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Jod-Basedow phenomenon

The Jod-Basedow phenomenon, also known as iodine-induced hyperthyroidism or Jod-Basedow syndrome, is a rare form of thyrotoxicosis characterized by the sudden onset of hyperthyroidism following exposure to excess iodine in individuals with preexisting thyroid abnormalities, such as multinodular goiter or latent Graves' disease.^[1] This condition arises when the thyroid gland fails to adapt to the iodine load through the normal protective Wolff-Chaikoff effect, instead leading to accelerated synthesis and release of thyroid hormones.^[1] It is particularly observed in iodine-deficient populations or patients receiving iodinated contrast media during imaging procedures, amiodarone therapy, or iodine supplements.^[2] The term "Jod-Basedow" derives from the German word Jod (meaning iodine) and Carl Adolph von Basedow (1799–1854), the physician who described Graves' disease, with the phenomenon first coined by Theodor Kocher in 1910 to highlight the risk of hyperthyroidism after iodine administration in susceptible patients.^[3] Historically, it was more prevalent in regions with endemic iodine deficiency, where reintroduction of iodine could paradoxically trigger thyroid overactivity in autonomous nodules or latent autoimmune conditions.^[1] In modern contexts, the increased use of iodinated contrast agents in diagnostic imaging has raised its incidence, especially among elderly patients or those with chronic kidney disease, who may have impaired iodine clearance.^[2] Clinically, the Jod-Basedow phenomenon presents with classic signs of thyrotoxicosis, including tachycardia, palpitations, weight loss, heat intolerance, anxiety, and diarrhea, typically emerging days to weeks after iodine exposure; severe cases can progress to atrial fibrillation, heart failure, or thyroid storm.^[1] Diagnosis relies on a history of recent iodine intake, suppressed thyroid-stimulating hormone (TSH) levels, elevated free thyroxine (T4) and triiodothyronine (T3), and low radioactive iodine uptake on scintigraphy, distinguishing it from other causes of hyperthyroidism.^[2] Risk factors include underlying thyroid autonomy, such as nontoxic goiter, Hashimoto's thyroiditis, or prior thyroid surgery, particularly in iodine-deficient areas.^[1] Management focuses on supportive care and thyroid hormone control, often involving beta-blockers like propranolol for symptom relief, antithyroid drugs such as methimazole to inhibit hormone synthesis, and, in refractory cases, corticosteroids, plasmapheresis, or surgical thyroidectomy.^[2] Prophylactic measures, such as perchlorate or antithyroid drugs before planned iodine exposure in high-risk patients, can prevent onset.^[1] The condition is generally self-limited but requires prompt intervention to avoid cardiovascular complications, underscoring the dual-edged nature of iodine in thyroid physiology.^[3]

Overview and Definition

Definition

The Jod-Basedow phenomenon, also known as iodine-induced hyperthyroidism, is a rare form of thyrotoxicosis characterized by the development of hyperthyroidism in individuals with underlying thyroid autonomy—such as multinodular goiter or latent Graves' disease—or thyroid conditions stemming from chronic iodine deficiency, following exposure to excess exogenous iodine. This condition arises when the thyroid gland in susceptible patients fails to appropriately downregulate hormone production in response to the iodine load, leading to overproduction of thyroid hormones.^[1]^[4] The onset typically occurs 2 to 12 weeks after iodine exposure, with most cases presenting within 3 to 10 weeks, though up to 75% may manifest within the first month. Key features include transient thyrotoxicosis, driven by enhanced synthesis and release of thyroxine (T4) and triiodothyronine (T3) from autonomously functioning thyroid tissue, which often resolves spontaneously over several months without permanent dysfunction in the majority of patients.^[1]^[4] This phenomenon is distinct from amiodarone-induced thyrotoxicosis, a related but separate entity where hyperthyroidism results from the combined effects of the drug's iodine content and its direct toxic impact on the thyroid, rather than solely from iodine overload.^[1]

