LaFranchi SH NIH , Watada H Sosa JA Rivkees SA , OBJECTIVES We designed a regimen to address the lack of a primary therapeutic effect of the MMI 15 mg/day by combining it with inorganic iodine at 38.2 mg/day. , Causes include Graves’ disease, toxic adenoma, and toxic multinodular goitre. , In others, radioactive iodine therapy, antithyroid drugs, or surgery are indicated to remove or destroy overactive thyroid cells, which may necessitate lifelong thyroid hormone replacement to maintain a normal hormone level. , , KI dose was adjusted to maintain normal maternal thyroid function every 1 to 3 months. Data are expressed as medians and ranges. Informed consent was obtained from all mothers. , Snyder D , Nagasaki K , , Kawamura M ". , The study protocol was approved by our clinical Institutional Review Board. They should only be used for limited periods of time and in specific situations: in patients with contraindications to thionamides (eg, due to agranulocytosis); for treatment of thyrotoxic crisis (see below); in cases when rapid control of hyperthyroidism is required. , , , Therefore, we cannot determine whether the TSH levels would have eventually normalized via the escape phenomenon, even if KI administration had continued. The iodine-containing compounds used in the treatment of hyperthyroidism are potassium iodide (KI) in the form of KI tablets, a saturated solution of potassium iodide (SSKI), and Lugol’s solution. It was discovered by Drs. Maia AL Chaikoff IL Pharmacotherapy. Fukushi M Ministry of Health, Labour and Welfare. For patients with Graves disease, the effects of inorganic iodine therapy appear quickly but are often considered transient [1]. Twenty-six infants for whom iodine concentrations in breast milk and infant urine could be measured simultaneously were selected from among the infants of lactating mothers with Graves disease who were treated with potassium iodide (KI) alone for thyrotoxicosis between September 2012 and August 2015. , Nowadays, patients with Graves' hyperthyroidism are initially treated with methimazole or propylthiouracil. Mukasa K Chung HR Minagawa M Shigihara N In contrast, we observed markedly higher levels of iodine in breast milk from inorganic iodine–treated lactating mothers with Graves disease (median, 15,050 μg/L; range, 831 to 72,000 μg/L). The Wolff–Chaikoff effect is a presumed reduction in thyroid hormone levels caused by ingestion of a large amount of iodine.. , Burch HB Accessed 8 September 2017. By extension, they were sometimes used to treat Graves' disease, but by the end of the century, they were considered to be a dangerous form of therapy. Mizokami T Sustained control of Graves' hyperthyroidism during long-term low-dose antithyroid drug therapy of patients with severe Graves' orbitopathy. However, They advocate a nutritional supplement program prior to using Iodine: Selenium. Food and Nutrition Board, Institute of Medicine We were unable to follow case 15. Inorganic iodine therapy, eg. Horikawa R Persistent Graves' hyperthyroidism despite rapid negative conversion of thyroid-stimulating hormone-binding inhibitory immunoglobulin assay results: a case report. , However, in this study, we used the blood levels of FT4 and TSH that were obtained when the data on iodine concentrations in breast milk and infant urine were obtained. Japanese journal of clinical medicine 64(12):2269-73 , In case 8, the blood TSH level was 5.7 μIU/mL at 2 months after birth. , , Alexander EK Presented at 15th International &14th European Congress of Endocrinology 2012, Florence, Italy. Of the 23 mothers, 14 had continuously received oral KI since before delivery. . Suzuki N When statistical correlations were evaluated only in the exclusively breastfed infants, there were no significant correlations between the blood TSH level and each variable (Supplemental Table 2). In case 15, the blood TSH level was 5.5 μIU/mL at 3 months after birth; however, we were unable to follow this case. In daily clinical practice, inorganic iodine may be administered to pregnant and lactating women with Graves disease for whom adverse reactions preclude the use of antithyroid drugs. Wolff J Kim BI He X Excessive iodine intake inhibits thyroid hormone synthesis through the organification defect. Literature Review. 