Autoimmune Thyroiditis and Iodine Therapy
Jorge Flechas


Autoimmune thyroiditis
Hashimoto’s thyroiditis
iodine therapy


The incidence of Hashimoto’s thyroiditis, also referred to as goitrous autoimmune thyroiditis, is estimated to be equivalent to that of Grave’s disease. Although first discovered one hundred years ago, the pathophysiology of this disease has not yet been completely defined. Patients present with varying degrees of symptoms and may present euthyroid. Studies have found associations between genetic predisposition, environmental factors and co-occurrence of other autoimmune disorders within patients with autoimmune thyroiditis. This has further impeded advances to clearly define the mechanisms associated with autoimmune thyroiditis as there are a number of potential confounding factors which are not shared by all patients. Concern has been raised suggesting that iodination of salt led to the emergence or increase in prevalence of autoimmune thyroiditis. In regions where chronic excess consumption of iodine occurs, studies have not found an association between iodine intake and prevalence of this disorder. Furthermore, autoimmune thyroiditis patients with low thyroid levels of iodine are at risk of developing hypothyroidism. Therefore iodine therapy is indicated in patients with autoimmune thyroiditis to preserve normal function of the thyroid, unless the patient has goiter. Patients receiving iodine therapy must be monitored closely to ensure the condition does not exacerbate.



Hashimoto H. Zur Kenntniss der lymphomatosen Veranderung der Schilddruse (Struma lymphomatosa). Arch Klin Chir. 1912; 97:219–48.
Abraham GE. The safe and effective implementation of orthoiodosupplementation in medical practice. The Original Internist. 2004; 11(1):17–36.
Gaitan E, Nelson NC, Poole GV. Endemic goiter and endemic thyroid disorders. World J Surg. 1991; 15:205–15.
Weaver DK, Batsakis JG, Nishiyama RH. Relationship of iodine to ‘lymphocytic goiters’. Arch Surg. 1968; 98:183–6.
Weaver DK, Nishiyama RH, Burton WD, Batsakis JG. Surgical thyroid disease. A survey before and after iodine prophylaxis. Arch Surg. 1966; 92:796–801.
Furszyfer J, Kurland LT, Woolner LB, Elveback LR, McConahey WM. Hashimoto’s thyroiditis in Olmsted County, Minnesota, 1935 through 1967. Mayo Clin Proc. 1970; 45:586–96.
Gordin A, Maatela J, Miettinen A, Helenius T, Lamberg B-A. Serum thyrotrophin and circulating thyroglobulin and thyroid microsomal antibodies in a Finnish population. Acta Endocrinol. 1979; 90:33–42.
Ling SM, Kaplan SA, Weitzman JJ, Reed GB, Costin G, Landing BH. Euthyroid goiters in children. Correlation of needle biopsy with other clinical and laboratory findings in chronic lymphocytic thyroiditis and simple goiter. Pediatrics. 1969; 44:695–708.
Turnbridge WMG, Evered DC, Hall R, Appleton D, Brewis M, Clark F, Evans JG, Young E, Bird T, Smith PA. The spectrum of thyroid disease in a community. The Whickham survey. Clin Endocrinol. 1977; 7:481–93.
Inoue M, Taetani N, Sato T, Nakajima H. High incidence of chronic lymphocytic thyroiditis in apparently healthy school children: epidemiological and clinical study. Endocrinol Jpn. 1975; 22(6):483–8.
Carey C, Skosey C, Pinnamaneni KM, Bransano CP, DeGroot LJ. Thyroid abnormalities in children of parents who have Graves’ disease. Possible pre-Graves’ disease. Metabolism. 1980; 29:369–76.
Mitchell JD, Kirkham N, Machin D. Focal lymphocytic thyroiditis in Southampton. J Pathol. 1984; 144:269–73.
Akamizu T, Amino N, DeGroot LJ. Hashimoto’s thyroiditis. DeGroot LJ, ed. .
