Prophylaxis and Treatment of Endemic Goiter in Peru with Iodized Oil1

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Abstract
Prevalence of goiter has been studied in 3 villages in the central highlands of Peru. Visible goiter was found in 52% of all persons; the highest rate was in women after puberty. Prevalence of endemic cretinism and of other obviously defective persons was 1.0–3.6%. Severe iodine deficiency was indicated by a high 131I thyroid uptake (74.5%) and low urinary excretion of iodine (UEI) (17.2 μg/24 hr). Plasma thyroxine values tended to be in the lower normal range, with many individuals below normal, but there was no clinical hypothyroidism. In order to test the effectiveness of iodized oil (Ethiodol) as a prophylactic of endemic goiter and also as a preventive of the appearance of new defective persons, 1771 villagers, excluding men over age 18, were injected with either iodized oil (Gr-I) or placebo (Gr-P) in doses ranging from 0.2 to 2.0 ml according to age. Eighteen months after the injection, visible goiter prevalence had decreased from 58 to 16% in Gr-I, while Gr-P changed only from 52 to 45 %. No side-effects or goitrous newborns were recorded in Gr-I. There was a depression of the 131I uptake to below normal at the 9th month, at a time when plasma inorganic iodine (PII) was above normal. Thyroid clearance of iodide was similarly low, and absolute iodine uptake (AIU) was normal. Plasma thyroxine values were normal. In women given 0.2 ml Ethiodol, PBI and total serum iodine (SI) were similar to Gr-P at 19 months, but 131I thyroid uptake was still significantly lower and UEI still significantly higher. UEI fell exponentially after 6 months (from 859 to 168 μg/24 hr in the over 13 yr-2.0 ml group). Iodized oil once absorbed from the muscle may be stored in other tissues. An empirical formula to predict the maintenance of UEI at 50 μg/24 hr above basal excretion has been derived. With a 2.0 ml dose this minimum should be reached by the 27th month, while after 0.2 ml this happened by the 15th month. It is too early to realize the effect of iodine prophylaxis in reducing the occurrence of defective persons. Iodine in human milk indicated that newborn children in Gr-I were receiving a good iodine supply. The physiologic rise of PBI during pregnancy failed to occur in Gr-P but occurred normally in Gr-I. The implications of this observation on the maternal-fetal thyroid interactions are discussed.

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