THE AMERICAN JOURNAL OF CLINICAL NUTRITION

vol. 22, No. 12, December, 1969, pp. 1597-1607

Printed in U.S.A.

Prophylaxis and Treatment of Endemic

Goiter with Iodized Oil in
1
Rural Ecuador and Peru

JOHN KEVANY,2 M.D., R0DRIG0 FIERRO-BENITEZ,3 M.D., EDUARDO A. PRETELL,4 M.D.,

AND JOHN B. STANBURY,5 M.D.

complete or unavailable and because sur-

AuTH FEW EXCEPTIONS endemic goiter
continues as a major health problem veys have been limited in geographic scope
in those areas of the world where the or to special age groups (1, 2).
disease has been known for generations. If endemic goiter implied only an en-

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Substantial understanding of its patho- largement of the thyroid, it could be dis-
genesis, simple and effective preventive missed as a trivial affliction. In fact, severe
measures, and a rising world economy endemic goiter is accompanied by a sub-
have done little to reduce its prevalence stantial incidence of cretinism and deaf-
on a worldwide scale. This state of affairs mutism. Furthermore, there is good rea-
is due principally to the low priority ac- son for suspecting that, in many cases, tile
corded to the disease by health authorities mental retardation (apart from overt cre-
and to the ubiquitous conflicts of interest tinism), neuromuscular disturbance, and
between the public and private sectors. short stature that usually accompany se-
One of the most extensive and severe vere endemic goiter may in fact be causally
focuses of endemic goiter occurs in Latin related. In addition, it has been suggested
America. The disease is widespread that the disease may have an unfavorable
throughout Central and South America effect on general health and educational
but is concentrated in the mountain ranges capacity.
extending along the Pacific coast from In view of the magnitude and severity
Mexico to Chile. As an estimate, over 10 of the problem, the Pan American Health
million people may be affected by this Organization (PAHO) has maintained an
condition. Precise figures cannot be ob- active program of technical assistance in
tained because morbidity statistics are in- this field during the past 2 decades. Of the

1 Supported in part by U. S. Public Health Service 26 member governments, 17 have a defined

Grants AM 12748 and AM 10992, The National
problem of endemic goiter, and endemic
Association for Retarded Children, The Pan Ameri- cretinism is known to exist in several of
can Health Organization, Fondo Nacional de Salud these afflicted areas. Fifteen of the 17 coun-
y Bienestar Social and Servicio Especial de Salud
tries have enacted legislation requiring the
P#{252}blica of Peru.
iodization of salt, and the remaining 2
2 Pan American Health Organization, Washington,
D. C. ‘Departamento de Radiois#{243}topos, Escuela have legislation under consideration. De-
Polit#{233}cnica Nacional, Quito, Ecuador. Departa- spite this expression of official concern,
mento de Endocrinologia, Instituto (IC Investiga- effective programs have been established
ciones de Ia Altura, Lima, Peru. Unit of Experi-
in less than half of the countries affected,
mental Medicine, Department of Nutrition and
Food Science, Massachusetts Institute of Technology, and many of the most serious areas of en-
Cambridge, Massachusetts. demia are still without any preventive
1597
 1598 Kevany et al.

illeasures. In view of this, the PAHO de- moteness and because, in both, endemic
Ci(ICd to look for alternate methods of pre. goiter is severe and cretinism is common-
vention of endemic goiter and cretinism. place. They are about 70 km north of Quito,
This decision in no way conflicted with the 6 miles apart, and ethnically, socially, and
Priority given to salt iodization but rather biologically comparable (6). The villagers
1V1S directed to finding an interim solu- have unusually limited social mobility and
tiOll. The PAHO also recognized that some contact with tile outside world, charac-
of the most severely affected populations teristics shared with hundreds of others
are so isolated from normal commercial in the South American Andean region.
cilallnels that the people will continue to Ihe sociocconomic situation is precarious
use primitive sources of uniodized salt in both villages (Table i). There is a high
even if salt iodization is implemented on a infant mortality rate, a high incidence of
national scale. illegitimacy, a low level of literacy, and a
Among various alternative methods for great poverty reflected by the low per capita
supplying dietary iodine, one has been income and small percentage of artisans.
provision of parenteral iodine to establish Chronic iodine deficiency is severe in both