Epidemiology

The Jod-Basedow phenomenon is a rare cause of thyrotoxicosis, primarily documented through case reports and limited epidemiological studies, with underreporting likely due to challenges in linking it directly to iodine exposure.^[1] Its incidence is low overall but increases in specific contexts, such as following iodine supplementation programs in historically deficient regions, where prevalence of induced hyperthyroidism has been estimated at 1-20%.^[5] Epidemic occurrences have been noted in areas like Tasmania, Zaire, Zimbabwe, and parts of Europe and Asia prior to widespread iodization, often transient and linked to public health interventions introducing iodized salt or oil.^[6] Higher risks are observed in populations from endemic goiter belts with chronic iodine deficiency, where underlying thyroid autonomy predisposes individuals to iodine overload.^[7] For instance, patients with multinodular goiter in such regions face a 10-20% incidence of thyrotoxicosis upon iodine exposure, including from iodinated contrast media used in procedures like CT scans.^[5] In iodine-sufficient areas, the overall prevalence after contrast administration remains very low at approximately 0.1-0.3% for overt hyperthyroidism, though subclinical cases may reach 4-5% in at-risk groups.^[8] As of 2025, recent studies report ICM-induced thyroid dysfunction prevalence ranging from 1-15%, with hyperthyroidism occurring in about 4.9-6% of cases in followed cohorts, particularly higher in those with preexisting thyroid conditions.^[9]^[10] Demographically, the condition predominantly affects older adults over 50 years, with a higher occurrence in females and those residing in or originating from iodine-deficient endemic areas; mean ages in reported series often exceed 80 years, and female-to-male ratios can be as high as 8:1.^[6] This trend underscores the role of predisposing conditions like multinodular goiter in amplifying vulnerability.^[7]

Etiology and Risk Factors

Sources of Iodine Exposure

The Jod-Basedow phenomenon, a form of iodine-induced hyperthyroidism, arises from excessive exogenous iodine intake, which overwhelms the thyroid's adaptive mechanisms in susceptible individuals.^[1] Common sources include medical interventions, medications, and dietary factors, particularly in regions with underlying iodine deficiency.^[2] Iodinated contrast media (ICM) used in computed tomography (CT) scans, angiography, and interventional radiology procedures represent a major acute source of iodine exposure. A typical single dose of ICM contains 15 to 60 grams of iodine, far exceeding the recommended daily allowance of 150 micrograms for adults, and can precipitate hyperthyroidism within weeks in at-risk patients.^[10] This exposure is particularly relevant for patients with underlying thyroid autonomy, such as nodular goiter, where the iodine load may stimulate autonomous hormone production.^[1] Amiodarone, an antiarrhythmic drug prescribed for cardiac conditions like atrial fibrillation, provides chronic iodine exposure due to its high iodine content—approximately 37% by weight, with each 200 mg tablet delivering about 75 mg of iodine, of which roughly 10% is released as free iodide daily.^[11] Prolonged therapy, often lasting months to years, can lead to cumulative iodine overload and thyrotoxicosis, distinct from acute triggers but still implicated in the Jod-Basedow phenomenon.^[12] Other sources encompass iodine-containing supplements, topical antiseptics, and dietary iodization efforts. Oral iodine supplements, sometimes used for purported health benefits, can deliver doses up to several milligrams daily, exceeding safe limits in vulnerable populations.^[2] Topical applications like povidone-iodine, employed in wound care or surgical scrubs, may result in systemic absorption, especially with repeated or prolonged use, contributing to iodine excess.^[13] Historically, mass iodization campaigns, such as the introduction of iodized salt in the early 20th century in iodine-deficient regions like the U.S. "goiter belt," temporarily increased hyperthyroidism incidence as populations adapted to higher iodine levels.^[14] In such areas, even standard iodized salt consumption (providing approximately 45 micrograms of iodine per gram in the US, or 20–40 micrograms per gram per WHO guidelines) can trigger the phenomenon when superimposed on latent thyroid disorders.^[15]^[16]

Predisposing Thyroid Conditions

The Jod-Basedow phenomenon primarily affects individuals with pre-existing thyroid autonomy, where nodules or regions of the gland produce thyroid hormones independently of thyroid-stimulating hormone (TSH) regulation, making them susceptible to excess iodine fueling overproduction. Autonomous thyroid nodules and toxic multinodular goiter are key predisposing conditions, as these autonomously functioning areas can rapidly synthesize and release hormones when exposed to iodine, leading to hyperthyroidism.^[17]^[5] In regions with long-standing iodine deficiency, nontoxic diffuse goiter often develops as an adaptive response, creating substrate-limited thyroid tissue that becomes hyperresponsive to sudden iodine influx, precipitating the phenomenon. Similarly, latent Graves' disease—an subclinical autoimmune state with TSH receptor antibodies—can be unmasked by iodine, as these antibodies stimulate hormone production in the presence of ample substrate. Hashimoto's thyroiditis with residual autonomous areas also heightens risk, particularly if initial hypothyroidism has partially resolved, leaving pockets of independent function.^[18]^[1] Beyond structural abnormalities, chronic kidney disease impairs iodine excretion via reduced renal clearance, prolonging exposure and amplifying risk in those with underlying thyroid issues.^[19]

