Published December 17, 2012
There is a lot of controversy when it comes to iodine supplementation for both Graves’ Disease and Hashimoto’s Thyroiditis. With regards to Graves’ Disease, most endocrinologists will tell their patients not to take any iodine. This is especially true if the radioactive iodine uptake test is high (for those who receive it), which is frequently the case. But regardless of the results of this test, just about every endocrinologist would advise their patients with Graves’ Disease to avoid taking iodine. As for Hashimoto’s Thyroiditis, many sources claim that people with this condition should also avoid consuming iodine. I’m going to discuss this, and also talk about whether iodine can actually trigger an autoimmune response in people who don’t currently have such a condition.
I of course have my own personal opinion when it comes to iodine and autoimmune thyroid conditions. I have done some research, and to be honest there are a lot of conflicts. Some research studies seem to provide evidence that iodine can cause health issues, including thyroid and autoimmune thyroid conditions, while other studies show that supplementing with iodine can help improve these conditions.
The Role Of Iodine In Thyroid Function
You might already be familiar with this, but I’d like to briefly discuss the role of iodine with regards to thyroid health. Iodine is important for the formation of thyroid hormone. This includes both T3 (triiodothyronine) and T4 (thyroxine). Three molecules of iodine are required for the formation of T3, while four molecules of iodine are required to produce T4.
Based on what I just stated, it would make sense to conclude that a deficiency in iodine can lead to a decrease in thyroid hormone production, thus resulting in a hypothyroid condition. On the other hand, too much iodine can potentially lead to an excess in thyroid hormone production, thus leading to a hyperthyroid condition. However, it would be erroneous to conclude that most hypothyroid conditions are caused by a deficiency in iodine, and similarly, that most hyperthyroid conditions are caused by an excess in iodine. Hopefully you agree with me so far.
Regardless of whether someone has a hypothyroid condition or a hyperthyroid condition, in most cases there is an autoimmune component to these conditions. In other words, about 90% of people with hypothyroidism have Hashimoto’s Thyroiditis, while about 90% of people with hyperthyroidism have Graves’ Disease. And in these conditions, it is the autoimmune response which is responsible for the thyroid function.
Iodine And The Autoimmune Component Of Thyroid Disease
This is where it begins to become somewhat controversial, and where perhaps our personal biases come into play. With Hashimoto’s Thyroiditis, the hypothyroid condition is caused by the immune system attacking the thyroid gland, thus leading to destruction of the thyroid gland. So the condition itself has nothing to do with iodine. It’s a similar problem with Graves’ Disease, as TSH-receptor antibodies are the culprit, and they stimulate the thyroid gland to produce an excess of thyroid hormone. So iodine isn’t the villain here either.
So what’s the problem with taking iodine with either condition? Well, the controversy seems to be centered around thyroperoxidase (TPO) which is an enzyme that is necessary for the production of both T3 and T4. There is some evidence that consuming iodine will increase the TPO antibodies, which of course are the main antibodies found in people with Hashimoto’s Thyroiditis, and are also found in some people with Graves’ Disease. Without question there are people with both Hashimoto’s Thyroiditis and Graves’ Disease who don’t do well when consuming iodine. On the other hand, there are also people with these conditions who not only have felt better when taking iodine, but also restored their health back to normal while taking iodine. I’m an example of this, as I personally took iodine when I was diagnosed with Graves’ Disease and received great results.
With regards to Graves’ Disease, many people aren’t aware that Lugol’s solution was commonly used to treat hyperthyroidism before radioactive iodine treatment was used. Does this mean that everyone with hyperthyroidism and Graves’ Disease should supplement with iodine? Of course not, as everyone is different, and to say that everyone needs to take a certain vitamin or mineral would be incorrect. With that being said, iodine supplementation can be beneficial for many people with hyperthyroidism and Graves’ Disease.
But what about studies which show that increased iodine intake in certain countries correlates with an increased incidence of autoimmune thyroid disease, mainly Hashimoto’s Thyroiditis? Well, some studies suggest that these people were deficient in selenium. And adequate selenium is important for the oxidation of iodide to iodine. If there isn’t sufficient selenium then this can cause oxidative damage and trigger an autoimmune response. Numerous studies have shown an increase in thyroid antibodies in those with a selenium deficiency, and this is the reason why this occurs. Other mineral deficiencies can also play a role in this. In any case, it most likely wasn’t the iodine itself that triggered an autoimmune thyroid condition, but taking iodine in the presence of certain mineral deficiencies.
My Opinion With Regards To Iodine Supplementation
So where do I stand with regards to iodine supplementation? First of all, if someone is to supplement with iodine I do think they should first be tested to confirm an iodine deficiency is present. Second, if they are found to be deficient in iodine, then I think they should begin supplementing with small doses of iodine. With regards to iodine supplementation in people with Graves’ Disease, if someone with this condition has an iodine deficiency then I won’t hesitate to recommend iodine supplements, once again after proper testing and then starting with a smaller dosage. And in most cases there aren’t any problems. Sure, every now and then someone will appear to be sensitive to iodine, although keep in mind that sometimes an increase in symptoms is due a detoxification reaction due to bromine toxicity, which can be further explained in Dr. David Brownstein’s excellent book “Iodine, Why You Need It, Why You Can’t Live Without It”.
As for people with Hashimoto’s Thyroiditis, I’m admittedly still cautious about giving people with this condition iodine, although I know people with Hashimoto’s Thyroiditis who have done fine taking iodine, including some of my patients. Plus, Dr. David Brownstein has seen many people with Hashimoto’s Thyroiditis and gives most of them iodine without a problem, and I’m guessing the reason why it’s not a problem is because he makes sure to also give selenium and other minerals to prevent oxidative damage to TPO from occurring. There is no doubt that the debate will continue, as some people with autoimmune thyroid conditions who are reading this might become open to iodine supplementation, while others will continue to avoid this mineral.
For those who are still concerned about iodine supplementation causing an autoimmune response, this is possible, but if the proper precautions are taken then this is unlikely to happen. Keep in mind that there are a lot of factors which can trigger an autoimmune response, and if someone is taking large doses of iodine and perhaps has other unaddressed mineral deficiencies such as selenium then this potentially can increase the chances of this happening. So based on this information, one way to help prevent this is to begin with small doses of iodine and at the same time correct any mineral deficiencies. If one wants to “play it safe” then they can first correct these other mineral deficiencies, suppress the autoimmune response, and then take iodine after this is done. This of course assumes they have a deficiency, as not everyone has low levels of iodine..
Either way, just like any other mineral deficiency, I do think that anyone who has an iodine deficiency eventually needs to get this addressed, and many times doing so can be an important component of restoring one’s health back to normal. This doesn’t mean that everyone with thyroid and autoimmune thyroid conditions needs to take iodine, as I don’t recommend for all of my patients to take iodine. For those who do supplement with iodine I’m not a big fan of taking large doses immediately, especially without any testing. So you first want to get tested, and then go about this cautiously if it is determined that you are deficient in iodine. While iodine supplementation may not be for everyone, for others it can be an important part of their recovery when following a natural treatment protocol.