Use of major dietary iodine sources in married student households
by Elizabeth Kathleen Divers Jacobs
A thesis submitted to the Graduate Faculty in partial fulfillment of the requirements for the degree of
MASTER OF SCIENCE in Home Economics
Montana State University
© Copyright by Elizabeth Kathleen Divers Jacobs (1970)
Abstract:
A survey was conducted to investigate the extent of iodized salt usage, reasons for the purchase of
iodized or uniodized salt, from what sources information concerning the use of iodized salt is obtained,
and the frequency with which fish, marine and shell, are served in households in the married student
housing at Montana State University, Bozeman. Structured interviews were conducted with 66
household members responsible for choosing the food their families purchased.
Survey results showed that 72.7% of the households use iodized salt, and 83.3% have fish served at
least twice a month. Uniodized salt was used and fish was served less than twice a month in 9.1% of
the households . Over half of the respondents (54.5%) use iodized salt because it is better for their
health, and 42.4% chose the type of salt they bought by picking up the first package they saw-. Mothers
were the source of knowledge about iodized salt usage for the highest percentage of household
members (43.6%), with schools a close second (40.0%).
It was concluded that a state-wide medical survey of goiter enlargement in Montana would be valuable
to justify programs to increase iodized salt usage, such as education of mothers and school children. In p r e s e n tin g th is t h e s i s in p a r tia l fu lfillm e n t o f th e r e q u ir e ­
m e n ts fo r a n a d v a n c e d d e g re e a t M o n ta n a S ta te U n iv e r s ity , I a g re e
t h a t th e L ib rary s h a ll m ake i t f r e e ly a v a ila b le fo r i n s p e c tio n . I fu r­
th e r a g re e t h a t p e rm is s io n for e x te n s iv e c o p y in g o f t h i s t h e s i s fo r
s c h o la r ly p u rp o s e s m ay be g ra n te d b y my m a jo r p r o f e s s o r , o r , in h is
a b s e n c e , by th e D ire c to r o f L ib r a r ie s . I t is u n d e rs to o d th a t a n y c o p y ­
in g o r p u b lic a tio n o f th is t h e s i s fo r f in a n c ia l g a in s h a ll n o t b e a llo w e d
w ith o u t my w ritte n p e r m is s io n .
D ate
( T & n,,. rd- 14 . I q fIO
A
I
USE OF MAJOR DIETARY IODINE SOURCES IN
MARRIED STUDENT HOUSEHOLDS
bY
ELIZABETH KATHLEEN DIVERS JACOBS
'j
A t h e s i s s u b m itte d to th e G ra d u a te F a c u lty in p a r tia l
fu lfillm e n t o f th e re q u ire m e n ts fo r th e d e g re e
■'o f
MASTER OF SCIENCE
in
Home E co n o m ics
A pproved:
/
H eacj// M a jo r D e p a rtm e n t ^
MONTANA STATE UNIVERSITY
B o zem an , M o n ta n a .
D e c e m b e r, 1970
-iii-
ACKNOWLEDGEMENTS
I w o u ld lik e to e x p r e s s my s in c e r e th a n k s to D r. A ndrea
P a g e n k o p f, my a d v is o r , fo r h e r g u id a n c e , s u p p o rt, an d p a tie n t a d ­
v ic e th ro u g h o u t my g ra d u a te s tu d ie s ; to D r. M a rjo rie K e ise r for h e r
g u id a n c e w ith my t h e s i s .
M y th a n k s is a ls o g iv e n to th o s e m a rrie d s tu d e n ts w ho so k in d ly
p a r tic ip a te d in my s tu d y by g iv in g th e ir v a lu a b le tim e fo r a n in te rv ie w .
I am g ra te fu l to my h u s b a n d , M r. D o n ald J a c o b s , fo r h is
p a tie n c e w ith a w ife w ith whom i t w a s s o m e tim e s d if f ic u lt to g e t
a lo n g ; to my p a r e n t s , M r. an d M rs . R e g in a ld D iv e rs , fo r th e u s e o f
th e i r c o o l b a s e m e n t in w h ic h I c o u ld w rite my t h e s i s in co m fo rt and
w ith p r iv a c y .
TABLE OF CONTENTS
PAGE
VITA...............................................................................
A CKNOW LEDGEM ENTS......................................................................................
iii
ABSTRACT . . . •.................................................................. ................... ................v i i i
CHAPTER I .
INTRODUCTION AND PURPOSES
CHAPTER II .
REVIEW OF LITERATURE
.........................................
I
..............................................
3
The M e ta b o lic N e e d fo r Io d in e b y H u m a n s ................................. ...
3
U se o f Io d in e b y th e T hy ro id G l a n d ..............................................
3
C o n s e q u e n c e s a n d P re v e n tio n o f Io d in e D e fic ie n c y
. . . .
7
. . .......................................
17
D ie ta r y R e q u ire m e n ts fo r Io d in e b y th e Body ..................................
18
E ffe c ts o f E x c e s s iv e Io d in e In ta k e
B a la n c e S tu d ie s on Io d in e I n t a k e ......................................................
18
R ecom m ended I n ta k e o f I o d i n e ................................................ . . .
18
S o u rc e s o f Io d in e in th e U n ite d S ta te s o f A m erica
19
. . . . .
CHAPTER II I. ■ M E T H O D ........................................................■........................
S u rv e y I n s t r u m e n t .............................................................................................
S a m p lin g P r o c e d u r e ..................................................................................... ■
22
22
23
S u rv ey M e t h o d ......................................................................
S u rv ey o f G ro c e ry S to re s
...........................................................
25
T re a tm e n t o f D a t a ..................................................................
CHAPTER IV.
RESULTS AND D IS C U S S IO N ......................................
C h a r a c te r is tic s o f th e S am ple
S a lt U s a g e
2
26
. ................................. ..........................
26
....................... ................................ _ . • • • • • .........................
26
F is h C o n s u m p t io n ......................................................................................... ■
34
—V”
CHAPTER V.
SUMMARY, CONCLUSIONS , RECOMMENDATIONS .
37
Sum m ary o f M e th o d an d R e s u l t s ...........................................................
37
C o n c lu s io n s
38
............. ■.................................................... ................... ...
R e c o m m e n d a tio n s fo r F u rth e r S t u d y ...................................................
APPENDIX A.
39
SURVEY INTERVIEW QUESTIONNAIRE . . . .................
41
APPENDIX B. INTERVIEW ANSWER S H E E T ..............................................
44
APPENDIX C . LETTER OF IN T R O D U C TIO N ..............................................
45
APPENDIX D . TOTAL SAMPLE TALLY SHEET .............................. ...
46
APPENDIX E .
.................................
47
1 6 -2 0 Y e a r s .......................................... . . . . . ' ..........................................
47
2 1 -2 5 Y e a r s ....................................
