scholarly journals Persistence of severe iodine-deficiency disorders despite universal salt iodization in an iodine-deficient area in northern India

2009 ◽  
Vol 13 (3) ◽  
pp. 424-429 ◽  
Author(s):  
Subhash Yadav ◽  
Sushil Kumar Gupta ◽  
Madan M Godbole ◽  
Manoj Jain ◽  
Uttam Singh ◽  
...  
Keyword(s):  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Vulnerable Groups ◽  
Urinary Iodine Concentration ◽  
Iodine Deficiency Disorders ◽  
Cross Sectional Survey ◽  
Iodine Nutrition ◽  
Salt Iodization ◽  
Goitre Prevalence ◽  
The Impact

AbstractObjectiveThe aim of the present study was to determine the impact of universal salt iodization (USI) on the prevalence of iodine deficiency in the population of an area previously known to have severe iodine deficiency in India.DesignIn a cross-sectional survey, a total of 2860 subjects residing in fifty-three villages of four sub-districts of Gonda District were examined for goitre and urinary iodine concentration. Free thyroxine and thyroid-stimulating hormone levels were also measured. Salt samples from households were collected for estimation of iodine content.ResultsA reduction in goitre prevalence was observed from 69 % reported in 1982 to 27·7 % assessed in 2007. However, 34 % of villages still had very high endemicity of goitre (goitre prevalence >30 %). Twenty-three per cent of households consumed a negligible amount (<5 ppm) and 56 % of households consumed an insufficient amount (5–15 ppm) of iodine from salt.ConclusionsAlthough there was an overall improvement in iodine nutrition as revealed by decreased goitre prevalence and increased median urinary iodine levels, there were several pockets of severe deficiency that require a more targeted approach. Poor coverage, the use of unpackaged crystal salt with inadequate iodine and the washing of salt before use by 90 % of rural households are the major causes of persisting iodine-deficiency disorders. This demonstrates lapses in USI implementation, lack of monitoring and the need to identify hot spots. We advocate strengthening the USI programme with a mass education component, the supply of adequately iodized salt and the implementation of complementary strategies for vulnerable groups, particularly neonates and lactating mothers.

scholarly journals Iodine Deficiency Disorders After Sixteen Years of Universal Dietary Salt Iodization in a Severe Iodine Deficiency Village in Niger

2014 ◽  
Vol 8 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Hassimi Sadou ◽  
Ibrahim G. Dandano ◽  
Mousbahou M. Alma ◽  
Hamani Daouda
Keyword(s):  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Iodine Concentration ◽  
Urinary Iodine Concentration ◽  
Iodine Deficiency Disorders ◽  
Dietary Salt ◽  
Salt Iodization ◽  
And Gender ◽  
Goitre Prevalence ◽  
The Impact

Introduction: Since 1996, Niger has officially adopted the universal dietary salt iodization program (UDSI). Objective: It is a before‑after trial study conducted to determine the impact of UDSI program in Tiguey 16 years after. Subjects and methods: The study was centered on 371 volunteers whose thyroid gland was palpated and urinary iodine concentration (UIC) determined in 319 of them. Results: The total goitre rate (TGR) was 13.20% with 9.70% invisible but palpable goitre (G1) and 3.50% visible goitre (G2). In 1987, the TGR was 77.15%, with 25.25% G1 and 51.90 % G2. The median UIC was 166.00 μg/L, the 20th percentile 66.40 μg/L and the 80 percentile was 300 μg/L. 68.34 % of the volunteers had a UIC ≥ 100 μg/L, 2.51% <20 μg/L, 10.97% between 20 and 49 μg/L and 18.18% between 50 and 99 μg/L. In 1987, only 3.96% of the studied sample had a UIC ≥ 100 μg/L, 45 % had a UIC <20 μg/L, 35% between 20 and 49 μg/L and 16% from 50 to 99 μg/L. No significant relationship was found between UIC and age and gender or goitre prevalence and gender (P> 0.05). However, goitre prevalence increases significantly with age (p < 0.05). Conclusion: The implementation of the UDSI program in Niger decreased goitre prevalence and significantly improved the nutritional iodine status of the populations of Tiguey. However a slight endemic goitre and mild to moderate iodine deficiency persists.

