GOITRE

Evening Post, Volume CIV, Issue 23, 27 July 1927, Page 13

GOITRE

DIFFICULTIES MET WITH

THE lODINE DOSE

An interesting review of .some recent investigations into the prevalence of goitre in New Zealand, carried out while acting as a delegate to the medical congress in Dunedin, was presented by Dr. D. Gifford Croll, C.8.E., at a meeting of the Queensland branch of the British Medical Association, recently. "So prevalent is goitre in the South Island of Nejfr Zealand," said Dr. Croll, in. the course of his address, "that in some of the schools 60 per cent, of the children are affected thereby. It lessens, of course, with adult, life, but is still so common that, in walking down the principal street of Dunedin, I was able' to count twelve persons with goitre in five minutes." .

Dr. Croll stated that Professor Hercus, of Otago University, had shown that throughont New Zealand the incidence of goitre fluctuates consistently with the amount of iodine in the soil. In those districts in which the,soil is poor.in iodine the vegetables, fruits, milk, butter, and meats are deficient in iodine, and the incidence of goitre amongst men,, animals, and fish is proportionately high. Secondary-factors, of course, play, an. important part- the iodine deficiency merely makes the patient susceptible, the secondary factors determine the attack. THE PREVENTIVE ASPECT. Kef erring to the treatment of. the various conditions of the thyroid gland to be observed in goitre eases> Dr. Croll is reported in the Sydney ; "Morning Herald" as havingr placed ; emphasis first of all upon the preventive aspect of {he complaint. :.;..- ---"It would, at first appear easy," he said, "to give iodine to all school chil-1 dren in an affected district, and so com-! pensate for the deficiency. This was done in some goitre districts in America, Switzerland, and New Zealand, with satisfactory results, but it soon appeared that there was a very serious pitfall. If iodine is given, except in physiological doses, to- a- person suffering .from,, goitre, it appears^ to- have an irritating effect upon.the glandular tissue, causing further hypertrophy and so converting a harmless into a toxic goitre. This is much more liable to oaeur in adults than in children, but an outbreak of toxic goitre in the districts where it was tried caused a cessation of the practice. It was found that the minimum daily requirement was 100 micrograinmes and that tho maximum daily amount which can bo considered physiological' and which thus is not liable to produce toxic symptoms, was 700 microgrammes. Tho problem, therefore,.resolves itself into giving betweon 100 and 700 microgrammes per day to every person within the affected areas. There are various suggestions such •as iodised manure, iodised water supply, foody et cetera, but in all it is difficult to get neither more nor less than the required amount."

"Tho proposal which seems most promising at present is iodised salt. Tho total amount of salt used daily by each. person for all purposes, including cooking, is fairly constant at about ton grammes, and it has been calculated that if sale be iodiser, 1 in 250,000, each person will- receive 100 microgrammes per day. This would be sufficient if there were a total lack of iodine in the food and there would be no danger of exceeding 700 microgrammes per day where the soil, was normal in iodine. Its. worst failing is that tho iodine is lost in cooking unless tho water is kept and used for soups, stews, et cetera. The removal of all soptie foci and the avoidance.of overwork or worry aro, of course, indicated as preventive measures, these being secondary factors-in the causation of goitre." . ■ •