48
2 6 -3 0 Y e a r s ...........................................................
49
3 1 -5 0 Y e a rs . . . .............................................................................................
50
TALLY SHEETS FOR AGE GROUPS
LITERATURE CITED
51
-v i-
LIST OF TABLES
TABLE
PAGE
1.
R ecom m ended D a ily D ie ta ry A llo w a n c e s fo r Io d in e .................
20
2.
R e s p o n d e n ts ' S o u rc e o f K now ledge A bout Io d iz e d S a lt . . . .
33
3.
F re q u e n c y F is h i s S e rv e d in H o u s e h o ld s U sin g Io d iz e d
o r U n io d iz e d S a lt
36
"
-v ii-
LIST OF FIGURES
FIGURE ’
PAGE
I . The T hyroid B o d y ....................•............................................ •...................
5
2 . The F o llic le s o f a H um an T h y r o i d ....................................................
5
3 . G o ite r B elts o f th e U n ite d S ta te s o f A m e r i c a ....................... ... .
12
4 . Age D is trib u tio n o f th e S a m p le ...........................................................
27
5 . P e rc e n ta g e o f H o u s e h o ld s w ith M em b ers o n S p e c ia l
D i e t s .................................................
27
6 . P e rc e n ta g e o f F a m ilie s U sin g S a lt O th e r T han a t th e
T a b le o r D u rin g C o o k in g ..................................................................
28
7 . P e rc e n ta g e o f H o u s e h o ld s U s in g Io d iz e d o r U n io d iz e d
S a lt fo r V a rio u s P u r p o s e s ...............................................................
28
8 . H o u s e h o ld s U s in g Io d iz e d S a lt C o m p ared to T h o se
' W h ic h H av e H e ard o f U s in g Io d iz e d S a l t ..............................
30
_
9 . R e a s o n s fo r P u r c h a s e o f Type o f S a lt U s e d .................................
30
10. P e rc e n ta g e o f H o u s e h o ld s S e rv in g F is h a t V ario u s
F r e q u e n c i e s ............................................................................ ... . . . .
35
-v iii-
ABSTRACT
A s u rv e y w a s c o n d u c te d to in v e s t ig a te th e e x te n t o f io d iz e d
s a l t u s a g e , r e a s o n s fo r th e p u rc h a s e o f io d iz e d o r u n io d iz e d s a l t ,
from w h a t s o u r c e s in fo rm a tio n c o n c e rn in g th e u s e o f io d iz e d s a l t is
o b t a i n e d , a n d th e fre q u e n c y w ith w h ic h f i s h , m a rin e a n d s h e l l , a re
s e r v e d in h o u s e h o ld s in th e m a rrie d s tu d e n t h o u s in g a t M o n ta n a S ta te
U n iv e r s ity , B o z e m a n . S tru c tu re d in te rv ie w s w e re c o n d u c te d w ith 66
h o u s e h o ld m em b ers r e s p o n s ib le fo r c h o o s in g th e food th e ir fa m ilie s
p u rc h a se d .
S u rv e y r e s u l t s sh o w e d th a t 72.7% o f th e h o u s e h o ld s u s e
io d iz e d s a l t , an d 83.3% h a v e f is h s e r v e d a t l e a s t tw ic e a m o n th .
U n io d iz e d s a l t w a s u s e d an d f is h w a s s e rv e d l e s s th a n tw ic e a m onth
in 9.1% o f th e h o u s e h o ld s .
O v e r h a lf o f th e r e s p o n d e n ts (54.5%) u s e io d iz e d s a l t b e c a u s e
i t i s b e tte r fo r th e ir h e a l t h , an d 42.4% c h o s e th e ty p e o f s a l t th e y
b o u g h t b y p ic k in g up th e f i r s t p a c k a g e th e y saw-. M o th e rs w e re th e
s o u rc e o f k n o w le d g e a b o u t io d iz e d s a l t u s a g e fo r th e h ig h e s t p e r c e n t­
a g e o f h o u s e h o ld m em bers (43.6%), w ith s c h o o ls a c lo s e s e c o n d
(40.0% ).
I t w a s c o n c lu d e d th a t a s ta t e - w i d e m e d ic a l s u rv e y o f g o ite r
e n la rg e m e n t in M o n ta n a w o u ld be v a lu a b le to j u s tif y p ro g ram s to i n ­
c r e a s e io d iz e d s a l t u s a g e , s u c h a s e d u c a tio n o f m o th e rs an d s c h o o l
c h ild re n .
CHAPTER I
INTRODUCTION AND PURPOSES
In tro d u c tio n
G o ite r is n o t a n e w d i s e a s e : r e f e r e n c e s to a s w e llin g o f th e n e c k
go b a c k to th e C h in e s e in th e s e c o n d m ille n iu m B . C . - ( l ) . T here h a v e
th e re fo re b e e n r e p o rts o f g o ite r fo r m an y c e n t u r i e s , b u t th a t d o e s n o t
m e an th e d i s e a s e is no lo n g e r a p ro b lem : p re lim in a ry r e s u l t s o f th e
19 68 N a tio n a l N u tritio n S u rv e y , c o n d u c te d b y th e U n ite d S ta te s P u b lic
H e a lth S e r v ic e 's N u tritio n P ro g ra m , in d ic a te a 5% in c id e n c e o f e n ­
la r g e d th y ro id s
o r g o ite r (2) .
R e ta r d a tio n , b o th p h y s ic a l a n d m e n ta l, o c c u rs w h en g e n e r a tio n s
a re s u b je c te d to io d in e d e f ic ie n c y (3 ). B o zem an , M o n ta n a , h a s e x ­
tre m e ly s m a ll a m o u n ts o f io d in e in i t s w a tb r s u p p ly (4 ), a n d a c o n c o m ­
it a n t la c k o f io d in e in th e s o i l . T h ere is l i t t l e io d in e to be f o u n d ,
th e r e f o r e , in th e food p ro d u c e d in th e B ozem an a r e a , s o o th e r s o u rc e s
o f io d in e m u s t be u s e d . Io d iz e d s a l t a n d m arin e o r s h e l l f i s h are th e
tw o m a jo r n u tr itio n a l s o u r c e s o f io d in e (3 ).