scholarly journals Women Remain at Risk of Iodine Deficiency during Pregnancy: The Importance of Iodine Supplementation before Conception and Throughout Gestation

Nutrients ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. 172 ◽  
Author(s):  
Kristen Hynes ◽  
Judy Seal ◽  
Petr Otahal ◽  
Wendy Oddy ◽  
John Burgess
Keyword(s):  
At Risk ◽  
Pregnant Women ◽  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Iodine Concentration ◽  
Urinary Iodine Concentration ◽  
Iodine Nutrition ◽  
Supplement Use ◽  
Iodine Supplementation ◽  
The Impact

In Australia, pregnant women are advised to take an iodine supplement (I-supp) (150 µg/day) to reduce risks to the foetus associated with iodine deficiency (ID). To examine the impact of this recommendation on iodine status, and to identify factors that contribute to adequacy during gestation, supplement use and Urinary Iodine Concentration (UIC) was measured in 255 pregnant women (gestation range 6 to 41 weeks) in Tasmania. The median UIC (MUIC) of 133 µg/L (Inter-quartile range 82–233) was indicative of ID, being below the 150–249 µg/L range for adequacy during pregnancy. Women taking an iodine-containing-supplement (I-supp) had a significantly higher MUIC (155 µg/L) (n = 171) compared to the combined MUIC (112.5 µg/L) (n = 84) of those who had never (120 µg/L) (n = 61) or were no longer taking an I-supp (90 µg/L) (n = 23) (p = 0.017). Among women reporting I-supp use, the MUIC of those commencing the recommended 150 µg/day prior to conception was significantly higher than those starting supplementation following pregnancy confirmation: 196 (98–315) µg/L (n = 45) versus 137.5 (82.5–233.5) µg/L (n = 124), p = 0.032. Despite recommendations for iodine supplementation pregnant Tasmanian women remain at risk of ID. Commencing an I-supp of 150 µg/day prior to conception and continuing throughout pregnancy is required to ensure adequacy. Timely advice regarding the importance of adequate iodine nutrition, including supplementation is needed to reduce the risk of irreversible in utero neurocognitive damage to the foetus.

scholarly journals Iodine-deficiency disorders in the Aseer region, south-western Saudi Arabia: 20 years after the national survey and universal salt iodization

2015 ◽  
Vol 18 (14) ◽  
pp. 2523-2529 ◽  
Author(s):  
Fuad I Abbag ◽  
Saeed A Abu-Eshy ◽  
Ahmed A Mahfouz ◽  
Suliman A Al-Fifi ◽  
Hussein El-Wadie ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Iodine Deficiency ◽  
Water Samples ◽  
Urinary Iodine ◽  
Iodine Content ◽  
National Study ◽  
Urinary Iodine Concentration ◽  
Iodine Deficiency Disorders ◽  
Table Salt ◽  
Salt Iodization

AbstractObjectiveTo study (i) the current prevalence of iodine-deficiency disorders among schoolchildren in south-western Saudi Arabia after universal salt iodization and (ii) the iodine content of table salts and water.DesignCross-sectional study on a stratified proportional allocation sample of children. Thyroid gland enlargement was assessed clinically and by ultrasound scanning. Urine, table salt and water samples were taken to measure iodine content.SettingsThe Aseer region, south-western Saudi Arabia.SubjectsSchoolchildren aged 8–10 years.ResultsThe study included 3046 schoolchildren. The total goitre rate amounted to 24·0 %. Prevalence of enlarged thyroid by ultrasound was 22·7 %. The median urinary iodine concentration of the study sample amounted to 17·0 µg/l. The iodine content of table salt ranged from 0 to 112 mg/kg; 22·5 % of the table salt samples were below the recommended iodine content (15 mg/kg) set by WHO. The total goitre rate increased significantly from 19·8 % among children using table salt with iodine content ≥15 mg/kg to reach 48·5 % among children using table salt with 0 mg iodine/kg. Analysis of water samples taken from schools showed that the majority of water samples (78·8 %) had an iodine content of 0 µg/l.ConclusionsThe study documented that 18 years after the national study, and after more than a decade of universal salt iodization in Saudi Arabia, the problem of iodine-deficiency disorders is still endemic in the Aseer region. Efforts should focus on fostering advocacy and communication and ensuring the availability of adequately iodized salt.

