially, to iodine replacement. In Kurt's case, iodine replacement alone normalized his thyroid measures completely. With improved thyroid measures, Kurt also felt better with renewed energy and a 22 mg/dl reduction in LDL cholesterol. Make no mistake: Iodine deficiency is real. While most of my colleagues have dismissed iodine deficiency as a relic of the early 20th century and third world countries, you can also find it in your neighborhood.