Endemic Goiter

ENDEMIC GOITER. The Adaptation of Man to Iodine Deficiency. By John B. Stanbury, Gordon L. Brownell, Douglas S. Riggs, Hector Perinetti, Juan Itoiz, and Enrique B. Del Castillo. Cambridge, Massachusetts, Harvard University Press, 1954. 209 pp. $4.00. This monograph reports the results obtained by the Andean Goiter Expedition, a joint project undertaken by Harvard Medical School, the University of Cuyo, and the Central Hospital of Mendoza, Argentina. The object of the venture was to use modern analytical and radioactive tracer techniques for studying the metabolism of iodine and the alterations of thyroid function in human beings living in an area of iodine deficiency. The opportunity for such studies is limited, both because there are only a few places where iodine deficiency is well established and because the widespread use of prophyllactic iodination of salt or other common articles of diet has cured the deficiency in most of the accessible areas where it was known to exist. The sale of iodized salt has been made mandatory in Mendoza, the subject of the present observations, since the expedition completed its work. The present work therefore probably represents one of the last opportunities to study endemic iodine deficiency. Knowing this, the authors have brought their full experimental armamentarium to bear on the study of the effects of iodine deprivation on thyroid function, and also the effects of various pharmacological and dietary influences on the altered thyroid metabolism. The methods used for experimental and mathematical analysis are clearly presented, and the observations are given in great detail. The book is well-organized, with separate sections for methodology, observations, and interpretation. At the end of each chapter there is a brief bibliography and a summary. Each chapter therefore can be read as a separate paper. The sections concerned with developing a mathematical model for thyroid function are set forth in simple style, and the limitations of the model are described explicitly. The last chapter summarizes the entire work. Although the study concerns a very special and unusual clinical situation, the information obtained is of basic importance to the understanding of normal thyroid physiology. The clinician will be particularly interested in the relative efficacy of iodide and dessicated thyroid in suppressing endogenous thyroid activity, in the observations on the mechanism of action of methimazol, in the description of the development of hyperthyroidism in a single case after the administration of large amounts of iodide to a previously deficient patient (iodbasedow), and in the ability of the iodinedeficient thyroid to maintain normal levels of hormonal activity. The book will be useful to anyone interested in thyroid function.