scholarly journals A Household-Based Survey of Iodine Nutrition in Moroccan Children Shows Iodine Sufficiency at the National Level But Risk of Deficient Intakes in Mountainous Areas

Children ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 240
Author(s):  
Laila El Ammari ◽  
Naima Saeid ◽  
Anouar Talouizte ◽  
Hasnae Gamih ◽  
Salwa Labzizi ◽  
...  
Keyword(s):  
Iodine Deficiency ◽  
Rural Areas ◽  
Economic Status ◽  
National Level ◽  
Urinary Iodine ◽  
Iodine Concentration ◽  
Urinary Iodine Concentration ◽  
Iodine Nutrition ◽  
Salt Iodization ◽  
Moroccan Children

Historically, mountainous areas of Morocco have been affected by endemic goiter and severe iodine deficiency. In 1995, Morocco legislated salt iodization to reduce iodine deficiency. There has been no national survey of iodine nutrition in school-age children for nearly 3 decades. Our aim was to assess iodine nutrition in a national sample of 6–12-year-old children in Morocco to inform the national salt iodization strategy. In this cross-sectional household-based survey, we randomly recruited healthy 6–12-year-old children from 180 clusters in four geographic zones (north and east, central, north and south) covering the 12 regions of Morocco. A questionnaire was completed, including socio-economic status and parental level of education. In addition, anthropometric measurements were taken to assess nutrition status, and a spot urine sample was collected to measure urinary iodine concentration (UIC). A total of 3118 households were surveyed, and 1043 eligible children were recruited, 56% from urban areas and 44% from rural areas. At the national level, the percentage of surveyed samples with UIC < 50 μg/L was 21.6% (19.2%; 24.2%), which exceeds the WHO suggestion of no more than 20% of samples below 50 μg/L, despite an adequate level of median urinary iodine concentration (mUIC) at 117.4 µg/L (110.2; 123.3). There were no statistically significant differences in mUIC comparing urban vs. rural areas and socio-economic status. However, the mUIC was significantly lower in the central (high-altitude non-coastal) zone (p < 0.004), where the mUIC (95% CI) was deficient at 89.2 µg/L (80.8; 102.9). There was also a significant difference in the mUIC by head of household education level (p = 0.008). The mUIC in Moroccan children >100 µg/L indicates iodine sufficiency at the national level. However, the percentage of surveyed samples with UIC < 50 μg/L above suggests that a significant proportion of children remain at risk for iodine deficiency, and it appears those at greatest risk are residing in the central (high altitude non-coastal) zone. A national level mUIC value may conceal discrepancies in iodine intake among different sub-groups, including those defined by geographic region.

scholarly journals Silent iodine prophylaxis in Western Europe only partly corrects iodine deficiency; the case of Belgium

2000 ◽  
pp. 189-196 ◽  
Author(s):  
F Delange ◽  
A Van Onderbergen ◽  
W Shabana ◽  
E Vandemeulebroucke ◽  
F Vertongen ◽  
...  
Keyword(s):  
Iodine Deficiency ◽  
Western Europe ◽  
Urinary Iodine ◽  
Iodine Concentration ◽  
Urinary Iodine Concentration ◽  
Iodine Nutrition ◽  
Iodine Prophylaxis ◽  
Salt Iodization ◽  
Goiter Prevalence ◽  
The Status

