A Young Mom WIth Hashimotos Thyroiditis

Christina is a 32 year old mom with Hashimotos Thyroiditis. Unfortunately, the autoimmune thyroid disease has damaged her thyroid gland and slowed thyroid function. Her lab panel revealed elevated TPO antibodies and low Free T3 levels.  When first seen a year ago, Christina complained of chronic fatigue, weight gain, a “puffy” appearance of the eyes and face, dry skin and hair loss.  Thankfully, these symptoms all resolved over time on a treatment program with Nature-Throid (RLC Labs) 2 grains per day, selenium supplement,  200 mcg per day and iodine supplement, Iodoral half tablet (6.25 mg) daily.  Christina takes Celtic sea salt daily as well, to avoid Dermo-Bromism. Above left image woman on telephone courtesy of wikimedia commons.

Low Iodine Levels in Mom

Christina had low iodine levels. Her baseline urinary iodine excretion was 49 mcg/L indicating moderate iodine deficiency based on WHO Guidelines.(1)  Iodine supplements were given to correct this.

A Happy Mom Calls to Share the News !

After six months on our treatment program which includes iodine supplementation and prenatal vitamins containing methyl folate, Christina calls to share the good news. She is expecting !!

Why is Iodine So Important?
Raising Baby IQ with Iodized Salt

In 1924 iodized salt was introduced in the US, and average IQ increased by 15 points in iodine deficient areas of the country according to studies on military recruits.  Global programs to eliminate iodine deficiency have also improved IQ in other countries.  See universal salt iodization by Sullivan 1995.

Iodine Deficient Moms Cause Mental Retardation in Babies

Maternal iodine deficiency is the single most common cause of preventable mental retardation in children, and is a global health problem addressed by the World Health Organization.(5-7)

Low Maternal Iodine is Still a Problem

In spite of Iodized salt in the US, one third of young women have low iodine levels placing the baby at risk for neuro-developmental delay (2-4).  Low maternal iodine level is a preventable cause of mental retardation.(2)  As noted above, low maternal iodine levels have a deleterious effect on the baby’s brain development and IQ scores.  In many countries, screening programs have been instituted to detect Congenital Hypothyroidism caused by iodine deficiency so the babies can be treated immediately.  Left Image Smiling Baby courtesy of Wikimedia Commons.

How Much Iodine ?

Our office program for the expectant mom with Hashimoto’s Thyroiditis is 225-450 mcg of Potassium Iodide daily.  We monitor the spot urinary iodine excretion.  We also monitor thyroid labs, TSH, Free T3, Free T4 and antibody levels.  As the pregnancy progresses, we typically note declining TPO antibody levels related to “immune tolerance” of pregnancy as reported by Balucan et al.(8-9)

Excess Maternal Iodine May Raise TSH in Newborn

Although Iodine deficiency is the topic of this article, we will now discuss the other side of the coin, “Maternal Iodine Excess” causing “Transient Congenital Hypothyroidism in the newborn” reported in the pediatric literature. (15)  For this reason, for maternal iodine intake, we recommend the range of 225-450 mcg/day,  well below the 1,100 mcg per day upper limit set by the Food and Nutrition Board (FNB) of the Institute of Medicine.

Asian Cultures Have High Dietary Iodine Intake

Asian cultures such as Japan and Korea, mothers consume kombu soups containing sea weed with high iodine content, (2000-3000 mcg per day), and elevated TSH levels suggesting hypothyroidism may be discovered  in the newborn baby during congenital hypothyroidism screening. (16-18)  These cultural practices have been followed for centuries, while only recently the newborn thyroid screening programs been established. (16-18)

Iodine Is a Supplement Available at the Health Food Store

Don’t Go It Alone.

For anyone thinking of supplementing with Iodine, I would recommend seeking out and working closely with a knowledgeable physician who can  monitor iodine levels, thyroid function, and supervise your  program.  For a list of iodine-literate practitioners click here.

Conclusion:

Making sure our moms-to-be have healthy Iodine levels will produce more intelligent babies with higher IQ.