-2 -
P u rp o s e s
T his s tu d y w a s u n d e rta k e n to in v e s t ig a te th e fo llo w in g tre n d s
am ong s tu d e n ts liv in g in m a rrie d s tu d e n t h o u s in g a t M o n ta n a S ta te
U n iv e rs ity : (I) th e e x te n t o f io d iz e d s a l t u s a g e ; (2) r e a s o n s for th e
p u r c h a s e o f io d iz e d o r u n io d iz e d s a lt ; (3) from w h a t s o u r c e s in fo rm a ­
tio n c o n c e rn in g th e u s e o f io d iz e d s a l t is o b ta in e d ; an d (4) th e f r e ­
q u e n c y w ith w h ic h f i s h , m a rin e a n d s h e l l , a re s e r v e d . I t w a s h o p e d
t h a t t h e s e tre n d s w o u ld le a d to c o n c lu s io n s re g a rd in g th e fo llo w in g
p o s s i b i l i t i e s : (a) w h e th e r a s t a t e - w i d e g o ite r s u rv e y in M o n ta n a w o u ld
b e o f v a lu e ; an d (b) i f e d u c a tio n o n p u rp o s e s an d m e th o d s o f g o ite r
p ro p h y la x is i s n e c e s s a r y .
/
CHAPTER II
REVIEW OF LITERATURE
' B efore a d i s c u s s i o n o f th e s u rv e y th a t w a s c o n d u c te d , th is c h a p ­
te r w ill p r e s e n t so m e b a c k g ro u n d in fo rm a tio n a b o u t w hy th e re i s a n e e d
fo r io d in e by th e h u m an b o d y an d how m uch io d in e i s re q u ire d . It i s
im p o rta n t to know h o w th e b o d y u s e s i o d i n e , w h a t m ay b e th e c o n s e ­
q u e n c e s o f a n io d in e d e f ic ie n c y , an d w h a t m e th o d s a re a v a ila b le for
p re v e n tin g t h e s e d e f ic ie n c y d i s e a s e s f o r th e y a re r a r e ly c u re d o n c e
th e y a re w e ll e s t a b l i s h e d in a hum an ( I ) .
The M e ta b o lic N e e d fo r Io d in e by H um ans
U se o f Io d in e b y th e T hyroid G la n d
Io d in e is e s s e n t i a l in th e m a n u fa c tu re o f th y ro id h o rm o n e s ,
w h ic h a f f e c t a h u m a n ' s r a te o f g ro w th a n d d e v e lo p m e n t. T hyroid h o r­
m o n es a re p ro d u c e d in th e th y ro id g la n d .
The T hyroid G la n d
.
.
In 19 65 W ils o n e t a l w ro te: "A ll t i s s u e s an d s e c r e tio n s o f th e
b o d y th u s fa r a n a ly z e d h a v e b e e n fo u n d to c o n ta in io d in e " (3: 1 6 7 ). O f
th e 2 0 -5 0 m illig ra m s o f io d in e fo u n d in th e hum an b o d y , h o w e v e r,
20 -4 0 % o f i t is lo c a te d in th e th y ro id g la n d (5 ). The n am e " th y r o id ,"
w h ic h m e a n s " s h i e l d - s h a p e d ," w a s g iv e n to th e g la n d in 1656 by
T hom as W h a rto n ( 1 ,6 ) . F ig u re I i l l u s t r a t e s th e p la c e m e n t o f th e th y ro id
-4-
w ith r e s p e c t to a h u m a n 's t r a c h e a , o r w in d p ip e . F ib ro u s c o n n e c tiv e
t i s s u e s u p p o rts an d c r e a te s a fram ew o rk fo r th e g la n d . The a c t i v e ,
f u n c tio n a l t i s s u e c o n s i s t s o f a nu m b er o f f o ll ic le s w h ic h re s e m b le th e
s a c s o f a n o ra n g e s e c t i o n , e x c e p t fo r b e in g s p h e r ic a l a n d m ic r o s c o p ic .
E p ith e lia l c e l l s o f th e f o llic le w a ll m a n u fa c tu re th y ro id h o rm o n es (F ig ­
ure 2 ). A c o llo id flu id in th e c e n te r o f th e c e ll s to r e s th e h o rm o n es ( 6) .
B io s y n th e s is a n d m e ta b o lis m o f th y ro id h orm ones
The b io s y n th e s is a n d m e ta b o lism o f th y ro id h o rm o n e s is a co m ­
p le x p r o c e s s th a t is n o t y e t fu lly u n d e rs to o d . B au m an n , in 1895 (5) o r
1896 ( l ) , f i r s t d e m o n s tra te d th a t io d in e w a s a n o rm al c o n s titu e n t o f
th e th y ro id g la n d . Io d in e i s c o n su m e d in o rg a n ic o r in o rg a n ic food
fo rm s , a n d r e a d ily a b s o r b e d in to th e b lo o d s tre a m from th e s m a ll i n ­
t e s t i n e (3 ). The b lo o d io n iz e s io d in e (Ig) to io d id e (I ) . Io d id e is th e
c h e m ic a l form in w h ic h th e m in e ra l i s tra n s p o rte d from th e b lo o d in to
th e th y ro id g la n d (7 ,8 ,9 ,1 0 ). Io d id e i s th e n c o n c e n tr a te d an d s to re d in
th e c o llo id a l m a tte r o f th e th y ro id c e ll (3 ,9 ,1 0 ). W h en th e n e e d for
th y ro id h o rm o n es a r i s e s , io d in e i s re m o v e d from s to ra g e an d co m b in ed
w ith th y r o g lo b u lin , a p ro te in (3 ,8 ,9 ,1 0 ).
T h y ro x in e i s th e m o s t a b u n d a n t th y ro id h o rm o n e . I t is e v e n tu a lly
form ed by th e a d d itio n o f io d in e to t y r o s i n e , a n a m in o a c i d , w ith in th e
th y ro g lo b u lin m o le c u le . E nzy m es th e n r e l e a s e th y ro x in e from th e
-5 -
T hyroid
C a r tila g e ------(Adams A pple)
Is th m u s
o f -----T hyroid
__ T hyroid
G lan d
•T rachea
F ig u re I — The T hyroid Body
( S e b r e ll, W . 1949. Io d in e — a
food e s s e n t i a l . P u b . H e a lth R ep .
64: 1077)
F o llic le
F ig u re 2 — The F o llic le s o f a Human T hyroid
( S e b r e ll, W . 1 9 4 9 . I o d in e - - a food e s s e n t i a l .
P u b . H e a lth R e p . 6 4 :1 0 7 7 )
-6 -
p r o te in , a n d i t is tr a n s p o r te d in to th e b lo o d (8 ,9 ,1 0 ). T h ere a re th re e
p r o te in s th a t c a rry th y ro x in e in th e b lo o d to b o d y t i s s u e s (11, 12) .
The c a ta b o lis m o f th y ro x in e e x e m p lifie s th e b o d y 's a b ility to
c o n s e rv e i t s im p o rta n t c o n s t i t u e n t s . W h ile th e b re a k d o w n o f th y ro x in e
u s u a lly b e g in s in th e l i v e r , th e k id n e y a n d m u s c le t i s s u e s m ay a ls o
i n i t i a t e c a ta b o lis m (12,13). The liv e r r e l e a s e s th y ro x in e from i t s c a r r ie r
p ro te in an d s e c r e t e s i t in to th e i n t e s t i n e s by w a y o f th e b i l e . N in e ty s e v e n p e r c e n t o f th e th y ro x in e t h a t r e a c h e s th e s m a ll b o w e l i s r e ­
a b s o r b e d in to th e b lo o d (12). T h is c o n s e rv a tio n o f th y ro x in e m e an s th e
th y ro id g la n d o n ly h a s to r e p la c e th re e p e r c e n t o f th e th y ro x in e i t
s e c re te s .