OBJECTIVE: Belgium is one of the Western European countries in which no program of iodine-deficiency correction using iodized salt has been implemented, in spite of well-documented mild iodine deficiency. In 1995, the median urinary iodine concentration was 55 microg/l (normal: 100-200) and the prevalence of goiter was 11% (normal: below 5%) in representative samples of schoolchildren aged 6-12 years. Based on these results, the authors of the present study and others had emphasized to health professionals and to the public the necessity for iodine supplementation. The objective of this study was to evaluate as to whether these efforts had resulted in an improvement in the status of iodine nutrition. DESIGN: We performed a national survey of the status of iodine nutrition in Belgium based on the determination of thyroid volume, obtained by ultrasonography, and urinary iodine concentrations in schoolchildren. METHODS: A mobile van equipped with an ultrasound instrument, a computer and a deep-freeze visited 23 schools selected from across the country. The sample included 2855 schoolchildren (1365 boys and 1490 girls) aged 6-12 years. RESULTS: The results show a homogeneous situation in the whole country, with a median urinary iodine concentration of 80 microg/l and a goiter prevalence of 5.7%. Urinary iodine slightly decreases with age in girls and reaches a critical value of 59 microg/l at the age of 12 years, together with a goiter prevalence of 18.4%. CONCLUSION: Iodine nutrition has improved slightly in Belgium but mild iodine deficiency continues, with public-health consequences. The improvement indicates silent iodine prophylaxis, as no official salt-iodization measures have been taken. Silent iodine prophylaxis only partly corrects iodine deficiency in Western Europe. Active measures, including the implementation of a program of salt iodization, are urgently required.

Salt iodisation and public health campaigns to eradicate iodine deficiency disorders in Armenia

2003 ◽  
Vol 6 (5) ◽  
pp. 463-469 ◽  
Author(s):  
Laura Rossi ◽  
Francesco Branca
Keyword(s):  
Iodine Deficiency ◽  
Control Measure ◽  
Urinary Iodine ◽  
Vulnerable Groups ◽  
Urinary Iodine Excretion ◽  
Urinary Iodine Concentration ◽  
Iodine Deficiency Disorders ◽  
Children Under Five ◽  
Iodised Salt ◽  
Under Five

AbstractBackground:Iodine deficiency disorders (IDD) are endemic in the mountain regions of Armenia. Universal salt iodisation has been chosen as the control measure.Objectives:(1) To measure the prevalence of iodine deficiency in the Armenian population; (2) to evaluate household use of iodised salt; and (3) to monitor iodised salt promotion strategies.Design:Cross-sectional study on a nationally representative sample of 2627 households, including 3390 children under five and 2649 women of fertile age. Cluster sampling design on four population strata: residents, refugees, rural and urban.Results:Thyroid was palpable in one-third of the women, 6% of them having a visible goitre. Median of urinary iodine excretion in children was 139.5 μgl−1. One-third of the children showed low urinary iodine concentration. Iodised salt was consumed in 66% of the households. The national IDD control programme included modernisation of the Yerevan Salt Factory, legislative regulation of the iodine content of the salt, and public information by the media.Conclusions:Armenia was still an endemic zone for goitre in 1997. The iodine status of children under five in 1997 was not considered alarming even though 33% of them had low values of urinary iodine. After four years of intervention strategies, the use of iodised salt has increased by 17%. Further efforts should be made to control salt imports and to monitor IDD indicators in vulnerable groups.

Study of Urinary Iodine Level Assessment and its Relation to Thyroid Function during Pregnancy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Magda Shoukry Mohamed ◽  
Merhan Samy Nasr ◽  
Salah Hussien El-Halawany ◽  
Ahmed Mohamed Abbas ◽  
Salma Said Hassan Tayeh
Keyword(s):  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Significant Negative Correlation ◽  
Iodine Deficiency Disorders ◽  
Iodine Excess ◽  
Salt Iodization ◽  
Excess Iodine ◽  
Iodine Supplementation ◽  
Iodine Level

Abstract Background The global effort to prevent iodine deficiency disorders through iodine supplementation, such as universal salt iodization, has achieved impressive progress during the last few decades. However, iodine excess, due to extensive environmental iodine exposure in addition to poor monitoring, is currently a more frequent occurrence than iodine deficiency. Iodine excess is a precipitating environmental factor in the development of autoimmune thyroid disease. Aim of the study to evaluate the urinary iodine level as a marker of iodine status in pregnant women in 3rd trimester and assess its relation to thyroid functions. Patients and Methods This Cross Sectional Study was conducted on 100 subjects with their ages ranging from 18-35 years old, pregnant females, at the third trimester, selected from Obstetric Out- patient Clinic of Ain shams University Hospitals. Samples were collected from participants in cairo, during the Spring and Summer from March to August. Results in our study, there was a significant negative correlation between Urinary Iodine level and TSH as Iodine difficient group has the Highest TSH, and the Highest Thyroid Volume, as there was a significant negative correlation between Urinary Iodine level and Thyroid Volume. Conclusion TSH level and Thyroid Volume were global effort to prevent iodine deficiency disorders through iodine supplementation, such as universal salt iodization, has achieved impressive progress during the last few decades. However, iodine excess, due to extensive environmental iodine exposure in addition to significantly higher in Iodine difficient group than Excess iodine group, And FT4 level was lower in Iodine difficient group than excess iodine group.

