I've been looking at the relationship between iodine and Hashi's and I would love to discuss the mechanistic case for disease progression.
Hashi's prevalence increased in multiple countries following population level iodine supplementation programs. And the proposed mechanism is specific - iodine excess causes hyper-iodination of thyroglobulin, altering its conformation, exposing novel epitopes, and generating antibodies that cross react with TPO.
We have no RCT examining iodine reduction as an isolated variable in iodine-sufficient Hashi's patients with TPO titers as the primary endpoint. Given the mechanistic plausibility and consistency of indirect evidence, should iodine reduction be incorporated into the standard of care?
Also, practically, has anyone here tracked TPO antibodies before and after reducing iodine or dairy consumption? I call out dairy specifically because the recommended daily intake for iodine is 150mcg but 1 cup of whole milk has ~100mcg, 1 cup of greek yogurt has ~115mcg, one egg has 25mcg. As a midwesterner, this adds up quickly!