Japanese Reactor Accident and Radiation Leak
In the aftermath of the Japanese Earthquake and Reactor Accident, reports of radiation leakage has spurred interest and demand for Iodine tablets as a preventive agent. Iodine tablets prevent the uptake of radioactive I-131 by the thyroid gland, thereby preventing radiation induced thyroid cancer. (1)(2)(1A)
The Safety of Iodine Tablets
One televised doctor, a toxicologist, appeared on television to warn viewers about possible allergic reactions to Iodine.(3) After viewing television news reports on Iodine tablets, calling them unsafe and dangerous, some patients have called into the office asking questions about the safety of Iodine tablets. (3) Left Image: Iodine tablets in Japan, courtesy of wikimedia commons (13)
Can I Have An Allergic Reaction to Iodine?
For thirty years as a radiologist in the hospital, a large part of my job was to inject iodine contrast into people every day, so they could have their X-Ray test. And yes, we had some allergic reactions to the injections, and even some deaths from it. As a precaution, we always asked the patient if they had a pre-existing “iodine allergy”. So yes, there is such a thing as “iodine allergy” to iodine X-Ray contrast. However, (and this is the really important part), iodine contrast is not the same as elemental iodine. The molecular structures of the two are quite different. And, in addition, there can be no such thing as allergy to elemental iodine. Here is why:
No Allergy to Elemental Iodine -It’s an Essential Nutrient
Elemental Iodine is present in iodized salt and in other foods. Iodine is an essential nutrient, which means we need it to live. We have a long list of essential nutrients such as water, oxygen, iron, vitamin C etc., which are all examples of things that we need to live. If we don’t get them, we get sick and/or die. Iodine is one of those things. As a result, there can be no such thing as allergy to elemental iodine. Such a person could not take in Iodine, would get sick and die. For example, if a developing embryo is iodine deficient, it exhibits growth and mental retardation, a condition known as cretinism. When a population is severely iodine deficient, then there is increased incidence of goiter (thyroid enlargement), cretinism, mental retardation, decreased fertility rate, increased perinatal death, and infant mortality.(11)
Adverse Effects From Elemental Iodine
While there can be no “allergy” to Elemental Iodine, we observe various adverse reactions from elemental iodine in iodine deficient people starting high doses. This has been well described, and can be easily avoided by starting with small doses of iodine and gradually increasing dosage over time. Probably the most common report is a “metallic taste” in the mouth, which is harmless and merely means you are taking the “right stuff”. Another possible set of adverse reactions relates to the fact that the severely iodine deficient person may be Bromine toxic, and undergoes rapid Bromine excretion when starting the Iodine tablets. Bromine is irritating and the excretion can cause skin itching or rash, nausea and other symptoms. This is usually transitory and is gone in a few days.
Elemental Iodine and the Thyroid Gland
Another set of warnings appeared on television about possible adverse effects of Iodine for people who are either low thyroid or high thyroid. This will be discussed below in an article I wrote which was published in the “Townsend Letter for Doctors” .
Iodine is Safe and Effective by Jeffrey Dach MD (10)
Townsend Letter, Feb-March, 2011
Contrary to the editorial by Alan Gaby in the December 2010 issue Townsend Letter on iodine supplementation, I have been using iodine in clinical practice and find it both safe and beneficial. We have used iodine supplementation routinely in our practice for the past five years primarily as a safe and effective agent for prevention of breast cancer. And, in fact we have had virtually no breast cancer in our patient population on bioidentical hormones using iodine supplementation.
