In Reply We would like to thank Millon-Ramirez and coauthors for bringing our attention to their previous study on the association of iodine deficiency and hearing impairment among 150 children (aged 6-14 years). As we emphasized in our research letter, few studies have been conducted about this potential relationship, and among them we cited the study by Valeix et al. We agree with Millon-Ramirez and coauthors that in populations with adequate nutritional iodine levels there are individuals with less than adequate iodine intake, which could affect the thyroid system and thus auditory function. Moreover, the potential role of other chemical exposures, such as perchlorate, thiocyanate, and nitrate, which may disturb thyroid function should not be discarded. Alterations may occur either at the iodine uptake level in the thyroid cell by competing for the sodium iodine transporter, by inhibition of the deiodinase activity, or by other mechanisms (reviewed by Zoller).
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