Articles with Related Interest:

Iodine and Hashimoto’s Autoimmune Thyroid Disease

Hashimotos, Selenium and Iodine, Part Two

Iodine and Bromine Detox With Unrefined Salt

Iodine Induced Hyperthyroidism 

David Brownstein on Thyroid Health and  Iodine

Jeffrey Dach MD
7450 Griffin Road Suite 190
Davie, Florida, 33314
954-792-4663

Links and references

1) Iodine Guidelines: WHO_Urinary Excretion 2013 World Health Organization  World Health Organization Urinary Iodine Excretion Guidelines:
50-99 mcg/L indicates mild deficiency,
20-49 mcg/L indicates moderate deficiency,
and less than 20 mcg/L indicates severe deficiency.

2) 2012_Leung_iodine_intake_during_pregnancy_Thyroid
http://www.ncbi.nlm.nih.gov/pubmed/23134529
Thyroid. January 2013, 23(1): 7-8. Sufficient Iodine Intake During Pregnancy: Just Do It.  Angela M. Leung, Elizabeth N. Pearce, Lewis E. Braverman

According to data from the National Health and Nutrition
Examination Survey (NHANES), the median urinary iodine
concentration in U.S. adults decreased by over 50% from the
early 1970s to the late 1990s (10). Of particular concern in the
NHANES data is that the prevalence of urinary iodine
values < 50 lg/L among women of childbearing age increased
by almost fourfold, from 4% to 15%, during this period.

The most recent NHANES survey (2005–2008)
demonstrated that 35.3% of pregnant women had urinary
iodine levels below 100 lg/L (11), which suggests mild iodine
deficiency (12).

Reductions in U.S. dietary iodine have been variously ascribed to a possible reduction in the iodine content of dairy products, the removal of iodate dough conditioners in commercially produced bread, new recommendations for reduced salt intake for blood pressure control, the recent increased use of Kosher and sea salts (which contain no iodine), and the increasing use of noniodized salt in manufactured or ‘‘pre-made’’ convenience foods (13).

NHANES Survey showing 50% decline in Iodine levels

3) http://www.ncbi.nlm.nih.gov/pubmed/9768638
Hollowell JG, Staehling NW, Hannon WH, Flanders DW,
Gunter EW, Maberly GF, Braverman LE, Pino S, Miller DT,
Garbe PL, DeLozier DM, Jackson RJ 1998 Iodine nutrition in
the United States. Trends and public health implications:
iodine excretion data from National Health and Nutrition
Examination Surveys I and III (1971–1974 and 1988–1994). J
Clin Endocrinol Metab 83:3401–3408.

4) http://www.ncbi.nlm.nih.gov/pubmed/21323596
Thyroid. 2011 Apr;21(4):419-27.
Iodine status of the U.S. population, National Health and Nutrition Examination Survey, 2005–2006 and 2007–2008.
Caldwell KL, Makhmudov A, Ely E, Jones RL, Wang RY.

This report presents urinary iodine (UI) concentrations for the general U.S. population during 2005-2006 and 2007-2008.

The median UI concentrations for the general U.S. population in 2005-2006 and 2007-2008 were 164 mg/L (95% confidence interval [CI] 154-174) and 164 mg/L (95% CI 154-173), respectively. Also, the proportions of the population with a UI concentration of < 50 mg/L during these survey periods were 9.8% ± 1.3% and 8.8% ± 0.4%, respectively. The median UI concentration and prevalence of ≥ 200 mg/L appeared to be higher in children and persons ≥ 70 years than in other age groups. (ii) In both surveys, children aged 6-11 years had median UI concentrations of ≥ 200 mg/L, and about 5% of them had a UI concentration of < 50 mg/L. (iii) All pregnant women (sample size 184) surveyed during 2005-2008 had a median UI concentration of 125 mg/L (95% CI 86-198), and 56.9% ± 7.9% of this group had a UI concentration of < 150 mg/L. UI concentrations were lower among non-Hispanic black survey participants than non-Hispanic white and Mexican-American participants.

5) http://blogs.discovermagazine.com/crux/2013/07/23/how-adding-iodine-to-salt-boosted-americans-iq/#.VMt8xiy6b2I
How Adding Iodine to Salt Boosted Americans’ IQ
By Lisa Raffensperger | July 23, 2013 3:00 pm

The economists found that in the lowest-iodine areas—the bottom quarter of the study population—the introduction of iodized salt had stark effects. Men from these regions born in 1924 or later were significantly more likely to get into the Air Force and had an average IQ that was 15 points higher than their predecessors.

