Goitre

This is the most common presentation. Since the deficiency is endemic, goitres tend to occur in those areas. Goitres present as large swellings in the anterior neck. There usually only have cosmetic consequences, but if they a large then can cause compressive symptoms such as recurrent laryngeal nerve compression causing hoarseness of voice. The goitre may also compress the trachea causing airway obstruction.

Hypothyroidism

This is becoming very rare, and happens in individuals with severe deficiency with goitres. The patient presents with typical symptoms such as weight gain, mental slowing, cold intolerance, menorrhagia and mood disorders.

Cretinism

This is the most catastrophic consequences of these deficiency. The affected children suffer from mental retardation, stunted growth and mutism [8].

• Malnutrition

  Results: Mean age was 3.3±1.6 years, with 51% female, median family income USD 30/week, and 16% malnutrition. [ncbi.nlm.nih.gov]

  The nonprofit and agency cite breast cancer, fibrocystic breast disease and complications during pregnancy among the health issues linked to iodine deficiency (an insidious form of malnutrition that has historically been associated with goiter and cretinism [adweek.com]

  Other agencies involved include the Micronutrient Initiative (MI), Programme Against Micronutrient Malnutrition (PAMM), and USAID/Opportunities for Micronutrient Interventions (OMNI). [unu.edu]

  General Assembly on Children, GAIN is the only international organization focused entirely on ending malnutrition. [gainhealth.org]

  More recently Micronutrient Initiative and the Program Against Micronutrient Malnutrition have joined the Partnership as technical agencies. [scielosp.org]

• Myxedema

  Myxedema is a rare but life-threatening complication of hypothyroidism that can be caused by iodine deficiency. [healthline.com]

  Thus, iodine toxicity can eventually cause iodide goiter, hypothyroidism, or myxedema. Very large amounts of iodide may cause a brassy taste in the mouth, increased salivation, GI irritation, and acneiform skin lesions. [merckmanuals.com]

  Usually, patients remain euthyroid; however, severe iodine deficiency in adults may cause hypothyroidism (endemic myxedema). It can decrease fertility and increase risk of stillbirth, spontaneous abortion, and prenatal and infant mortality. [msdmanuals.com]

• Weight Loss

  Is iodine the new "it" supplement for weight loss? Let's tackle the tangled issue of iodine and weight, as well as understand the dangers of unnecessary supplementation. [greenmedinfo.com]

  Iodine is crucial for metabolism and weight loss. Iodine stores in fat cells. Toxic halogens can also store in fat cells, blocking the release of fat and blocking weight loss. Low thyroid has long been associated with modest weight gain. [sott.net]

  The symptoms of either can be hypothyroidism—in which metabolism slows and weight and cholesterol increases—or hyperthyroidism—where metabolism increases resulting in weight loss. [veganhealth.org]

  Goiters that result from other conditions, such as hypothyroidism or hyperthyroidism, can be associated with a number of symptoms, ranging from fatigue and weight gain to unintended weight loss, irritability and trouble sleeping. [mayoclinic.org]

• Unconsciousness

  Symptoms include: an intense intolerance to cold temperatures drowsiness followed by extreme fatigue, and ultimately, unconsciousness In people with hypothyroidism, certain things can trigger a myxedema coma. [healthline.com]

• Recurrent Infection

  infections Sensitivity to cold Cold hands and feet Brain fog Thinning hair Constipation Shortness of breath Impaired kidney function Muscle weakness and joint stiffness Source : https://draxe.com/iodine-deficiency/ [eastafro.com]

  Symptoms of iodine deficiency include depression, difficulty losing weight, dry skin, headaches, lethargy or fatigue, memory problems, menstrual problems, hyperlipidemia, recurrent infections, sensitivity to cold, cold hands and feet, brain fog, thinning [draxe.com]

• Diarrhea

  Getting a very large dose of iodine (several grams, for example) can cause burning of the mouth, throat, and stomach; fever; stomach pain; nausea ; vomiting; diarrhea ; weak pulse; and coma. The upper limits for iodine are listed below. [ods.od.nih.gov]