Duntas LH. Environmental factors and autoimmune thyroiditis. Nat Clin Pract Endocrinol Metab. 2008; 4:454–60.
Cooper GS, Bynum MLK, Somers EC. Recent insights in the epidemiology of autoimmune diseases: improved prevalence estimates and understanding of clustering of diseases. J Autoimmune. 2009: 33(304):197–207.
Schreiber FS, Ziob T, Vieth M, Elsbernd H. Atypical celiac disease in a patient with type 1 diabetes mellitus and Hashimoto’s thyreoiditis.Dtsch Med Wochenschr. 2011; 136(3):82–5.
Betterle C, Lazzarato F, Presotto F. Autoimmune polyglandular syndrome type 2: the tip of an iceberg? Clin Exp Immunol. 2004; 137(2):225–33.
Molitch ME, Gillam MP. Lymphocytic hydrophysitis. Horm Res. 2007; 68(Suppl 5):145–50.
Neufeld M, Blizzard RM. Polyglandular autoimmune diseases. In: Pinchera A, Doniach D, Fenzi GF, et al., eds. Symposium on autoimmune aspects of endocrine disorders. New York: Academic Press, 1980:357–65.
Metso S, Hyytia-Ilmonen H, Kaukinen K, et al. Gluten-free diet and autoimmune thyroiditis in patients with celiac disease. A prospective controlled study. Scand J Gastroenterol. 2012; 47:43–8.
Cosnes J, Nion-Larmurier I. [Complications of celiac disease]. Pathol Biol (Paris). 2013; 61:e21–6.
Adamson LA, Fowler LJ, Clare-Salzler MJ, Hobbs JA. Parvovirus B19 infection in Hashimoto’s thyroiditis, papillary thyroid carcinoma, and anaplastic thyroid carcinoma. Thyroid. 2011; 21:411–7.
Desailloud R, Hober D. Viruses and thyroiditis: an update. Virol J. 2009; 6:5.
Lehmann HW, Lutterbüse N, Plentz A, et al. Association of parvovirus B19 infection and Hashimoto’s thyroiditis in children. Viral Immunol. 2008; 21:379–83.
Mori K, Munakata Y, Saito T, et al. Intrathyroidal persistence of human parvovirus B19 DNA in a patient with Hashimoto’s thyroiditis. J Infect. 2007; 55:e29–31.
Mori K, Yoshida K. Viral infection in induction of Hashimoto’s thyroiditis: a key player or just a bystander? Curr Opin Endocrinol Diabetes Obes. 2010; 17:418–24.
Mori K, Yoshida K, Ishii K, et al. Experimental autoimmune thyroiditis in human parvovirus B19 transgenic mice. Autoimmunity. 2011; 44:483–9.
Morohoshi K, Takahashi Y, Mori K. Viral infection and innate pattern recognition receptors in induction of Hashimoto’s thyroiditis. Discov Med. 2011; 12:505–11.
Wang J, Zhang W, Liu H, et al. Parvovirus B19 infection associated with Hashimoto’s thyroiditis in adults. J Infect. 2010; 60:360–70.
Skillern PG, Crile G Jr, McCullaugh EP, Hazard JB, Lewis LA, Brown H. Struma lymphomatosa: primary thyroid failure with compensatory thyroid enlargement. J Clin Endocrinol Metab. 1956; 16(1):35–54.
Paris J, McConahey WM, Tausie WN, Woolner LB, Bahn RC. The effect of iodides on Hashimoto’s thyroiditis. J Clin Endocrinol Metab. 1961; 21:1037–43.
Endo T, Kaneshige M, Nakazato M, Kohgai T, Saito T, Onaya T. Autoantibody against thyroid iodide transporter in the sera from patients with Hashimoto’s thyroiditis possesses iodide transport inhibitory activity. Biochem Biophys Res Commun. 1996; 228(1):199–202.
