THE ROLE AND STRATEGY OF IODINE THERAPY IN THE MANAGEMENT OF ENDEMIC GOITER: A COMPREHENSIVE REVIEW

Abstract

Objective: To conduct a comprehensive review of the evidence concerning the role, efficacy, and safety of iodine therapy in the management of established endemic goiter, and to delineate modern therapeutic strategies based on patient stratification. Methodology: A systematic review of the literature was performed using PubMed/MEDLINE, Scopus, and WHO guidelines database from 1990 to 2024. Keywords included "endemic goiter," "iodine therapy," "potassium iodide," "goiter treatment," and "iodine deficiency disorders." This review synthesizes data from epidemiological studies, clinical trials, and consensus guidelines. Key Findings: The role of iodine therapy is distinct from public health prevention (Universal Salt Iodization). Therapeutic intervention with potassium iodide (KI) is primarily indicated for diffuse goiter in children, adolescents, and young adults, where it can lead to significant goiter regression and normalization of TSH. The strategy for adults with long-standing diffuse goiter is less clear, with iodine therapy primarily aimed at halting further growth rather than regression. In contrast, the initiation of iodine therapy in patients with established (often autonomous) nodular goiter, a common sequela of chronic deficiency, carries a significant risk of inducing iodine-induced hyperthyroidism (Jod-Basedow phenomenon) and is often contraindicated. Special populations, particularly pregnant women, require mandatory iodine supplementation (e.g., 250 mcg/day) to prevent fetal neurocognitive deficits, irrespective of salt iodization status. Conclusion: Iodine therapy is a cornerstone of endemic goiter management, but its strategy must be highly personalized. A "one-size-fits-all" approach is hazardous. The strategy shifts from "curative" (regression in children) to "stabilizing" (halting growth in adults) and "contraindicated" (risk of hyperthyroidism in nodular goiter). Clinical management requires careful pre-therapy assessment, including thyroid ultrasound and TSH, to stratify patients and select the appropriate therapeutic (or non-therapeutic) pathway.