36 year old female is seen in consultation for goiter, referred by her family physician. Prior work up included an FNA that was read as colloid goiter. Ultrasounds have shown progressive enlargement. There is a family hx of goiter in a sibling.
She as a history of ingesting a large amount of iodine containing supplements. She eats seaweed, kelp, and powdered seaweed at each meal. Bilateral nodular goiter is noted on neck examination. TFT's were borderline with TSH of 2.8 N 0.4-2.5,FT4 0.89 N 0.8-2.0 FT3 2.6 N 1.9-5.1 TG 154, TPO <10.1 TG AB <1,0. 24 hour urine free iodine was 3002 mcgs N 100-400.
The excessive use of iodine containing products such as seaweed will cause progressive thyroid enlargement as in this case.It can cause hypothyroidism in patients with autoimmune thyroid disorders, such as Hashimoto's thyroiditis. Non-toxic goiters can become toxic goiters. Even a normal thyroid that has 1/2 left after lobectomy may fail under the pressure of high dose iodine supplements.
Dr.G.
1 comment:
"She eats seaweed, kelp and powdered seaweed at each meal"
Seaweed is also a major source of goitrogens, including bromine and fluoride. These two elements are not good for the thyroid or helpful to the human body. Seaweed also contains many other trace minerals, besides iodine. You provide no evidence that it is the iodine which is causative, only that her urine had high iodine.
Seems that it is clearly the seaweed, and possibly, but not necessarily the iodine, which is the proximate cause of the thyroid problem.
I would not have bothered posting this note if the subject had only taken large doses of iodine or iodide supplements.
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