Pathophysiology

Mechanisms of Hyperthyroidism Induction

The Jod-Basedow phenomenon arises when excess iodine exposure leads to hyperthyroidism in individuals with underlying thyroid autonomy, such as multinodular goiter or latent Graves' disease, by providing substrate for unchecked hormone synthesis without effective regulatory inhibition.^[1] In normal thyroid glands, high iodine levels trigger the Wolff-Chaikoff effect, a transient inhibition of thyroid hormone production through suppression of iodide organification by thyroid peroxidase (TPO), mediated by elevated intrafollicular iodide concentrations that inhibit TPO activity and reduce coupling of iodotyrosines to form thyroxine (T4) and triiodothyronine (T3).^[7] However, in predisposed glands, particularly those with autonomous nodules, this inhibitory mechanism fails or is bypassed, allowing continued organification and coupling despite the iodine load; these nodules operate independently of pituitary thyrotropin (TSH) regulation, synthesizing and releasing excess T3 and T4 as iodine becomes available for iodination of thyroglobulin tyrosine residues.^[1]^[7] A key factor in this induction is the upregulation of the sodium-iodide symporter (NIS) in iodine-deficient states, where chronic TSH stimulation enhances NIS expression on the basolateral membrane of thyrocytes, facilitating active transport of iodide into the gland at concentrations 20-50 times higher than plasma levels.^[7] Upon sudden iodine excess, such as from iodinated contrast media or amiodarone, this upregulated NIS drives rapid and excessive iodide uptake, overwhelming the gland's capacity for autoregulation and promoting accelerated organification without the protective downregulation seen in normal escape from the Wolff-Chaikoff effect.^[1] In these scenarios, the failure to downregulate NIS mRNA and protein prevents the adaptive reduction in iodine influx, sustaining high intrathyroidal iodide availability for TPO-mediated iodination and subsequent hormone release.^[7] The onset of hyperthyroidism typically occurs within days to weeks following iodine exposure.^[1] Biochemically, this manifests as elevated serum free T4 and T3 levels due to increased synthesis, with concomitant suppression of TSH via negative feedback on the pituitary, often accompanied by elevated urinary iodide excretion up to three times normal values.^[7]^[1]

Comparison to Wolff-Chaikoff Effect

The Wolff-Chaikoff effect represents a protective autoregulatory mechanism in the thyroid gland, wherein an acute iodine load induces transient inhibition of thyroid hormone synthesis. This occurs through the accumulation of high intracellular iodide concentrations, which suppress organification of iodine by inhibiting thyroid peroxidase activity and downregulating the sodium-iodide symporter (NIS), thereby reducing thyroid hormone production for approximately 24 to 48 hours in individuals with normal thyroid function.^[20]^[21]^[7] In contrast, the Jod-Basedow phenomenon arises when this inhibitory response fails, leading to unchecked thyroid hormone overproduction and hyperthyroidism following iodine exposure. This failure is particularly evident in thyroids with underlying autonomy or chronic iodine deficiency, such as multinodular goiters, where nodular regions exhibit the Plummer effect—independent hormone synthesis that escapes normal regulatory feedback and exploits the sudden iodine availability to accelerate thyrotoxicosis.^[1]^[20] The fundamental distinction between these phenomena lies in the integrity of thyroid autoregulation: the Wolff-Chaikoff effect operates effectively in healthy glands to prevent excess hormone synthesis via intact inhibitory pathways and subsequent "escape" to normal function, whereas in Jod-Basedow, impaired autoregulation in predisposed glands—often demonstrated through altered iodine uptake kinetics in nodular tissues—prevents inhibition and promotes hyperproduction instead.^[21]^[1] This selective occurrence underscores why iodine loading is generally safe in euthyroid individuals but risky in those with subclinical thyroid autonomy.

Clinical Presentation

Symptoms and Signs

The Jod-Basedow phenomenon manifests primarily through the symptoms and signs of thyrotoxicosis, induced by excess iodine exposure in susceptible individuals. Common symptoms include palpitations, unintentional weight loss, heat intolerance, anxiety, fine tremor, and diarrhea, reflecting the hypermetabolic state driven by elevated thyroid hormone levels.^[1] These manifestations typically arise subacutely, worsening over weeks following iodine administration, with severity influenced by the iodine load and the patient's underlying thyroid autonomy.^[1] Physical signs often feature tachycardia, which is the most frequent initial presentation and may exacerbate preexisting cardiac conditions such as atrial fibrillation; a diffuse or nodular goiter may also be evident on examination.^[22]^[1] In elderly patients, presentations can be atypical, characterized by apathetic hyperthyroidism with predominant fatigue, depression, and reduced activity rather than classic hyperactive features.^[1] Rare neurological symptoms have been documented in case reports, including hypokalemic periodic paralysis, where acute muscle weakness occurs due to potassium shifts in the context of thyrotoxicosis following iodinated contrast or supplements; such cases, including reports through 2025, highlight the potential for severe, underrecognized complications.^[1]^[23]^[24] Laboratory confirmation, such as suppressed TSH with elevated free T4 and T3, supports the correlation of these clinical features with the underlying iodine-induced hyperthyroidism.^[1]