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long-term body stores. A number of years villages, and prevalence of goiter and associ-
ago a program of goiter prevention by the ated defects is high (Table ii). Salt used by
injection of iodized oil was begun in New the villagers contains 0.24 g/g iodine.
Guinea. Information available from those Iodine was given to the Tocachi pop-
surveys (3-5) indicated that prophylactic ulat 1011, while La Espcranza served as a
programs were effective in reducing the control village. The program was started
prevalence of goiter and that tile proced- in March 1966. The iodized oil was Ethio-
ure was practical and safe. The results (101 (37% iodized poppy seed oil, each
obtained in New Guinea, however, have milliliter containing 475 mg of iodine, ob-
not provided enough information regard- tained from E. Fougera, Inc., Hicksville,
ing the effectiveness of this form of pro- L. I., New York). Disposable plastic sy-
piiylaxis reducing
in incidence and have rillges were used to avoid problems of
given virtually no information regarding sterilization at high altitudes. The follow-
prevention of those disabilities that are ing dosage schedule was used:

epidemiologically associated with severe

up to 2 years 01(1: 0.2 ml of iodized oil
endemic goiter. With these considerations
2-6 years old: 0.5 ml of iodized oil
in view, field studies were begun in 1966 to 6-12 ‘SearS old: 1.0 ml of iodized oil
determine the feasibility and effectiveness 12 years old and up: 2.0 ml of iodized oil

of parenteral administration of iodized oil

The oil was administered intramuscu-
iii prevention and treatment of endemic
larly into the gluteal region of small chil-
goiter and the defects that may accompany
dren and into tile deltoid region of adults.
it.
Drawback was practiced to ensure that oil
Two neighboring countries of South
was not injected intravenously. Merthiolate
America, Ecuador and Peru, were se-
was used for skin sterilization.
lected for study since both presented
Thyroid size was evaluated by a modi-
areas with high prevalence of goiter and
fication of tile classification of Perez et aL
cretinism, and no preventive programs
(7).
were being undertaken.
Grade Oa:
THE PROGRAM IN ECUADOR not palpable
Grade Ob:
#{149}
Two villages, Tocachi and La Espe- palpable, but not visible with the head
ranza, were selected because of their re- raised
 Goiter in Ecuador and Peru 1599

Grade I: TABLE I
easily palpable with head in normal posi-
tion and visible with the head raised; those
Socioeconomic conditions in two Ecuadorian
glands presenting easily palpable nodules villages
with head in normal position but not visi-
ble with head raised were included in this Tocachi La Esperanza

grade
Grade ii: Percent of subjects born in 97 91
easily visible with head in normal position the village
Grade III: Percent of infant mortality 43 29
visible at a distance Percent of unwed mothers 26 14
Grade IV: Percent of subjects who are 31 34
monstrous goiters illiterate
Percent of subjects who 5 9
For epidemiologic purposes glands were have visited the coast
considered abnormal when grade Ob or region

larger. These glands were recorded as dif- Percent of artisans 5 5

Annual income per capita 90 85
fuse or nodular.
($)
Examination of selected children included

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an X-ray of the left hand and observation
for gingival emergence of the deciduous TABLE II
and permanent teeth. Hand X-rays were
Prevalence of goiter and of neural and niotor
taken using Kodak no-screen Ready Pack
abnormalities, percent of total population
medical X-ray films, at a tube-to-film dis-
(March 1966)
tance of 91.5 cm (36 inches) with a Bucky
field-portable X-ray unit. Anthropometric . La
Tocachi Esperanza
measurements were also made. For evalua-
tion of cretinism, the fundamental fact General goiter 69.7 52.8
taken into account was tile mental defi- Nodular goiter 41.1 23.4
ciency of the subject. The degree of defi- Diffuse goiter 28.6 29.3

ciency was obvious to the surveyor and Endemic cretinism 8.2 6.0
Deaf-mutism (severe impair- 4.5 2.5
confirmed by the manner in which the
ment in hearing and speech)
subject lived in relation to the rest of the Deafness (severe impairment I .6 0.0
community. in hearing)
Shortly after tile completion of the in- Mutism (severe limitation in 0.4 0.4
jection program a physician and a midwife speech)
Motor abnormalities 1 .0 0.8
were assigned full time to Tocachi and
Other congenital malforma- 0.4 1 .2
La Esperanza. These villages had not
tions
had a physician in residence before. Small
dispensaries were established for adminis-
tering to the general medical needs of the incidence have been conducted at 6, 12,
communities, but particularly to keep con- 20, and 25 months after the injection pro-
tinuous close observation on the effects of gram.
the prophylactic program and on the
THE PROGRAM IN PERU
progress and results of pregnancies as they
might occur. All pregnancies in both vil- The plan in Peru has been similar in
lages have been followed and neuromotor most respects (8). Three central sierra vil-
development and physical growth of all of lages, Tapo (3,311 m), Huasahuasi (3,531
the children born in both villages have m), and Ataquero (3,100 m) were selected.
been studied since March 1966. Epidemio- A net growth rate of 3% per annum
logical surveys for goiter prevalence and assured a high percentage of children.
1600 Kevany et al.

