Compensatory mechanisms preventing thyrotoxicosis in oversupply with iodine

The Wolff–Chaikoff effect[1] is a presumed reduction in thyroid hormone levels caused by ingestion of a large amount of iodine.[2]

It was discovered by Drs. Jan Wolff and Israel Lyon Chaikoff at the University of California, Berkeley: in 1948, they reported that injection of iodine in rats almost completely inhibited organification (thyroglobulin iodination) in the thyroid gland.[3][4] However, recent research into the study shows that the thyroid hormone levels of the rats were not checked prior to injections.

Patients with Graves' disease are more sensitive than euthyroid patients,[5] and iodine has been used to manage Graves' disease.

The Wolff–Chaikoff effect is known as an autoregulatory phenomenon that inhibits organification in the thyroid gland, the formation of thyroid hormones inside the thyroid follicle, and the release of thyroid hormones into the bloodstream.[6] This becomes evident secondary to elevated levels of circulating iodide. The Wolff–Chaikoff effect is an effective means of rejecting a large quantity of imbibed iodide, and therefore preventing the thyroid from synthesizing large quantities of thyroid hormone.[7] Excess iodide transiently inhibits thyroid iodide organification. In individuals with a normal thyroid, the gland eventually escapes from this inhibitory effect and iodide organification resumes; however, in patients with underlying autoimmune thyroid disease, the suppressive action of high iodide may persist.[8] The Wolff–Chaikoff effect lasts several days (around 10 days), after which it is followed by an "escape phenomenon,"[9] which is described by resumption of normal organification of iodine and normal thyroid peroxidase function. "Escape phenomenon" is believed to occur because of decreased inorganic iodine concentration inside the thyroid follicle below a critical threshold secondary to down-regulation of sodium-iodide symporter (NIS) on the basolateral membrane of the thyroid follicular cell.

The Wolff–Chaikoff effect has been used as a treatment principle against hyperthyroidism (especially thyroid storm) by infusion of a large amount of iodine to suppress the thyroid gland. Iodide was used to treat hyperthyroidism before antithyroid drugs such as propylthiouracil and methimazole were developed. Hyperthyroid subjects given iodide may experience a decrease in basal metabolic rate that is comparable to that seen after thyroidectomy.[6] The Wolff–Chaikoff effect also explains the hypothyroidism produced in some patients by several iodine-containing drugs, including amiodarone. The Wolff–Chaikoff effect is part of the mechanism for the use of potassium iodide in nuclear emergencies.[10][11][12][13]

The Wolff–Chaikoff effect is subject to an escape phenomenon that limits its action after several days. It is to be distinguished from the Plummer effect, which inhibits the proteolysis of thyroglobulin and the release of pre-formed thyroid hormones from follicles.[14] Both effects operate on different time scales.[14] Only the Wolff–Chaikoff effect is helpful to prevent the thyroid from uptaking radioactive iodine in the case of nuclear emergencies. Therefore, "plummering" with high-dose iodine is only effective in a short time window after the release of radionuclides.[15] Wrong timing of iodine use may even increase the risk by triggering the Plummer effect.[16]

The Plummer effect, the Wolff-Chaikoff inhibition effect, and the adaptive escape phenomenon, synergistically work together to fend off potentially harmful consequences of excess iodine load and ensure thyroid homeostasis.[17]