F u n c tio n s o f th y ro id ho rm o n es.
.
" I n v e s tig a tin g th e m e c h a n is m o f a c tio n o f th e th y ro id ho rm o n es
i s s o m e w h a t lik e p e e lin g th e s u c c e s s i v e la y e r s o f a n o n io n . N ot o n ly
m ay i t b rin g te a r s to th e e y e s , b u t a f te r e a c h s u c c e s s f u l s t e p , o n e is
l e f t w ith th e la y e r b e n e a th .!'(14: 2 6 7 ). A d is c u s s io n o f how th e th y ro id
h o rm o n e s perform th e ir fu n c tio n s i s n o t, th e r e f o r e , w ith in th e lim ita ­
tio n s o f th is s tu d y ; w h a t h a p p e n s w h en th y ro id h o rm o n e s a re o r a re n o t
p r e s e n t w ill b e d i s c u s s e d .
The m a jo r f u n c tio n s o f th y ro x in e in v o lv e r a te s o f e n e rg y m e ta b ­
o lis m a n d g ro w th a n d d e v e lo p m e n t. O x id a tio n r a te s in th e c e ll s o f a
hum an b o d y a re a f f e c te d by th y ro x in e le v e l s (3 ,1 4 ). An in c r e a s e in
th y ro x in e s e c r e tio n in c r e a s e s e n e rg y m e ta b o lis m , a n d th e re fo re b a s a l
-7-
m e ta b o lic r a te (3 ). N orm al d e v e lo p m e n t a t p u b e rty i s a ls o d e p e n d e n t
' o n p ro p e r th y ro id fu n c tio n (15). A d e f ic ie n c y o f th y ro x in e c a u s e s
s t e r i l i t y in a n im a ls (3), a n d im p ro p e r f e ta l g ro w th in h u m an s (16).
C o n s e q u e n c e s an d P re v e n tio n o f Io d in e D e fic ie n c y
S im p le a n d to x ic g o ite r
The fo rm a tio n o f a g o ite r is a m e c h a n is m b y w h ic h th e th y ro id
c o m p e n s a te s fo r a la c k o f io d in e (3 ). An io d in e d e f ic ie n c y r e s u lts in a
lo w e r le v e l o f th y ro x in e in th e b lo o d / s e n s itiz in g th e p itu ita r y g la n d ,
w h ic h a c t i v a t e s th e thyroid- (17). A d e c r e a s e in b lo o d th y r o x in e , t h e r e ­
f o r e , s tim u la te s th e th y r o i d . It e n la r g e s to b e co m e m ore e f f ic ie n t,
form ing a g o ite r (3,17,18).. C h a t i n , in th e la te n in e te e n th c e n tu r y ,
fo u n d a c o r r e la tio n b e tw e e n a la c k o f io d in e in ta k e a n d g o ite r ( I ) .
A fter B au m an n 's d is c o v e r y o f io d in e in th e th y ro id , a n d a d e m o n s tra ­
tio n b y H o p k in s in 1912 th a t d i s e a s e c o u ld b e c a u s e d b y a la c k of
tr a c e e le m e n ts , C h a t i n 's th e o ry w a s a c c e p te d .
S ta g e s o f g o ite r fo r m a tio n . — T here a re th re e s ta g e s o f sim p le
g o ite r , th e l a s t o f w h ic h m ay e v e n tu a lly le a d to to x ic g o ite r . W h en
th e r e i s a lo w io d in e i n t a k e , th e c o llo id c e n te r o f th y ro id f o llic le s
c o n ta in s l e s s io d in e ( 6) . The c e l l s th e n in c r e a s e in n u m b er and s iz e
to c o m p e n s a te .. P a re n c h y m a to u s g o ite r i s th e f ir s t s ta g e ( 6) . The th y ­
r o i d 's e p i th e lia l c e l l s m u ltip ly a b n o rm a lly (h y p e rp la s ia ) w h en th e
io d in e c o n te n t o f th e th y ro id g o e s b e lo w 0.1% (15). The r e s u l t is a
—8™
h a r d , s y m m e tric a l g o ite r . M u ltip lic a tio n o f th e c e l l s m ay c o n tin u e
u n til e x h a u s tio n , o r i t w ill s to p a n d th e f o ll ic le s f ill w ith c o llo id a l
m a tte r. At th is s e c o n d s ta g e th e g o ite r i s c o llo id a l in n a t u r e , and
v e ry s o f t ( 6) . The io d in e c o n te n t o f th e g la n d m ay b e a d e q u a te fo r a
th y ro id o f n o rm al s i z e , b u t th e re is n o t e n o u g h fo r th e th y r o id 's i n ­
c r e a s e d s i z e . A fter a f i r s t o r s e c o n d s ta g e g o ite r , a n a d e n o m a to u s
g o ite r m ay form ( 6) . A denom as a re a s y m m e tric a l an d u n e v e n . T hey
u s u a lly o c c u r a f te r th ir ty y e a r s o f a g e in h u m a n s . A fter fif te e n y e a rs
o f a n a d e n o m a to u s g o ite r , a to x ic g o ite r m ay d e v e lo p ( 6): th e th y ro id
b e c o m e s h y p e r a c tiv e , so th e th y ro id h o rm o n es a re p r e s e n t in th e b lo o d
a t to x ic l e v e l s . T h y ro to x ic o s is c a n b e f a t a l .
E tio lo g y . ;—T h ere a re s e v e r a l e tio lo g ic a l f a c to r s in sim p le o r
e n d e m ic g o ite r: d ie ta r y io d in e d e f i c i e n c y , g o ite r-p r o d u c in g a g e n t s , o r
g o itro g e n s in th e d i e t , e x c e s s iv e in ta k e s o f c a lc iu m o r f lu o r in e , a n d
h e r e d ity (19). A d e f ic ie n t in ta k e o f io d in e m ay b e a b s o lu te o r r e la tiv e
(20,21)-. A b so lu te d e f ic ie n c y i s th e r e s u l t o f a v e ry lo w d ie ta r y i n ta k e ,
w h e re a s e x c e s s re q u ire m e n ts fo r io d in e b y th e b o d y w ill c a u s e a r e l a ­
tiv e , d e f ic ie n c y o f-io d in e (21) .