Tarma, a nearby town equipped with RESULTS

laboratory and hospital facilities, served

Goiter Prevalence
as headquarters for the field work. More
detailed laboratory work was carried out Administration of iodized oil in Tocachi
in Lima, about 5 hr away by automobile. caused a regular and consistent fall in the

Iodized oil or a placebo was injected prevalence of goiter for 20 months, both
into 1,771 subjects. The placebo was poppy in the total population and in men and
seed oil without iodine. Nine hundred women taken separately. The ratio of

and twenty-three subjects in the three goiter in women to that in men increased
villages were injected with iodized oil while the prevalence of goiter in the total
(GrI) and 848 with the placebo (GrP). In- population decreased (Fig. 1). After the
jections were done in females up to 45 20th llTlOIlth the prevalence began to rise
again.
years of age and in men up to 18. Among
the schoolchildren, groupings for the pla- At the time of the survey 6 months after
iodization, nodular goiter had increased
cebo and the iodized oil were predeter-
noticeably while diffuse goiter had de-
mined at random within a given age. Care

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creased, but in tile following surveys (up
was taken to match the size of goiter. In
to the 20th month) nodularity also stead-
other groups randomization was accom-
ily decreased. The Ethiodol produced a
plished by consecutive alternation of io-
distinct decrease of the incidence of grade
(line and placebo injection. The doses
used were the following:
II goiters and larger, and this decrease
continued into the survey conducted 25
less than 1 year old: 0.5 ml
months after iodization. Although the de-
from 1 to 5 years old: 1.0 ml
crease ill size of large goiters was achieved
OVC1 6 years old: 2.0 ml
at the expense of an increase in the mci-
In adult women with nodular goiter the dence of grade I goiters, after the survey
close was reduced to 0.2 ml. All injections at 12 montlls grade I goiters also tended to
were performed in the 1st week of October diminisll. This trend persisted after 20
1966. months. After the 20th-month survey, how-
Surveys were also made for bone and ever, this type of goiter (but not those of
neurological maturation. Reevaluation of larger size) tended to increase in the total
the prevalence of goiter was made at 6, population. lt seems certain that the sharp
12, and 18 months after injection. At the increase of nodular goiter found 6 months
time of reevaluation, the examiners were after iodization was a result of involution
ignorant of both the prior estimated gland of hyperplastic thyroid tissue.
size and the type of injection. Clinical as- The degree of reduction in goiter di-
sessment was made by members of the same illinished as age increased. Tile maximum
team throughout the program. reduction was seen during tile first 18
Particular attention has been paid to years of life. There was minimal reduction
the females in the child-bearing age (16-45 after 40 years of age. Reduction at 25
years old). As many pregnancies as possi- months after iodization was 36% for the
ble occurring in both the GrP and GrI total population. There was not a single
groups were followed throughout gesta- instance of palpable thyroid in children
tion. Newborns were recorded for the pur- born in Tocachi to iodized motllers. Eight-
pose of future evaluation. In addition, een percent of the children of La Espe-
serum levels of thyroid hormone were in- ranza up to 2 years of age who were exam-
vestigatecl in pregnant women, as well as ined at the time of the 25th-month survey
iodine content in milk from lactating presented palpable glands. As to overall
women. goiter prevalence in La Esperanza, the re-
 (;oiter in Ecuador and Peru 1601

TOTAL POPULATION #{149}.

=
814 WOMEN o--c
0 MEN
0 70
0
I-

Lii 60
.
I.-
0
0
0
SI
:
U-
0 11 #{149}
40

Li ________#{149} ..#{149}.#{149}.#{149}.#{149}
0 #{149}#{149}#{149}#{149}
#{149}-
z 30
Lii
0
0 0
20
z

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0
10

MONTHS

5 10 15 20 25

TIME IN MONTHS

FIG. 1. Effect of administration of iodized poppy seed oil (Ethiodol) on the incidence of goiter in a
village of rural Ecuador. Insert shows the ratio of goiter in women and men.

