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Iodine is a non-metallic element from the halogen group. Its chemical symbol is I and it has the atomic number Z = 53 in the periodic table of the elements. Pure iodine (iodine) is black-grey with a metallic luster and already changes into the gaseous state at room temperature (sublimation). When heated, it forms violet vapors that are a strong irritant to the eyes and mucous membranes of the respiratory tract. Its name is derived from the Greek word "ioeides" = violet, violet-like. In the earth's surface it is the 70 most abundant element. Iodine was first obtained as an element by the French chemist Bernard Courtois (1777-1838) in 1811. In nature, it is found in small concentrations in the soil, in certain rocks, in lakes, the sea and even in the air. Industrially, it is mainly extracted from Chilean saltpetre deposits or from seaweed. Iodine is hardly used in the technical industry. Iodine is an essential trace element. In medicine, it is used as a disinfectant, a thyroid medication and an X-ray contrast agent. As a food supplement, it is added to table salts in the form of sodium potassium iodate. In the event of radioactive contamination of the environment, such as after the reactor accident in Chernobyl, it is available in state stores as potassium iodide so that it can be taken in increased quantities for a few days. This "saturates" the thyroid gland with harmless iodine and reduces the incorporation of radioactively contaminated iodine. Hyperthyroidism or thyroid cancer, on the other hand, are treated with radioactive iodine. For this purpose, the patient is administered a capsule containing the iodine isotope I 131 with an activity of about 100 mCi in the case of thyroid cancer, and 5-50 mCi in the case of hyperthyroidism. Another application of iodine is the removal of mercury from carpets. Iodine charcoal is used for this purpose. Iodine is found in sea fish, iodized table salt, and to some extent in drinking water. It is incorporated into thyroid hormones. Too little iodine in food and drinking water leads, among other causes, to enlargement of the thyroid gland (goiter). The areas on earth where there is a lack of iodine are called iodine deficiency areas. Germany belongs to the iodine deficiency areas, whereby the iodine deficiency is particularly pronounced in the mountainous regions. This iodine deficiency is caused by the ice ages, during which the iodine deposits were washed out by the meltwater.

Thyroid hormones

Iodine plays a crucial role especially in the synthesis of thyroid hormones. In the thyroid gland, about 80% of the iodine ingested daily is consumed. A deficiency of thyroid hormones (hypothyroidism), on the other hand, has negative effects on the growth and development of the body. Especially in early stages of physical development, i.e. in the embryonic period and in infancy, a deficiency of thyroid hormones can lead to severe physical and mental underdevelopment. Therefore, especially in these phases of life, the healthy function of the thyroid gland is important, which can only be guaranteed by an adequate supply of iodine.

The two main thyroid hormones are:

Triiodothyronine (T3) and tetraiodothyronine (T4), known as thyroxine for short. As can already be seen from the names of the hormones, iodine is an essential component. T3 contains three iodine molecules and T4 correspondingly four. Iodine must be ingested with food. The daily iodine requirement is 200 µg (millionths of a gram). The iodine reaches the thyroid gland with the blood from the gastrointestinal tract and is incorporated into the thyroid hormones there after several intermediate steps, including iodination and iodization. An average of 100 µg of T4 and 10 µg of T3 are produced daily and stored in the thyroid gland. When needed, the hormones are then released into the blood. In the blood, more than 99% of both hormones are bound to transport proteins and only a very small proportion is present as free, i.e. unbound hormone. This is referred to as free T3 (FT3) and free T4 (FT4). Only the free hormones are metabolically active. The half-life for T3 is twenty hours, that for T4 eight days. In this case, the half-life is the time after which the original amount of these hormones has been reduced to half. The formation of thyroid hormones is controlled by a feedback mechanism in higher-level centers in the brain, the hypothalamus and the pituitary gland.

Food containing iodine

The most important suppliers of iodine are sea fish and marine animals. Cod and haddock are particularly rich in iodine. Good suppliers are also meat and dairy products, although not all types of cheese, as iodine is sometimes lost during fermentation. Bread and other dishes should be salted with iodized salt to guarantee a minimum supply.

Iodine deficiency

The symptoms of iodine deficiency, which leads to an underactive thyroid gland (hypothyroidism), usually appear insidiously, so that one does not notice any complaints at first. Only when the underactivity becomes more severe do those affected complain of:

  • Fatigue
  • Lack of drive
  • Growth and development disorders in children
  • Increased need for sleep
  • Concentration disorders
  • Sensitivity to cold
  • Constipation, i.e. constipation

Patients are generally slowed down in activity and attention. The skin is dry, cool, pale and often doughy as a result of increased fluid retention in the subcutaneous fatty tissue. This change is referred to as myxedema. Patients' voice is rough and hoarse as a result of myxedema of the vocal cords, and speech is often slurred and slurred as a result of myxedema of the tongue. Patients' pulse is slowed and muscle reflexes are weakened. In older patients, often only some of these symptoms are present. Here, weakness and lack of strength, sensitivity to cold, and constipation predominate. Mild forms of hypothyroidism are therefore often overlooked.

