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You don’t see many people with goiters anymore. I remember seeing them as a kid, pointing out some poor person’s huge neck to my mother while asking, “Hey, what’s growing on that woman’s neck?” before getting an educational jab in the ribs. To see a mild goiter click here.
Goiter is enlargement of the thyroid gland, which requires a little bit of iodine to function normally. When a person becomes severely deficient in iodine for a lengthy period, the thyroid, in order to continue producing enough life-sustaining thyroid hormone, gets larger in an effort to trap more iodine and make more hormone. You get naturally occurring iodine from veggies–but only if they’re grown in iodine-rich soil–and from the sea via fish and seaweed.
We in the Great Lakes region live in an area called the Goiter Belt because our soil is iodine deficient. At one point goiter and thyroid deficiency were becoming so prevalent in the US–whole towns had goiters–that scientists in the early 19th century figured out a way for everyone to get enough iodine. By adding iodine to table salt, goiter virtually disappeared.
And the story should end there.
But then the American Heart Association declared salt a nutritional villain, which to a certain extent it is. Heart patients and people with high blood pressure should avoid excess salt, and for years all of us were adding too much salt to our food. But over the past 20 years or so, our habits changed. Now we’re using so little salt that some of us are actually becoming iodine deficient. Moreover, when we do use salt we’re often using un-iodized forms such as sea salt and kosher salt.
Because much of our US soil remains iodine-poor, vegans and vegetarians have the most significant iodine deficiency problems, while meat and fish eaters and people who eat processed foods (to which manufacturers add tons of salt) have very little problem getting enough iodine.
With iodine deficiency, there are three broad areas of health concern:
• Most obvious, with insufficient iodine you can’t make enough thyroid hormone and may develop a mildly underactive thyroid (mild hypothyroidism). Symptoms include weight gain, brain fog, sluggishness, fatigue, cold hands and feet, thinning hair, constipation, and low basal body temperature. To diagnose underactive thyroid, doctors check blood levels of TSH (thyroid stimulating hormone), and there’s a lot of debate currently over what a normal level of TSH is. Formerly, any TSH level under 5.0 was considered to reflect a normal thyroid. Now a TSH under 2.5 seems to be a better indicator (in other words, if your TSH is above 2.5, you may have a mildly underactive thyroid). Temperature can also be a good indicator of thyroid health. For instructions on testing your thyroid function with a thermometer, click here.
• Iodine deficiency is linked to cyst formation (cysts are non-cancerous fluid-filled sacs within normal tissue). Most commonly, breast and ovarian tissue are affected by cysts. Nutritionally oriented doctors regularly recommend an iodine supplement for women with fibrocystic breast disease or recurring ovarian cysts.
• There seems to be a link between chronically low levels of iodine and breast cancer risk. Breast tissue and thyroid tissue concentrate stores of iodine. Suggestions of a cancer link came about when scientists recognized that breast cancer and hypothyroidism are both most common in menopausal women; that women with breast cancer often have enlarged thyroids, suggesting chronic iodine deficiency; and that Japanese women living in Japan have a very high iodine intake (from fish and seaweed) and the world’s lowest incidence of breast cancer. Americans of Japanese descent have the same breast cancer risk as white Americans.
Because iodine is concentrated in the thyroid and breast, there’s no good way to directly measure iodine deficiency in your body as a whole. Unlike measuring blood glucose or blood calcium, there is no test for “blood iodine.” To determine iodine deficiency, doctors rely on thyroid tests, but to complicate matters, iodine deficiency is just one of several causes of underactive thyroid.
Taking care of your iodine level is easy. Simply use a little iodized salt on your food, one teaspoon daily maximum–and you don’t even need that much to ensure a healthy thyroid. By the way, make it fresh salt, as iodine levels in salt decline after a month or two, and more rapidly in humid weather.
For patients with signs of mild hypothyroidism, I’ve been recommending the herbal product Thyroid Support, which contains a high amount of plant-based iodine. Most people with hypothyroidism require thyroid hormone replacement (such as Armour Thyroid).
For patients with breast cysts, fibrocystic breast syndrome, or recurring ovarian cysts, I recommend regular iodine supplementation using Iodoral. You don’t need much: one capsule 3 or 4 times a week is fine.
David Edelberg, MD