We conducted a population-based study of 313 case -control pairs in Kuwait to examine the aetiology of thyroid cancer, the second most common neoplasm among women in this and several other countries in the Gulf region. Among the demographic variables, individuals with 12+ years of education had a significantly reduced risk of thyroid cancer (OR=0.6; 95% CI: 0.3 -0.9). The average age at diagnosis (+s.d.) of thyroid cancer was 34.7+11 years in women and 39+13.4 years in men. History of thyroid nodule was reported only by cases (n=34; 10.9%; lower 95% CI: 12.0); and goitre by 21 cases and four controls (OR=5.3; 95% CI: 1.8 -15.3). There was no significant increase in risk with history of hypothyroidism (OR=1.8) or hyperthyroidism (OR=1.7). For any benign thyroid disease, the OR was 6.4 (95% CI: 3.4 -12.0); and the population attributable risk was about 26% (95% CI: 21.1 -30.9). Stepwise regression analysis showed that high consumption of processed fish products (OR=2.2; 95% CI: 1.6 -3.0) fresh fish (OR=0.5; 95% CI: 0.4 -0.7) and chicken (OR=1.7; 95% CI: 1.2 -2.3) were independently associated with thyroid cancer with significant dose-response relationships. Among the thyroid cancer patients who reported high consumption of fish products, a large majority also reported high consumption of fresh fish (98%) and shellfish (68%). No clear association emerged with consumption of cruciferous vegetables. These data support the hypothesis that hyperplastic thyroid disease is strongly related to thyroid cancer; and that habitual high consumption of various seafoods may be relevant to the aetiology of thyroid cancer. The association with chicken consumption requires further study. In most countries, thyroid cancer accounts for approximately 1 -5% of all cancers in females and 52% in males. The age-standardised incidence rates (per 100 000) of thyroid cancer, across most populations, vary from about 2 -10 in females and 1 -3 in males (Parkin et al, 1997). Since the late 1970s, thyroid cancer has consistently been the second most commonly recorded neoplasm (after breast) among Kuwaiti women. During the period 1994 -1998, thyroid cancer accounted for 8.1 and 2.1% of all cancers among Kuwaiti women and men, respectively; and 8.7 and 3.3% of all cancers among non-Kuwaiti (expatriate) women and men, respectively. Similarly high relative frequency and incidence rates of the disease have also been observed in other countries in the Gulf region (Figure 1).Evidence from epidemiological studies suggests that exposure to ionising radiation, especially during childhood and adolescence, is the main risk factor for thyroid cancer (Ron et al, 1995); and history of hyperplastic thyroid disease (i.e., nodule/adenoma and goitre) is an important determinant of the cancer . The study of dietary habits and micro-nutrients in thyroid cancer has been prompted by the essential role of iodine in thyroid function and the potential influence of iodine-rich seafood and goitrogenic vegetables (World Cancer Research Fund, 1997).We conducted a population-b...