A national survey conducted in 1995-96 showed that mild to moderate iodine deficiency existed in Macedonia (median urinary iodine [UI] concentration 117 microg/l). It was concluded that a new legal regulation should be introduced concerning the iodination of table salt for human consumption. The iodine level was recommended to be 20-30 mg/kg salt, exclusively in the form of the more stable potassium iodate. The new regulations were instituted and became effective in October, 1999. National surveys performed in 2000 and 2001 showed increased median UI concentrations (154.1 microg/l in 2000 and 164.5 microg/l in 2001). In 2001, UI excretion was assessed in 490 pregnant and lactating women (median UI concentration 140 microg/l). During the last three surveys, household salt specimens were assessed for iodine content. The findings showed an increase of the percentage of the optimal iodine content in household salt (42-69%), which correlated with the higher IU excretion results. The new regime of salt iodination was proved to be highly effective in correcting the iodine deficiency in Macedonia.
Monitoring studies can be optimized by including centralized standardization procedures that improve the comparison between studies. No study of iodine consumption can replace the direct measurement of health outcomes and the evaluation of the costs and benefits of the program. It is particularly important that health economic evaluation should be conducted in mildly iodine-deficient areas and that it should include populations from regions with different environmental, ethnic, and cultural backgrounds.
Aspiration biopsies were performed on 1536 patients with goiter who showed scintigraphically "cold" nodules. Twelve among them had clinical and cytological positive diagnosis. The remaining 1524 patients had aspiration biopsies without suspicion of the malignant nature of their goiters. Among them, 45 patients had a positive or suspect cytological diagnosis. Fourteen had not been yet operated on. Thirty-one were operated on and 28 malignancies were confirmed histologically. In three patients, cytological diagnosis was false positive. The remaining patients were cytologically negative. Thirty-seven were operated on and four false negative cases were found. The application of aspiration biopsy on every patient with a cold thyroid nodule resulted in the detection and very early diagnosis of clinically unsuspected thyroid neoplasms, the great majority of which were confined to the gland itself without metastatic spread. This fact makes the prognosis better. In addition, it is probable that the early detection of differentiated thyroid neoplasms and their surgical ablation interrupt their natural course towards anaplastic carcinoma, with its grim prognosis. Cancer 45340-344, 1980. OITER IS USUALLY a benign, hyperplastic, or in-G flammatory enlargement of the thyroid gland, which, if not excessively large or hormone-producing, does not warrant therapeutical measures and has little influence on general health status. About 2.5% of all new goiters, however, are malignant thyroid neoplasms, requiring a different therapeutic approach and prognosis. A reliable and sure diagnostic differentiation between a usual hyperplastic or inflammatory goiter and a malignant goiter is needed to evaluate each case. Unless metastasis or local extension is evident, no purely clinical means exists to confirm or exclude car-cinoma of a thyroid nodule.5 Therefore, the patient with thyroid neoplasia in an early phase can be mis-diagnosed and/or overlooked. Only a histological diag
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