Thyroid Gland and Iodine

Breast Cancer, Weight Loss and Tamoxifen

A Reader Writes:

I went through chemo for breast cancer and radiation... I was told that the radiation may have caused my hypothyroid...but, who's to say. I put on a lot of weight from my breast cancer and esp. being on Tamoxifen for 5 yrs. I got diagnosed with the thyroid thing about 1/2 yr ago & I was dying to lose weight finally being off the Tamoxifen... Now I feel stuck again - because I can't lose the 65lbs.... and I believe it's from the thyroid. I'm taking Levoxyl for six months maybe 7 and I had a blood test with my primary about 2 months ago. She said I was fine and I shouldn't be gaining weight...I'm not really gaining I've been 189-192 off and on now for months and months... I can't seem to lose weight. What should I do?

Dr. David Derry Responds:

Dear Patient,

First, radiation to your breast for prevention of local recurrences can affect your thyroid gland. The thyroid gland in your neck is in close proximity to your breast and depending on the angle used by the radiation machine, the dosage used and also how good the machine is at preventing radiation scatter, the radiation can cause affects both short term and long term on your thyroid gland health.(1)

In addition chemotherapy (Tamoxifen included) are toxic compounds and can have side effects on many organs including the thyroid gland. The combination of chemotherapy and radiation can lead to clinically obvious low thyroid disease. However this low thyroid condition can be masked by normal thyroid function tests. Blood thyroid function tests become unreliable when a patient is treated with such agents as radiation and chemotherapy. Because they are unreliable, common sense dictates treat patients on the basis of their symptoms. Your weight problem is just one of them. I would expect that a detailed medical functional inquiry of all organ systems would reveal many areas showing low thyroid function.

Having said all that, breast cancer has been one of my interests for many years. I would like to tell you my thoughts on breast cancer and thyroid disease in an abbreviated form. Breast cancer takes around 20-30 years to develop. The discovered lump represents the end stage of slow cancer progression over decades. The longest period is the first phase of cancer development. This phase which is often called precancerous happens as as a normal cell is gradually turned into a cancer cell. These precancerous lesions are known as fibrocystic disease (lumpy, tender breasts) of the breast. (2-3,13-14) Most fibrocystic disease is benign, harmless and has no consequences.

On the other hand, some more advanced forms of fibrocystic disease have clearly defined tendencies towards breast cancer. So there are grades of fibrocystic disease with some of the cells looking more abnormal than in the benign forms. The greater the difference in the cells from normal (abnormal) the greater chance of these cells converting to a cancer cell over 10-20 years. So if you have fibrocystic disease still at the age of 45-55, you likely have had this for many years. There maybe then a significant chance the cells may change into a cancer cell. The good news is that it can be cleared up completely with a daily intake of iodine.(9)

In 1993 Ghent and Eskin (2) published a landmark paper on the treatment of severe fibrocystic disease of the breast with iodine supplements. This paper was the result of more than 30 years of marvelous research by Dr. Bernard. A. Eskin of the Medical College of Pennsylvania in Philadelphia. First in animals and then in humans he proved fibrocystic disease of the breast is the result of low dietary iodine. He has shown also that this can go on to develop into breast cancer.(2-8) I feel Dr. Eskin's research represents a major step toward conquering breast cancer and likely other cancers.

Our main significant source of iodine in our diets is iodized salt. But since the high blood pressure studies in the 1950s on salts and their effects on blood pressure, there has been a steady urging, on all women and the elderly especially, to decrease their salt intake. Women are also told to restrict salt in pregnancy. This salt avoidance leads to a relative dietary iodine deficiency. What's more children are also being taught to restrict their salt intake because of obesity. If this lowers the children's iodine intake then they will end up low thyroid and gain even more weight. Although there is still iodine in the diets of women it is much lower in general than was anticipated if they were taking a normal salt diet. (10-13) By law in some countries, but not in the United States, iodine is put into table salt. All other sources of salt, such as processed fast foods do not have iodine in them. So children can be eating a lot of salt but without any iodine in it.

