European Journal of Nutrition

, Volume 56, Issue 3, pp 965–971 | Cite as

Strong association of relatively low and extremely excessive iodine intakes with thyroid cancer in an iodine-replete area

  • Hye Jeong Kim
  • Na Kyung Kim
  • Hyeong Kyu Park
  • Dong Won Byun
  • Kyoil Suh
  • Myung Hi Yoo
  • Yong-Ki Min
  • Sun Wook Kim
  • Jae Hoon ChungEmail author
Original Contribution



The relationship between iodine intake and development of thyroid diseases shows a U-shaped curve with an increase of risk in both deficient and excessive iodine intakes. Our aim was to investigate the relationship between iodine intake and thyroid cancer in patients with thyroid nodules in an iodine-replete area.


Retrospective analysis of 1170 patients with thyroid nodules was performed. Urinary iodine concentration (UIC) was measured by inductively-coupled plasma mass spectrometry. Predictive factors for thyroid cancer were evaluated using multivariate logistic regression models.


The median UIC in all patients with thyroid nodules was 360 μg/L (range from 4 to 9631 μg/L). More than half of the patients (650/1170, 56 %) belonged to the category of excessive iodine intake (UIC ≥ 300 μg/L) according to WHO iodine recommendations. Patients with thyroid cancer were more likely to be distributed in UIC < 300 μg/L and in UIC ≥ 2500 μg/L than those with benign thyroid nodules. Male gender (OR 1.528, p = 0.028) and UIC were independent predictors for thyroid cancer. The multivariate-adjusted OR (95 % CI) in the relatively low (UIC < 300 μg/L) and extremely excessive (UIC ≥ 2500 μg/L) iodine intake groups for thyroid cancer were 1.519 (1.099–2.098) and 1.874 (1.094–3.208), respectively, compared to the other iodine intake group (300–2499 μg/L).


Male gender and UIC were independent predictors of thyroid cancer in patients with thyroid nodules. This study suggests that relatively low and extremely excessive iodine intakes are associated with thyroid cancer in an iodine-replete area.


Iodine Thyroid nodules Thyroid cancer 



This study was supported by the Research Grant Number CB-2011-03-02 of the Korean Foundation for Cancer Research and Soonchunhyang University Research Fund.

Compliance with ethical standards

Conflict of interest

The authors have nothing to disclose.