A lo w d ie ta r y in ta k e o f io d in e m ay n o t be s o le ly d u e to a b ad
c h o ic e o f food s o u r c e s . The p h y s ic a l e n v iro n m e n t o f th e a re a in q u e s ­
tio n c a n b e a la r g e f a c to r . F oods p ro d u c e d in c e r ta in a r e a s o f th e
w o rld c o n ta in l i t t l e o r no i o d i n e , a s a r e s u l t o f lo w io d in e le v e ls in
-9 -
th e s o il a n d w a te r (2 0 ). A fter th e l a s t Ic e A g e , g la c i e r s r e c e d e d ,
s w e e p in g a w a y th e i o d in e - r i c h s o i l . T hen a p r o c e s s o f re p le n is h in g
th e s o i l b e g a n , u s u a ll y by a ir - b o r n e io d in e from th e s e a . It h a s b e e n
fo u n d t h a t th e s h o r te r a n a r e a 's p o s t - g l a c i a l p e r io d , th e g r e a te r th e
lik e lih o o d o f e n d e m ic g o ite r (2 0 ). A reas w ith a g r e a t d e a l o f ra in an d
flo o d in g l o s e s o il io d in e ; c ro p p in g a ls o d e p le te s th e s o i l 's io d in e
c o n te n t (20 ) .
S o il a n d w a te r c o n te n t a re n o t th e o n ly p h y s ic a l fa c to rs th a t
lim it d ie ta r y in ta k e o f i o d i n e . A c o ld c lim a te w ill in d ir e c tly in flu e n c e
th e p r e v a le n c e o f e n d e m ic , g o ite r a s a r e s u l t o f a n in c r e a s e d d em an d
fo r th y ro id h o rm o n e s to r e g u la te th e b o d y 's m e ta b o lic r a te (2 0) . Io d in e
in ta k e m ay n o t be s u f f ic ie n t to s u p p ly th is in c r e a s e d re q u ire m e n t fo r
th y ro id h o rm o n e s . ' V a ria tio n s in s u n lig h t an d r a in f a ll h a v e b e e n s u g ­
g e s te d a s a f a c to r t h a t in f lu e n c e s th e g o itr o g e n ic p r o p e r tie s o f som e
fo o d s (2 0 ). P ro x im ity to th e s e a m ay a ls o b e im p o rta n t in th e a v a i l a ­
b ility o f s e a f o o d s , w h ic h h a v e a h ig h io d in e c o n te n t (2 0) .
I n h a b ita n ts o f so m e a r e a s o f g o ite r e n d e m ic ity c o n su m e a v e ry
m o n o to n o u s d i e t , w h ic h m ay b e p a r t o f th e ir c u ltu ra l h e r i t a g e . If th e
food i s p ro d u c e d in a n a re a w ith v e ry l i t t l e n a tu ra l io d in e , th e ir d ie t
w ill be d e f ic ie n t in th is e le m e n t (20 ) .
D ie ta r y in ta k e o f io d in e m ay b e a d e q u a t e , a n d i t s a b s o rp tio n
n o rm al; y e t th y ro id e n la rg e m e n t w ill s t i l l o c c a s i o n a l l y o c c u r . Extents i v e r e s e a r c h h a s b e e n d o n e o n g o ite r-p r o d u c in g a g e n ts in food (2 2 ) .
-1 0 -
G o ite r h a s b e e n p ro d u c e d in ra b b its fed c a b b a g e d ie ts (3 ). Blum s u g ­
g e s te d t h a t th e g o itro g e n in c a b b a g e m ay in h ib it r e a c tio n s in th e liv e r
th a t s u p p ly io d in e to th e th y ro id g la n d (2 2 ). C le m e n ts an d W is h a rt
i n v e s t ig a te d p o s s ib le r e a s o n s fo r th e fa ilu re o f a g o ite r p r o p h y la c tic
a tte m p t w ith B elg ian c h ild re n (2 3 ). T hey fo u n d th a t d a iry co w s w e re
c o n su m in g a n u n c o o k e d f o r a g e , c h o u - m o e llie r , th a t w a s know n to
c o n ta in a g o itr o g e n . T h is fo ra g e w a s from th e C ru c ife ra e b r a s s i c a
fa m ily w h ic h a ls o c o n ta in s c a b b a g e (2 3 ). The p r e s e n c e o f a g o itro g e n
in v e g e ta b le o ils h a s b e e n s u g g e s te d : r a ts fed th e s e o ils h a d i n ­
c r e a s e d io d in e r e q u ir e m e n ts . O th e r fo o d s th a t m ay c o n ta in g o itro g e n s
a re : c a u lif lo w e r , tu r n i p s , B ru s s e l s p r o u t s , k a le (2 ), r u t a b a g a , f ilb e r t
n u t s , w a ln u ts , c a n n e d b a k e d b e a n s , s tr in g b e a n s , a n d p e a s (2 5 ).
G ro u n d -n u ts o r p e a n u ts (2 6) , p e a c h e s , p e a r s , s t r a w b e r r i e s , s p in a c h ,
c a r r o t s , a n d p e rh a p s s o y b e a n s a re a fe w m ore o f th e m an y p o s s ib le
»
■
'
-
O
-
J
g o itr o g e n - c o n ta in in g fo o d s (20 ) .
U n d e r c e r ta in c o n d itio n s , th e re i s a n in c r e a s e d n e e d for io d in e
by th e b o d y (21,2 6) . If io d in e in ta k e d o e s n o t m e e t t h e s e e x c e s s r e ­
q u ir e m e n ts , a d e f ic ie n c y w ill r e s u l t (2 7 ).
D u rin g f e ta l l i f e , p u b e rty ,
p re g n a n c y , l a c t a t i o n , a n d m e n o p a u s e , " G ro w th , d i f f e r e n tia tio n , an d
e n e rg y tra n s fo rm a tio n s a re th e g r e a te s t" (27: 1 4 6 3 ). T h e s e p e rio d s a re
w h e n g o ite r m o s t f r e q u e n tly d e v e lo p s . O th e r f a c to rs w h ic h m ay i n ­
c r e a s e th e b o d y 's n e e d for io d in e in c lu d e in f e c tio n , in ju r y , an d th e
p r e s e n c e o f to x ic a g e n ts in th e b o d y (2 7 ).
-1 1 -
E x c e s s iv e m in e ra l in ta k e a n d h e r e d ity a re tw o e tio lo g ic a l fa c to rs
o f g o ite r th a t h a v e b e e n in v e s t i g a t e d . T here h a v e b e e n som e re p o rts o f
e x c e s s i v e c a lc iu m o r flu o rin e in ta k e s c a u s in g g o ite r in a n im a ls (19).