  Toxic amounts of iodine usually cause an IgD immune response along with toxic symptoms, including: acne, rashes, diarrhea, fever, headache, increased salivation, metallic taste in mouth, nausea, and sneezing. [sott.net]

• Failure to Thrive

  Babies born to mothers with severe iodine deficiency may have: Mental retardation Slow growth or failure to thrive Hearing and speech impairments Low intelligence Cretinism Short stature Abnormal gait Low iodine results in many of these birth abnormalities [vitamins.lovetoknow.com]

• Dental Caries

  […] since the beginning of administration of iodine to prevent goitre, children have less caries. Iodine seems to increase resistance to caries, retarding the process and reducing its incidence." Dental Caries, American Dental Association (ADA). [realrawfood.com]

• Hypertension

  The incidence of pre-eclampsia, non-proteinuric gestational hypertension, gestational diabetes, glycosuria, anaemia, post-partum haemorrhage, preterm delivery, mode of delivery, being small for gestational age, and large for gestational age did not differ [ncbi.nlm.nih.gov]

  References Hypertension, dietary salt restriction, and iodine deficiency among adults. Tayie FA, Jourdan K.Am J Hypertens. 2010 Oct;23(10):1095-102. [quickanddirtytips.com]

  Salt contributes to hypertension (high blood pressure) and there are efforts globally to encourage people to eat less salt by avoiding adding salt in cooking and at the table. [m.betterhealth.vic.gov.au]

  Early symptoms of hypothyroidism: Fatigue Cold intolerance, increased sensitivity to cold Cold hands and feet Constipation Weight gain High cholesterol Essential hypertension Goiter Thin, brittle fingernails Hair loss; thin, brittle hair Puffiness in [heartlandnaturopathic.com]

• Tachycardia

  In case of a hormone deficiency caused by hypothyroidism, the heart rate is slowed down and the diastolic blood pressure is increased; in contrast, hyperthyroidism with increased thyroid hormone levels can lead to cardiac dysrhythmia (tachycardia) and [bfr.bund.de]

  She suffers continual uncontrolled neuro/muscular contractions (jerking) and postural orthostatic tachycardia syndrome (POTS) and many other symptoms of systemic autoimmune dysregulation. [collective-evolution.com]

• Sweating

  Lack of iodine in the sweat glands manifests as dry skin with a decreased ability to sweat. Iodine can also be concentrated in the stomach tissue, and the lack of iodine in the stomach manifests as achlorhydria (lack of digestive acid production). [helpmythyroid.com]

  They also develop symptoms like dry mouth, dry skin, lack of sweating, reduced alertness, muscle pain, and difficulty maintaining low body fat. [t-nation.com]

  The only way to remove them is high iodine and vitamin C intake along with sweating. The best way to sweat out toxins is to use dry heat sauna with beneficial Far Infrared light/heat. [sott.net]

• Fear

  Small salt makers who fear extra expense often lobby against it. So do makers of iodine pills who fear losing their market. Rumors inevitably swirl: iodine has been blamed for AIDS, diabetes, seizures, impotence and peevishness. [nytimes.com]

  And it has fallen further in recent years due to allergy fears and our changing tastes. [dailymail.co.uk]

  But some people fear that by doing this they won't get enough iodine in their diets. Not to worry, explains the June 2011 issue of the Harvard Heart Letter. Salt provides only a fraction of daily iodine intake for most Americans. [health.harvard.edu]

  Don't fear salt The science of salt is infamously fickle. [shape.com]

• Fussiness

  My problem with most recipes for Red Wine Beef Stew is they are way too fussy. I have stripped this recipe down to its most basic elements, removing any extraneous and unnecessary steps and ingredients. [cheeseslave.com]

• Neck Swelling

  Symptoms It usually presents with a swelling in the front of the neck due to an enlarged thyroid gland (goitre). The neck swelling is initially smooth but eventually get nodular with time. [symptoma.com]

