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Stable thyroid function despite regular use of povidone-iodine throat spray for SARS-CoV-2 prophylaxis

Quek et al., Annals of Medicine, doi:10.1080/07853890.2022.2108132
Nov 2022  
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Safety analysis of 42 day treatment with a povidone-iodine throat spray in 117 patients compared with 60 controls, showing no significant differences in thyroid function. Authors note the study included relatively young and healthy patients, levels of circulatory iodine were not directly measured, and patients with symptomatic thyroid disease were not included.
Quek et al., 18 Nov 2022, Singapore, peer-reviewed, 10 authors. Contact: raymond_seet@nus.edu.sg.
This PaperPovidone-Iod..All
Stable thyroid function despite regular use of povidone-iodine throat spray for SARS-CoV-2 prophylaxis
Amy May Lin Quek, Mei Yen Ng, Ooiean Teng, Nicole-Ann Lim, Geelyn Jeng Lin Ng, Samantha Peiling Yang, Mikael Hartman, Paul Anantharajah Tambyah, Alex R Cook, Raymond Chee Seong Seet
Annals of Medicine, doi:10.1080/07853890.2022.2108132
Background: It is unclear whether unintentional ingestion of povidone-iodine following its application to the oropharyngeal space could affect thyroid function. Objective: To examine thyroid function among individuals who regularly apply povidone-iodine throat spray for SARS-CoV-2 prophylaxis. Methods: We designed a case-control study to compare thyroid function among participants who received povidone-iodine throat spray three times a day for 42 days ('cases') and those who received vitamin C ('controls'). Thyroid function was assessed by profiling serum TSH, free T3, and free T4; iodine status was estimated using serum thyroglobulin level, while infection status was determined by measuring anti-SARS-CoV-2 antibody against the nucleocapsid antigen. All measurements were performed in pairs, at baseline and 42 days later. Pre-post changes in thyroid function were compared between groups, before and after stratification according to baseline TSH quartiles. Results: A total of 177 men (117 cases and 60 controls) (mean age, 32.2 years) were included. Despite comparable demographics and clinical profiles, no clinically or statistically significant differences were observed in thyroid indices between 'cases' and 'controls' before and after stratification according to TSH quartiles. None of the participants developed symptomatic hypo-or hyperthyroidism throughout the study. Post-hoc analysis did not reveal differences in thyroid function according to infection status. Conclusions: Data from this study support the overall safety of povidone-iodine use in the oropharyngeal space for SARS-CoV-2 prophylaxis among individuals with normal thyroid function and subclinical thyroid disease.
Author contributions All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved and have given final approval of the version to be published. QMLA, RSCS, PAT, and MH contributed to the conception and design of the study and acquisition of data, drafted the article, and revised it critically for important intellectual content. NAL, GJLN, SPY, OT, and MYN have contributed to the conception and design of the study and acquisition of data and revised it critically for important intellectual content. ARC has contributed to statistical analysis, interpretation of the data, and revised the manuscript for important intellectual content. Disclosure statement No potential conflict of interest was reported by the author(s).
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