Prevalence of goitre in the southern mountainous regions of Bulgaria, 1986-1989.

Iodine supplementation programmes began in designated high risk mountainous districts in Bulgaria in 1958. The prevalence of goitre fell. But the programmes became less effective and by the mid 1980s there were strong indications that goitre was resurgent. Ten villages that had been surveyed in 1956 and 1974 were re-surveyed between 1986 and 1989. All persons available were examined (not just residents)--at home, workplace or school--by a trainee or specialist endocrinologist. Goitres were graded according to the WHO/ICCIDD system. 2,901 females and 1,885 males were examined. Diffuse, stage 1 enlargements were common in males and females under 35, with prevalences exceeding 20% in several age/sex groups. Nodular stage 1 and 2 enlargements became commoner at ages above 45, with prevalences exceeding 15% in females over 55. Overall prevalences were 28% in females and 14% in males. 6 cretins were identified. In recognised endemic areas of Bulgaria, epidemiological surveillance of IDD should be maintained. Detailed studies are required to determine why iodine supplementation became less effective after the mid 1970s and to develop and test new, cost-effective public health strategies appropriate to the changed socio-political circumstances.