Potential Complications

The Jod-Basedow phenomenon, if severe or untreated, can precipitate thyroid storm, a life-threatening escalation of thyrotoxicosis characterized by extreme hyperthermia, tachycardia exceeding 140 beats per minute, gastrointestinal disturbances such as diarrhea and vomiting, and central nervous system manifestations including delirium, agitation, or coma. This condition arises from the acute surge in thyroid hormone production following high iodine exposure, overwhelming compensatory mechanisms and leading to multiorgan dysfunction and failure, with mortality rates approaching 20-30% even with intensive care.^[1]^[25] Cardiovascular complications are prominent, particularly in elderly patients or those with preexisting cardiac conditions, where the hypermetabolic state induces high-output heart failure through increased myocardial oxygen demand, tachycardia, and reduced diastolic filling time. Atrial fibrillation occurs in up to 15% of thyrotoxic cases and is exacerbated by iodine-induced hyperthyroidism, potentially leading to thromboembolic events or hemodynamic instability.^[1]^[26]^[27] Prolonged thyrotoxicosis from the Jod-Basedow phenomenon contributes to osteoporosis by accelerating bone resorption via elevated thyroid hormone levels, which inhibit osteoblast activity and enhance osteoclast function, resulting in reduced bone mineral density and increased fracture risk, especially in postmenopausal women. In pregnancy, maternal iodine excess can cross the placenta, potentially inducing fetal thyrotoxicosis, miscarriage, preterm labor, or low birth weight, though these risks are rare and depend on the underlying thyroid autonomy. Rare complications in reported 2020s cases include pericardial effusion due to hyperdynamic circulation. Recent 2025 reports also describe associations with diabetic ketoacidosis following contrast exposure in susceptible individuals.^[28]^[29]^[1]^[23]

Diagnosis

Laboratory Evaluation

Laboratory evaluation for suspected Jod-Basedow phenomenon primarily involves assessing thyroid function to confirm thyrotoxicosis, with biochemical confirmation of iodine exposure and evaluation for underlying or complicating conditions.^[1] Thyroid function tests are essential, revealing suppressed thyroid-stimulating hormone (TSH) levels typically below 0.1 mU/L, alongside elevated free thyroxine (T4) and triiodothyronine (T3) concentrations, often exceeding the upper reference limits by 50% or more in overt cases.^[30] These abnormalities usually manifest 2 to 12 weeks following iodine exposure, with peak hormone levels occurring around 4 to 8 weeks as the thyroid utilizes the excess iodine substrate for hormone synthesis.^[31] To verify recent iodine overload, measurement of urinary iodine excretion is recommended, where levels exceeding 300 µg/L—often up to three times the normal range of 100-199 µg/L—indicate significant exposure.^[1] In patients with potential overlap of autoimmune thyroid disease, such as latent Hashimoto's thyroiditis, testing for thyroid autoantibodies like anti-thyroid peroxidase (anti-TPO) antibodies may be performed to identify predisposing factors, though these are not universally elevated in Jod-Basedow cases.^[28] If thyroid storm is suspected as a severe complication, additional laboratory assessment includes leukocytosis and abnormal liver function tests to gauge systemic involvement.

Imaging and Functional Tests

Thyroid ultrasound serves as an initial imaging modality to evaluate for underlying structural abnormalities, such as nodules or goiter, that predispose patients to the Jod-Basedow phenomenon following iodine exposure.^[32] Color Doppler ultrasonography can further assess thyroid vascularity, with increased blood flow patterns indicating autonomous nodular function that may contribute to iodine-induced hyperthyroidism.^[33] Functional scintigraphy, including radioiodine uptake scans, typically reveals low or undetectable uptake due to saturation of the thyroid with exogenous iodine, which inhibits further radioiodine absorption.^[1] This contrasts with Graves' disease, where diffuse high uptake is observed, aiding in differentiation.^[34] Similarly, technetium-99m pertechnetate scans demonstrate uniformly diminished tracer uptake across the thyroid gland, reflecting competitive inhibition by excess iodine. Computed tomography (CT) or magnetic resonance imaging (MRI) may be considered if extrathyroidal complications, such as cardiovascular effects from thyrotoxicosis, require evaluation; however, iodinated contrast should be avoided to prevent exacerbation of hyperthyroidism.^[35] Non-contrast CT or MRI is preferred in such cases.^[1]