suits indicated that tllere was a significant to be more pronounced in the 13- to 18-
increase during the same period. year- and under-6-year-old groups than in
The findings in tile three Peruvian vil- the 6- to 12-year-old subjects.
lages were similar. Fifty percent of the
population were affected with goiter dur- Thyroid Function and Iodine Metabolism
ing the first 5 years of life. This was pri- In tile Ecuadorian study, uptake of
niarily of the Ob degree; thereafter, more ‘‘I by the thyroid proved to be depressed
than 90% were goitrous. Size of goiter and at the time of the survey at 6 months. A
nodularity increased with age. The prev- restoration toward normality was observed
alence of “endemic cretinism” and other in successive control surveys (Fig. 3). The
defects varied from 1.0% to 3.6% in the urinary excretion of iodine (UEI) (Fig. 4)
three villages. followed an exponential pattern. Since
Goiter prevalence in the iodized group the subjects on whom UEI determina-
in Peru decreased steadily for 18 months tions were done were adults who had re-
after tile injection program (Fig. 2). A ceived 2 ml of Ethiodol (950 mg), elimina-
striking fall from 58 to 16% in visible tion of those 950 mg would be virtually
goiter as well as from 86 to 52% in palpable accomplished at the 40th month after in-
goiter occurred in tile iodized group, while jectiomi. These results iniply that a dose
the placebo group changed only slightly equal to half of that used would reduce the
from 52 to 45% in the former and 81 to total effective time by only 5 months.
78% in the latter. In both groups the de- Changes in thyroid function tests at
crease was more marked in males than in different stages of the Peruvian study are
females. In addition, the decline appeared shown in Fig. 5. The 24-hr thyroid uptake
 Male Sexes

Placebo

(7

odized Oil

>

a-

_j_____l -- 3 24
Months

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FIG. 2. Decline in goiter in three Peruvian villages after the administration of iodized poppy seed oil.
A comparison is made with subjects injected with noniodized oil. In each case the ordinate isfrom0 to
100%.
90

80

70 -

60

Li
.4 50

Q-w

40

30-

3k

20

10

20 25

TIME IN MONTHS
MARCH 1966 - APRIL 1968

Fio. 3. Effect of administration of iodized oil on radioactive iodine uptake by the thyroid.

I 602
 Goiter in Ecuador and Peru 1603

1000

900
OBSERVED RESULTS (2 ml of ETHI000L)

800 EXPECTED RESULTS (1 ml of ETHI000L)

700

600

500

400
EXCRETION FACTOR = UEIt = UEI.e#{176}26
\
300

Li

200

Li
z
0 w
-z
z

IL <
\
100
C.)
90
ZciI’
0o 80
\

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1- 70-
Li a
60
\
Li
50- \
\
>- 40-
\
.4
z 30- \

\
20 \
\
\

\
10
6 #{149}2 8 24 30 36 42

TIME IN MONTHS
FIG. 4. Urinary excretion of iodide following administration of iodized oil. The iodide is excreted
exponentially.

fell from a control level of 75.1 ± 0.9% to (41.5 mg), ilad a higher UEI at 6 months
15.8 ± 1.4% at 9 months but increased than the 13-year-and-over groups, which
slightly to 19.5 ± 0.3% and 21.9 ± 1.1% had an average dose of 23.0 mg. However,
at 13 and 19 months, respectively. This values in both groups continued to fall to
change corresponded to a rise above nor- equivalent levels throughout the later
mal levels of both serum iodide and PBI. perio(Is. The UEI for the latter group fell
These reached maximum levels by tile 9th exponentially after 6 months. The slopes,
month and then fell to normal by the 1 9th and therefore tile T112, were similar for
month. Serum thyroxine remained within both 2.0 ml an(1 0.2 ml doses in this group
normal limits. Tile values for urinary ex- (Fig. 5).
cretion of iodide (UEI) in relation to tile
(lose of Ethiodol at two different age levels
Effects in Infants and Children

appear in Table III. The 6- to 12-year A total of 92 deliveries was recorded

group, which received about double the among the women of child-bearing age
dose of iodine per kilogram of body weight in the three Peruvian villages. Of these, 58
1604 Kevany et al.

away. One hundred seventy-seven children

were born in La Esperanza (to untreated
2
mothers) during the same period; 17
(9.6%) died and 5 (2.7%) went away.
too- lOU-
The children of both Ecuadorian villages
subsist in a generally poor environment;
80- 8-
there is high infant morbidity and mor-
“ E
o 0
0
tality. Children of Tocachi presented a
D60
higher degree of morbidity and also showed
2
a higher degree of undernutrition.
40 4. Special emphasis has been placed on the
‘I-Uptake effects of iodized oil on growth and de-
2O 2- velopment of infants and children. These
studies have been materially enhanced by
the availability of a full-time physician and
0 6 9 13 9
a midwife for the program in Ecuador.
Months

