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Should we treat subclinical hypothyroidism in obese children?

BMJ 2016; 352 doi: (Published 16 March 2016) Cite this as: BMJ 2016;352:i941

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Rapid Response:

Re: Should we treat subclinical hypothyroidism in obese children?

There is a controversy that, although the iodine fortification of salt has decreased goitre due to hypothyroidism, it has paradoxically increased autoimmune thyroiditis (1-6), so it acts as adouble-edged sword. Either lowering or raising the iodine content of the diet will cause iodine deficiency thyroid disorders or autoimmune thyroiditis respectively.


1. Weaver DK, Nishiyama RH, Batsakis JG. Iodine induced thyroid disease. Ann Clin Lab Sci. 1976 Nov-Dec;6(6):545-50.

2. Rink T, Schroth HJ, Holle LH, Garth H. [Effect of iodine and thyroid hormones in the induction and therapy of Hashimoto's thyroiditis]. Nuklearmedizin. 1999;38(5):144-9. .

3. Foley TP Jr. The relationship between autoimmune thyroid disease and iodine intake: a review. Endokrynol Pol. 1992;43 Suppl 1:53-69. Review.

4. Boyages SC, Bloot AM, Maberly GF, Eastman CJ, Li M, Qian QD, Liu DR, van der Gaag RD, Drexhage HA. Thyroid autoimmunity in endemic goitre caused by excessive iodine intake. Clin Endocrinol (Oxf). 1989 Oct;31(4):453-65.

5. Mooij P, de Wit HJ, Drexhage HA. An excess of dietary iodine accelerates the development of a thyroid-associated lymphoid tissue in autoimmune prone BB rats. Clin Immunol Immunopathol. 1993 Nov;69(2):189-98.

6. Markou KB, Georgopoulos NA, Makri M, Vlasopoulou B, Anastasiou E, Vagenakis GA, Kouloubi K, Theodosopoulos N, Lazarou N, Veizis A, Sakellaropoulos G, Vagenakis AG. Improvement of iodine deficiency after iodine supplementation in schoolchildren of Azerbaijan was accompanied by hypo and hyperthyrotropinemia and increased title of thyroid autoantibodies. J Endocrinol Invest. 2003;26(2 Suppl):43-8.

Competing interests: No competing interests

08 April 2016
Neeru Gupta
Scientist F
Jugal Kishore, Neeta Kumar and KK Jani
Indian Council of Medical Research
Ansari Nagar, New Delhi-110029.