An enlarged thyroid, or goiter, is the most overt sign of iodine deficiency. Hypothyroidism from iodine deficiency presents with a decrease in T3 and T4 and an increase in thyroid-stimulating hormone (TSH), thyroglobulin, and reverse T3, an inactive form of thyroid hormone generated by the removal of an iodine group from thyroxine. Symptoms of hypothyroidism include fatigue, dry skin, hair loss, weight gain, cognitive impairment, and depression. Several factors can cause iodine deficiency. As already noted, low levels of iodine in the soil or water in particular areas may cause this deficiency, as may salt-restrictive diets. Intake of large amounts of cruciferous vegetables, cassava, millet, and soya flour is another source of iodine deficiency through the goitrogenic substances such as C-glycosylflavones (C-GFs), glucos-inolates, and isoflavones, and this will also affect thyroid function. Additionally, vitamin A and iron deficiency, as well as the selenium deficiency noted earlier, can exacerbate iodine deficiency.10 Intake of particular elements that compete with iodine for uptake and utilization, such as chlorine, fluorine, and bromine, may also be a factor.
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