Background:
“Iodine is an essential component of thyroid hormones, which are necessary for normal growth, development, and metabolism during gestation, infancy, and throughout life”. (Caldwell, K. et al., 2005), and iodine deficiency is the most common cause of preventable brain damage. (WHO 1994)
With the introduction of iodized salt in the 1920's, and later use of iodine in the dairy and baking industries, iodine deficiency was eliminated in the U.S. However, there has been a dramatic decline in the iodine nutrition status of US women since the mid-1970's. Furthermore, most Americans may be exposed to perchlorate which inhibits iodine absorption by the thyroid gland. Due to concern about the iodine status of U.S. women, the American Thyroid Association recommends that all pregnant and lactating women receive iodine as a daily multi-vitamin/mineral supplement.
In addition to a preconception health issue, sub-optimal iodine status could be a national preparedness issue. Absorption of radioactive iodine can lead to increased risk of thyroid cancer. Such risk can be reduced if the population has optimal iodine status.

International guidelines require that all salt for human and animal consumption be fortified with iodine. In the U.S., 60-70% of table salt is iodized. However, commercially produced food products contribute the bulk of salt in the American diet; yet essentially none of that salt is iodized.


Objectives:
1. Describe the public health consequences of iodine deficiency, and the current iodine status of U.S. population.
2. Discuss strengths and weaknesses of current strategies to ensure optimal iodine nutrition in the U.S.

Methods:
1. Review of iodine status of U.S. women of childbearing age, and its public health implications.
2. Discussion of the role of iodized salt in ensuring optimal iodine nutrition.

Results:
Iodine status of U.S. women may be less than optimal, especially during pregnancy. Consumption of iodized salt is a proven public health intervention.

Conclusion and implications for practice:
Iodine status of U.S. women of childbearing age, especially pregnant women, should be monitored, and the food industry should be engaged as partners in public health to improve iodine nutrition as an adjunct to preconception health, as well as to protect against potential exposure to radioactive iodine.