  I have experienced the following symptoms which are all deficiency related: Muscle cramps and joint pain Carpal tunnel/tendinitis A feeling of neck swelling/enlargement Hoarse voice or weak voice Dry skin, brittle fingernails Menstrual irregularities [iodine-resource.com]

  Grade 2: A swelling in the neck that is clearly visible when the neck is in a normal position and is consistent with an enlarged thyroid when the neck is palpable. Unique codes were assigned to each participant to ensure confidentiality. [bmcresnotes.biomedcentral.com]

• Irritability

  Symptoms: edgy, irritable, anxious, rash, headache, metallic taste, thyroid pain, palpitations, GI No anaphylaxis Caution Labs: HS CRP > 3, Sed > 20, Fibrinogen > 350 mg/dL, +ANA, elevated Immunoglobulins, HLA B27, methylation defects Hashimoto's Protocal [fullspectrumfamilymed.com]

  If the contact is short, it may merely irritate and inflame the skin but extended contact can cause skin lesions. Gaseous iodine is also an irritant. [progressivehealth.com]

  Very large amounts of iodide may cause a brassy taste in the mouth, increased salivation, GI irritation, and acneiform skin lesions. [merckmanuals.com]

  […] diet, why cows’ milk is such a good source, and the potential solution for those who struggle with regular dairy. 11 common digestives disorders Sun, December 25, 2016 Common digestives disorders from heartburn and indigestion to diverticulitis and irritable [express.co.uk]

  Symptoms of Lymphatic Congestion Mild skin irritation Sore joints in the morning Cold hands and feet Moderately swollen or sore breasts Mild cellulite Elevated histamine response to environmental irritants Mild headaches Benign cyst formation Accumulated [lifespa.com]

Individual tests are usually rare with most tests being done at community levels. The most common system is to measure iodine concentrations in urine; the deficiency is classified as:

• Mild: 50 to 99mcg/l
• Moderate: 20 to 49 mcg/l
• Severe: < 20mcg/l [9]

Supplementation is the mainstay of treatment, but will not reverse the signs, such as goitre or cretinism, but will correct hypothyroidism. Goitres are usually a cosmetic problem, and if there is no indication only supplementation is indicated. Thyroidectomy will be required if there are compressive symptoms. Some nodules may become semiautonomous once iodine levels are normalized, causing hyperthyroidism.

Unfortunately once the consequences of iodine deficiency set in, supplementation will not reverse it. This is true for goitres and cretinism. A continuous supplementation program is required, to avoid these consequences [7].

The daily requirement for iodine is approximately 52mcg per day (150mcg/day as per World Health Organisation recommendations) in adults with the highest requirements during pregnancy, when they may reach 250mcg/day. Intake of less than 30mcg over a prolonged period will lead to moderate to severe deficiency. Iodine is found in many food naturally, such as fish, some drinking water and from produce grown in iodine rich soil. Mountainous regions have low levels of iodine in the soil and if there are no other sources of iodine, the inhabitants may become deficient [2] [3].

There are over 2.2 billion people who are at risk of iodine deficiency. The clinical disorders tend to be worse in areas with other concomitant deficiencies such as vitamin A. The distribution of the deficiency has no race or gender prediction and is totally geographical. The incidence has significantly reduced since the early 20th century due to mandatory iodine supplementation in salt. In many countries uniodinated salt is very rare [4] [5].

Iodine is easily absorbed in the gut as iodide and then actively taken up by the thyroid gland where it is incorporated to form thyroxine and triiodothyronine. Thyroid hormones are important for regulating metabolism, and are essential in neuronal and sexual development in neonates.

If there is deficiency, the body has a number of mechanisms to try and maintain hormone levels. The pituitary releases more thyroid stimulating hormone, when the levels of thyroxine drop. This stimulates the thyroid follicle cells to take up more iodine from circulation to produce more thyroxine. There is also increased production of triiodothyronine which requires less iodine atoms and is more active (this conserves iodine).

