ENDEMIC GOlTER Report of the Meeting of the PAHO Scientific Group on Research in Endemic Goiter held in Puebla, Mexico, 27 to 29 June 1968 COMPILED AND EDITED BY JOHN B. STANBURY, M.D. PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the WORLD HEALTH ORGANIZATION 1969 ENDEMIC GOITER Report of the Meeting of the PAHO Scientific Group on Research in Endemic Goiter held in Puebla, Mexico, 27 to 29 June 1968 Compiled and Edited by JOHN B. STANBURY, M.D. Professor of Experimental Medicine, Department of Nutrition and Food Science, Massachusetts Institute of Technology; Lecturer, Harvard Medical School; Board of Consultation, Massachusetts General Hospital Scientific Publication No. 193 PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the WORLD HEALTH ORGANIZATION 525 Twenty-Third Street, N.W. Washington, D. C. 20037 C~~~~~~~~~~~~~~~~~~~~~~~ CONTENTS Page Preface-J. B. Stanbury ...................................... vii Participants ............................................... xi SECTION I. Endemic Goiter and Cretinism: General Aspects 1. Intrathyroid Iodine Metabolism in Goiter-A. M. Ermans ......... 1 2. Recent Advances in the Knowledge of the Control of Thyroid Growth and Function-J. E. Dumont, P. Neve, and J. Otten ........ 14 3. Pathophysiology of Nontoxic Goiter-C. Beckers ................ 30 4. A Thyroid Model and its Analysis by Computer-P. L. Decostre, R. D. Phair, I. W. Dingwell, and L. J. DeGroot .................... 49 5. Observer Variation in Grading and Measuring the Thyroid in Epidemi- ological Surveys-R. MacLennan, E. Gaitán, and M. C. Miller ....... 67 6. Prevention of Endemic Goiter in Latin America-J. P. Kevany ...... 78 7. Endemic Cretinism: A Search for a Tenable Definition-A. Querido .. 85 8. Endemic Cretinism-J. E. Dumont, F. Delange, and A. M Ermans ... 91 SECTION II. Endemic Goiter in the Congo and New Guinea 9. Permissive Nature of Iodine Deficiency in the Development of Endemic Goiter-A. M. Ermnans, C. Thilly, H. L. Vis, and F. Delange . 101 10. Treatment of Idjwi Island Endemic Goiter by Iodized Oil-F. Delange, C. Thilly, P.Pourbaix, and A. M.Ermnans ...................... 118 11. Endemic Goiter in New Guinea and the Prophylactic Program with Iodinated Poppyseed Oil-I. H. Buttfield and B. S. Hetzel ......... 132 SECTION III. Endemic Goiter in Argentina and Paraguay 12. Characteristics of Endemic Goiter in a Mapuche Indian Tribe in Chiquillihuin, El Malleo, Province of Neuquen, Argentine Republic: I. General Aspects and Some Functional and Genetic Studies-O. J. Degrossi, N. Altschuler, H. Forcher, A. A. Zaninovich, O. M. Mutchinick, and C. L. Enriori .............................. 149 13. Characteristics of Endemic Goiter in a Mapuche Indian Tribe in Chiquillihuin, El Malleo, Province of Neuquen, Argentine Republic: II. Iodine Kinetic Studies-O: J. Degrossi, T. Watanabe, N. Altschuler, V. Pecorini, and C. Santillán ............................... 159 14. Endemic Goiter in the Republic of Paraguay-N. Altschuler, O. J. Degrossi, R. Ceriani,H. Forcher, V. Mayor, and C. L. Enriori....... 168 iii CONTENTS (cont.) SECTION IV. Endemic Goiter in Brazil 15. Endemic Goiter in Brazil-G. A. Medeiros-Neto, L. C. G. Lobo, and W. Nicolau ................................................ 179 16. Studies on the Concentration of Particulate Iodoprotein, RNA, and DNA in Normal and Endemic Goiter Glands-G. A. Medeiros-Neto, W. Nicolau, andA. B. Ulhoa Cintra ............................. 183 17. Studies on Endemic Goiter and Cretinism in Brazil: 1. Epidemiologi- cal Survey in Mato Grosso-L. C. G. Lobo, A. Quelce-Salgado,andA. Freire-Maia ............................................. 194 18. Studies on Endemic Goiter and Cretinism in Brazil: 2. Genetic Studies-L. C. G. Lobo, A. Quelce-Salgado, and A. Freire-Maia....... 208 19. Studies on Endemic Goiter and Cretinism in Brazil: 3. Thyroid Function Studiecs-D. Dosen+hal, L. C. G. Lob, M A. ello, uan J. Fridman ............................................... 217 SECTION V. Endemic Goiter in Chile 20. Endemic Goiter in Chile-J. Barzelatto ........................ 229 21. Study of Endemic Goiter in the American Indians-J. Barzelatto and E. Covarrubias ........................................... 233 22. Endemic Goiter in Pedregoso (Chile): Experimental Goitrogenic Activity of "Piñón"-M. Tellez, A. Gianetti, E. Covarrubias, and J. Barzelatto .............................................. 245 23. Genetic Questions Related to the Goiter Endemia of Pedregoso (Chile)-E. Covarrubias, J. Barzelatto, and R. Guiloff ............. 252 SECTION VI. Endemic Goiter in Colombia 24. Studies on the Pathogenesis of Endemic Goiter in the Cauca Valley, Colombia-E. Gaitán and H. W. Wahner ....................... 