What are the symptoms of iodine deficiency?
All of the symptoms of iodine deficiency are related to its effect on the thyroid:

Goiter - Without adequate iodine, the thyroid progressively enlarges (develops a goiter) as it tries to keep up with demand for thyroid hormone production. Worldwide, iodine deficiency is the most common cause of thyroid enlargement and goiter (see Goiter brochure). Within a goiter, nodules can develop. Patients with a large goiter may experience symptoms of choking, especially when lying down, and difficulty swallowing and breathing.

Hypothyroidism – As the body’s iodine levels fall, hypothyroidism may develop, since iodine is essential for making thyroid hormone. While this is uncommon in the United States, iodine deficiency is the most common cause of hypothyroidism worldwide (see Hypothyroidism brochure).

Pregnancy-related problems - Iodine deficiency is especially important in women who are pregnant or nursing their infants. Severe iodine deficiency in the mother has been associated with miscarriages, stillbirth, preterm delivery, and congenital abnormalities in their babies. Children of mothers with severe iodine deficiency during pregnancy can have mental retardation and problems with growth, hearing, and speech. In the most severe form, an underactive thyroid can result in cretinism (a syndrome characterized by permanent brain damage, mental retardation, deaf mutism, spasticity, and short stature), though this is not seen in the United States. Congenital hypothyroidism due to iodine deficiency is the most common preventable cause of mental retardation in the world. Even mild iodine deficiency during pregnancy, which may be present in some women in the United States, may be associated with low intelligence in children.

CAUSES

What are the causes of iodine iodine deficiency?
Since the body does not make iodine, it relies on the diet to have enough iodine. Thus, iodine deficiency is caused but not having enough iodine in the diet. Iodine is present naturally in soil and seawater. The availability of iodine in foods differs in various regions of the world (see Table 1). Individuals in the United States can maintain adequate iodine in their diet by using iodized table salt (unless they have to restrict the amount of salt in their diet), by eating foods high in iodine, particularly dairy products, seafood, meat, some breads, and eggs, and by taking a multivitamin containing iodine (see below). However, the amount of iodine in foods is not listed on food packaging in the U.S., and it can be difficult to identify sources of iodine in foods.

[From WHO, UNICEF and ICCIDD 2001 Assessment of the Iodine Deficiency Disorders and monitoring their elimination. A guide for programme managers. WHO publ., Geneva. WHO/NHD/01.1]

How do you diagnose iodine deficiency?
Iodine deficiency is diagnosed across populations and not specifically in individuals. Since iodine is released from the body through the urine, the best way to determine iodine deficiency across a large population is to measure the amounts of iodine in urine samples. Iodine deficiency is defined as a median urinary iodine concentration less than 50 μg/L in a population (see Table 2).

In the United States, iodine status has remained generally adequate in the last 2 decades although studies have shown that urinary iodine levels dropped by about half between the early 1970s and the early 1990s. However, iodine deficiency is a major issue in other parts of the world, including parts of Europe, Africa and Asia.