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Particular attention has been given to the
Fic. 5. Effect of iodized oil on radioactive iodine
perinatal period. Somatic growth has gen-
uptake, plasma thyroxine iodine (I-T4), protein-
bound iodine (PB!), and total serum iodine (SI).
erally been similar in children from To-
cachi and La Esperanza. It has been lower
were in the iodized group. The plasma in both villages than in a low income in-
thyroxine levels in the pregnant noniodized fant group from Quito, and relatively lower
group had a mean value of 5.2 ± 0.4 /Lg/ still when compared with American stand-
100 ml during the last 5 months of preg- ards.
nancy, and thus failed to rise, as normally There was a falloff in developmental
occurs. The mean value in the iodized sub- averages of children around 6 months old.
jects was 7.9 ± 0.7 g/ 100 ml. The content Gains in weight and height lagged more
of iodine in milk from 9 women injected markedly after this age. The percentage
with 2 ml of iodized oil was 9.7 ± 1.2 increase in height 12 months after delivery

g/100 ml, whereas it was 1.9 ± 0.7 g/ was 37% in Tocachi and 40.5% in La
100 ml in women injected with 0.2 ml Esperanza. Thus, in Tocachi there is the
iodized oil, and 0.0 to 0.5 zg/100 ml in same kind of handicap in height as is
four given the placebo oil. found in adults. The expected normal in-
Ninety children were born in Tocachi crement for height is, at this age, 50%.
from March 1966 to April 1968 (to iodized The weight and height deceleration are
mothers); 16 (17%) died and 2 (2%) went obvious signs of undernutrition, possibly

TABLE III
Urinary excretion of iodine per 24-hr period after administration of Ethiodol

Dose Months after injection

Age in years
Ethiodol, Iodine, 6 9 13 15
ml mg/kg
19

6-12 2.0 41.5 ± 1.1 1,079 ± 101 497 ± 49 346 ± 29 274 ± 24 169 ± 15
13 or over 2.0 23.0 ± 0.7 859 ± 64 621 ± 47 345 ± 29 253 ± 25 168 ± 16
13 or over 0.2 2.0 230 ± 45 76 ± 16 62 ± 6 48 ± 4

Values are in micrograms.

 Goiter in Ecuador and Peru 1605

including iodine undernutrition, and the COMMENTS

high incidence of disease.

Endemic goiter and its accompanying
The increase in head circumference in defects are found today in their virgin form
both villages and for each group was lower in some of the rural communities of An-
than the American standard. However, it dean Ecuador and Peru. Iodization of
was interesting to note that averages in common salt has not been implemented in
Tocachi were slightly better than those the highland regions of these countries.
in La Esperanza in all age groups.
The socioeconomic conditions of the An-
A large number of infants and young dean people, basically composed of Amer-
children were found in La Esperanza with indian and mixed European stock, have
Ob thyroids and 4% had grade I diffuse varied little since Spanish colonial times.
goiter. No case of thyroid enlargement Everything points to an endemic of ancient
was found in Tocachi in the comparable date, the primary causative factor of which
age group. has been a deficiency of iodine.
Levels of neurologic maturation (Gesell’s
Because of economic strictures and
standards) were reached in both villages at
geographical isolation there is little ex-

