Iodine is a crucial micronutrient essential for the proper functioning of the thyroid gland, which plays a key role in regulating metabolism, growth, and development. However, both iodine deficiency and excess can lead to significant health problems. A comprehensive study conducted in the southwestern region of Colombia sheds light on this delicate balance, illustrating what researchers refer to as a "U-shaped" curve of iodine impact.
Study Design and Methodology
The Vargas-Uricoechea et al. (2022) study involved 412 adults from both rural and urban areas in the Cauca department of Colombia. Participants underwent various assessments, including measurement of iodine levels through median urinary iodine concentration (mUIC), evaluation of thyroid function using blood tests, and assessment of thyroid size via physical examination and ultrasound imaging. Additionally, researchers tested for thyroid autoantibodies, which are markers of autoimmune activity against the thyroid.
A U-Shaped Risk: Iodine Deficiency and Excess
One of the most striking findings of the study was the distribution of iodine levels in the population. About 30% of participants had excessively high iodine levels (mUIC ≥ 300 µg/L), while approximately 25% had low iodine levels (< 100 µg/L). These figures demonstrate a U-shaped pattern: individuals at both extremes of iodine intake had a higher risk of thyroid dysfunction.
Socioeconomic Factors and Iodine Status
Excessive iodine intake was more common among individuals from higher socioeconomic backgrounds and those living in rural areas. In contrast, iodine deficiency was more prevalent among individuals from lower socioeconomic strata. This variation was not fully explained by reported salt consumption, which was consistent across groups. Nearly all participants used salt in cooking, and 94% reported using iodized salt. The average salt intake was 13.2 grams per day—almost triple the WHO recommendation.
Unreported Iodine Sources and Cultural Factors
Researchers suggested that other dietary sources—such as bouillon cubes, processed foods, or supplements—might explain iodine disparities. In rural areas, traditional cooking practices or misconceptions about iodized salt might also contribute to imbalances.
Thyroid Autoimmunity in the Population
Over 30% of participants tested positive for at least one thyroid autoantibody, such as anti-TPO, anti-Tg, or TRAb. These markers indicate immune responses targeting the thyroid, often leading to conditions like Hashimoto’s thyroiditis or Graves’ disease. Autoimmunity was more common in older adults, especially women over 60.
Link Between Excess Iodine and Autoimmunity
The study’s findings align with global research showing that excess iodine can increase the antigenicity of thyroid proteins, raising the risk of autoimmune thyroid diseases—especially in genetically predisposed individuals. This highlights the importance of monitoring even beneficial programs like universal salt iodization.
Hormone Levels and Hypothyroidism
Participants with excessive iodine intake were more likely to have elevated thyroid-stimulating hormone (TSH), an indicator of hypothyroidism. Many of these participants also had low free T4 (FT4), confirming underactive thyroid function.
Goiter Prevalence and Measurement
Goiter was common: physical exams found it in 41.7% of participants, while ultrasounds identified it in 34%. The higher rate from physical exams suggests some overestimation, but ultrasound still revealed a high goiter burden, even in a region previously considered free of iodine deficiency.
Goiter and Iodine Levels: Another U-Shape
Goiter prevalence was higher among women, people with high TSH, and rural residents—especially those with excess iodine. However, goiter also occurred among individuals with iodine deficiency. Notably, the middle socioeconomic group had the lowest goiter prevalence, suggesting a protective effect of moderate iodine intake.
Family History and Genetic Susceptibility
About one-third of participants had a first-degree relative with a thyroid disorder, reinforcing the role of hereditary factors in autoimmune thyroid conditions. Genetic risk likely interacts with environmental and dietary factors to influence thyroid health.
Accuracy of Thyroid Assessments
Researchers found poor agreement between clinical and ultrasound evaluations of thyroid size, concluding that ultrasound should be the preferred diagnostic tool in population studies due to its precision.
Public Health Implications
This study underscores the importance of nuanced public health strategies around iodine. While universal salt iodization reduces deficiency, it may contribute to iodine excess if not carefully monitored. Regular surveillance of population iodine levels is crucial—especially in regions with varied diets and living conditions.
The Role of Education and Awareness
Educational campaigns can improve public understanding of iodine sources and promote balanced nutrition. Health professionals should consider both deficiency and excess when diagnosing thyroid disorders and educating patients.
A Global Trend: Rising Iodine Excess
The Colombian study echoes global patterns. In countries with longstanding iodization programs, iodine excess is increasingly reported. For example, Colombia’s 2015 National Survey found that 75% of school-age children and 70% of women of childbearing age had excessive iodine levels.
Study Limitations
The study had some limitations: data on salt use and family history were self-reported, which can lead to recall bias. Other factors affecting thyroid health—such as smoking, vitamin D or selenium levels, or environmental toxins—were not examined. mUIC is also a less precise individual measure compared to a 24-hour urine sample.
The U-Shaped Curve: A Call for Balance
The evidence confirms that both iodine deficiency and excess can harm thyroid health. Public health must move beyond binary thinking and recognize that too much iodine can be as dangerous as too little. Policy, education, and surveillance must all reflect this complexity.
A Path Forward: Precision in Public Health
To safeguard thyroid health globally, stakeholders must work together to:
- Monitor iodine levels regularly
- Educate the public on balanced iodine intake
- Tailor interventions to diverse populations
- Avoid a one-size-fits-all approach
The U-shaped curve of iodine impact serves as a powerful reminder: when it comes to iodine, balance—not simply more—is the key to health.