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Effects of Chronic Iodine Excess in a Cohort of Long-Term American Workers in West Africa

Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, Boston University School of Medicine (E.N.P., S.P., L.E.B.), Boston, Massachusetts 02118; Peace Corps Office of Medical Services (A.R.G.), Washington, D.C. 20526; U.S. General Accounting Office (D.B.G.), Washington, D.C. 20008; National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention (L.K.K., R.L.), Atlanta, Georgia 30341

Address all correspondence and requests for reprints to: Lewis E. Braverman, M.D., Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, 88 East Newton Street, Evans 201, Boston, Massachusetts 02118. E-mail: lewis.braverman{at}bmc.org.

Abstract

A cross-sectional survey of 102 Peace Corps volunteers in Niger, West Africa, in 1998 had previously demonstrated a high rate of thyroid dysfunction and goiter attributable to excess iodine from their water filters. The Peace Corps volunteers were followed-up a mean of 30 wk after they ceased using iodine-based water filtration systems. Goiter was present in 44% of subjects during excess iodine ingestion and in 30% after removal of excess iodine. Mean serum iodine decreased from 293 µg/liter during excess iodine ingestion to 84 µg/liter after cessation of excess iodine. Mean total serum T₄ values increased from 100.4 to 113.3 nmol/liter (7.8 to 8.8 µg/dl). Mean serum free T₄ increased from 32.2 to 34.7 pmol/liter (2.5 to 2.7 ng/dl). Mean serum TSH decreased from 4.9 to 1.8 mU/liter. Mean serum thyroid peroxidase antibody levels decreased from 33,000 to 22,000 IU/liter (33 to 22 IU/ml).

We found that during prolonged excess iodine exposure there were marked increases in serum total iodine concentrations, and the prevalence of goiter, elevated serum TSH values, and elevated serum thyroid peroxidase antibody values increased. The prevalence of all abnormalities decreased after removal of excess iodine from the drinking water system.

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