Urinary iodine excretion is currently the most convenient laboratory marker of iodine deficiency. Accelerating international interest in correcting this condition demands rapid, simple methods for assessment and monitoring. We describe two adaptations of the Sandell-Kolthoff reaction, in which urine is first digested with chloric acid and iodine then determined from its catalytic reduction of ceric ammonium sulfate in the presence of arsenious acid. Both methods use gentle digestion by chloric acid in a heating block. Method A detects iodine in a colorimeter, method B by the indicator ferroin and a stopwatch. Results with 12 samples ranging from 1.8 to 19.0 micrograms/dL (0.14-1.48 mumol/L) differed from those in a reference laboratory by a mean of 9.1% for method A and 15.7% for method B. One technician can perform at least 150 tests per day at a total cost of less than $0.50 each. The speed, low cost, and simple instrumentation make these methods well suited to epidemiological assessment of iodine deficiency in developing countries.

Abstract. Thyroid volume of 1397 German and 303 Swedish adults were estimated by sonography. Thyroid size of 6–16 year old Germans (n = 619) was determined and compared with findings on palpation. Thyroid volume was more than twice as great in German (21.4 ± 15.6 ml, mean ± sd) than in Swedish adults (10.1 ± 4.9 ml). The echopattern was abnormal in 16% of the Germans and in 3.6% of the Swedes. German children have a thyroid volume ranging from 1.8 ± 0.4 ml at 6 years to 10.8 ± 6.0 ml at 16 years of age. Palpation is by comparison an unreliable method for determining thyroid size. In Germany, the iodine excretion was less in children (n = 619, 39.5 ± 30.5, 34.1 μg I/g creatinine, mean ± sd, median) than in adults (n = 1193, 83.7 ± 94.4, 62.6), (P <0.001) and much lower than that observed in Sweden (adults n = 98, 170.2 ± 93.3, 141.4; 13 year olds n = 113, 172.9 ± 224.1, 124), (P < 0.0001). Serum thyrotropin concentration was significantly higher (P <0.001) in Sweden (n = 62, 1.49 ± 0.82 mU/ml), than in Germany (n = 91, 0.97 ± 0.52 mU/ml), while serum thyroglobulin was increased in Germany (n = 91, 72.6 ± 50.6 μg/l) as compared to Sweden (n = 62, 23.5 ± 17.4), (P <0.0001). These results indicate the goitrogenic effect of iodine deficiency and the continuing need for an effective iodine prophylaxis in the FRG.

The value of ultrasonography compared with established diagnostic procedures was investigated by reviewing medical records of 92 patients (88 women and 4 men, age 11 -81 years, mean age 47) with lymphocytic thyroiditis. Clinical manifestations of the disease and serum antimicrosomal antibodies and TSH were determined in all patients. The thyroid was examined by ultrasound. Both lobes were aspirated by a fine needle under sonographic control and smears examined cytologically. A total of 27 (29.3%) patients had no clinical symptoms. Antimicrocosmal antibodies were undetectable in 12 (13%) patients, 16 (17.4%) had low litres 1:32-1:100, and 64 (69.6%) We reviewed the charts of all ambulatory and hospitalized patients (N 106) from the department of internal medicine, where LT was suspected by fine needle aspiration cytology (INA) between January 1984 and December 1987. The study included only patients (N = 92,88 women, 4 men, age 11-81 years, mean age 47) where the following four diagnostic procedures were available: 1. measurement of antimicrosomal antibodies (Mi-ab); 2. TSH; 3. ultrasonography and 4. FNA of the thyroid. Frequently patients were discovered prior to diagnostic (iodine-containing contrast media) or therapeutic (amiodarone) procedures where thyroid disorders had to be excluded, or by inadvertently testing the thyroid. Clinical manifestations were recorded; Mi-ab was determined by immunofluorescence (6); TSH was run in duplicate by a supersensitive luminescence immunoassay from Henning, Berlin, FRG (7); T, and Ts were measured using commercial kits (Henning). Thyroid morphology was investigated by ultrasound (SRT, linear MHz 5, General Electric, Rancho Cordova, CA). The echopatterns, focal or scattered, were classified according to their echogenity in normal, solid, no echo, sonolucent and echocomplex, the sonolucent muscles serving as Ana CIKIOCT. 121, 1 in der Schilddrüsensonographie. Fortschr Geb Rontgenstr 145, 1986;3:283-7. 26. Baker BA, Gharib H, Markowitz Ii. Gorrelation of thyroid antibodies and Cytologie features in suspected autoimmune thyroid disease. Am J Med 1983; 74:941-8. 27. Löwhagen T, Linsk JA. Aspiration biopsy cytology of the thyroid gland. In: Linsk JA, Fran/en S, eds. Glinical aspiration cytology. 1st edn, London: JB Lippincott Company, 1983:61-83.

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Oral iodized oil is the major alternative to iodized salt for correcting endemic iodine deficiency. This study responds to a need for better guidelines in its use. Schoolchildren, aged 6-11 yr, from a severely iodine-deficient area of Algeria received iodized poppy seed oil (Lipiodol) in a single oral dose containing 120, 240, 480, or 960 mg iodine (groups A-D) or in an im injection of 480 mg iodine (group E). Thyroid volume by ultrasonography had not changed 395 days after treatment in groups A, B, and C, had decreased in groups D and E. Urinary iodine concentration rose rapidly from an initial median of 0.21 mumol/L, but fell below 0.79 mumol/L (the currently accepted level for indicating iodine deficiency) by 150 days for groups A and B, and by 395 days for groups C and D. Median serum TSH and T4 levels were normal before and after treatment, whereas high initial serum thyroglobulin values decreased in all groups after iodized oil treatment. For correcting iodine deficiency in children, we recommend single oral doses of Lipiodol containing 240 mg iodine for 6-month coverage or 480 mg for 12 months. These doses may not completely sustain iodine sufficiency, but will prevent the worst of the iodine deficiency disorders. Additionally, we conclude that the urinary iodine concentration is the most useful epidemiological indicator for assessing current iodine status, and thyroid volume and serum thyroglobulin levels are the best markers for assessing chronic effects.