Management and Treatment

Prophylactic Measures

Prophylactic measures for the Jod-Basedow phenomenon focus on identifying at-risk individuals and implementing interventions prior to iodine exposure, particularly from iodinated contrast media (ICM) used in medical imaging. High-risk groups include patients with underlying thyroid autonomy, such as nodular goiter or multinodular goiter, especially in iodine-deficient or endemic areas where the prevalence of such conditions is higher.^[36]^[1] Screening begins with baseline thyroid-stimulating hormone (TSH) testing in these high-risk populations before planned procedures involving ICM, allowing for risk stratification and timely prophylaxis. If TSH is suppressed or low-normal in the context of known thyroid nodules, alternative imaging modalities should be considered, such as ultrasound or gadolinium-enhanced magnetic resonance imaging (MRI), to avoid unnecessary iodine load.^[36]^[1] For patients requiring ICM despite elevated risk, pretreatment with antithyroid drugs like methimazole (20-30 mg daily, starting the day before the procedure and continuing for 14 days) or propylthiouracil is recommended to inhibit thyroid hormone synthesis. Potassium perchlorate, at doses of 600-1000 mg daily (e.g., 900 mg/day for up to 2 weeks), can be used alone or in combination to competitively block iodine uptake by the thyroid gland, particularly in urgent cases. These strategies have demonstrated efficacy in reducing the incidence of iodine-induced hyperthyroidism by up to fivefold in high-risk cohorts, with no significant adverse effects reported.^[37]^[36]^[1] The 2021 European Thyroid Association guidelines emphasize these prophylactic approaches for patients in iodine-deficient regions or with nodular thyroid disease, recommending individualized assessment to balance procedural benefits against thyroid risks. Patient education on reporting prior thyroid issues and avoiding iodine-containing supplements further supports prevention efforts.^[36]^[1]

Therapeutic Interventions

The primary therapeutic approach for Jod-Basedow phenomenon involves immediate discontinuation of the exogenous iodine source to halt further thyroid hormone synthesis acceleration.^[38] Antithyroid drugs, such as methimazole (typically 10-40 mg daily) or propylthiouracil (300-600 mg daily in divided doses), are initiated to inhibit thyroid peroxidase and block new hormone production, thereby reducing circulating thyroid hormone levels.^[1]^[38] Concurrently, beta-blockers like propranolol (40-120 mg daily) are used to control adrenergic symptoms such as tachycardia, tremors, and anxiety by non-selectively blocking beta-adrenergic receptors, providing rapid symptomatic relief without affecting hormone levels directly.^[1]^[38] In severe cases, especially those escalating to thyroid storm, adjunctive therapies target accelerated hormone metabolism and circulation. Corticosteroids, such as prednisone (40-60 mg daily), are administered to suppress peripheral deiodination of thyroxine (T4) to the more active triiodothyronine (T3), facilitating faster normalization of hormone levels.^[38] For refractory hyperthyroidism unresponsive to medical management, plasmapheresis can be employed to directly remove excess thyroid hormones from the plasma, often as a bridge to definitive treatment, with sessions typically reducing free T4 by 20-50% per procedure.^[39] In life-threatening scenarios, such as refractory thyroid storm, urgent total thyroidectomy may be required after stabilization to eliminate the hyperfunctioning gland.^[38] Ongoing management includes serial laboratory monitoring of thyroid-stimulating hormone (TSH), free T4, and total T3 levels, initially every 1-2 weeks, to guide dose adjustments and assess response.^[1] Recovery to euthyroidism generally occurs within 4-12 weeks after iodine withdrawal and initiation of therapy, though persistent cases may require extended treatment.^[1] Lithium carbonate (300-900 mg daily) has been reported as an adjunct in select resistant cases to enhance iodine blockade and inhibit hormone release, particularly when standard antithyroid drugs are contraindicated or ineffective.^[1]