scholarly journals Iodine Status of Taiwanese Population in 2013: 10 Years After Changing From Mandatory to Voluntary Salt Iodization

2017 ◽  
Vol 39 (1) ◽  
pp. 75-85 ◽  
Author(s):  
Fan-Fen Wang ◽  
Kam-Tsun Tang ◽  
Wen-Harn Pan ◽  
Justin Ging-Shing Won ◽  
Yao-Te Hsieh ◽  
...  
Keyword(s):  
Age Groups ◽  
Urinary Iodine ◽  
Iodine Concentration ◽  
World Health ◽  
Urinary Iodine Concentration ◽  
Taiwanese Population ◽  
Iodine Nutrition ◽  
Iodine Status ◽  
Salt Iodization ◽  
Health Organization

Background: In 2003, Taiwan’s iodine policy changed from mandatory to voluntary. The Nutrition and Health Survey in Taiwan (NAHSIT) 2001-2002 for schoolchildren showed adequate iodine nutrition, while NAHSIT 2005-2008 for adults showed the iodine status was at borderline adequacy. Objective: To investigate the iodine status of the Taiwanese population from schoolchildren to adulthood 10 years after the change of the salt iodization policy. Method: Urinary iodine was measured in samples from subjects in NAHSIT 2013. Results: The median urinary iodine concentration (UIC) of the Taiwanese population aged 6 years and above in 2013 was 96 μg/L, indicating mild iodine deficiency. The median UIC of 6- to 12-year-old schoolchildren was 124 μg/L (interquartile range [IQR]: 92-213 μg/L), and 115 μg/L (IQR: 80-166 μg/L), 125 μg/L (IQR: 74-161 μg/L), 73 μg/L (IQR: 52-131 μg/L), and 78 μg/L (IQR: 52-132 μg/L) in populations aged 13 to 18 years, 19 to 44 years, 45 to 64 years, and ≥65 years, respectively. Declining iodine nutrition in age groups ≥45 years old was noted that the median UIC of populations aged 45 to 64 years and ≥65 years was 99 and 88 μg/L, respectively, in NAHSIT 2005-2008. The median UIC of schoolchildren was not lower than that during the mandatory salt fortification period, but the distribution of urinary iodine levels signified a dietary pattern change. Conclusion: Wide-ranging variation in iodine nutrition levels was observed in different age groups. Universal salt iodization, as suggested by the World Health Organization, should be the best strategy to achieve adequate iodine nutrition.

Iodine nutrition status of women after 10 years of Lipiodol supplementation: a cross-sectional study in Xinjiang, China

2020 ◽  
pp. 1-13
Author(s):  
Lixiang Liu ◽  
Peng Liu ◽  
Qin Lin ◽  
Xiaohui Su ◽  
Jia Huang ◽  
...  
Keyword(s):  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Nutrition Status ◽  
Thyroid Peroxidase ◽  
Urinary Iodine Concentration ◽  
Free Triiodothyronine ◽  
Iodine Nutrition ◽  
Detection Rates ◽  
Status Of Women

