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How Do You Know If You Need Iodine?

Are you wondering about the role of iodine in your health? Where does iodine work in the body and how might it help you? How do you figure out if you need extra iodine?  Are you consuming enough in your diet or do you even need iodine?  You might have lots of questions about iodine and in this article we look at some of these questions around iodine.   We look at what sign or symptom can tell you about iodine what tests you can do to determine your iodine status and what makes one curious about their iodine status to begin with.  

So if you want to understand how you know if you need more iodine, keep reading. 

How Do You Know If You Need Iodine? Symptoms and Diet

There are a few different ways to understand when someone might need iodine.  We will cover the considerations I look at when approaching this question.  The first thing though is to mention is that iodine is essential.  We all need it.  Really what we want to look at is how do you know if you need more iodine, outside of what you are getting from your diet.  There are two main categories of things to look at. Those are signs and symptoms and direct iodine testing.  On the testing side there are direct and indirect measurements of iodine.  There are also other measurements and assessment techniques that suggest iodine deficiency.   With any of these tests you want to look at how likely it is that you are getting an accurate result.  What is the sensitivity and specificity of the test in terms of detecting the people that actually do have iodine deficiency?

The first sign and symptom that comes to mind with iodine deficiency are for hypothyroid.   Most of the iodine in our bodies is used for thyroid hormone production.  In fact about 90% of the iodine your body holds onto is used for your thyroid.  That's why these signs and symptoms are critical to look at for iodine deficiency. 

In the u.s, most people get plenty of iodine because it comes from food sources like salt specifically.  If you eat prepared foods like soups and things like this, or you eat take out on a regular basis, you are probably getting plenty of iodine.  Most of these prepared foods contain iodized salt.  Iodine is also in some vegetables and other plants that we consume.  This is especially true if they are grown close to the coastal areas.  This is where most of the iodine is naturally occurring because of its proximity to the ocean.  Similarly, seafood seaweed and things like this have lots of iodine.  You really don't need a lot of iodine as long as you've been maintaining your levels over time.  When you are not getting enough from your daily food eventually your stores go down.  In some cases, you do need more based on environmental things as well.  If you have signs and symptoms of hypothyroid, like fatigue, constipation, weight gain or actual labs showing hypothyroidism, consider an iodine test. 


Also just consider your intake of some of the foods mentioned.  If you don't use iodized salt, you don't eat out, have more of a restrictive diet, don't eat prepared foods, you might consider getting your iodine tested.  For instance, some people use salt but they only use Himalayan sea salt, which is not iodized (unless it says it is).  So if you have a more controlled diet, you may be restricting some of the foods that are supplying your iodine.  These are some of the dietary lifestyle things that make me think someone might have iodine deficiency.  If any of this describes you and you have not done thyroid labs, consider doing a TSH, T4 and T3 test.  Low T4 and high TSH are indicators of iodine deficiency.  You need the iodine in order to make thyroid hormone that is what your T4 is made of. 


Testing to See If You Need Iodine

I mentioned that most of the iodine is used for thyroid hormone production.  Some is used in other tissues too.  In particular, breast tissue where it is thought to support healthy breakdown of estrogen.  If you are someone with fibrocystic breast disease, that may also be a sign or symptom to be evaluated for iodine deficiency.  These signs and symptoms should be looked at in the in the context of  your diet.  No test is 100% sensitive or specific.  That's why it is best to use multiple ways to evaluate and look at the question, how do you know if you need more iodine.  As a general rule, the iodine that's consumed in your daily diet gets excreted through the urine.  The remaining is used for making thyroid hormone and any other tissues that may need extra iodine.  Because of this, urinary iodine is a very sensitive and specific way to test for iodine deficiency.  If the level excreted is low, that means you are deficient in iodine.  You are deficient in the amount that you consume on a daily basis, this suggests your diet leading up to the test is devoid in iodine.  Urinary iodine test is one of the better tests for detecting iodine deficiency.  However, it may not be covered by your insurance even though it is the better test.  This test is done usually as a first morning void.  When you do the test you want to avoid any extra supplemental iodine before the test.  For the urinary test you want to make sure it uses a mass spectrometry to measure the iodine.  This is the gold standard and ensures you are getting the most accurate result. 

There is also a whole blood iodine. This test looks at the levels of iodine in your plasma and serum.  Just like with the urinary iodine test, you do want to avoid taking extra supplemental iodine before the test.  The idea is when you are taking iodine on a regular basis your tissue levels are getting saturated.  When you go to do the test you should have a much higher overall baseline and the blood test will show up as more normal.  As you supplement regularly, your tissues are saturated and you the excrete more because less is going to be sucked up by the tissues.  With the blood test a low or low normal level suggests iodine deficiency.  This is especially true in the context of hypothyroid symptoms or actual hypothyroidism. 

There is also a a test called urinary iodine challenge test.  This test, in theory, accounts for goitrogens.  Goitrogens are the things that can prevent iodine uptake by the thyroid cells.  The idea with this is you take a large bolus, several milligrams of iodine.  Then you see how much urinary iodine comes out.  As mentioned previously, ninety percent of what you consume should go out through the urine.  The remaining ten percent goes to the cells and tissues mostly the thyroid.  This  assumes that your cells and tissues are adequately saturated.  However if very little iodine comes out after you do the challenge, it assumes that some of that iodine is displacing (because of the large quantity) some of those goitrogens.  Then the tissues are becoming more saturated and less goes out through the urine.  What are goitrogens? 

Goitrogens are things like fluoride, chloride, glucoscinnalates.  Glucosinolates are from uncooked cruciferous vegetables.  They are in cooked cruciferous vegetables as well but to a lesser extent.  It is best if you're going to eat them, to cook them first.  Usually you would have to consume large copious amounts of these things to have an impact on your thyroid hormone production.   I have also heard of an empirical test where you drop iodine on your skin and see if it how long it takes to absorb.  I don't recommend using this method.  It it's not really sensitive and it's not very specific either.  In my practice we use the combination of looking at diet in conjunction with signs and symptoms hypothyroid and the blood test.  When you are low, we suggest supplementation gradually. 

Here is a separate video looking at problems of excess iodine

That should give you a better understanding of How you know if you need iodine.  Let me know what your experience is with iodine testing and if you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on how to test and treat iodine deficiency, click in the link below to get started. 

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