Precautions and Prevention

In Medical Imaging

In medical imaging procedures involving iodinated contrast media (ICM), such as computed tomography (CT) scans and angiography, risk stratification is essential to prevent triggering the Jod-Basedow phenomenon in susceptible patients. Clinicians should evaluate patient history for underlying thyroid conditions, including nodular goiter, latent Graves' disease, or thyroid autonomy, and consider pre-procedure thyroid ultrasound to detect autonomous nodules or multinodular goiter.^[36] Baseline thyroid-stimulating hormone (TSH) testing is recommended for high-risk groups, such as the elderly or those in iodine-deficient regions, where the incidence of iodine-induced hyperthyroidism can reach 1-10% following ICM exposure.^[36]^[10] Patients identified as at risk should be informed of this potential 1-5% complication rate in vulnerable populations, with emphasis on the transient but possibly severe thyrotoxicosis that may ensue.^[1]^[40] To minimize exposure, alternative imaging modalities are preferred when clinically feasible for high-risk individuals. Non-contrast CT protocols, ultrasound, or magnetic resonance imaging (MRI) with gadolinium can often suffice for diagnostic needs without introducing excess iodine.^[36]^[41] ICM should be avoided entirely in patients with overt hyperthyroidism or known thyroid autonomy, as these conditions heighten the risk of autonomous hormone overproduction upon iodine load.^[36] Institutional protocols for safe ICM use incorporate supportive measures to mitigate risks, including adequate hydration to promote renal iodine excretion, particularly in patients with compromised kidney function that could prolong iodine retention.^[1] Post-procedure thyroid function monitoring—measuring TSH, free T4, and free T3—is advised for high-risk cases at 3-4 weeks, with extended follow-up up to 3 months if symptoms like tachycardia or weight loss emerge.^[36]^[41] Recent guidelines, including updates referenced in 2024 reviews, stress obtaining informed consent from at-risk patients, detailing the potential for Jod-Basedow onset and outlining monitoring plans to facilitate early intervention.^[36]^[40]

With Iodine-Containing Drugs

The Jod-Basedow phenomenon can be induced by chronic exposure to iodine from certain medications, particularly in individuals with underlying thyroid autonomy or latent Graves' disease, leading to hyperthyroidism. Amiodarone, an antiarrhythmic drug with high iodine content (approximately 37% by weight), is the most commonly implicated agent due to its long-term use in cardiovascular conditions. Prior to initiating amiodarone therapy, a baseline thyroid evaluation is recommended, including measurement of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels, along with thyroid ultrasound if nodular disease is suspected, to identify at-risk patients. Monitoring of TSH levels every 3 to 6 months is advised during treatment, with more frequent assessments in the first year or in high-risk populations such as those with preexisting thyroid nodules. If hyperthyroidism develops, switching to non-iodinated alternatives like dronedarone or sotalol should be considered when clinically feasible to mitigate ongoing iodine load. Other iodine-containing drugs and supplements also pose risks for inducing the Jod-Basedow phenomenon, though less frequently than amiodarone due to lower or intermittent dosing. Topical iodides, such as povidone-iodine used in wound care, and oral iodine supplements for thyroid protection in radiation exposure scenarios, can contribute to excess iodine intake, particularly in susceptible individuals. In patients with renal impairment, dose adjustments for these agents are essential, as reduced clearance may prolong iodine exposure and heighten the risk of thyroid dysfunction. Pregnant women require special caution, as iodine excess from these medications can cross the placenta and induce fetal goiter or neonatal hyperthyroidism, necessitating avoidance or strict monitoring during gestation. Management protocols for drug-induced Jod-Basedow emphasize early intervention to prevent complications. If hyperthyroidism emerges, prompt initiation of antithyroid therapy, such as methimazole, is recommended alongside discontinuation of the offending drug when possible. Recent cardiology trials from the 2020s, including analyses of long-term amiodarone users in atrial fibrillation cohorts, report an incidence of Jod-Basedow phenomenon ranging from 2% to 10%, with higher rates in iodine-deficient regions, particularly in patients with multinodular goiter. Therapeutic options for these cases align with general management of iodine-induced hyperthyroidism, as detailed in broader treatment guidelines.