See also

References

  1. ↑ Dorland (2011). Dorland's Illustrated Medical Dictionary. Elsevier Health Sciences. p. 2083. ISBN 9781416062578.
  2. ↑ Nosek, Thomas M. "Section 5/5ch5/s5ch5_6". Essentials of Human Physiology. Archived from the original on 2016-03-24.
  3. ↑ Panneels, V.; Juvenal, G.; Boeynaems, J.M.; Durmont, J.E.; Sande, J. Van (2009). "Iodide Effects on the Thyroid: Biochemical, Physiological, Pharmacological, and Clinical Effects of Iodide in the Thyroid". In Preedy, Victor R.; Burrow, Gerard N.; Watson, Ronald Ross (eds.). Comprehensive Handbook of Iodine: Nutritional, Biochemical, Pathological and Therapeutic Aspects. Academic Press. p. 304. ISBN 9780080920863.
  4. ↑ Wolff J, Chaikoff IL (1948). "Plasma inorganic iodide as a homeostatic regulator of thyroid function". J Biol Chem. 174 (2): 555–564. doi:10.1016/S0021-9258(18)57335-X. PMID 18865621.
  5. ↑ King; Tekoa, Mary Brucker (2010). Pharmacology for Women's Health. Jones & Bartlett Learning. p. 549. ISBN 9780763753290.
  6. 1 2 Goodman, Louis Sanford; Gilman, Alfred Goodman (1996). Goodman and Gilman's the pharmacological basis of therapeutics (9th ed.). McGraw-Hill. p. 1402. ISBN 978-0-07-026266-9.
  7. ↑ Markou, K (May 2001). "Iodine induced hypothyroidism". Thyroid. 11 (5): 501–10. doi:10.1089/105072501300176462. PMID 11396709.
  8. ↑ dennis L. Kasper, stephen L. Hauser, J. Larry Jameson, Anthony s. fauci, dan L. Longo, Joseph Loscalzo (2015). Harrison's Principles of Internal Medicine. 19th Edition. McGraw-Hill Education. P: 2285. ISBN 978-0-07-180216-1
  9. ↑ Eng P, Cardona G, Fang S, Previti M, Alex S, Carrasco N, Chin W, Braverman L (1999). "Escape from the acute Wolff-Chaikoff effect is associated with a decrease in thyroid sodium/iodide symporter messenger ribonucleic acid and protein". Endocrinology. 140 (8): 3404–10. doi:10.1210/endo.140.8.6893. PMID 10433193.
  10. ↑ Yoshida, S; Ojino, M; Ozaki, T; Hatanaka, T; Nomura, K; Ishii, M; Koriyama, K; Akashi, M (1 May 2014). "Guidelines for iodine prophylaxis as a protective measure: information for physicians". Japan Medical Association Journal. 57 (3): 113–23. PMC 4356652. PMID 25784824.
  11. ↑ Sternthal E, Lipworth L, Stanley B, Abreau C, Fang SL, Braverman LE (1980). "Suppression of thyroid radioiodine uptake by various doses of stable iodide". N Engl J Med. 303 (19): 1083–8. doi:10.1056/nejm198011063031903. PMID 7421914. The effect is rapid because of rapid inhibition of intrathyroid organification of iodide (acute Wolff–Chaikoff effect) and saturation of the iodide-transport mechanism.
  12. ↑ Becker DV (1983). "Physiological basis for the use of potassium iodide as a thyroid blocking agent logistic issues in its distribution". Bull N Y Acad Med. 59 (10): 1003–8. PMC 1911930. PMID 6582961. In larger amounts [potassium iodide] acts immediately to block further uptake of iodide by several means, particularly by saturating the iodide transport mechanisms of the thyroid, by inhibiting the intrathyroidal organification of iodide, and by simple dilution.
  13. ↑ Adelstein SJ (1991). "Intervention procedures for radionuclides." Anticarcinogenesis and Radiation Protection 2. Springer US. pp. 227-8. "'Cold' iodide is effective in four ways: (a) by diluting the entering iodide pool; (b) by saturating the iodide transport system; (c) by blocking organification of iodide and thus inhibiting thyroid hormone synthesis (the Wolff-Chaikoff effect); and (d) by promoting excretion and thus lowering the total body dose."
  14. 1 2 Saller, B; Fink, H; Mann, K (1998). "Kinetics of acute and chronic iodine excess". Experimental and Clinical Endocrinology & Diabetes. 106 Suppl 3: S34-8. doi:10.1055/s-0029-1212044. PMID 9865552.
  15. ↑ Zanzonico, PB; Becker, DV (June 2000). "Effects of time of administration and dietary iodine levels on potassium iodide (KI) blockade of thyroid irradiation by 131I from radioactive fallout". Health Physics. 78 (6): 660–7. doi:10.1097/00004032-200006000-00008. PMID 10832925. S2CID 30989865.
  16. ↑ Meristoudis, G; Ilias, I (June 2022). "Caveats in the use of potassium iodide for thyroid blocking". European Journal of Nuclear Medicine and Molecular Imaging. 49 (7): 2120–2121. doi:10.1007/s00259-022-05797-7. PMID 35403862. S2CID 248071284.
  17. ↑ Jing, Li; Zhang, Qiang (15 September 2022). "Intrathyroidal feedforward and feedback network regulating thyroid hormone synthesis and secretion". Frontiers in Endocrinology. 13: 992883. doi:10.3389/fendo.2022.992883. PMC 9519864.
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