Endemic goitre in Guinea-Bissau.

The presence of endemic goitre in the hinterland of Guinea-Bissau was reported by Costa in 1954 [1], and it is believed that the situation he described persists to the present day. The Ministry of Public Health, Guinea-Bissau, the Institute of Hygiene and Tropical Medicine, Lisbon (IHMT), and the Department of Endocrinology of the Portuguese Cancer Institute (IPO) therefore cooperated in a survey of two affected areas and one supposedly unaffected area of Guinea-Bissau in order to characterize the current situation. Materials and methods The whole adult population of six villages in each of the regions of Oio, Gabun and Cacheu were observed (Fig. 1). Children and adolescents aged less than 15 years were also observed in one village in each of the study regions. Thyroids were classified according to the criteria proposed by Thilly et al. [2], which we have already used in a previous study [3]. From a 10% randomly selected sample of adults, serum samples were obtained for the assay of thyroxine (T4), triiodothyronine (T3) and thyrotropin (TSH), as well as random urine samples for the assay of iodine and creatine. The sera were separated locally with manual or electric centrifuges, and the samples were transported in isothermal boxes with thermal accumulators before being frozen a few hours later. The frozen samples were transported at the end of the study to the Department of Endocrinology, IPO, where they were processed by conventional methods. TSH was determined using an immunoradiometric assay (IRMA). (a) The results for five serum samples were excluded from the calculations because they were from pregnant women (T4 > 11.5 [microgram]/100 ml; TSH > 0.5 [microUnit]/ml; confirmed by [beta]-specific chorionic gonadotropin assay). Similarly, the results for two urine samples were discarded because their iodine concentrations were >300 [microgram]/g creatinine. Mean values were compared using Student's t-test. Results The prevalence of goitre in the three study regions, according to grade and sex, are summarized in Table 1. Children were considered separately from adults, but further stratification of age groups was not possible because of the lack of reliable data. No cretinism was observed. The results of the hormonal assays and of the Table 1: Prevalence of goitre among the study adults and children, according to grade, sex, and region, Guinea-Bissau No. with grade of goitreL with grade 2 % with or grade 3 Region n 1a 1b 2 goitre goitre Oio Females 365 59 62 55 19 53 20 Males 167 16 9 12 0 22 7 Children 59 14 15 0 0 0 Gabu Females 344 53 66 44 2 48 13 Males 276 25 8 9 0 15 3 Children 96 17 12 2 0 32 2 Cacheu Females 279 35 34 4 1 27 2 Males 228 10 0 0 0 4 0 Children 89 3 0 0 0 6 0 determinations of urinary iodine are summarized in Table 2. …