History and Nomenclature

Historical Discovery

The Jod-Basedow phenomenon, characterized by iodine-induced hyperthyroidism, was first observed in the early 19th century during initial therapeutic uses of iodine for goiter treatment. In 1820, Swiss physician Jean-François Coindet reported successful reduction of goiter size with oral potassium iodide but noted paradoxical exacerbation of symptoms, including severe tachycardia and signs of thyrotoxicosis in some patients, marking the earliest documented cases of this adverse effect.^[3] These observations highlighted iodine's dual role in thyroid physiology, beneficial in deficiency states yet potentially harmful in predisposed individuals with underlying nodular or autonomous thyroid tissue. Throughout the early 20th century, reports of the phenomenon increased in iodine-deficient endemic areas following the introduction of iodine prophylaxis. In Switzerland, the 1922 implementation of voluntary salt iodization confirmed the risk in populations transitioning from chronic deficiency to adequate intake, particularly among older adults with preexisting goiters.^[42] Similar patterns emerged in other regions adopting iodized salt, such as the United States in the mid-1920s, where epidemiological data showed elevated thyrotoxicosis incidence shortly after widespread supplementation, underscoring the phenomenon's association with sudden iodine excess in vulnerable thyroid glands.^[15] In the mid-20th century, wartime and postwar studies further elucidated the mechanism, particularly during iodine prophylaxis efforts. Although specific military applications during World War II are less documented, the 1948 discovery of the Wolff-Chaikoff effect by Jan Wolff and Israel Chaikoff described iodine's transient inhibitory action on thyroid hormone synthesis, providing a counterpoint that explained why some individuals escaped inhibition and developed hyperthyroidism.^[3] Confirmation came in the 1950s through radioiodine tracer studies; John B. Stanbury's 1952 investigations in iodine-deficient regions of Argentina used radioisotopes to demonstrate heightened thyroidal iodine avidity and autonomous uptake in nodular glands, directly linking excess iodine to the Jod-Basedow effect in long-standing deficiency states.^[42] Since the mid-20th century, the phenomenon has been well-characterized with no major mechanistic updates, though retrospective analyses as of 2023 have revisited historical cohorts to assess long-term impacts of iodization programs on thyroid autonomy.^[42] These reviews reinforce the foundational observations from Coindet and Stanbury, emphasizing preventive strategies in at-risk populations without altering core understandings established decades prior.

Etymology and Naming

The term "Jod-Basedow phenomenon" originates from "Jod," the German word for iodine, combined with "Basedow," honoring the German physician Karl Adolph von Basedow (1799–1854), who in 1840 first described the clinical triad of goiter, hyperthyroidism, and exophthalmos in what is now known as Graves' disease.^[43] Although von Basedow did not directly observe or describe iodine-induced hyperthyroidism, the nomenclature links the condition to his seminal work on thyroid hyperactivity in endemic goiter regions.^[44] The eponym was coined in 1910 by Swiss surgeon Theodor Kocher in his publication Über Jodbasedow, to denote the paradoxical induction of hyperthyroidism by excess iodine administration, particularly in iodine-deficient patients with underlying nodular goiters.^[3] Kocher's term highlighted the risk observed during early 20th-century iodine supplementation efforts, distinguishing it from von Basedow's primary description of autoimmune thyroid disease.^[45] Alternative designations include iodine-induced hyperthyroidism and Jod-Basedow syndrome, emphasizing the etiological role of exogenous iodine without invoking the eponymic confusion with Graves' disease (also termed Basedow's disease in some European contexts).^[1] In the 19th century, nonspecific adverse effects from iodine excess, such as metallic taste and gastrointestinal upset, were broadly termed "iodism," but this did not specifically address thyrotoxicosis until Kocher's delineation.^[46] The nomenclature solidified in post-1950s endocrinology following epidemiological confirmations of the phenomenon, such as Stanbury et al.'s 1951 study in Argentina linking iodine prophylaxis to hyperthyroidism outbreaks, leading to its routine inclusion in major texts by the 1970s.^[47]

