AACE 2017 Annual Meeting – Case Report in Error
At the AACE 2017 Annual Meeting, Sarah Fishman, MD, PhD, of Lenox Hill Hospital, in New York, NY, presented a case report of a patient who developed thyroid disease after taking 2000 mcg per day of iodine in the form of a nutritional supplement containing iodine. Left image iodine tablets used in event of nuclear power plant accident emergency .
This case is in error because the patient had pre-existing toxic nodular goiter with autonomous nodule. In these rare cases, Iodine is contraindicated because iodine will cause thyrotoxicosis. The iodine did not cause the underlying thyroid disease of toxic nodular goiter. This case report is a gross error.
This error was made because the authors are so focused on vilifying iodine, they missed the correct diagnosis of toxic nodular goiter with autonomous nodule. Iodine is so safe, in 1924, the government mandated a program of salt iodination for the entire population resulting in considerable health benefits for the population. The government also mandates 65 mg of iodine for the population surrounding a nuclear power plant accident.
In general, Iodine serves to suppress thyroid function, and does not cause hyperthyroidism in the general population. In agreement is Dr. Dayan in his 1996 article on Chronic Autoimmune Thyroiditis in the New England Journal (3):
“However, iodine reduces thyroid secretion in both subjects with thyroid autoantibodies and those without thyroid autoantibodies, suggesting that it acts by inhibiting the biosynthesis and release of thyroid hormone rather than by augmenting thyroid autoimmunity. “(3)
Conclusion: This Case Report is deceptive and misleading and misses the patient’s correct diagnosis. Iodine did not cause the patient’s underlying thyroid disease of toxic nodular goiter with autonomous nodule. Yes, Iodine did cause the thyrotoxicosis episode which resolved upon withdrawing the iodine. Iodine is contra-indicated in these rare cases, and generally safe for the remainder of the population.
Articles with Related Interest:
Links and references
1) May 04, 2017 Case: Dietary Supplement Use Leads to Thyroid Disease
3) Autoimmune_Thyroiditis_Dayan_NEJM_1996 (Full pdf)
N Engl J Med. 1996 Jul 11;335(2):99-107.
Chronic autoimmune thyroiditis. Dayan CM, Daniels GH.
“However, iodine reduces thyroid secretion in both subjects with thyroid autoantibodies and those without thyroid autoantibodies, suggesting that it acts by inhibiting the biosynthesis and release of thyroid hormone rather than by augmenting thyroid autoimmunity. “
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