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Jooste
Endemic goitre in the absence of iodine deficiency in schoolchildren of the Northern Cape Province of South Africa.Jooste PL, Weight MJ, Kriek JA, Louw AJ. Eur J Clin Nutr. 1999 Jan;53(1):8-12.
"OBJECTIVE: The study was undertaken to investigate whether endemic goitre still exists in the Northern Cape Province of South Africa more than 55 years after it was reported and, if so, whether iodine deficiency, or fluoride in the drinking water, is linked to the goitres.
DESIGN: Cross-sectional study of children in three pairs of towns.
SUBJECTS: The 6-, 12- and 15-year-old children (n = 671) who had been lifetime residents in two Northern Cape towns with low levels, two towns with near optimal levels and two towns with high levels of fluoride in the drinking water were recruited through the schools as study participants.
RESULTS: Endemic goitre was found in all the towns except one, ranging from 5% to 29%. Iodine deficiency did not prevail in the study area because the median urinary iodine concentration, exceeding 1.58 micromol/l in all but one of the towns, indicated a more than adequate iodine consumption. The drinking water and, to a lesser extent, iodised salt were important sources of iodine. No relationship was found between fluoride in the water and the mild goitre prevalence (5% to 18%) in the four towns with either a low or near optimal fluoride content in the water. The causal factor(s) responsible for the goitres in these four towns were not clear from our data. However, the prevalence of goitre was higher (28% and 29%) in the two towns with high levels of fluoride in the water.
CONCLUSION: These results indicate that either a high fluoride level in the water or another associated goitrogen, other than iodine deficiency, may have been responsible for these goitres."
Iodine deficiency and endemic goitre in the Langkloof area of South Africa.Jooste PL, Weight MJ, Kriek JA. S Afr Med J. 1997 Oct;87(10):1374-9. [abstract only]
"OBJECTIVE: To quantify the prevalence of iodine deficiency and endemic goitre in the Langkloof area. DESIGN: A cross-sectional study.
SETTING: Four primary schools in four communities in the Langkloof.
SUBJECTS: 565 primary schoolchildren from Standard 2 to Standard 5.
OUTCOME MEASURES: Clinical diagnosis of thyroid size by palpation, level of iodine in urine and drinking water samples, level of iodine in iodised salt samples from the area, percentage of households with iodised salt on the premises, and anthropometric measures of body height and weight.
RESULTS: The prevalence of endemic goitre varied from 14.3% to 30.2% in the four communities and, based on urinary iodine levels, the iodine deficiency ranged from mild to severe. Both iodised and non-iodised salt were available at the local grocery stores but only small percentages of households had iodised salt in the house. The iodine content of drinking water was low. Anthropometric indices of undernutrition indicated medium to high levels of stunting in three of the four communities, the worst being in the community with the highest goitre prevalence.
CONCLUSIONS: Endemic goitre caused by iodine deficiency is a public health problem in the Langkloof, varying in severity from mild to severe in the different communities. The impact of mandatory iodisation of table salt, introduced at the end of 1995, needs to be assessed in these communities."
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