2016 Jan;36(1):64-83. doi: 10.1002/phar.1676. , Brämswig J Peeters RP However, inorganic iodine therapy appears to be a potentially useful alternative for mothers with Graves disease with adverse reactions to antithyroid drugs who are contraindicated for iodine-131 therapy because they wish to continue breastfeeding (due to the superiority of breast milk to formula or due to infant rejection of formula) and do not wish to undergo surgery. Kasai T , It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Choi CW The median KI dose was 50 mg/d (range, 10 to 100 mg/d). Blood samples were collected from infants using an easy-to-perform filter paper procedure. 1). Braverman LE Anzo M Shin CH Minamitani K IODINE AND INORGANIC IODIDES: HUMAN HEALTH ASPECTS First draft prepared by John F. Risher and L. Samuel Keith, United States Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, Georgia, USA Published under the joint sponsorship of the United Nations Environment Programme, the Too little iodine and you may experience hypothyroidism, a condition in which the thyroid does not produce enough hormones. Ermans AM [Article in Dutch] Authors F SCHWARZ, P J DER KINDEREN. Four infants (cases 8, 15, 20, 23) had blood TSH levels ≥5 μIU/mL within 6 months after birth; these levels decreased to <5 μIU/mL in three infants (cases 8, 20, and 23) during KI administration. Leung AM Iodine induced hyperthyroidism is frequently observed in patients affected by euthyroid iodine deficient goiter when suddenly exposed to excess iodine. Bourdoux P Please enable it to take advantage of the complete set of features! Yang SW Takeno K Noh J This study evaluated the effects of inorganic iodine therapy administered to lactating mothers with Graves disease on the thyroid function of breastfed infants. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Greenlee MC In some cases, the disease spontaneously remits. Overview of dietary reference intakes for Japanese (2015). Epub 2011 Aug 11. Remission of Graves' hyperthyroidism predicted by smooth decreases of thyroid-stimulating antibody and thyrotropin-binding inhibitor immunoglobulin during antithyroid drug treatment. The thyroid hormone response to salt removal suggested a salt influence upon the development of hyperthyroidism. Some infants were exclusively breastfed, whereas others received mixed feedings (breast milk and formula). , Excessive Iodine Intake And Goiter On the other hand, an excess of iodine content in the body can result to a condition called hyperthyroidism, which happens if the body produces too much thyroid hormone. The escape phenomenon may occur after 36 to 40 weeks of gestation [20]; our study suggests that it may occur in postneonatal infants. Studies of the administration of inorganic iodine during breastfeeding found that when lactating mothers with euthyroidism received overdoses of iodine, preterm newborn infants and neonates ingested excessive levels of iodine through the breast milk and developed hypothyroidism [9–12]. Kikukawa Y High median iodine concentrations were detected in breast milk (15,050 μg/L; range, 831 to 72,000 μg/L) and infant urine (15,650 μg/L; range, 157 to 250,000 μg/L). Komiya K Briefly, the outer edge of the footpad was pricked with a sterile needle, and blood was blotted onto filter paper. , . , Honda A  |  Fujikawa M Only one infant (case 22) showed subclinical hypothyroidism, and the blood TSH level normalized after discontinuing KI. . The critical effect of iodine and inorganic iodides are disturbances in thyroid function occurring after increased iodine or iodide intake. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. 2019 Oct;26(5):232-240. doi: 10.1097/MED.0000000000000492. Boulvain M Sato J Chanoine JP . , . Boston BA First, the previously reported studies included both preterm newborn infants and neonates, with the former group being more likely to be affected by iodine overload [12]. Sesser D In our study, all examined infants had surpassed the newborn stage and were considered less likely to experience iodine overload–related effects on thyroid function. Brown RS , These 26 infants included two brothers and two infants from a set of triplets; thus, there were 23 breastfeeding mothers. , , Eating too many iodine-rich or iodine-fortified foods may lead to hyperthyroidism or worsen it in some cases.. A teaspoon of iodized salt gives you 284 micrograms of iodine. In summary, our study found that inorganic iodine therapy, when administered to lactating mothers with Graves disease, did not affect the thyroid function in most infants, despite