Major Health Issues

B A C K G R O U N D Th i s review is based on the report of the subcommittee for the study of endemic goiter and i od ine deficiency o f the European Thy ro i d Assoc iat ion (1,2). Ep idemio log i e Information on the prevalence o f goiter and al imentary iodine supply is scanty for most European countries. A l though regional data are avai lable, these do not necessarily reflect the Situation throughout the country f rom wh ich they orig inate. The regional data give relat ively good Information conceming the populat ion sample studied; however, it is frequently dif f icult to conclude which part of the total populat ion of a given area is represented by the sample studied and what percent of the total inhabitants of the country l ive in the areas studied. Mos t surveys have used the Standard Classification of goiter size aecording to the Pan Amer i c an Heal th Organizat ion from 1974 (3), which is associated with a significant risk o f overest imation in chi ldren and underestimation in adults, as Sonographie vo lumetry has shown (4-6). D a i l y urine iodine exeretion and iodine exeretion from spot urine samples have been wide ly aeeepted as a satisfactory index o f iodine intake (7). S ince Europe is , except for one Span ish region (8), not considered to suffer f rom protein malnutr i t ion , the urine iodine/creatinine ratio is acceptable (9). Hard ly any data are available on the potential effects o f dietary goitrogens (10-12). L imitat ions of the study of endemic goiter and