267 25. Thyroid Function in Adolescents from the Goiter Endemic of the Cauca Valley, Colombia-H. W. Wahner and E. Gaitán ............ 291 SECTION VII. Endemic Goiter in Ecuador 26. Iodized Oil in the Prevention of Endemic Goiter and Associated Defects in the Andean Region of Ecuador: I. Program Design, Effects on Goiter Prevalence, Thyroid Function, and Iodine Excretion-R. Fierro-Benítez, I. Ramirez, E. Estrella, C. Jaramillo, C Díaz, and J. Urresta ............................................... 306 27. Iodized Oil in the Prevention of Endemic Goiter and Associated Defects in the Andean Region of Ecuador: II. Effects on Neuro-Motor Development and Somatic Growth in Children before Two Years-L. Ramirez, R. Fierro-Benítez, E. Estrella, C. Jaramillo, C. Díaz, and J. Urresta .................................................. 341 iv CONTENTS (cont.) 28. Iodine Therapy for Endemic Goiter and Its Effect upon Skeletal Development of the Child-H. Israel, III, R. Fierro-Benítez, and J. Garcés ................................................. 360 29. Neurological Aspects of Endemic Cretinism-P. R. Dodge, 1. Ramirez, and R. Fierro-Benítez ..................................... 373 30. Effect on Intelligence of Iodine in Oil Administered to Young Andean Children: A Preliminary Report-P. R. Dodge, H. Palkes, R. Fierro-Benítez, and 1. Ramírez .............................. 378 3 1. Growth Hormone in Relation to Endemic Cretinism and Dwarfism-M. R. Harrison,R. Fierro-Benítez, 1. Ramirez, S. Refetoff, and J. B. Stanbury ....................................... 381 SECTION VIII. Endemic Goiter in Mexico 32. Endemic Goiter in Mexico and Its Changing Pattern in a Rural Community-J. A. Maisterrena,E. Tovar, and A. Chávez .......... 397 33. Iodine Nutrition Levels of Schoolchildren in Rural Mexico-E. Tovar, J. A. Maisterrena, and A. Chávez ............................. 411 SECTION IX. Endemic Goiter in Peru 34. Endemic Goiter in Rural Peru: Effect of lodized Oil on Prevalence and Size of Goiter and on Thyroid Iodine Metabolism in Known Endemic Goitrous Populations-E. A. Pretell, F. Moncloa, R. Salinas, R. Guerra-García,A. Kawano, L. Gutiérrez, J. Pretell, and M. Wan .. 419 Index ..................................................... 441 v PREFACE Magnificent ceramic sculptures dating from pre-Colombian times are unassailable witness to the existence of goiter in the western world before the European settlement. Among the many figurines found in museums of archeology in the Republics of Central and South America, those with goiter are rare. The prevalence of goiter among the American Indians before Pizarro can only be conjectured. In the years which followed the Conquest numerous travelers on both sides of the spine of the Andes commented in their journals on the high frequency of the disease among the indigenes. Did the degradation and improvishment of a great people which certainly followed the arrival of the Spanish perturb some ecological balance which necessitated growth of the thyroid? We would like to know. The first demonstrations of the effectiveness of iodine in eliminating endemic goiter were the trials of Marine and Kimball in Akron, Ohio, in 1917. The results were startling and were soon confirmed in Switzerland and later in Guatemala, where endemic goiter has now virtually vanished. No serious doubt remains concerning the effectiveness of iodized salt in prophylaxis of goiter, and as a public health measure salt iodization is economical, safe, and accepted. Irndeed many of the governments of Latin America have taken heed and legislated iodization of salt, but with few exceptions programs have not been implemented effectively, nor the endemics reduced in scope. The reasons for these failures are in part economic, in part political, and in part sociogeographic. Endemic goiter remains today a major medical problem of rural Latin America, with an incidence and impact which is probably as significant as it was a century or two ago, and even more important because of the extraordinary rapid population growth of that part of the world. In 1961, the Scientific Advisory Committee of the Pan American Health Organization (PAHO), a panel of distinguished medical scientists from the Western Hemisphere, set priorities for health research in Latin America. High on the list was endemic goiter. It was abundantly evident that the challenge of endemic thyroid disease warranted this degree of concern. It was also clear that much remained to be learned about the thyroid in endemic goiter. It also seemed possible that application of available research methods not only might yield some practical dividends, but also might provide a nidus in various academic centers around which research enterprise in medical science would crystallize. The recommendations