high levels of exposure to iodine via breast milk. , Fukata S Ishikawa N , 2000 Oct;10(10):891-6. doi: 10.1089/thy.2000.10.891. Koga Y Grobman WA Hyperthyroidism is a condition in which thyroid gland produces too much of the hormone thyroxine, characteristic by elevated T 3 and T 4 level that result in accelerate body’s metabolism, causing sudden weight loss, a rapid or irregular heartbeat, sweating, and nervousness or irritability. , eds. , , Laurberg P , Diagnosis guide. TSH concentrations are expressed as serum concentrations, which are calculated by multiplying the whole blood values by 1.6 [13]. Treatment of thyrotoxicosis. Iodine is the fuel it runs on. , . Iodine was used to treat hyperthyroidism before the discovery of thionamide antithyroid drugs. Would you like email updates of new search results? . In case 20, the blood TSH level was 7.1 μIU/mL at 4 months after birth but decreased to 0.4 μIU/mL after 1 month; the maternal KI dose was maintained during this period. , Effect of inorganic iodine compounds and of di-iodotyrosine on uncomplicated hyperthyroidism and experimental Graves' disease. Pearce EN , Mandel SJ Pardou A Braverman LE The 2017 American Thyroid Association guidelines strongly recommend against sustained iodine intake exceeding 500 to 1100 μg/d while breastfeeding due to concerns about the potential for inducing hypothyroidism in the infant [24]. People with less iodine intake in daily life are presumed more susceptible to excessive iodine. . , , The effects of maternal inorganic iodine therapy on infant thyroid function are not well known. Moreover, because iodine sensitivity varies greatly among individuals, a further accumulation of cases may reveal overt hypothyroidism. Iodine concentrations in breast milk and infant urine were measured on the same day. Her only additional iodine intake was the salt she used for cooking. Given the importance of thyroid hormones to normal brain development during infancy, the thyroid function of infants should be closely monitored to ensure a rapid recovery from subclinical hypothyroidism while their mothers receive inorganic iodine. Cooper DS , In Japan, inorganic iodine is empirically administered to Graves disease patients with mild hyperthyroidism and to those with a history of adverse reactions to antithyroid drugs. This site needs JavaScript to work properly. , All statistical analyses were performed with EZR software (Saitama Medical Center, Jichi Medical University, Saitama, Japan) [16], which is a graphical user interface for R (The R Foundation for Statistical Computing, Vienna, Austria). . Ito K Breast milk was collected by manual expression, and infant urine was collected in a self-adhesive sterile urine bag on the same day as the infant thyroid function analyses.  |  , Brent GA Ohye H Several reports have indicated that the administration of an iodine overdose to lactating mothers causes hypothyroidism in their infants [9–12]. , . Dosiou C Generally, inorganic iodine is used for preparation of surgery, for treatment of thyroid storm, and after radioiodine therapy for Graves disease [2]. Inorganic iodine therapy is likely to be effective in patients with mild hyperthyroidism , but the factors that predict the efficacy of inorganic iodine therapy before treatment are unknown . . Nowadays, patients with Graves' hyperthyroidism are initially treated with methimazole or propylthiouracil. , The 26 infants included 14 boys and 12 girls, with a median age of 3 months (range, 0 to 10 months) and a median gestational age at birth of 38 weeks (range, 35 to 41 weeks). Iodine concentration measurements were outsourced to the Hitachi Chemical Clinical Laboratory (Tokyo, Japan), which implemented a microplate method based on the Sandell–Kolthoff reaction [15]. Iodine-induced hyperthyroidism in a patient with a normal thyroid gland Shmuel Shilo and Harry J. Hirsch Shaare Zedek Medical Centre, Jerusalem 91002, Israel Summary: Iodine-induced hyperthyroidism can develop even in the presence of an otherwise normal gland. , , Tajima T . Bandai S Hyperthyroidism is common and generally responds well to medical therapy. We note that the study setting of Japan, where dietary iodine intake is sufficient, may have buffered the effects of excess iodine exposure. This is achieved by decreasing the intrathyroidal inorganic iodine concentration by down regulation of the sodium iodine symporter ... Hyperthyroidism in patients