If it is true there has been a general decrease in salt intake and thus iodine intake since the 1950s, there should have been a general increase in the number of women with fibrocystic (lumpy) disease of the breast. But if as well even lower iodine intake was occurring in the female population, worse forms of fibrocystic disease would occur which are statistically directly related to breast cancer. The chances of getting breast cancer then go up considerably. Now if we put this together with the incidence of breast cancer going from 1 in 23 in the mid 1960s to 1 in 8 currently then it seems to fit together. Over the last 80 years hundreds of publications have confirmed statistical correlation between the worse forms of fibrocystic disease of the breast and subsequent breast cancer. Unfortunately if you have fibrocystic disease you really don't know what type you have without a biopsy. On the other hand if you take iodine in adequate amounts daily all of the fibrocystic disease disappears so that you are essentially preventing breast cancer from occurring. If a cancer has already started it is unlikely it will be stopped with the iodine at that dose.

From my personal investigations cancer is roughly divided into two phases. The first part is the precancerous phase (before cancer) and involves the change of a normal cell into a cancer cell. This first phase of cancer development takes about 10-30 years. Iodine in adequate doses stops and reverses this stage of the cancer process by causing the natural death of abnormal cells (apoptosis). Iodine circulates throughout the body in the extracellular fluids found between the cells of the body. If cell surface proteins have the amino acid tyrosine on the outside, the passing iodine reacts with this tyrosine. This little reaction denatures the protein and thus kills the cell. It is implied all vertebrate cell membranes do not have tyrosine on the portion of the protein sticking out into the extracellular fluid.

However, the intra membrane proteins may have tyrosine which is only exposed when the membrane is distorted by abnormal cell development such as we see in the precancerous forms of fibrocystic disease. This would then expose the tyrosine to the iodine passing in the extracellular fluid. Again the iodine would denature the protein by reacting with the tyrosine and thus kill off the cell. So thus we have surveillance system for removing abnormal cells from our bodies. On the other hand low iodine intake allows cells to proceed and develop towards cancer. This is more indirect because the gradual increase in abnormal cells are just not being eliminated from the body because there is inadequate iodine to carry this out.

Once the cell has become a cancer cell then it can take two different turns. It can multiply and spread or it can multiply and just stay where it is. The second is called carcinoma in situ. (cancer at the site) The second phase(cancer multiplying and spreading) is the part we are all familiar with. Since on average breast cancer cells double every 100 days, it takes 9 years before mammograms can pick it up and around 11 years before we find it ourselves. (15)

This second clinical part of the cancer phase (the spreading) seems to be arrested by adequate levels of thyroid hormone in all tissues. Thyroid hormone completely controls the connective tissue which forms a strong sieve-like barrier to the passage of cancer cells trying to spread.(16-18) Low levels of thyroid hormone in the tissues (especially connective tissues) promotes the spread of cancer cells. So the body cancer defense system has two parts iodine for the first pre-cancer phase and thyroid hormone and iodine together for the second clinical phase. There is some overlapping of these two defense systems. The excess iodine flows out in the urine. Of course, because the iodine flows out in the urine it is preventing the development of abnormal cells in the bladder and kidney system at the same time. This then prevents cancers developing there.

Now you ask how much is adequate thyroid hormone? Clinically, it means, for you personally, enough thyroid to bring your weight back down. With the increase in metabolism caused by the thyroid together with the thyroid induced personal well-being and motivation you should easily return to your normal weight. You should feel good in yourself and coping well with your life (well-being). If those are all in place then you are likely on a dose that will stop the cancer from spreading. In a normal person this would be between 200 and 400 micrograms of thyroxine. If you combine thyroid hormone treatment with adequate amounts of iodine to prevent any new cancers from developing, then you likely have a good prognosis. For the 8 years I tried this regime on 10 breast cancer patients -- there were no recurrences and everyone felt well. There are exceptions to the dosage -- related to childhood frightening events. I will discuss this in another answer.(9)

An adequate dose of iodine can be defined as more than 4 mg per day. Lugol's solution is an iodine-in-water solution used by the medical profession for 200 years. One drop (6.5 mg per drop) of Lugol's daily in water, orange juice or milk will gradually eliminate the first phase of the cancer development namely fibrocystic disease of the breast so no new cancers can start. It also will kill abnormal cells floating around in the body at remote sites from the original cancer. Of course this approach appears to work for prostate cancer as prostate cancer is similar to breast cancer in many respects. Indeed, it likely will help with most cancers. Also higher doses of iodine are required for inflammatory breast cancer. As well we know that large doses of intravenous iodine are harmless which makes one wonder what effect this would have on cancer growth.

I hope this helps you understand breast cancer better.

