GOITROUS ENDEMIC IN GUINEA

We identified a major goitrous area in the Republic of Guinea, charact erised by an overall goitre prevalence of 70% in adults. Thyroid swell ing was sometimes present at birth and affected 55% of schoolchildren. A difference between sexes appeared at puberty. Endemic cretinism, ma inly in its myxoedematous form, was found in about 2% of goitrous pati ents. In this region, iodine deficiency is the primary causative facto r (median urinary concentrations of 16 mu g/L, and in 69% of inhabitan ts below the critical threshold of 20 mu g/L). The diet contained subs tantial amounts of thiocyanate anions (median 6 mg/L in urine and in 2 7%, more than 10 mg/L) likely to further depress iodine bioavailabilit y. Other dietary compounds, notably flavonoids were suspected to contr ibute. Overall nutritional and general health appeared satisfactory. T he affected population is borderline euthyroid with a trend towards hy pothyroidism in protracted disease. This area of Guinea may be regarde d as the epicentre of the west African endemic acid as one of the most severely goitrous regions ever described, requiring urgent public hea lth measures.