
(13%); and desserts made with milk (10%). These
results for the US TDS were based on a yearly analysis
of 234 core foods for iodine content. Iodine intakes
from the 1982–1991 US TDS ranged from 170 mg per
day for infants to 386 mg per day for 25–30-year-old
men. Average intakes for the more recent (1990–
1991) TDS, were somewhat lower, ranging from
117 mg per day for infants to 317 mg per day for 14–
16-year-old males, and there seems to have been a
declining trend in iodine intake from 1982 to 1991.
Nonetheless, these more recent iodine intakes are well
above the RDAs without including iodine from dis-
cretionary salt (that added during cooking or at the
table). Thus, the TDS estimates of iodine intake
would be underestimated for individuals using iod-
ized salt. The use of a half a teaspoon of iodized salt
per day (iodized at the US level of 76 mg of iodine per
gram of salt) would add an additional 208 mgof
iodine.
Iodine Deficiency
0013 Dietary iodine deficiency leads to a decrease in
plasma T
4
and an increase in TSH. Under the influ-
ence of TSH, the thyroid becomes overactive, leading
to hypertrophy and hyperplasia of the gland. This is
known as ‘endemic goiter.’ Most individuals with
goiter are euthyroid (i.e., have normal thyroid levels).
Goiters range in size for modest enlargements to those
that are several times the normal size and are fre-
quently nodular in appearance. Large goiters may
cause obstruction of the trachea and esophagus, and
interfere with breathing and speaking. Prolonged
deficiency of iodine, resulting in decreased levels of
thyroid hormones, causes hypothyroidism or myx-
edema. The characteristics of this disease include
decreased metabolic rate, fatigue, cold intolerance,
weight gain, puffy face, dry skin, hoarse voice,
edema, easy bruising, drooping upper eyelids, mental
apathy, and problems with coordination. These
symptoms are reversible with iodine therapy. Iodine
deficiency during fetal development, infancy, or early
childhood may result in cretinism, a condition that
is not reversible and is characterized by retarded
growth, mental retardation, deafness, and neuro-
logical problems.
0014 In a few geographical areas, the development of
endemic goiter as a result of iodine deficiency may
be exacerbated by the ingestion of naturally occurring
compounds in foods, known as ‘goitrogens.’ Goitro-
gens act by impairing iodine uptake by the thyroid or
impairing the incorporation of iodine into tyrosine.
Foods that contain goitrogenic substances include
cassava, sweet potatoes, millet, and vegetables of the
genus Brassica such as cabbage, broccoli, and turnips.
The goitrogenic effect of these foods is not usually
apparent if the diet is adequate in iodine. (See Goitro-
gens and Antithyroid Compounds.)
0015The FAO/WHO estimates that more than 20% of
the world’s population lives in geographic areas that
are iodine-deficient. Iodine deficiency affects about
685 million people in Asia and the Pacific, 150 mil-
lion in Africa, almost 55 million in the Americans,
33 million in North Africa and the Near East, and 82
million in Europe. Goiter from iodine deficiency
affects about 200 million people world-wide. Preva-
lence rates for goiter of 5–20% are considered mild;
in some communities, in Africa, Asia, and Latin
America, more than 60% of the people have goiter.
Children and women are more vulnerable to iodine
deficiency than other population subgroups. About
26 million people have some degree of brain damage
and mental retardation, and six million are affected
by cretinism because of iodine deficiency.
Iodine Toxicity
0016Some individuals can tolerate very high levels of
iodine with no apparent side-effects, and iodine
intakes of up to 1 mg per day are probably safe for
the majority of the population but may cause adverse
effects in some individuals. Those who are most likely
to respond adversely to iodine are those who have
lived in areas of endemic goiter or who for other
reasons have a habitually low intake of iodine, those
with other thyroid disorders, and those who are sen-
sitive to iodine.
0017Exposure to excessive iodine has occurred through
foods, water supplies, drugs, dietary supplements,
topical medication, and/or iodinated contrast media
(used for X-rays). In the past, iodine-containing drugs
(most commonly potassium iodide solutions) have
been prescribed as expectorants for respiratory dis-
ease such as asthma, bronchitis, cystic fibrosis, and
chronic pulmonary obstruction. Such drugs have also
been prescribed for goiter, hyperthyroidism, rheuma-
tism, and syphilis. Amiodarone, an iodine-containing
drug, was prescribed for cardiac problems. The
medical literature reveals that excessive exposure to
iodine has resulted in thyroiditis, goiter, hypothyroid-
ism, hyperthyroidism, sensitivity reactions, or acute
responses for some individuals. Maternal iodine
exposure during pregnancy has resulted in goiter,
respiratory problems, enlarged hearts, and death of
infants.
0018Iodine-induced hyperthyroidism may occur in
some people receiving iodine supplementation. This
condition is referred to as Jod–Basedow disease.
These individuals may have underlying Graves’
disease (hyperthyroidism) and react adversely when
IODINE/Physiology 3359