David

1. Links,J.M. Chapter 16. Radiation physics and Chapter 17, Williams,E.D. Biologic effects of radiation on the thyroid. in Werner and Ingbar's The Thyroid. Eds Braverman, L.C. and Utiger,R.D. J.B. Lippincott Company 1991. Philadelphia pages 405-436.
2. Ghent,W.R., Eskin,B.A., Low,D.A., Hill, L.P.. Iodine replacement in fibrocystic disease of the breast. Can J Surg 1993; 36:453-460.
3. Ghent,W.R., Eskin, BA Iodine deficiency breast syndrome. In: Medeiros-Neto G, Gaitan E, editors. Frontiers in Thyroidology, Proceedings of the Ninth International Congress, 1985. New York: Plenum, 1986: 1021-1026.
4. Eskin,B.A., Grotkowski,C.E., Connolly,C.P., Ghent,W.R.. Different tissue responses for iodine and iodide in rat thyroid and mammary glands. Biol Trace Element Res 1995; 49:9-19.
5. Eskin,B.A.. Iodine metabolism and breast cancer. Trans NY Acad Sci 1970; 32:911-947.
6. Eskin,B.A.. Iodine and breast cancer. Biol Trace Element Res 1983; 5:399-412.
7. Eskin,B.A.. Dietary iodine and cancer risk. Lancet 1976; 8:807-808.
8. Eskin,B.A., Krouse,T.B., Modhera,P.R., Mitchell,M.A.. Etiology of mammary gland pathophysiology induced by iodine deficiency. In: Medeiros-Neto G, Gaitan E, editors. Frontiers in thyroidology, Proceedings of the Ninth International Congress. New York: Plenum, 1986: 1027-1031.
9. Derry, DM. Breast Cancer and iodine Preventing and surviving.Trafford Publishing company, Victoria, Canada. 2001.
10. Lee,K., Bradley,R., Dwyer,J., S. L. Lee,S.L.. Too much or too little: The implication of current Iodine intake in the United States. Nutrition Reviews 57:177-181, 1999.
11. Hollowell,J.G., Staehling,N.W., Hannon,W.H. et al. Iodine nutrition in the United States. Trends and public health implications: Iodine excretion data from national health and nutrition examination surveys I and III (1971-1974 and 1988-1994). J Clin Endocrinol Metab 83:3401-3408, 21998.
12. Thomson,C.D., Colls,A.J., Conaglen, J.V., Macormack,M., Stiles,M., Mann.J.. Iodine status of New Zealand residents as assessed by urinary iodide excretion and thyroid hormones. British Journal of Nutrition 78 (6):901-912, 1997.
13. Glinoer,D. Feto-maternal repercussions of iodine deficiency during pregnancy. An update. Annales d Endocrinologie. 64 (1):37-44, 2003.
14. Gullino PM. Natural history of breast cancer. Cancer 39, 2697-2703. 1977.
15. Clark WH. The nature of cancer: morphogenesis and progressive (self ) disorganization in neoplastic development and progression. Acta Oncol 1995; 34:3-21. 16. Clark WH. Tumour progression and the nature of cancer. J Cancer 1991; 64:631-644. 17. Smith,T.J., R. S. Bahn, and C. A. Gorman. Connective tissue, glycosaminoglycans, and diseases of the thyroid. Endocr.Rev. 10:366-391, 1989.

Disappearing Iodine Test

A Reader Writes:

A friend of mine was just diagnosed with a possible thyroid disorder (her test was in the form of a drop of iodine on her arm and watching how fast it disappeared). Her chiropractor suggested she start off by taking something called Thyroid Helper which can be found at ... Have you ever heard of this and do you know how effective it might be?

David Derry Responds:

The "test" of putting iodine on the skin to watch how fast it disappears is not an indicator of anything. The iodine disappearance rate is unrelated to thyroid disease or even iodine content of the body.(1-2) Meticulous research by Nyiri and Jannitti in 1932 showed clearly when iodine is applied to the skin in almost any form, 50% evaporates into the air within 2 hours and between 75 and 80 percent evaporates into the air within 24 hours. (1) A total of 88 percent evaporates within 3 days and it is at this point that the evaporation stops. The remaining 12 percent that is absorbed into the skin has several fates. Only 1-4% of the total iodine applied to the skin is absorbed into the blood stream within the first few hours. The rest of the iodine within the skin (8-11%) is slowly released from the skin into the blood stream.