H o w e v e r, D e m a rc h i e t a l . foun d t h a t a r e a s in Ira q w ith h a rd w a te r h a d
no g o ite r e n d e m ic ity (2 8) . E x te n s iv e r e s e a r c h h a s b e e n p erfo rm ed on
th e f a c to r o f h e re d ity in g o ite r e tio lo g y . E arly c o n c lu s io n s in d ic a te
th a t h e r e d ity i s a d e f in ite f a c to r in s u s c e p t i b i l i t y to th y ro id e n la r g e ­
m e n t (2 9 ). The in h e r ita n c e o f a s u s c e p t i b i l i t y to g o ite r m ay d iffe r in
d iff e r e n t fa m ilie s : e ith e r r e c e s s i v e o r d o m in a n t g e n e s , a n d s e x - lin k e d
o r n o n - s e x - lin k e d g e n e s (2 9 ).
I n c i d e n c e . — In c id e n c e o f g o ite r in c e r ta in a r e a s o f th e U n ite d
S ta te s is m uch g r e a te r th a n in o th e r a r e a s (F ig u re 3 ). In 1920 a g o ite r
s u rv e y w a s m ade by th e U n ite d S ta te s D ra ft Board ( 4 ) Th e y c o n s id e re d
g o ite r s o n ly so la rg e th a t m ilita ry c o lla r s c o u ld n o t be b u tto n e d a ro u n d
th e d r a f t e e 's n e c k . M o n ta n a h a d th e fo u rth l a r g e s t r a tio o f g o ite rs p e r
I fiOOOmen d ra fte d : 21.00 (4 ). In g e n e r a l, g o ite r is m o s t p re v a le n t in
th e G re a t L a k e s re g io n a n d th e P a c if ic N o rth w e st (4 ). O le s e n com ­
p ile d s u rv e y d a ta on c h ild re n in 43 s t a t e s , an d fo u n d a g o ite r i n c i ­
d e n c e o f te n to fif ty tim e s m ore th a n th e D ra ft Board (4 ). T h is w as
m a in ly d u e to th e s m a lle r s iz e o f g o ite r re p o rte d b y O l e s e n 1s d a ta . A
s u rv e y o f 9,321 c h ild re n in s e v e n M o n ta n a c o u n tie s r e v e a le d a n i n c i ­
d e n c e o f th y ro id e n la rg e m e n t a s fo llo w s : 13.4% fo r b o y s , an d 32.0% fo r
g ir ls (4 ,3 0 ,3 1 ). G o ite r i s u s u a lly c o n s id e r e d to b e m ore p re v a le n t in
i
ND
I—*
I
G o ite r B elts
F ig u re 3 — G o ite r B elts o f th e U n ite d S ta te s
(S c rim sh a w , N . 1 9 6 4 . The g e o g ra p h ic p a th o lo g y
o f th y ro id d i s e a s e . In The T h y ro id . J. H azard
a n d D . S m ith , e d s . B altim ore: W illia m s and
W ilk in s , p . 101)
—13 —
th e .fem ale p o p u la tio n , d u e to a g r e a te r n u m b er o f s t r e s s p e rio d s d u rin g
th e liv e s o f f e m a l e s , s u c h a s p re g n a n c y (15). F ig u re s fo r c o m p a ra tiv e
in c id e n c e b e tw e e n fe m a le s a n d m a le s ra n g e from 6:1 to 5:2 (4,15,27,
3 0,31).
P ro p h y la c tic m e a s u re s . — G o ite r p ro p h y la x is is c o n s id e re d
e s s e n t i a l n o t o n ly to p re v e n t g o ite r i t s e l f , b u t a ls o to p re v e n t th e
c o m p lic a tio n s t h a t go w ith th e d i s e a s e (3 2 ). If a m o th e r la c k s io d in e
h e r fe tu s w ill f a il to d e v e lo p n o rm a lly . P h y s ic a l r e ta r d a tio n c a n be
c o rre c te d w ith io d in e a d m in is tr a tio n , b u t th e r e s u ltin g m e n ta l r e ta r d a ­
tio n i s i r r e v e r s ib le . T here is o fte n a n e e d fo r s u r g ic a l p ro c e d u re s in
th e tre a tm e n t o f g o ite r . P ro p h y la x is w o u ld p re v e n t th e n e e d for th e s e
o p e r a tio n s , w ith th e i r e x p e n s e s a n d c o m p lic a tio n s (3 2 ). G o ite r p ro ­
p h y la x is is m ore e f f e c tiv e w h en a p p lie d a s e a r ly in lif e a s p o s s ib le
(3 3 ). C u rtis a n d F ertm an b e lie v e a p p lic a tio n c o u ld b e d e c r e a s e d a f te r
p u b e rty in m a le s , b u t s h o u ld c o n tin u e th ro u g h o u t a f e m a le 's re p ro ­
d u c tiv e y e a r s (3 3 ).
E a rly m e th o d s o f g o ite r tr e a tm e n t an d p ro p h y la x is go b a c k to th e
re c o m m e n d a tio n o f s e a w e e d by C h in e s e a u th o r itie s ( I ) . In th e tw e lfth
c e n tu ry A .D . R oger o f S a le m o re c o m m e n d e d b u rn t s p o n g e fo r g o ite r
tr e a tm e n t. O ne o f th e f i r s t an d m o s t w id e ly - u s e d p ro p h y la c tic , m e a ­
s u r e s in th e U n ite d S ta te s w a s io d iz e d s a l t .
H ir s c h f e l d e r , in 1 9 2 2 ,
w ro te t h a t th e la c k o f io d in e in ta k e w a s a food d e f ic ie n c y , an d so
io d in e s h o u ld be s u p p lie d w ith a fo o d s o u rc e (3 4 ). Io d iz e d ta b le s a l t
-14-
w a s re c o m m en d e d a s th e m o st c o n v e n ie n t lo n g -te rm m e th o d o f a d m in ­
is te r in g io d in e . H irs c h fe ld e r a ls o g a v e a r e c ip e fo r th e p re p a ra tio n o f
io d iz e d s a l t by a h o u s e w if e .
K now ledge th a t g o ite r w a s p r e v a le n t in M ic h ig a n le d to a c a m ­
p a ig n fo r m a s s g o ite r p ro p h y la x is (3 5 ). In 1924 S h erm an reco m m en d ed
in v e s tig a tio n in to c o m p u lso ry s a l t io d in a tio n a s a .m ea n s, o f g o ite r p r e ­
v e n tio n (3 6) . In 1 9 2 4 , O lin a ls o e n d o rs e d io d iz e d s a l t a s th e m o st
c o n v e n ie n t v e c to r fo r io d in e (3 5 ). The f i r s t c o n c e n tr a tio n o f io d in e
a d d e d to s a l t , u s e d in M ic h ig a n , w a s 0.02% o f th e s a l t a s so d iu m
io d id e (3 3 ). M a r in e , h o w e v e r, "recom m ended a c o n c e n tra tio n o f 0.005%
to 0.01% so d iu m o r p o ta s s iu m io d id e (2 6) . In 1949 th e A m erican P u b lic
H e a lth A s s o c ia tio n th e n re c o m m en d e d a c o n c e n tra tio n o f 0.01% p o t a s ­
siu m io d id e a s s u f f ic ie n t fo r.p ro p h y la x is (3 3 ). On th e a s s u m p tio n th a t
a v e r a g e s a l t in ta k e w a s 6.2 gram s p e r d a y , 4 7 4 m ic ro g ra m s io d in e
w o u ld b e c o n su m e d w ith th e re c o m m en d e d c o n c e n tra tio n o f 0.01%
p o ta s s iu m io d id e (3 3 ).