In terms of iodine testing, we test everybody routinely. We do a simple spot iodine urine level, which is done by one of the large national labs (we have Quest or LabCorp in our area). This is easy, since the patient is already at the lab for a complete blood test panel, and is already providing a spot urine sample for the U/A (routine urinalysis). So, another spot urine in a cup for the iodine level is easy to do. This is easier and more convenient than the 24-hour leading test, and I have found the results of the spot test very useful. In patients already supplementing with iodine, the urine spot iodine test is omitted, since high urinary excretion makes the spot urine test useless. However, as a baseline test before starting iodine, I have found the spot urine iodine extremely useful. If the spot urine test results are high, the patient will usually admit to a diet that includes seaweed, or is already on an iodine supplement of some type. Mostly we find the results at the low end of the range.
Hashimoto’s and Iodine
In patients with Hashimoto’s thyroiditis with elevated TPO and/or ThyroGlobulin antibodies, it is ill advised to start worth high dose iodine as this may aggravate the inflammation in the thyroid gland. It is important to first start selenium, and start the iodine supplement at a low dose around 225mcg per day- See my previous article on this topic here.
Hashimoto’s thyroiditis common, and almost an epidemic, and may be increasing in incidence. On a routine basis, initial evaluation includes thyroid antibody levels and serum selenium level. I have found that in almost all patients with elevated antibodies, selenium supplementation will normalize and drive down antibody levels on serial lab studies over time.
In order to prevent adverse effects from iodine in Hashimoto’s patients, patients are first given selenium supplements, usually 200-400 meg of seleno-methionine for three weeks before starting the iodine supplementation at 225 mcg per day. Over time,this is increased to 6.25 mg (half the 12.5 mg Iodoral tab) every other day. Starting with this lower dose of iodine avoids the various adverse effects of skin itching and metallic taste and GI symptoms that can be reported at first. These are usually transient, and after a week or so, the dose can be safely increased to a full tablet daily.
Occasionally, we see a typical Hashimoto’s patient with an elevated TSH around 5 or 6, and also an upper range free T3 around 350 to 400. These patients respond to selenium supplementation well, and follow-up labs usually show free T3 coming down to the 280-300 level, which in retrospect indicates the patient initially exhibited a slight thyrotoxic effect of the Hashimoto’s thyroiditis, which then cooled down after the selenium. At this point it is safe to start the iodine supplement 225 mcg/day, and then gradually introduce Iodoral. If a Hashi’s patient with a slightly overfunctioning thyroid and coexisting low selenium level is then started on iodine without first optimizing the selenium level, this will aggravate the thyroiditis.
Leaving the area of Hashimoto’s and going to the general patient (with normal antibody levels without Hashi’s), another big issue with iodine supplementation is that the TSH may go up, which is then interpreted by the family physician as a sign of hypothyroidism. This is merely transient, and the TSH returns to normal after discontinuing the Iodine supplement.
Case Report-Massive Iodine with Increased TSH
A good example of this is a 55-year-old woman who came to see me after taking an iodine supplement from a health food store, hoping to shrink her goiter. The high school kid at the health food store gave her the wrong dosage instructions. The patient had been taking a huge overdose of iodine for months. She felt fine. However, a routine thyroid lab panel at her primary care physician showed a TSH of 65 ! ! The doctor was very concerned and told her that “she “blew out” her thyroid with the health food store iodine, that she was severely hypothyroid”. The doctor then gave her a prescription for Synthroid, a thyroid pill, for her “hypothyroid” state.
No Acute Distress
This pleasant woman was sitting in the office in no distress. She said she felt fine, and in fact had no symptoms of hypothyroidism. Her repeat lab panel showed the Free T3 was normal at 330 indicating normal thyroid function, and no need Synthroid. I explained to the patient that the elevated TSH was an caused by the iodine supplement. The patient was advised to stop the iodine and recheck the TSH. Six weeks later the TSH of 65 had come down to 10. Twelve weeks later, the TSH was down to 4. The lady said thank you and I never saw her again.
The Iodine Book
All this information is David Brownstein’s Iodine book, which explains practical aspects of iodine supplementation in clinical practice. In order to safely use iodine, the biochemistry and physiology of the thyroid gland must be reviewed and understood by the practitioner. Much of this information is newly uncovered, and is beautifully presented in Dr Brownstein’s Iodine book.
