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Iodine deficiency syndrome — Clinical Guidelines

Overview

Iodine deficiency syndrome encompasses a range of disorders resulting from insufficient iodine intake, affecting thyroid function and leading to developmental issues in children and pregnant women 1 4.

Diagnosis

Urinary Iodine Concentration (UIC): Measure UIC as the median in μg/L to assess iodine status 1.

Target Population: Focus on pregnant women, children, and populations reliant on iodine-deficient diets 3 4.

Grading: Adequate intake defined as UIC ≥150 μg/L; deficiency <150 μg/L; excess >200 μg/L 1.

Management

Iodine Fortification: Mandatory iodization of salt to ensure adequate intake 1.

Supplementation: Daily iodine supplements recommended, especially for pregnant and lactating women (250 μg/day) 4.

Dietary Sources: Encourage consumption of iodized salt, dairy products, seaweed, and fish 4.

Special Populations

Pregnancy: Increased iodine requirements; median UIC in Belgian pregnant women was 124.1 mg/l (uncorrected) and 122.6 mg/g creatinine (corrected), highlighting ongoing deficiencies despite supplementation 3.

Children: Vulnerable to developmental impacts; programs reaching poorest populations show improvement but deficiencies persist in some regions 1.

Key Recommendations

Implement mandatory iodization of salt to cover at least 88% of the global population to combat iodine deficiency 1 (Evidence: Strong).

Pregnant and lactating women should receive iodine supplementation of 250 μg/day to meet increased requirements 4 (Evidence: Strong).

Regularly monitor iodine status through UIC surveys in nationally representative samples to guide public health interventions 1 (Evidence: Moderate).

Consider additional dietary sources and fortification strategies beyond salt in regions with persistent deficiency 1 (Evidence: Expert opinion).

References

1 Zimmermann MB, Andersson M. GLOBAL ENDOCRINOLOGY: Global perspectives in endocrinology: coverage of iodized salt programs and iodine status in 2020. European journal of endocrinology 2021. link 2 Sekhon I, Pearce EN, He X, Lee SY. Iodine Content in Meal Replacements in the United States. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2021. link 3 Vandevijvere S, Amsalkhir S, Mourri AB, Van Oyen H, Moreno-Reyes R. Iodine deficiency among Belgian pregnant women not fully corrected by iodine-containing multivitamins: a national cross-sectional survey. The British journal of nutrition 2013. link 4 Obican SG, Jahnke GD, Soldin OP, Scialli AR. Teratology public affairs committee position paper: iodine deficiency in pregnancy. Birth defects research. Part A, Clinical and molecular teratology 2012. link 5 Montero R, Sánchez-Alcázar JA, Briones P, Hernández AR, Cordero MD, Trevisson E et al.. Analysis of coenzyme Q10 in muscle and fibroblasts for the diagnosis of CoQ10 deficiency syndromes. Clinical biochemistry 2008. link 6 Zimmermann MB. Interactions of vitamin A and iodine deficiencies: effects on the pituitary-thyroid axis. International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition 2007. link

Iodine deficiency syndrome