T h ere w e re som e o b je c tio n s to th e u s e o f io d iz e d s a l t . In 192 8
o n e re p o rte d r e s u l t o f io d iz e d s a l t in ta k e b y th o s e p e o p le w ith th y ro id
e n la r g e m e n ts w a s h y p e rth y ro id ism (3 7 ). K im ball s tu d ie d th e s itu a tio n
in h u m a n s . He fo u n d m uch l e s s h y p e rth y ro id ism am ong th o s e w ho h a d
u s e d io d iz e d s a l t th a n am ong th o s e w ho h a d n o t u s e d a n y io d iz e d s a l t
b e fo re (3 7 ). A n o th er o b je c tio n to io d iz e d s a l t w a s th e o x id a tio n l o s s
o f io d in e t h a t o c c u rre d d u rin g s to r a g e (3 8 ). Io d iz e d s a l t fo r h u m a n s,
—15 —
0.02 %, l o s t fo rty p e r c e n t o f i t s io d in e in e ig h te e n m o n th s (3 8 ).
S to ra g e lo s s w a s f in a lly c u t to 0.9% o f th e io d in e in fo u r m o n th s by
m illin g th e p o ta s s iu m io d id e w ith c a lc iu m s t e a r a t e .
I o d in a tio n o f s a l t is n o t a lw a y s p r a c tic a l (3 9 ). T h ere a re s e v ­
e r a l o th e r m e a n s o f g o ite r p r o p h y la x is . Io d iz e d w a te r w a s a m ajo r
p o s s i b i l i t y re c o m m en d e d b y S h erm an (3 6 ). In th e e a r ly 1 9 2 0 's ,
R o c h e s te r , N ew Y o rk , in te r m itte n tly io d iz e d th e ir w a te r fo r tw o y e a rs
(4 0 ). The io d in e c o n c e n tr a tio n w a s so lo w th a t tw o q u a rts o f w a te r .
h a d to be c o n su m e d d a ily b y e a c h p e r s o n (4 0 ). In h a la tio n o f a 10%
io d in e s u s p e n s io n p ro v e d to b e u n p o p u la r, a s d o s a g e w a s v a ria b le
(4 0 ). An io d id e s a l t in a ta b le t o r s o lu tio n form h a d a d is a g r e e a b le
t a s t e , e v e n w h en m ix ed w ith l a c t o s e , m ilk s u g a r (4 0 ). Io d iz e d c h o c o ­
la te t a b l e t s w e re u s e d in M ic h ig a n , b u t w e re found to b e c u m b erso m e
fo r m a s s p r o p h y la c tic m e a s u re s (4 0 ).
Io d iz e d o il in je c tio n s w ere
g iv e n to N e w G u in e a n a tiv e s in 1965 (41). A lth o u g h th is m eth o d d id
n o t c a u s e a n y i l l e f f e c ts , in je c tio n s a re fe a re d b y m an y p e o p le , so
th e s u c c e s s o f a m a s s in je c tio n pro g ram is q u e s tio n a b le .
E x te n s iv e s u rv e y s h a v e b e e n c o n d u c te d in M ic h ig a n a n d O h io to
t e s t th e e f f e c t o f g o ite r p ro p h y la x is w ith io d iz e d s a l t (3 ). A su rv e y
w a s c o n d u c te d in O hio in 1925 b e fo re s a l t io d in a tio n , w h ic h b e g a n in
1 9 2 9 . R e s u lts o f a r e s u r v e y in 1955 b y H am w i e t a l . s h o w e d th a t th e
in c id e n c e o f th y ro id e n la rg e m e n t d e c r e a s e d from 32.3% to 4.05% (4 2 ). ■
O f th o s e th y ro id s e n la r g e d a t a l l , 99.9% w e re o n ly s lig h tly e n la r g e d .'
-1 6 -
In C le v e la n d K im ball found m any w e re n o t u s in g io d iz e d s a l t b e c a u s e
i t w a s " m e d ic a te d " s a l t (4 3 ). A n o th er co m m ent w a s t h a t a s th e re h a d
b e e n no r e c e n t p u b lic ity , th e g o ite r " e p id e m ic " h a d p a s s e d . K im ball
s u g g e s te d c h a n g in g " io d iz e d " s a l t to " e n ric h e d " s a l t , a s som e n a tu ra l
s a l t d o e s c o n ta in io d in e .
G o ite r p ro p h y la x is w ith io d iz e d s a l t h a s b e e n s u c c e s s f u l in
o th e r a r e a s o f th e w o r ld . G o ite r in c id e n c e s o f 98% , 95% , an d 85%
h a v e b e e n re d u c e d to 32% , 30% , a n d 23% , r e s p e c t i v e l y , in S o u th '
A m erica (4 4 ).
O th e r th y ro id d is o rd e rs
C re tin is m a n d m y x e d e m a . — G o ite r is n o t th e o n ly r e s u l t o f
io d in e d e f ic ie n c y . W h en a n tith y ro id d ru g s a re g iv e n to fe m a le m am ­
m a ls , th e ir o ffs p rin g e x h ib it s ig n s o f c re tin is m (16). C re tin is m is a
la c k o f n o rm al g ro w th a n d d e v e lo p m e n t d u rin g f e ta l lif e ( 6) . D e g e n e r­
a tio n o f th e th y ro id a f te r b irth i s know n a s m y x ed em a ( 6) . M y x ed em ic
■humans a ls o la c k n o rm al g ro w th an d d e v e lo p m e n t.
C a n c e r . — N in e ty p e r c e n t o f a ll c a n c e r s o f th e th y ro id a r is e
from g o ite r s (2 6) . R e c e n tly , in itia tio n o f b r e a s t c a n c e r in fe m a le r a ts
h a s b e e n fo u n d to o c c u r d u rin g io d in e d e f ic ie n c y (4 5 ). U n til c a r ­
c in o m a d e v e lo p s , th e p r o c e s s is r e v e r s i b l e , a lth o u g h tre a tm e n t w ith
io d in e m ay be in h ib ite d by s e x h o rm o n e s s u c h a s e s tr o g e n . E sk in
th e re fo re s u g g e s te d a w o m a n 's io d in e s ta t u s s h o u ld b e c h e c k e d b e fo re
-1 7 -
e s tr o g e n tre a tm e n ts fo r c o n tr a c e p tio n o r p o s t- m e n o p a u s e a re
in itia te d .
