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Sir

We are a group whose mission is to promote awareness of the importance of iodine in the diet and to make evidence-based recommendations to eradicate iodine deficiency in the UK. We were pleased to note the article (Nov 17th) drawing attention to the problem of iodine deficiency in the UK in which your readers were reminded that two thirds of schoolgirls in Britain are iodine deficient. However, we were concerned by some other assertions. Although you recorded the case of a young girl with a goitre (thyroid enlargement) we wish to stress that most people with iodine deficiency in this country do not have a goitre. Iodine deficiency may be present for years before goitre presents but the condition is still important enough to have negative effects on pregnancy and the child. Secondly, we do not agree that iodine drops, which may cause gross overdosing, are appropriate for the treatment of iodine deficiency in the UK. In particular, we caution strongly against treating someone with a goitre before making a formal diagnosis. Furthermore, treatment with unknown amounts of iodine to people with unknown diagnoses may actually be harmful.

We would recommend a sustained delivery of iodine to the population such that iodine levels are sufficient for everyone. This may be achieved by ensuring a diet containing adequate iodine (provided mainly by milk and dairy foods in the UK as well as sea fish and eggs) and also the possible provision of iodised salt on a national scale. The UK is currently one of only 32 countries (out of around 190) in the world without adequate provision of iodised salt. In the meantime, the British Dietetic Association has a Food Fact sheet on Iodine, suitable for adults, that provides information on safe ways to achieve adequate dietary intake of iodine (https://www.bda.uk.com/foodfacts/Iodine).
While the Department of Health has recognised that iodine deficiency may be a problem in the UK with consequent effects on pregnancy and the child, little or no public health action has so far been implemented.

Yours sincerely

Prof John Lazarus Chair UK Iodine Group University of Cardiff
Dr S Bath University of Surrey
Dr E Combet University of Glasgow
Mrs J Hickey British Thyroid Foundation
Prof Kate Jolly University of Birmingham
Prof Michael Marsh Kings College Hospital London
Dr Alex Stewart Public Health England, Liverpool
Dr Mark Vanderpump Royal Free Hospital, London
Prof Graham Williams Imperial College London
Prof John H Lazarus MA MD FRCP FRCOG FACE
Regional Coordinator Iodine Global Network West and Central Europe
Emeritus Prof Clinical Endocrinology
Cardiff University

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