I would urge all practitioners to routinely test antibody levels, serum selenium, and baseline spot urine for iodine on all patients before starting iodine supplementation. These tests are available at the large national labs and are convenient and easy to do. In patients with elevated antibody levels, supplementation with selenium avoids the adverse effects of iodine supplementation. Selenium reduces antibody levels, cools down the thyroiditis, making it safe to start the iodine. As you know, iodine supplementation is preventive for goiter and breast cancer, and yet there is greater benefit such as utility in normalizing blood sugar in type 2 diabetes, and utility to prevent the many thyroid nodules and cysts common in the population. (10)
Comment on TSH level and Thyroid Failure
Regarding the question about the elevated TSH indicating “early” or subclinical ” thyroid failure in the above patient:
I do not believe the above patient with the elevated TSH had thyroid failure because of the following facts:
1) Thyroid failure is associated with signs and symptoms of a low thyroid condition. She had none. She felt fine with normal energy and no fatigue.
2) Thyroid failure is associated with measurably low levels of thyroid hormone in the blood. This patient had normal levels of blood thyroid hormones on her lab panel.
Iodine puts the “brakes” on thyroid hormone release by the thyroid gland, explaining the benefit and routine use of lugol’s Iodine for thyroid storm and as a pre-operative treatment for Graves’ Disease hyperthyroidism. (15-17)
David Brownsteins’s blog is an excellent source of information on iodine and I strongly recommend his series of articles on iodine protection after the Japanese nuclear accident. (12) Dr. David Brownstein is author of an important book on Iodine, an excellent resource for those interested in further reading.
For articles with related interest:
Breast Cancer Prevention and Iodine Supplementation by Jeffrey Dach MD
Iodine Treats Breast Cancer, Overwhelming Evidence by Jeffrey Dach MD
For more on Iodine Supplementation, see the entire series in the Townsend Letter (4-8):
Megadose iodine: an idea whose time has gone. Townsend Letter, Dec, 2010 by Alan R. Gaby
Iodine Debate Continues – Reply to Alan Gaby by Guy Abraham Feb 2011 Townsend Letter
Older Debate 2006
Iodine debate continues Rebuttal Number Two Townsend Letter, April 2006 by David Brownstein, Guy Abraham
Alan Gaby’s Reply to Rebuttal Number Two Townsend Letter April 2006.
The Iodine Debate from Iodine Research
The Great Iodine Debate – Weston Price
(1) The moment nuclear plant chief WEPT as Japanese finally admit that radiation leak is serious enough to kill people By David Derbyshire . 19th March 2011 Read more: http://www.dailymail.co.uk/news/article-1367684/Japan-earthquake-tsunami-Fukushima-nulear-plant-radiation-leak-kill-people.html#ixzz1IkADt3gB
Core of Stricken Reactor Probably Leaked, U.S. Says. The statement came as the Tokyo Electric Power Company, the operator of the Fukushima Daiichi plant, started to inject nitrogen into the reactor containment vessel of unit No. 1 to prevent a possible explosion.
(2) http://www.princeton.edu/sgs/publications/Nuclear-Power-Plant-Emerg-Kah-von-Hippel.pdf N J Med. 2004 Apr;101(4):22-7; quiz 28-30. Nuclear power plant emergencies and thyroid cancer risk. What New Jersey physicians need to know.
Kahn LH, von Hippel F.
(3) http://www.signonsandiego.com/news/2011/mar/22/no-need-to-take-potassium-iodide-at-this-time/ No need to take potassium iodide at this time. Tablets would protect thyroid gland from absorbing iodine contaminated by radiation
By Union-Tribune Tuesday, March 22, 2011 at 12:01 a.m.