However Nyiri and Jannitti's findings that "The percentage of iodine penetration through the skin is the same, irrespective of whether the cells have a high or low vitality, or are dead, and irrespective of the direction of penetration" have important implications for iodine functions in the body, skin, pregnancy and fetus and also for the therapeutic use of topical and oral iodine. Iodine would be the only compound of significance during early pregnancy which can pass rapidly through all tissues of the fetus without the aid of any blood vessel or lymphatic transport. It could be that not only does iodine control natural cell death (apoptosis) (5) in the fetus but may also influences stem cell development.

Nyiri and Jannetti also mentioned iodine applied on the skin can be used to shrink swelling of the thyroid gland (goiters). So even small amounts of iodine absorbed through the skin can have good effects on body organs. From my own clinical experience, repeated application of iodine (Lugol's) to the skin appears to cause regeneration of the skin from the bottom up (Quiescent, stable or stem cell) (3) eventually sloughing the old version of the skin off like a snake molting. If there was a precancerous lesion on the old skin, it is replaced with new skin minus the lesion. There does not seem to be any skin lesions which are not helped or cured by this procedure. In some cases I found clinically obvious low thyroid conditions also needed to be treated to be more effective. Minor lacerations and healing of surgical wounds respond well. If skin regeneration is from the bottom, then there is little or no scar formation.

My parents' generation tended to put tincture of iodine onto a fresh wound to prevent infection. This turns out to be helpful but not the best way to use it. Besides it stung badly when applied. It is much more effective (and doesn't hurt) to apply iodine repeatedly after a scab has been formed. The iodine put onto the scab helps to organize total repair of the tissue. It is implied a similar approach could be taken to burns of all depths but at the same time the physiology of burns suggest there is an acute lack of thyroid hormone. (3)

All pre-malignant lesions and many other oddities of the skin appear to respond to this regeneration process triggered by topical iodine. I have mentioned previously a patient with a biopsy-proven breast cancer lesion (she refused surgery because of previous cancer treatment) that was strongly fixed to the skin responding well to topical iodine and ended up being a dimple on the breast three year later. (6)

It is my belief a water solution of iodine (like Lugol's) is an important therapeutic agent for skin. Because of its effectiveness and the results, perhaps many skin diseases are related to local tissue areas of relative iodine deficiency. Perhaps the most graphic lesions are the "keloid" (worm) incision scars formed after surgical procedures. If the iodine intake and tissue levels are adequate, such as in Japan, keloid formation doesn't happen (7). In addition, iodine's ability to trigger natural cell death (apoptosis) (5) makes it effective against all precancerous skin lesions and likely many cancerous lesions. The local site is replaced with normal skin. However, even lesser doses of topical iodine seem to reverse the ominous appearance of skin lesions. Because my older brother died of metastatic melanoma, my chances of getting a malignant melanoma are increased by 400 times. (8-9) Having grown up in Venezuela near the equator my sun exposure at a young age was far above normal. So all suspicious lesions I notice are returned to normal with topical Lugol's.

One of the most famous of documentation of iodine skin therapy to a famous person occurred in the American Civil War.

"On September 29, 1862, Colonel John B. Gordon held the center of General Lee's army at the battle of Antietam, or Sharpsburg. The first volley from the northern lines sent a ball through the calf of Gordon's right leg; soon after, another went through the muscles of his thigh; a third pierced his left arm, tearing asunder the tendons and mangling the flesh; a forth ripped through his shoulder leaving a wad of clothing embedded in its track. Still, no bones were broken; but, while Gordon lingered in the firing line, "with", as he says himself, "but little of my usual strength", a fifth ball struck him squarely in the face.

Dr. Weatherly of the 6th Alabama Regiment, in charge of medical arrangements, had the Colonel removed to a base hospital, and prescribed tincture of iodine to be painted on the wounds three or four times a day. The case was unpromising. Gordon's eyelids were greatly swollen; one eye was completely closed, the other almost so; his jaw was immovably clenched, and, to make matters worse, erysipelas (staphylococcus infection of skin) had set in on the left arm.