with ischaemic heart disease after iodine load induced by … Further studies are warranted. , Accessed 8 September 2017. Mita T HHS According to maternal interviews, all infants underwent mass screening for congenital hypothyroidism at 4 to 7 days after birth and received normal results. BACKGROUND Methimazole (MMI) is usually used at an initial dose of 30 mg/day for severe Graves' disease (GD) hyperthyroidism, but adverse effects are more frequent at this dose than at MMI 15 mg/day. Uchida T Kameda T Noh JY , Regarding the second possibility, the Japanese diet includes high daily levels of iodine ingested via seaweed [21]. , Because of the long history of iodine deficiency in Germany, there is a high preva-lence of subclinical and manifest thyroid gland diseases. Yoshihara A Therefore, it is important to know the effects of this type of therapy on fetal and infant thyroid function. , Brown RS Supernatants of centrifuged breast milk samples and urine samples were stored at −20°C until further analysis. Each circle indicates the KI dose administered to one mother. Because the Wolff–Chaikoff effect is generally transient in the normal thyroid, thyroid hormone synthesis would normalize within a few days because of the so-called escape phenomenon [19]. Leung AM Curr Opin Endocrinol Diabetes Obes. Laurberg P However, the infants of lactating mothers with Graves disease might be less likely to have elevated blood TSH levels for 2 to 3 months after birth because of the effects of maternal thyrotropin receptor antibodies. However, inorganic iodine is transferred to fetuses via the placenta and to infants via breast milk [5]. COVID-19 is an emerging, rapidly evolving situation. , However, a virtually complete remission or longstanding euthyroid state may be obtained with inorganic iodine therapy alone in patients with mild Graves' disease, who show small thyroid volume and low TRAb titers. To analyze the differences between these two groups more accurately, data on frequency of formula feeding and iodine content of formula, which were not available in this study, are needed. , NLM ; Mass Screening Committee; Japanese Society for Pediatric Endocrinology; Japanese Society for Mass Screening Braverman LE Matsumoto M , , , E. Abraham M.D. , , Two months after KI discontinuation, the blood TSH level normalized to 2.3 μIU/mL (Fig. Delange F  |  , However, a virtually complete remission or longstanding euthyroid state may be obtained with inorganic iodine therapy alone in patients with mild Graves' disease, who show small thyroid volume and low TRAb titers. Nine mothers started or resumed oral KI therapy after the development or exacerbation of postpartum thyrotoxicosis. The median iodine concentrations of all 26 infants were 15,050 μg/L (range, 831 to 72,000 μg/L) in breast milk and 15,650 μg/L (range, 157 to 250,000 μg/L) in infant urine, and these concentrations correlated significantly (r = 0.699; P < 0.001). , eds. Goto H Cooper DS Ikenoue H 2011 Sep;21(9):951-6. doi: 10.1089/thy.2011.0039. , Suzuki M The KI doses correlated with the iodine concentrations in both breast milk (r = 0.636; P < 0.001) and infant urine (r = 0.610; P < 0.001) (Table 2). , Stan MN Conversely, hyperthyroidism occurs when the thyroid produces too much of the thyroid hormone thyroxine. In other words, thyroid function might have normalized after transient hypothyroidism. IV. Ito K , Although one infant had subclinical hypothyroidism (blood TSH, 12.3 μIU/mL), the TSH level normalized to 2.3 μIU/mL at 2 months after KI discontinuation. Clipboard, Search History, and several other advanced features are temporarily unavailable. In: Endocrine Abstracts. Kobayashi S Second, the lactating mothers in the earlier studies did not have Graves disease. In contrast, we observed a high median infant urinary iodine concentration of 15,650 μg/L (range, 157 to 250,000 μg/L). , Hamada K The normal thyroid function observed in most infants included in this study might be associated with the sufficient iodine intake in Japan. , . Arrows indicate data from the same cases. Hyperthyroidism may be asymptomatic or present with significant symptoms. Case numbers are shown in Supplemental Table 1. In: Inorganic iodine decreases serum thyroid hormone concentrations in patients with Graves' hyperthyroidism without adverse reaction, but this effect usually continues only a limited time. 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