Iodine Deficiency and Hypothyroidism From Voluntary Diet Restrictions in the US: Case Reports

Abstract

Iodine deficiency is rare in the United States today, and this is largely due to the effectiveness of iodization in the general food supply. Recent trends among specific populations of children in the United States include adopting food restrictions, such casein-free and gluten-free diets. Although the effect of these types of diets on overall nutrition status and certain micronutrients has been studied in children with autism spectrum disorder, the effect of these limitations on iodine levels in children has not been assessed. We present here 2 cases of iodine deficiency resulting from severe food restriction and associated primary hypothyroidism. In 1 case a classic presentation with a goiter was seen. These children were able to discontinue thyroid hormone treatment once iodine levels were normalized. There were no adverse events or unanticipated outcomes. The occurrence of these cases of iodine deficiency in the United States points to the need for thyroid function testing in children with severe food restrictions, especially those who have limited exposure to dairy, baked goods, and table salt.

Severe Hypothyroidism and Large Goiter due to Iodine Deficiency in an Adolescent Male in the United States: A Case Report and Review of the Literature

“…When unacknowledged, iodine defciency not only leads to hypothyroidism but can impair growth and cognitive development [17]. Tere are few modern case reports of iodine defciency in developed nations secondary to diets restricted for autism spectrum disorder, food aversion, and food allergies (Table 1) [7][8][9][10][11][12]. All except two patients were treated with iodine supplementation.…”

“…We performed a literature review and identifed 6 case reports from developed nations, describing 7 children aged 7.5 months to 12 years with hypothyroidism due to iodine defciency (Table1)[7][8][9][10][11][12].…”

Mild-to-Moderate Gestational Iodine Deficiency Processing Disorder

“…Many expectant mothers are either unaware of the dangers of mild-to-moderate GID or unaware of what actions they need to take to maintain their iodine levels before, during and after pregnancy to try to prevent GIDPD [6,8,10]. The indications are that pregnant women in developed countries are more likely to have GID because of voluntary diet restrictions, either unknowingly or knowingly (such as, vegans and vegetarians) choosing to avoid or restrict their intake of foods high in iodine, such as dairy products, eggs and sea foods [107,108,109]. Certainly, women’s self-perceptions about their physical appearance and body image is strongly influenced by the popular media [110], which can place undue social pressure on women, planning to become pregnant, to inadvertently restrict their diet of micronutrients in an effort to maintain a specific body image [111,112,113].…”

Severe Acquired Primary Hypothyroidism in Children and its Influence on Growth: A Retrospective Analysis of 43 Cases

“…The etiology of primary acquired hypothyroidism mainly includes autoimmune thyroiditis, i. e. Hashimoto's disease, with additional iatrogenic cases occurring in inappropriate L-thyroxine (LT4)-substitution after thyroidectomy (either surgical or by radioiodine treatment) or as a complication of drug treatment in the setting of Graves' disease. Hypothyroidism caused by iodine deficiency in children in western countries has become very rare, but can still occur in families that follow a restricted diet [2].…”