A Survey of Schoolchildren from a Server Endemic Goitre Area in Spain

All the boys and girls between six and fourteen years old regularlyattending school in three villages from an area in Spain knownas Las Hurdes were studied with respect to thyroid size, bodyweight and height. Casual urine samples were obtained for thedetermination of iodine and creatinine concentrations. Capillaryblood was spotted on filter paper and used for the determinationof thyroxine and thyrotrophin by radioimmunoassay. The samesurvey was carried out in 354 school children from Madrid, whosedata were used as a reference of the adequacy of the methodsemployed in Las Hurdes. Goitre prevalence was very high, the overall frequency; being86 per cent The concentration of iodine in the urine was <20µg/lin 71 per cent of the school children. The concentration ofcreatinine in the urine was also half that found in childrenfrom Madrid, and the daily creatinine excretion in childrenfrom Las Hurdes was lower than expected from their body weightTheir somatic development, as measured by height and weight,was retarded markedly, both as compared to the Madrid, referencegroup and to international charts. Serum T4 was less than 78nmol/1 (6 µg/d1) in 46 per cent of the children from LasHurdes, and serum TSH greater than 7·5 mU/l in 40 percent A relatively low stature (below the 10th percentile) wasassociated with either a low serum T4, an elevated serum TSH,or both, In 30 per cent of the children. These results indicate that the persistence of endemic goitrein Las Hurdes is of great significance and that there is a continuingrisk of the birth of cretins. Observations made a decade earlierin the same area show that the goitre endemic is not diminishing,and that an iodization programme is urgently needed. It alsoappears that a high proportion of the ‘normal’ schoolchildrenhave features found in hypothyroidism.