(4) Megadose iodine: an idea whose time has gone. Townsend Letter, Dec, 2010 by Alan R. Gaby
(5) Iodine debate continues Townsend Letter, Feb-March, 2011 by David Brownstein, Guy Abraham
(6) Alan Gaby replies Townsend Letter, Feb-March, 2011
(7) Another positive report on iodine Townsend Letter, Feb-March, 2011 by Kent Holtorf
(8) Rebuttal to Dr. Gaby’s iodine editorial Townsend Letter, Feb-March, 2011 by Geoffrey S. Ames
(9) Townsend Letter February / March 2011 . Letters to the Editor, Iodine is Safe and Effective by Jeffrey Dach MD
(10) Townsend Letter February / March 2011. Letters to the Editor, Iodine is Safe and Effective by Jeffrey Dach MD
(11) http://www.ncbi.nlm.nih.gov/pubmed/8054857 Thyroid. 1994 Spring;4(1):107-28. The disorders induced by iodine deficiency. Delange F. When the physiological requirements of iodine are not met in a given population, a series of functional and developmental abnormalities occur including thyroid function abnormalities and, when iodine deficiency is severe, endemic goiter and cretinism, endemic mental retardation, decreased fertility rate, increased perinatal death, and infant mortality.
(12) http://drdavidbrownstein.blogspot.com/2011/04/japanese-radiation-update-7-why-you.html Japanese Radiation Update 1-7: Why You Should Consider Iodine Therapy
Iodine distributed to the humanitarian effort in Japan. 22 March 2011
Iodine May Cause Elevated TSH Without thyroid failure
Clin Endocrinol (Oxf). 1992 Jun;36(6):573-8.
The effect of iodide on serum thyroid hormone levels in normal persons, in hyperthyroid patients, and in hypothyroid patients on thyroxine replacement. Philippou G, Koutras DA, Piperingos G, Souvatzoglou A, Moulopoulos SD.
Athens University School of Medicine, Department of Clinical Therapeutics, Alexandra General Hospital, Athens, Greece.
Inhibition by Iodine of the Release of Thyroxine from the Thyroid Glands of Patients with Thyrotoxicosis. LEONARD WARTOFSKY, BERNARD J. RANSIL, and SIDNEY H. INGBAR. From the Thorndike Memorial Laboratory, Harvard (Second and Fourth)Medical Services, Boston City Hospital, and the Department of Medicine,Harvard Medical School, Boston, Massachusetts 02118
Horm Metab Res. 1976 Jul;8(4):286-91. Effect of iodine upon the TRH induced release of TSH in euthyroid, hypothyroid and hyperthyroid individuals. Waldhäusl W, Haydl H.
Bleys, Joachim, Ana Navas-Acien, and Eliseo Guallar. “Serum selenium levels and all-cause, cancer, and cardiovascular mortality among US adults.” Archives of internal medicine 168.4 (2008): 404-410. Serum selenium and all cause cancer cardiovascular mortality Bleys Joachim Arch int med 2008
Mazokopakis EE, Papadakis JA, Papadomanolaki MG, et al. Effects of 12 months treatment with L-selenomethionine on serum anti-TPO levels in patients with Hashimoto’s thyroiditis. Thyroid. 2007 Jul;17(7):609-12. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17696828.>
Mazokopakis EE, Chatzipavlidou V. Hashimoto’s thyroiditis and the role of selenium. Hell J Nucl Med. January-April 2007. Available at: http://nuclmed.web.auth.gr/magazine/eng/jan07/8.pdf
Turker O et al. Selenium treatment in autoimmune thyroiditis: 9-month follow-up with variable doses. J Endocrinol. 2006;190:151-156. Available at: http://joe.endocrinology-journals.org/cgi/content/full/190/1/151
Zimmermann MB, Kohrle J. The impact of iron and selenium deficiencies on iodine and thyroid metabolism: biochemistry and relevance to public health. Thyroid. 2002 Oct;12(10):867-878. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12487769.>
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