6) COGNITIVE_EFFECTS_SALT_IODIZATION_Feyrer_July_2013
http://www.nber.org/papers/w19233
Feyrer, James, Dimitra Politi, and David N. Weil. The Cognitive Effects of Micronutrient Deficiency: Evidence from Salt Iodization in the United States. No. w19233. National Bureau of Economic Research, 2013.

Iodine deficiency is the leading cause of preventable mental retardation in the world today. The condition, which was common in the developed world until the introduction of iodized salt in the 1920s, is connected to low iodine levels in the soil and water. We examine the impact of salt iodization on cognitive outcomes in the US by taking advantage of this natural geographic variation. Salt was iodized over a very short period of time beginning in 1924. We use military data collected during WWI and WWII to compare
outcomes of cohorts born before and after iodization, in localities  that were naturally poor and rich in iodine. We ˝find that for the one quarter of the population most deficient in iodine this intervention
raised IQ by approximately one standard deviation. Our results can explain roughly one decade’s worth of the upwardtrend in IQ in the US (the Flynn Effect). We also document a large increase in thyroid
related deaths following the countrywide adoption of iodized salt, which affected mostly older individuals in localities with high prevalence of iodine deficiency.

Interpreting our measure in terms of IQ, our nding is that in iodine-decient regions, iodization raised IQ scores by roughly one standard deviation, or 15 points. Given that one-quarter of the population lived in such regions, this implies a nationwide increase in average IQ of 3.5 points.

7) Salt_Iodization_American_Worker_Adhvaryu_2013
Adhvaryu, Achyuta, et al. “Salt Iodization and the Enfranchisement of the American Worker.” (2013).

In 1924, The Morton Salt Company, the largest salt producer in the United States, began nationwide distribution of iodine-fortified salt. Access to iodine, a key determinant of cognitive ability, rose considerably, leading to increased intelligence quotients particularly in places where deficiency was previously rampant. We compare outcomes for cohorts exposed in utero to iodized salt to slightly older, unexposed cohorts, across individuals born in states with previously high versus low iodine deficiency rates. We document substantial impacts of salt iodization. High school completion rose by nearly 6 percentage points, and labor force participation went up by 1 point. Analysis of income transitions by quantile shows that new
labor force joiners entered at the bottom of  the wage distribution and took up blue collar jobs, pulling down average wage income conditional on employment. Our results inform the ongoing debate on salt iodization in many low-income countries. We show that blanket
iodized salt distribution in fact had a very targeted impact, benefiting the worker on the margin of employment, and generating sizeable economic returns at low cost.

8) Maternal thyroid deficiency during pregnancy Haddow New Eng J Med 1999
Haddow, James E., et al. “Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child.” New England Journal of Medicine 341.8 (1999): 549-555.

9) Balucan, Francis S., Syed A. Morshed, and Terry F. Davies. “Thyroid autoantibodies in pregnancy: their role, regulation and clinical relevance.” Journal of thyroid research 2013 (2013).

10) Iodine: Its Role In Health and Disease  Some New Exciting Concepts  Michael B. Schachter, M.D.

11) An Iodine Primer By Dr. Davis | July 9, 2012

12) Iodine to the Rescue Dr Sircus on June 11, 2012

13) Iodine—Are You Getting Enough? Many Americans Aren’t
2012  Dr. J. E. Williams

14) Safe Uses of Iodine Blog Alexander Haskell

15) Connelly, Kara J., et al. “Congenital hypothyroidism caused by excess prenatal maternal iodine ingestion.” The Journal of pediatrics 161.4 (2012): 760-762.

16) Nishiyama, Soroku, et al. “Transient hypothyroidism or persistent hyperthyrotropinemia in neonates born to mothers with excessive iodine intake.” Thyroid 14.12 (2004): 1077-1083.

17) Iodine_induced_neonatal_hypothyroidism_Emder_2011_JPCH  Emder, Phillip John, and Michelle Marion Jack.”Iodine‐induced neonatal hypothyroidism secondary to maternal seaweed consumption: A common practice in some Asian cultures to promote breast milk supply.” Journal of paediatrics and child health 47.10 (2011): 750-752.

18) Chen, Wen, et al. “Neonatal thyroid function born to mothers living with long‐term excessive iodine intake from drinking water.” Clinical endocrinology (2014).

Jeffrey Dach MD
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