There’ s also a study that showed that bromine in doses more than 300 times the normal levels produced no changes for TSH or T4 or thyroid-binding globulin, which you would expect there to be if it was affecting iodine.
Emma: So, we can accurately say that fluoride will displace iodine but that there are questions about chloride and bromide.
Miranda: Yes.
Emma: Okay. More research needed, right?
Miranda: Yeah, absolutely.
Emma: And what are the factors that drive low iodine levels that you see?
Miranda: So, there ' s topsoil depletion. We ' re not replacing that topsoil. There used to be the use of iodophor, which is a disinfectant used in both the dairy and the brewing industry, but that ' s actually not being used anymore, so we ' ve lost that indirect source. It ' s not being used as a fertiliser anymore in commercial agriculture.
We ' ve always talked about environmental goitrogens as well, that environmental goitrogen blocks the uptake of iodine.
And I think about that a lot, and it ' s like, yeah, but is that enough to be clinically relevant? Because we find those goitrogens in some of our leafy green vegetables, which are just so incredibly important for health generally. Are they really a major problem or are they like just a bit of a one-percenter? Because as we know, you cook the vegetables and there ' s no problem, right?
Emma: Mm, that ' s true.
Miranda: The goitrogens aren ' t an issue anymore. So, I do think about that a lot, comparing it to something like the phthalates, or the parabens, or the phenols, or the BPAs, which are so much stronger than any sort of vegetable-based thiocyanates or goitrogens. So, I question that a little bit sometimes.
Emma: Yes, and I think it ' s also about weighing up the pros and cons. I mean, when you ' re looking at broccoli and all these beautiful vegetables, are they a problem? Probably not.
Miranda: Exactly. In the bigger picture, comparative to everything else, it ' s interesting. And then of course, as we know, Australia introduced the iodisation of bread in 2009, and we did see a modest increase in the median urinary iodine concentration with that, particularly in pregnant women. And that public health initiative of iodine fortification in bread was based on people eating three slices of commercial non-organic bread a day.
So, when you look at that, all right, what level of the population is eating three slices of commercial non-organic bread a day? Most of the population would be eating that. So, I think our patients don ' t because we ' d be putting them on organic bread, if anything. But for the rest of the population eating three slices of commercial bread a day plus some sacks of table salt, which has also been iodised, many people would be actually getting more iodine than, say, our population group, our patients.
Emma: Is there a patient demographic that ' s a particular risk of having low iodine levels? Which patients should we keep in mind for this?
Miranda: Women are at higher risk than men of being iodine-deficient. That ' s hormonally driven, given the connection between thyroid, ovaries, and adrenals. And of course pregnant women in particular have the higher need- to sustain the foetus. In the first trimester of pregnancy, the foetus relies solely on the mother ' s thyroid hormones for its own thyroid development and
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