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older ages than is considered normal. There pectation that national programs for man-
was progressive behavioral retardation in
ufacture and distribution of iodized salt
both villages as tested by manipulative, will reach some of these rural populations
perceptual, linguistic, and gross motor in the near future. Accordingly, it has been
tasks. Average developmental quotient necessary to consider alternative forms for
in Tocachi was 92.77% (normal). It was
supplying iodine. One of these is by par-
89% in La Esperanza (low normal). enteral administration of iodized oil, since
these preparations release their iodide at a
Possible Toxic Effects
slow rate and may fulfill iodide needs for
In the survey conducted 6 months after many months after a single injection.
administration of Ethiodol, there were The results that have been obtained
about 15 subjects in Tocachi who presented conform to the reports of similar field
a clinical picture suggesting hyperthyroid- trials in New Guinea and recently in Africa
ism. They were taken to Quito for hos- (9) and indicate that this method of dis-
pitalization and examination. The dis- tributing iodine is technically simple, free
ease was confirmed in three women, all of serious risk, and effective to a consider-
elderly and with large nodular goiter. The able degree. Sequential surveys in the io-
laboratory tests useful for their diagnosis dized population in both the Ecuadorian
were the basal metabolic rate and the buta- and the Peruvian studies have disclosed
nol-extractable iodine serum, since the other a gratifying reduction in goiter size and,
tests were exactly the same as for other compared to control groups, a failure of
iodized subjects who were not suspected goiter to appear. In the Peruvian group
of having hyperthyroidism. All three re- a decline has been more evident in visible
sponded satisfactorily to therapy. goiter than in palpable goiter at all inter-
Neither iodine thyroiditis, “iodism,” vals (72% and 40%, respectively, by the
nor local reactions were observed. Most of 18th month) as a result of progressive
the newborn were seen within a few days shrinkage of goiters of large size. Many of
or weeks after delivery, and none was these have not completely disappeared
found to have goiter. Treatment with thy- and remain as palpable goiters of Ob de-
roid was begun at once when a diagnosis gree. Whether they will completely dis-
of cretinism was made. appear in time remains to be seen. Similar
1606 Kevany et al.

results have been obtained in Ecuador, among young schoolchildren. It will re-
but a small rise was seen in the occur- quire at least 2 additional years of observa-
rence of goiter between the 19th and the tion before the impact of the program on
25th month. The effectiveness of the io- many aspects of health can be appraised.
dized oil treatment as a preventive method Meanwhile, there seems to be every reason
is demonstrated by the fact that only to advise an extension of the program to
1.5% of new cases were recorded in iodized other communities where endemic goiter
children versus 7.2% in the controls. is severe and where there is no present
A finding of possible significance is possibility of an effective program of salt
that in pregnant women the physiologic iodization.
rise of PBI during normal pregnancy SUMMARY
failed to occur in the group that did not
Endemic goiter continues to be a sig-
receive prophylactic iodine. Many of these
nificant health problem in many areas of
values were in the hypothyroid range, and
the world. In some areas the disease is so
corresponding plasma thyroxine values
severe that cretinism and other associated
were even lower. Although a genetically
defects are found. In many areas, geo-

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impaired thyroxine-binding protein sys-
graphic, economic, and other factors pre-
tem may have been the cause of this phe-
vent the use of iodized salt as a preven-
nomenon, this possibility seems to be ruled
tive measure.
out by normally rising values in iodized
A pilot program using iodized poppy
pregnant women. The fetal thyroid un-
seed oil has been instituted in two rural
doubtedly shares with the mother’s gland
communities in Ecuador and three in Peru.
the low iodine supply from the diet. This
Results after approximately 2 years indi-
sharing results in a lower amount of io-
cate the feasibility and effectiveness of the
dine being available for the mother’s
programs. There has been a sharp reduc-
gland, which in turn is unable to main-
tion in the incidence of goiter. Cretinism
tain the required hormone levels. In any
has not yet appeared among the progeny
case, it may be expected that the hormone
of the population injected with iodized
contribution of the mother to the fetus
oil, but several instances have appeared in
must be small, because free T4 in all sub-
control groups. The use of iodized oil as
jects is decreased during pregnancy.
a public health procedure for the preven-
Whether the fetus is capable of synthe-
tion of endemic goiter and its associated
sizing its own T4 is unknown.
defects is an acceptable measure in regions
It is too early to know the effectiveness
where salt-iodization programs cannot be
of the iodization program in terms of linear
presently undertaken.
growth, honey development, psychologi-
cal and neurological growth, and learning REFERENCES
ability. Data presently available are con- 1. World Health Organization. Endemic Goitre.
sistent with, and suggestive of, a dramatic World Health Organ. Monograph Ser., no. 44,
Geneva: World Health Organ., 1960.
effect on the prevention of cretinism, but
2. STANBURY, J. B. Endemic Goiter. Symp. 3rd
the numbers involved are presently small. Meeting Scientific Group on Research in Endemic
The data on honey development, denti- Goiter of PAHO, June 27-29, 1968, Puebla,
tion, and linear growth show little im- Mexico. World Health Organ. In press.
provement resulting from the single fact 3. HENNESSY, W. B. Goitre prophylaxis in New
Guinea with intramuscular injections of iodized
or change, i.e., injection of iodine. Mental
oil. Med. J. Australia 1: 505, 1964.
performance seemed improved in one 4. BUi-FFIELD, I. H., M. L. BLACK, M. J. HOFFMANN,

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 Goiter in Ecuador and Peru 1607

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