Abstract This study examined the contribution of long-term use of Lipiodol capsules, as a supplement to iodised salt to the control of iodine deficiency disorders among women in Xinjiang of China. A total of 1220 women across Kashgar, Aksu, Turpan and Yili Prefectures were surveyed in 2017. Lipiodol capsules were administered twice yearly in Kashgar and once yearly in Aksu and Turpan, but not in Yili. Urinary iodine concentration (UIC), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroglobulin antibody, thyroid peroxidase antibody and thyroid volume values were assessed. All the women in the four areas were in a state of non-iodine deficiency by UIC. The UIC were higher than adequate in Kashgar and Aksu (619·4 v. 278·6 μg/l). Thyroid hormone levels differed significantly in Turpan and Yili (FT3: 4·4 v. 4·6 pmol/l, FT4: 13·8 v. 14·2 pmol/l, TSH: 2·0 v. 2·7 mIU/l), but did not differ significantly in Kashgar, Aksu and Yili. The four areas did not differ significantly with regard to thyroid nodules, autoimmune thyroiditis or goitre. However, the detection rates of subclinical hypothyroidism (16·6 %) and total thyroid dysfunction (25·4 %) were higher among women in Yili. The supplementation with Lipiodol capsules had improved the iodine nutrition status of women in iodine-deficient areas of Xinjiang since 2006. To avoid negative effects of excess iodine, we suggest a gradual discontinuation of Lipiodol capsules in women with special needs based on the existing iodine nutrition level of local women.

scholarly journals Thyroid ultrasound compared with World Health Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions of mild and severe iodine deficiency

2000 ◽  
pp. 727-731 ◽  
Author(s):  
M Zimmermann ◽  
A Saad ◽  
S Hess ◽  
T Torresani ◽  
N Chaouki
Keyword(s):  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Classification Systems ◽  
World Health ◽  
Urinary Iodine Concentration ◽  
Thyroid Ultrasound ◽  
Iodine Deficiency Disorders ◽  
Goiter Prevalence

OBJECTIVES: In 1994, WHO/International Council for the Control of Iodine Deficiency Disorders recommended replacing the WHO 1960 four-grade goiter classification with a simplified two-grade system. The effect of this change in criteria on the estimation of goiter prevalence in field studies is unclear. In areas of mild iodine deficiency disorders (IDD) where goiters are small, ultrasound is preferable to palpation to estimate goiter prevalence. However, in areas of moderate to severe IDD, goiter screening by palpation may be an acceptable alternative to thyroid ultrasound. To address these two issues, we compared WHO 1960 and 1994 criteria with thyroid ultrasound for determination of goiter prevalence in areas of mild and severe IDD in Morocco. DESIGN: A cross-sectional study of 400 six- to 13-year-old children from two mountain villages (Ait M'hamed and Brikcha) in rural Morocco was carried out. METHODS: Urinary iodine concentration (UI), whole blood TSH and serum thyroxine were measured. Thyroid size was graded by inspection and palpation by two examiners using both WHO 1960 and 1994 criteria. Thyroid volume was determined by ultrasound. Variation between examiners and examination methods was assessed. Sensitivity and specificity of the two classification systems compared with ultrasound were calculated. RESULTS: Median UIs in Ait M'hamed and Brikcha were 183 and 24 microg/l respectively. In Ait M'hamed, using 1960 and 1994 criteria, goiter prevalence was 21 and 26% respectively, compared with 13% by ultrasound. In Brikcha, with 1960 and 1994 criteria, goiter prevalence was 64 and 67% respectively, compared with 64% by ultrasound. Agreement between observers was better with the 1994 criteria than with the 1960 criteria in Ait M'hamed (kappa=0.53 and 0.47 respectively), while in Brikcha observer agreement was similar with the two systems (kappa=0.67). Using either the 1994 or 1960 criteria, agreement with ultrasound was only moderate in Ait M'hamed (kappa=0.41-0.44), but good in Brikcha (kappa=0.55-0.64). Overall, compared with ultrasound, sensitivity increased 3-4% using 1994 criteria, while specificity decreased 4-5%. CONCLUSIONS: The WHO 1994 criteria are simpler to use than the 1960 criteria and provide increased sensitivity with only a small reduction in specificity. Agreement between observers is better with the 1994 criteria than with the 1960 criteria, particularly in areas of mild IDD. Like the 1960 criteria, the 1994 criteria overestimate goiter prevalence in areas of mild IDD, compared with ultrasound. However, the 1994 palpation criteria provide an accurate estimate of goiter prevalence in areas of severe IDD, and may be an acceptable and affordable alternative to thyroid ultrasound in these areas.

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