Consequences of deficiency

• Goitre: This is one of the most well-known signs of iodine deficiency. The growth of the goitre is stimulated by the high levels of thyroid stimulating hormone, from the pituitary as a response to low thyroxine level. The chronic stimulation by the stimulating hormone causes follicle cells to proliferate and ultimately increase in the overall size of the goitre. The goitre is initially diffuse but eventually gets nodular with time, due to irregular proliferation.
• Hypothyroidism: This is extremely rare due to supplementation, but when it does occur there is a goitre. 
• Cretinism: This is a catastrophic consequence to a neonate. Thyroxine and iodine are required for maturation and development of the fetus. Children born with this, if not treated, will have mental retardation, and developmental problems [6].

Continuous population based iodine supplementation is recommended by the World Health Organisation which recommends 150mcg/day in nonpregnant individuals. This has been done in most countries with iodization of salt (In many countries, it is mandatory) [10].

Alterations in the levels of iodine, deficiency or excess have consequences on thyroid hormone production. Deficiency may impose a variety of consequences, including goitre, intellectual disability and hypothyroidism [1].

Definition

Iodine deficiency is a condition when there is a poor intake of a necessary element called iodine. Low levels of iodine cause imbalance of a hormone called thyroxine which is required for a number of important functions.

Cause

Iodine is usually found in food like vegetables and fish. In some areas there is poor levels of iodine in the soil and therefore the food in those regions has little iodine.

Symptoms

It usually presents with a swelling in the front of the neck due to an enlarged thyroid gland (goitre). The neck swelling is initially smooth but eventually get nodular with time. It can get to a size that it block the air pipes causing difficulty in breathing. The symptoms of low hormones, include weight gain, depression and mental slowing. In children born to mothers with iodine deficiency, there are at risk of mental retardation and poor growth.

Diagnosis

The diagnosis is usually not difficult as the goitres usually come from regions where there is deficiency. These regions tend to have many goitres. The iodine levels may be obtained from urine tests.

Treatment

Treatment includes adding iodine to food. Most countries add iodine to salt, and if you are found deficient you may be given an injection, but it is normally replaced by mouth. This does not reverse the goitre. The goitres are usually removed only if there are causing breathing problems or voice problems.

1. Walker SP, Wachs TD, Gardner JM, et al. Child development: risk factors for adverse outcomes in developing countries. Lancet 2007; 369:145.
2. WHO Secretariat, Andersson M, de Benoist B, et al. Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the Technical Consultation. Public Health Nutr 2007; 10:1606.
3. Zimmermann MB. Iodine deficiency. Endocr Rev 2009; 30:376.
4. ICCIDD, UNICEF, WHO. Assessment of iodine deficiency disorders and monitoring their elimination. Geneva, World Health Organization, 2001
5. Pearce EN, Andersson M, Zimmermann MB. Global iodine nutrition: Where do we stand in 2013?. Thyroid. May 2013;23(5):523-8
6. Zimmermann MB. Iodine requirements and the risks and benefits of correcting iodine deficiency in populations. J Trace Elem Med Biol. 2008;22(2):81-92
7. Zimmermann MB, Wegmuller R, Zeder C, et al. Rapid relapse of thyroid dysfunction and goiter in school-age children after discontinuation of salt iodization. Am J Clin Nutr. Apr 2004;79(4):642-5
8. Cao XY, Jiang XM, Dou ZH, et al. Timing of vulnerability of the brain to iodine deficiency in endemic cretinism. N Engl J Med 1994; 331:1739.
9. Food and Nutrition Board Institute of Medicine. Dietary reference intake. Washington, DC: National Academy Press, 2001.
10. Zimmermann MB, Aeberli I, Torresani T, et al. Increasing the iodine concentration in the Swiss iodized salt program markedly improved iodine status in pregnant women and children: a 5-y prospective national study. Am J Clin Nutr. Aug 2005;82(2):388-92.