title: Effect of excess iodine intake on thyroid diseases in different populations: A systematic review and meta-analyses including observational studies.
abstract: BACKGROUND
  Although several reports concerning the association of iodine excess and thyroid disease have appeared, no systematic review of the association between iodine excess intake and thyroid diseases, especially hyperthyroidism and hypothyroidism, has yet been reported.
  
  
  METHODS
  We conducted a systematic search of Ovid MEDLINE, PubMed, Cochrane Central Register of Controlled Trials databases, Ichushi-Web and CiNii database for intervention trials and observational studies. Search terms were constructed from related words for excess AND iodine intake or excretion AND thyroid hormones or diseases AND study designs. After considering the qualitative heterogeneity among studies, a meta-analysis was conducted and odds ratios and 95% confidence intervals (CI) were estimated in random-effects models. A protocol was registered with PROSPERO (No. CRD42015028081).
  
  
  RESULTS
  50 articles were included, including three intervention trials, six case-control studies, six follow-up studies and 35 cross-sectional studies. Three cross-sectional studies in adults included in meta-analysis. Odds ratio of overt and subclinical hypothyroidism between excess and adequate populations were 2.78 (CI:1.47 to 5.27) and 2.03 (CI:1.58 to 2.62) in adults, respectively. Source of excess iodine status was mainly iodized salt or water in included studies.
  
  
  CONCLUSIONS
  Although universal salt iodization has improved goiter rates, chronic exposure to excess iodine from water or poorly monitored salt are risk factors for hypothyroidism in free-living populations. Monitoring of both iodine concentration in salt as well as the iodine concentration in local drinking water are essential to preventing thyroid diseases. Hypothyroidism should be also carefully monitored in areas with excess iodine. Because of the low quality and limited number of included studies, further evidence and review are required.
authors.affiliation: Department of Social and Preventive Epidemiology, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Katagiri
authors.affiliation: Department of Social and Preventive Epidemiology, School of Public Health, the University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Xiaoyi
authors.initials: X
authors.lastname: Yuan
authors.affiliation: Department of Social and Preventive Epidemiology, School of Public Health, the University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Satomi
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Social and Preventive Epidemiology, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo, Japan.|Department of Social and Preventive Epidemiology, School of Public Health, the University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sasaki
mesh_terms: D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006042:Goiter / Q000139:chemically induced; D006801:Humans; D006980:Hyperthyroidism / Q000139:chemically induced; D007037:Hypothyroidism / Q000139:chemically induced; D007455:Iodine / Q000009:adverse effects*; D008297:Male; D064887:Observational Studies as Topic; D011247:Pregnancy; D017673:Sodium Chloride, Dietary / Q000009:adverse effects; D013959:Thyroid Diseases / Q000139:chemically induced*
chemical_list: D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007455:Iodine