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To report a case of iodine-induced (Jod–Basedow) hyperthyroidism leading to thyrotoxic periodic paralysis (TPP). Case Summary: A 64-year-old white male, one day ...
[24]
Thyroid Storm Precipitated by Radioiodine Contrast in Metastatic ...
Mar 31, 2021 · This iodine-induced thyrotoxicosis was likely through the Jod-Basedow phenomenon [10], which led to hypersecretion of thyroid hormones in ...
[25]
Review Article Atrial fibrillation and hyperthyroidism: A literature review
Hyperthyroidism is a well-known cause of atrial fibrillation with a 16%–60% prevalence of atrial fibrillation in patients with known hyperthyroidism.
[26]
Heart failure as a serious complication of iodinated contrast-induced ...
Oct 20, 2021 · Atrial fibrillation is a known complication of severe hyperthyroidism, which in this case was further exacerbated by pneumonia. Excess thyroid ...
[27]
Thyrotoxicosis - StatPearls - NCBI Bookshelf - NIH
Jan 18, 2025 · Thyrotoxicosis can lead to severe complications, such as delirium, altered mental status, osteoporosis, muscle weakness, atrial fibrillation, ...Missing: phenomenon | Show results with:phenomenon
[28]
Effect of Hyperthyroidism Control During Pregnancy on Maternal ...
Jun 23, 2022 · Our findings demonstrated that treating overt hyperthyroidism in pregnancy is mandatory and appears to reduce some potential maternal-fetal complications.Missing: Jod- | Show results with:Jod-
[29]
Hyperthyroidism: Diagnosis and Treatment - AAFP
Mar 1, 2016 · ... TSH level is normal at the time. Elevated or above-normal TSH levels (greater than 4.0 mIU per mL) at antithyroid drug discontinuation is ...
[30]
Iodinated contrast–induced thyrotoxicosis - PMC - NIH
Iodine administration to patients with underlying thyroid disease may lead to hypersecretion of thyroid hormones, a phenomenon known as the Jod–Basedow effect. ...
[31]
MON-451 Contrast Induced Hyperthyroidism (Jod Basedow ...
Oct 22, 2025 · Introduction: Iodine-induced hyperthyroidism (Jod-Basedow phenomenon) occurs when excessive iodine triggers thyrotoxicosis in individuals with ...
[32]
Thyrotoxicosis Imaging: Practice Essentials, Ultrasonography ...
May 23, 2022 · The assessment of thyroid blood flow by color-flow Doppler ultrasonography is valuable in the differentiation of destructive thyrotoxicosis from ...
[33]
Jod-Basedow Syndrome Following Oral Iodine and Radioiodinated ...
Jod-Basedow Syndrome Following Oral Iodine and. Radioiodinated-Antibody Administration. Ayda M. El-Shirbiny, Stavross S. Stavrou, Ann Dnistrian, Martin ...Missing: definition | Show results with:definition
[34]
Iodinated contrast-induced thyrotoxicosis - Radiopaedia.org
May 21, 2024 · Iodinated contrast-induced thyrotoxicosis is rare and may occur in patients with pre-existing thyroid disease and through complications of thyrotoxicosis.
[35]
2021 European Thyroid Association Guidelines for the Management ...
... CT scans [28]. More recently in Denmark, 14 patients (6% of all new cases of Hyper) had an ICM injection within 2 years before the hyperthyroid episode.
[36]
Safety and efficacy of prophylactic treatment for hyperthyroidism ...
May 14, 2023 · Introduction: The use of iodinated contrast media (ICM) can lead to thyrotoxicosis, especially in patients with risk factors, such as Graves' ...
[37]
Prevention and Treatment of Iodine-Induced Thyrotoxicosis
Older age patients are also at high risk of developing hypothyroidism after ICM exposure, as reported in a study including the Asian population [42]. Patients ...2. Risk Factors For... · Table 3 · 3.4 AmiodaroneMissing: demographics | Show results with:demographics
[38]
Exploring the role of plasmapheresis prior to thyroidectomy in ... - NIH
Oct 10, 2024 · We recognize plasmapheresis as an effective treatment option for reducing thyroid hormone levels prior to thyroidectomy in patients with thyrotoxicosis.
[39]
Iodinated contrast media (ICM)-induced thyroid dysfunction
Apr 29, 2025 · Acute iodine load may precipitate hyperthyroidism through the Jod-Basedow phenomenon, predominantly affecting individuals with autonomously ...
[40]
Iodine contrast should be avoided in patients with thyroid eye disease
Sep 26, 2024 · Iodinated contrast media (ICM) is known to trigger thyroid dysfunction and thyrotoxicosis in both euthyroid and susceptible individuals.
[41]
The Prevention of Iodine Deficiency: A History | Thyroid®
Feb 14, 2023 · ... confirm that the Jod-Basedow phenomenon in patients with long-standing iodine deficiency was caused by excess iodine. His further studies ...
[42]
Jod-Basedow phenomenon | Radiology Reference Article
Jul 23, 2025 · Jod-Basedow syndrome; Jod-Basedow effect; Iodine-induced hyperthyroidism; Jod Basedow phenomenon. Jod-Basedow phenomenon is hyperthyroidism ...
[43]
Iodine-Induced Hyperthyroidism: Occurrence and Epidemiology
Jod-Basedow. This term is incorrect because what von. Basedow and Graves described was exophthalmic goiter, and is not caused by ingestion of iodine. Within ...
[44]
Thyroid History Timeline
1912 Term Jod Basedow for iodine overdosage coined. 1912. Kocher coins term Jod Basedow for iodine overdosage. More. Event. 1912 Seasonal variation in thyroid ...Missing: phenomenon | Show results with:phenomenon
[45]
Iodine - an overview | ScienceDirect Topics
Iodine toxicity is also known as “iodism.” The problem occurs in patients who take large doses of potassium iodine continuously as medication. The symptoms ...
[46]
[PDF] OF ENDEMIC GOITRE - Europe PMC
of hyperthyroidism was named Jod-Basedow by Kocher40 in 1910. Still, many others refused to recognize Jod-Basedow. Yet, in 1951, Stanbury et al.,7 while ...<|separator|>