Mrs. Gordon, his wife, who nursed him - her name was Fanny, and she was then a beautiful girl of 25 - put a liberal interpretation on her instructions and painted the wounds, not three or four times a day, but, as Gordon himself says: "I think three to four hundred time a day." Fanny's diligence and devotion were rewarded. Her husband survived, outlived the war, became the Governor of Georgia, a General, and Commander-in-Chief of the United Confederate Veterans. He died in 1904." (10)

I think Fanny knew iodine applied often was a more effective way to deliver iodine to the body especially applied on multiple sites. Likely Gordon's iodine blood levels and tissue levels rose throughout his body. As iodine is by far the best antibiotic, antiviral and antiseptic of all time, the colonel's body defenses were able to gain control of the infections. At the same time local repeated application to the wound sites caused the skin to grow up from its bottom where all the cells (Stem cells) that make normal skin are residing. Likely this minimized or eliminated scar formation. Thus Nyiri's and Jannetti's studies confirm why Fanny's method of treatment worked so brilliantly. Some of our recent serious skin diseases such a "flesh-eating disease" should respond quickly to topical iodine treatment practiced by Fanny. Or, for another example, iodine put onto a mosquito bite would kill all bacteria and viruses at the site of the bite within 10-30 seconds making it impossible for any virus or bacteria to multiply and get started --such as in West Nile Fever. Naturally, this applies to tic bites (Lyme's disease) as well. For many decades in the 1800s people carried around little bottles of iodine around their necks to use on all occasions. People in mosquito and tic infested areas should think of doing this again. (8) In addition, it has been forgotten vaporized iodine rapidly kills air borne viruses such as polio and SARS viruses.. Used extensively in the forties and fifties it may be of use to explore this approach again.

There has been no significant clinical research on iodine therapy or use for 40 years. (11-15) I feel it is important for research to be directed at this potentially significant area of medical treatment. It is worth noting the greatest part of significant research with iodine was done before the Medline search facilities were available. Of course, since large doses of iodine are tolerated intravenously without side effects, it has yet to be explored what help this may have for many cancer patients or even other diseases.

I hope these concepts help.

David

References

1. Nyiri,W., Jannitti,M.. About the fate of free iodine upon application to the unbroken animal skin. J Pharmacol Exp Ther 45:85-107, 1932.
2. Biskind,M.S. Penetration through tissue of iodine in different solvents. Proc Soc Exp Biol Med 30:35-37, 1932.
3. Robbins pathologic basis of disease. Eds Cotran,R.S., Kumar,V., Collins,T. Sixth Edition W.B. Saunders Company, Philadelphia. 1999. Page 91. and page 434.
4. Gershenfeld,L. Iodine Editor Reddish.G.F. Antiseptics, disinfectants fungicides and chemical and physical sterilization, Philadelphia:Lea & FebigerHa, 1957. pages 223 277.
5. Derry,D.M. One hour lecture: Iodine, thyroid hormone and breast cancer. How to prevent and survive breast cancer. World Breast Cancer Conference, Victoria BC June 4-6, 2002..
6. Derry, DM. Breast cancer and iodine How to prevent and survive it. Trafford Publishing Victoria, Canada. 2001 page 89.
7. Updegraff,H.L. Reconstructive surgery and old facial burns. JAMA 101:1138-1140, 1933. page 1139
8. Clark WH. The nature of cancer: morphogenesis and progressive (self ) disorganization in neoplastic development and progression. Acta Oncol 1995; 34:3-21.
9. Clark WH. Tumour progression and the nature of cancer. J Cancer 1991; 64:631-644. 10. Kelly,F.C.. Iodine in medicine and pharmacy since its discovery--1811-1961. Proc R Soc Med 54:831-836, 1961.
11. Wayne,E.J,. Koutras,D.A.. Alexander,W.D.. Clinical aspects of iodine metabolism, Philadelphia:F.A. Davis Company, 1964.
12. Braverman,L.E.. Iodine and the thyroid: 33 years of study. Thyroid 4 (3):351-356, 1994.
13. Vagenakis,A.G.. Effects of iodides: clinical studies. Thyroid 1 (1):59-63, 1990.
14. Paul,T., Meyers,B., Witorsch,R.J., Pino,S., Chipkin,S., Ingbar,S.H. Braverman,L.E.. The effect of small increases in dietary iodine on thyroid function in euthyroid subjects. Metabolism. 37:121-124, 1988.
15. Zaichick,V. Zaichick.S.. Normal human intrathyroidal iodine. Science of the Total Environment 206 (1):39-56, 1997.