Chin HS, Chin DK, Morgenthaler NG, Vassart G, Costagliola S. Rarity of anti- Na+/I-symporter (NIS) antibody with iodide uptake inhibiting activity in autoimmune thyroid diseases (AITD). J Clin Endocrinol Metab. 2000; 85:3937–40.
Seissler J, Wagner S, Schott M, Feldkamp J, Scherbaum WA, Morgenthaler NG. Low frequency of autoantibodies to the human Na+/I-symporter (NIS) in patients with autoimmune thyroid disease. J Clin Endocrinol Metab. 2000; 85:4630–34.
Brown TR, Zhao G, Palmer KC, Sundick RS. Thyroid injury, autoantigen availability, and the initiation of autoimmune thyroiditis. Autoimmunity. 1998; 27:1–12.
Laurerberg P, Pedersen KM, Hreidarsson A, Sigfusson N, Iversen E, Knudsen PR. Iodine intake and the pattern of thyroid disorders: a comparative epidemiological study of the thyroid abnormalities in the elderly in Iceland and in Jutland, Denmark. J Clin Endocr Metab. 1998; 83:765–9.
Konno N, Makita H, Yuri K, Iizuka N, Kawasaki K. Association between dietary iodine intake and prevalence of subclinical hypothyroidism in the coastal regions of Japan. J Clin Endocr Metab. 1994; 78:393–7.
Tajiri J, Higashi K, Morita M, Umeda T, Sato T. Studies of hypothyroidism in patients with high iodine intake. J Clin Endocr Metab. 1986; 63:412–7.
Ruwhof C, Drexhage HA. Iodine and thyroid autoimmune disease in animal models. Thyroid. 2001; 11:427–36.
Dai YD, Rao VP, Carayannios G. Enhanced iodination of thyroglobulin facilitates processing and presentation of a cryptic pathogenic peptide. J Immunol. 2002; 168:5907–11.
Armengol MP, Sabater L, Fernández M, Ruíz M, Alonso N, Otero MJ, Martínez-Cáceres E, Jaraquemada D, Pujol-Borrell R. Influx of recent thymic emigrants into autoimmune thyroid disease glands in humans. Clin Exp Immunol. 2008; 153(3):338–50.
Weetman AP. Chronic autoimmune thyroiditis. In: Braverman LE, Utiger RD, eds. Werner & Ingbar’s the thyroid. Philadelphia, PA: Lippincott Williams & Wilkins, 2000;721–32.
Follis RH. Further observations on thyroiditis and colloid accumulation in hyperplastic thyroid glands of hamsters receiving excess iodine. Lab Invest. 1964; 13:1590–9.
Belshaw BE, Becker DV. Necrosis of follicular cells and discharge of thyroidal iodine induced by administering iodide to iodine-deficient dogs. J Clin Endocr Metab. 1973; 13:466–74.
Mahmoud I, Colin I, Many MC, Denef JF. Direct toxic effect of iodine in excess on iodine-deficient thyroid gland: epithelial necrosis and inflammation associated with lipofuscin accumulation. Exp Mol Pathol. 1986; 44:259–71.
Bagchi N, Brown TR, Sundick RS. Thyroid cell injury is an initial event in the induction of autoimmune thyroiditis by iodine in obese strain chickens. Endocrinology. 1995; 136:5054–60.
Many MC, Papadopoulaous J, Martic C, et al. Iodine-induced cell damage in mouse hyperplastic thyroid is associated to lipid peroxidation. In: Gordon A, Gross J, Hennenian G, eds. Progress in thyroid research. Proceedings of the 10th International Thyroid Conference. Rotterdam, Balkema, 1991:635–8.
DeGroot LJ, Thompson JE, Dunn AD. Studies on an iodinating enzyme from calf thyroid. Endocrinology. 1965; 76:632–45.
Okerlund MD. The clinical utility of fluorescent scanning of the thyroid. In: Kaufman L, Price DC, eds. Medical applications of fluorescent excitation analysis. Boca Raton, FL: CRC Press, 1979:149–60.

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