Overdose and poisoning

If you follow the recommendations of the respective manufacturer when taking iodine-containing supplements, overdoses cannot occur in principle. In the case of hypothyroidism, however, even small amounts of iodine can be harmful because of the disturbed thyroid function. Iodized table salt contains quite small amounts of iodine; 1 kg of iodized salt contains only 20 mg of the mineral, so an overdose can be practically ruled out in this way. Iodine tablets or iodine supplements in food supplements are also not harmful to health if taken in the correct dosage. However, some algae used in Asian cuisine contain a great deal of iodine - these so-called kombu algae are not to be confused with the relatively iodine-poor nori leaves used in the preparation of sushi! Stiftung Warentest found that 1 kg of the kombu algae can contain up to 3.8 mg of iodine, almost twice as much as in iodized salt (NaI). It should be mentioned that there is virtually no iodine in "normal" table salt, i.e. sodium chloride (NaCl). People suffering from an iodine allergy should not take iodine-containing supplements without a doctor's recommendation and, in the case of an upcoming radiological examination with iodine-containing contrast media, should very thoroughly weigh up the necessity of using the substances with the attending physician. In the event of an overdose with iodine, if, for example, 1000 µg, i.e. 1 mg, is taken daily, there will initially be complaints in the gastrointestinal area and skin rashes. In the case of extreme overdosage, a brown coloration of the mouth and throat leads to clear disturbances in the gastrointestinal tract, as well as dizziness, shock and shortness of breath. Furthermore, mucosal burns with bleeding and renal hemorrhage may occur. The lethal dose is about 3 g of iodine. In case of iodine poisoning, water mixed with flour or a solution of 15 g of sodium thiosulfate in 500 ml of water should be drunk. A carefully performed gastric lavage with a 1% sodium thiosulfate solution or with starch flour may also be performed. Furthermore, shock control and treatment of pain may be required.

Prevention of iodine deficiency

Iodine deficiency can be reduced by consistent use of iodized table salts. Eating sea fish twice a week is also recommended, as sea fish contains a lot of iodine. To ensure intake of the daily requirement, one can additionally take iodine supplements, which are recommended for competitive athletes and especially for pregnant and lactating women and women who wish to have children.

Iodine requirement

According to the German Nutrition Society (Deutsche Gesellschaft für Ernährung e.V.), the daily iodine requirement is 180 µg for children and the elderly, and 200 µg for adolescents and middle-aged adults. Pregnant women and nursing mothers should consume 230 to 260 µg per day. Increased consumption of iodized salt in recent years has improved the population's iodine supply; however, it is still believed that there is a daily deficit of at least one-third or even one-half of the recommended amount.

Demand in sport

In athletes, the iodine requirement could be somewhat higher due to increased shield gland activity. Nevertheless, a daily dose of 300mcg should not be exceeded.

Safety and side effects

Iodine is probably safe and harmless for most people when taken orally in recommended amounts or applied to the skin with appropriate use of approved products. Iodine can cause significant side effects in some people. Common side effects include nausea, stomach pain, runny nose, headache, metallic taste, and diarrhea. In sensitive people, iodine can cause side effects including swollen lips and face (angioedema), severe bleeding and bruising, fever, joint pain, enlargement of lymph nodes, allergic reactions including hives, and death. Large amounts of iodine or long-term use of iodine may not be safe and harmless. Adults should avoid prolonged use of dosages above 1100 mcg per day without medical supervision. In children, the following dosages should not be exceeded:

  • Children from 1 to 3 years: 200 mcg iodine
  • Children from 4 to 8 years: 300 mcg iodine
  • Children from 9 to 13 years: 600 mcg iodine
  • Children 14 years and older: 900 mcg iodine

In children and adults, there is concern that higher dosages may increase the risk of side effects such as thyroid problems. Iodine in higher doses can cause a metallic taste, pain around the teeth and gums, burning in the mouth and throat, increased salivation, sore throat, upset stomach, diarrhea, symptoms of decay, depression, skin problems, and many other side effects. When iodine is used directly on the skin, it can cause skin irritation, spots on the skin, allergic reactions and other side effects. One should not bandage skin areas treated with iodine too tightly to avoid iodine burns.

Precautions and warnings

Pregnancy and Lactation: Iodine is likely safe and harmless when taken orally at recommended levels or when used appropriately on the skin in the form of an approved product (2% solution) during pregnancy and lactation. Oral ingestion of higher dosages may not be safe and harmless. Pregnant and lactating women over 18 years of age should not take more than 1100 mcg of iodine per day, and women between 14 and 18 years of age should not exceed 900 mcg of iodine per day. Higher dosages could cause thyroid problems.

Autoimmune thyroid diseases: People suffering from autoimmune thyroid diseases may be particularly sensitive to the harmful side effects of iodine. Thyroid diseases such as hypothyroidism, enlarged thyroid (goiter) or thyroid tumors: prolonged intake of iodine could aggravate these diseases.

Interactions

One should not take iodine in combination with the following medications:

Medicines for the treatment of hyperthyroidism

Iodine can affect the thyroid gland. Taking iodine in combination with medication to treat hyperthyroidism could reduce thyroid function too much. For this reason, you should not take iodine when taking medications to treat hyperthyroidism. One should be cautious when using iodine in combination with the following medications:

Amiodarone

Amiodarone contains iodine. Taking iodine supplements in combination with amiodarone could result in too high levels of iodine in the blood. Too much iodine in the blood can cause side effects that affect the thyroid gland.

Lithium

Lithium may inhibit thyroid function. Taking lithium in combination with iodine could have additive or synergistic inhibitory effects on thyroid function. For this reason, thyroid function should be monitored when taking lithium and iodine.

medicines for high blood pressure (ACE inhibitors, angiotensin receptor blockers)

Some medications for high blood pressure might slow potassium excretion. Most iodine supplements contain potassium. Taking potassium iodide in combination with some high blood pressure medications could result in excessively high levels of potassium in the body. For this reason, potassium iodide should not be used when taking medication for high blood pressure.

Potassium-sparing diuretics

Most iodine supplements contain potassium. Some diuretics, called potassium-sparing diuretics, can increase potassium levels in the body. Taking potassium iodide in combination with potassium-sparing diuretics could result in excessively high levels of potassium in the body. For this reason, potassium iodide should not be used when taking potassium-sparing diuretics.