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IODINE METABOLISM OF ENDEMIC GOITER ON THE ÅLAND ISLANDS (FINLAND)^*

The Fourth Medical University Clinic (Maria Hospital) Helsinki/Helsingfors The Central Hospital of Åland Mariehamn The Medical Department of Maria Hospital, and the State Serum Institute Helsinki/Helsingfors, Finland

Studies of the urinary excretion of radioactive iodine and stable iodine, of the concentration of protein-bound iodine in serum, and calculation of the daily production of thyroid hormones, together with clinical investigation showed that: 1) with regard to the incidence of nodularity (86 per cent), the endemic goiter on the Åland Islands is comparable with that on the Finnish mainland; 2) in normal subjects, the average 48-hour excretion of radioactive iodine was 49.3 per cent of the administered dose; 3) the daily urinary excretion of stable iodine (corrected for methodologic error) was about 49.5 µg.; 4) with increasing size of the thyroid gland there was a statistically significant decrease in the excretion of radioactive iodine; in the group with the largest goiters this excretion was only 32.2 per cent; 5) in normal subjects the calculated daily roduction of thyroid hormones was the equivalent of about 62.5 µg. of iodine per day when corrected for methodologic error; it rose with increasing thyroid volume to a level of about 124.5 µg. per day for the group with the largest goiters, a value which differed significantly from that for the control group.

A relatively or absolutely diminished availability of iodine to the thyroid, avidently resulting from deficient intake of iodine, plays a significant part in the development of goiter on the Åland Islands. The increased daily production of thyroid hormones in the goiter group can be explained by an increased reutilization of the iodine liberated. The pattern of iodine metabolism in this endemia is compared with pattern in other endemic regions. The relationship with the tendency towards thyrotoxicosis, regarded as a characteristic feature of the Finnish endemia, is discussed.

^* This investigation has been aided by grants from the Sigrid Juselius Stiftelse, the Finska Lakaresallskapet and the County Board of Aland.

Received March 31, 1958.