  1. 1.
    Guth S, Theune U, Aberle J, Galach A, Bamberger CM (2009) Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest 39:699–706CrossRefGoogle Scholar
  2. 2.
    Oh EY, Jang HW, Lee JI, Kim HK, Kim SW, Chung JH (2010) Prevalence of thyroid nodules and cancer detected by ultrasonography in healthy Korean adults: clinical features and the risk for malignancy. J Korean Thyroid Assoc 3:142–148Google Scholar
  3. 3.
    Mazzaferri EL (1992) Thyroid cancer in thyroid nodules: finding a needle in the haystack. Am J Med 93:359–362CrossRefGoogle Scholar
  4. 4.
    Ron E, Lubin JH, Shore RE, Mabuchi K, Modan B, Pottern LM, Schneider AB, Tucker MA, Boice JD Jr (1995) Thyroid cancer after exposure to external radiation: a pooled analysis of seven studies. Radiat Res 141:259–277CrossRefGoogle Scholar
  5. 5.
    Czene K, Lichtenstein P, Hemminki K (2002) Environmental and heritable causes of cancer among 9.6 million individuals in the Swedish Family-Cancer Database. Int J Cancer 99:260–266CrossRefGoogle Scholar
  6. 6.
    Adjadj E, Schlumberger M, de Vathaire F (2009) Germ-line DNA polymorphisms and susceptibility to differentiated thyroid cancer. Lancet Oncol 10:181–190CrossRefGoogle Scholar
  7. 7.
    Dal Maso L, Bosetti C, La Vecchia C, Franceschi S (2009) Risk factors for thyroid cancer: an epidemiological review focused on nutritional factors. Cancer Causes Control 20:75–86CrossRefGoogle Scholar
  8. 8.
    Laurberg P, Bulow Pedersen I, Knudsen N, Ovesen L, Andersen S (2001) Environmental iodine intake affects the type of nonmalignant thyroid disease. Thyroid 11:457–469CrossRefGoogle Scholar
  9. 9.
    Feldt-Rasmussen U (2001) Iodine and cancer. Thyroid 11:483–486CrossRefGoogle Scholar
  10. 10.
    Williams ED, Doniach I, Bjarnason O, Michie W (1977) Thyroid cancer in an iodide rich area: a histopathological study. Cancer 39:215–222CrossRefGoogle Scholar
  11. 11.
    Kanno J, Onodera H, Furuta K, Maekawa A, Kasuga T, Hayashi Y (1992) Tumor-promoting effects of both iodine deficiency and iodine excess in the rat thyroid. Toxicol Pathol 20:226–235CrossRefGoogle Scholar
  12. 12.
    Burgess JR, Dwyer T, McArdle K, Tucker P, Shugg D (2000) The changing incidence and spectrum of thyroid carcinoma in Tasmania (1978–1998) during a transition from iodine sufficiency to iodine deficiency. J Clin Endocrinol Metab 85:1513–1517Google Scholar
  13. 13.
    Boltze C, Brabant G, Dralle H, Gerlach R, Roessner A, Hoang-Vu C (2002) Radiation-induced thyroid carcinogenesis as a function of time and dietary iodine supply: an in vivo model of tumorigenesis in the rat. Endocrinology 143:2584–2592CrossRefGoogle Scholar
  14. 14.
    Guan H, Ji M, Bao R, Yu H, Wang Y, Hou P, Zhang Y, Shan Z, Teng W, Xing M (2009) Association of high iodine intake with the T1799A BRAF mutation in papillary thyroid cancer. J Clin Endocrinol Metab 94:1612–1617CrossRefGoogle Scholar
  15. 15.
    Liu XH, Chen GG, Vlantis AC, van Hasselt CA (2009) Iodine mediated mechanisms and thyroid carcinoma. Crit Rev Clin Lab Sci 46:302–318CrossRefGoogle Scholar
  16. 16.
    Wang F, Wang Y, Wang L, Wang X, Sun C, Xing M, Zhao W (2014) Strong association of high urinary iodine with thyroid nodule and papillary thyroid cancer. Tumour Biol 35:11375–11379CrossRefGoogle Scholar
  17. 17.
    Kim JY, Moon SJ, Kim KR, Sohn CY, Oh JJ (1998) Dietary iodine intake and urinary iodine excretion in normal Korean adults. Yonsei Med J 39:355–362CrossRefGoogle Scholar
  18. 18.
    Lee JH, Ji OJ, Song MJ, Park HD, Kim HK, Kim SW, Chung JH, Lee SY (2010) Determination of urinary iodine concentration by inductively coupled plasma-mass spectrometry in thyroid cancer patients on low-iodine diet. Korean J Lab Med 30:351–356CrossRefGoogle Scholar
  19. 19.
    Choi J, Kim HS, Hong DJ, Lim H, Kim JH (2012) Urinary iodine and sodium status of urban Korean subjects: a pilot study. Clin Biochem 45:596–598CrossRefGoogle Scholar
  20. 20.
    Cho YW, Kim YS, Baick SH, Oh DY, Kim WJ, Chang NS, Kang MW, Kim KS (1994) Analysis of daily intake and urinary excretion of iodine in normal control and patient with thyroid disease. J Korean Soc Endocrinol 9:307–317Google Scholar
  21. 21.
    Curado MP, Edwards B, Shin HR, Storm H, Ferlay J, Heanue M, Boyle P (2007) Cancer incidence in five continents. IARC Scientific Publications, LyonGoogle Scholar
  22. 22.
    WHO/UNICEF/ICCIDD (2007) Assessment of iodine deficiency disorders and monitoring their elimination, a guide for programme managers. World Health Organization Press, GenevaGoogle Scholar
  23. 23.
    Lee J, Kim JH, Lee SY, Lee JH (2014) Iodine status in Korean preschool children as determined by urinary iodine excretion. Eur J Nutr 53:683–688CrossRefGoogle Scholar
  24. 24.
    Sun X, Shan Z, Teng W (2014) Effects of increased iodine intake on thyroid disorders. Endocrinol Metab (Seoul) 29:240–247CrossRefGoogle Scholar
  25. 25.
    Harach HR, Escalante DA, Onativia A, Lederer Outes J, Saravia Day E, Williams ED (1985) Thyroid carcinoma and thyroiditis in an endemic goitre region before and after iodine prophylaxis. Acta Endocrinol (Cph) 108:55–60Google Scholar
  26. 26.
    Bacher-Stier C, Riccabona G, Totsch M, Kemmler G, Oberaigner W, Moncayo R (1997) Incidence and clinical characteristics of thyroid carcinoma after iodine prophylaxis in an endemic goiter country. Thyroid 7:733–741CrossRefGoogle Scholar
  27. 27.
    Lee SH, Kim TY, Ryu JS, Gong G, Kim WB, Kim SC, Hong SJ, Shong YK (2008) Trends analysis of characteristics of thyroid cancer patients in one medical center. J Korean Endocrinol Soc 23:35–43CrossRefGoogle Scholar
  28. 28.
    Kweon SS, Shin MH, Chung IJ, Kim YJ, Choi JS (2013) Thyroid cancer is the most common cancer in women, based on the data from population-based cancer registries, South Korea. Jpn J Clin Oncol 43:1039–1046CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Hye Jeong Kim
    • 1
  • Na Kyung Kim
    • 2
  • Hyeong Kyu Park
    • 1
  • Dong Won Byun
    • 1
  • Kyoil Suh
    • 1
  • Myung Hi Yoo
    • 1
  • Yong-Ki Min
    • 2
  • Sun Wook Kim
    • 2
  • Jae Hoon Chung
    • 2
    Email author
  1. 1.Division of Endocrinology and Metabolism, Department of Internal MedicineSoonchunhyang University Hospital, Soonchunhyang University College of MedicineSeoulRepublic of Korea
  2. 2.Division of Endocrinology and Metabolism, Department of Medicine, Thyroid CenterSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea

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