E ffe c ts o f E x c e s s iv e Io d in e In ta k e
E ffe c ts o f e x c e s s i v e io d in e in ta k e h a v e b e e n r e c o r d e d . A stw o o d
c o n s id e r e d a n in ta k e o f fiv e m illig ra m s d a ily to b e e x c e s s i v e (3 2 ).
T h is c a n be c o m p a re d to th e p r e v io u s ly d i s c u s s e d a v e r a g e in ta k e o f
io d in e , 4 7 4 m ic ro g ra m s p e r d a y o r o n e - te n th o f fiv e m illig ra m s , b y th e
u s e o f io d iz e d s a l t (3 3 ). In 1926 H a rts o c k re p o rte d th e tre a tm e n t o f
s ix te e n m en fo r h y p e rth y ro id ism -, w h ic h w a s a ttr ib u te d to c o n tin u e d
u s e o f io d iz e d s a l t (4 6 ). He fo u n d a d e f in ite c o r r e la tio n b e tw e e n
h y p e rth y ro id ism an d th e u s e o f io d iz e d s a l t in o n e - f o u r th o f th e .a f o r e m e n tio n e d c a s e s (4 6 ). In 1953 M o rg a n s a n d T ro tte r re p o rte d o n tw o
c a s e s o f m yxedem a a ttr ib u te d to io d id e a d m in is tra tio n (4 7 ). W h en th e
io d id e - c o n ta in in g m e d ic a tio n w a s d is c o n tin u e d , sy m p to m s o f
m y x ed em a d is a p p e a r e d . The m o s t r e c e n t r e s e a r c h o n th e "su b ject o f
e x c e s s i v e io d in e in ta k e p o in te d to a n a u to re g u la to ry s y s te m to p r e ­
v e n t la rg e u p ta k e s o f io d id e b y th e th y ro id (4 8 ,4 9 ). S o c o lo w e t a l .
■
(48) e x p e rim e n t w ith r a t s , arid Y am am oto e t a l . (40) fo u n d a u to r e g u la I
tio n in h u m a n s .
-18-
D ie ta r y R e q u ire m e n ts fo r Io d in e b y th e Body
B a la n c e S tu d ie s o n Io d in e In ta k e
R e s u lts o f io d in e b a la n c e s tu d ie s w ith h e a lth y s u b je c ts (5 0 ), th e
.
n o n g o itro u s w ith lo w io d in e in ta k e s (51), an d p re g n a n t fe m a le s (52)
sh o w e d c o n s i s t e n t n e g a tiv e b a l a n c e s . The th y ro id a c q u ir e s 25 -3 5 % o f
in g e s t e d io d in e , a n d th e r e s t is e x c r e t e d , m a in ly in th e u rin e (10).
V ought a n d L o n d o n 's s tu d y o f th re e in p a tie n ts sh o w e d a n o b lig a to ry
io d in e e x c r e t i o n , no m a tte r how l i t t l e io d in e w a s c o n su m e d (5 0 ).
M a lv a u x e t a l . s tu d ie d n o n g o itro u s c h ild re n an d a d o le s c e n ts w h o se
io d in e in ta k e s w e re b e lo w 50 m ic ro g ra m s d a ily (51). Io d in e e x c r e tio n
c o n s i s t e n t l y e x c e e d e d io d in e in ta k e . I t w a s s u g g e s te d th a t th e re m ay
be o c c a s io n a l d a y s w ith e x tre m e ly h ig h in ta k e s o f i o d i n e , o r th e th y ­
ro id w o u ld b e co m e d e p le te d w ith in fo u r m o n th s (51). D w o rk in e t a l .
fo u n d no d iff e r e n c e in io d in e b a la n c e b e tw e e n p re g n a n t an d n o n p re n a n t fe m a le s (5 2 ). T h ere w a s a lso , no d iff e r e n c e b e tw e e n th e a n t e o r p o s t- p a r tu m m o n th s o f p re g n a n t !subj e c ts .
R ecom m ended In ta k e o f Io d in e
In 19 68 a n o f f ic ia lly r e c o g n iz e d d a ily re q u ire m e n t fo r io d in e w a s
e s t a b l i s h e d (5 3 ). C u rtis a n d F e rtm an s tu d ie d io d in e b a la n c e e x p e r i­
m e n ts , a n d c o n c lu d e d th a t 1 0 0 -2 0 0 m ic ro g ra m s o f io d in e w ere re q u ire d
for n o rm a l th y ro id a c ti v ity in a d u lts (3 3 ). In 19 55 A stw o o d re p o rte d
th a t th e a c c e p te d d a ily re q u ire m e n t fo r io d in e w a s 1 0 0 -2 00 m icro g ram s
-19-
(3 2 ). The Food an d N u tritio n Board o f th e N a tio n a l A cadem y of
S c i e n c e s —N a tio n a l R e s e a rc h C o u n c il e s ta b lis h e d io d in e r e q u ir e ­
m e n ts fo r r e s id e n ts o f th e U n ite d S ta te s (T able I ) . The Board in d i­
c a te d th a t 75 m ic ro g ra m s o f io d in e p e r d a y w a s th e m inim um am o u n t o f
io d in e n e e d e d by a n a d u lt (5 3 ).
S o u rc e s o f Io d in e in th e U n ite d S ta te s o f A m erica
N o n -g o itr o u s re g io n s . N o n -g o itf o u s re g io n s h a v e m an y s o u r c e s o f io d in e . O ne o f th e
m o s t b a s i c s o u r c e s i s w a te r .
H o w e v e r, so m e a r e a s h a v e b eco m e
g o itro u s w h en th e ir w a te r s u p p ly w a s c h a n g e d (54).. W h en th e w a te r
s u p p ly o f S t. G e o r g e , U ta h , w a s c h a n g e d from w e lls a n d s u rfa c e
s p rin g s to a n ig n e o u s ro c k s o u r c e , g o ite r b e c a m e e n d e m ic to th a t a re a
(5 4 ). S e a c o a s t a re a 's o fte n h a v e a s o u rc e o f io d in e in th e s e a food
a v a ila b le (5 5 ). V e g e ta b le s an d d a iry p ro d u c ts p ro d u c e d in io d in e - r ic h
s o il o fte n c o n trib u te m ore to to ta l d ie ta r y io d in e th a n s e a food (5 6 ). •
G o itro u s re g io n s
In g e n e r a l. — G o itro u s re g io n s m u s t re ly on io d iz e d s a l t or food
p ro d u c e d in n o n - g o itr o u s re g io n s a s s o u r c e s o f io d in e (3 6 ). J a rv is e t
a l . re c o m m e n d e d c a n n e d f i s h , e s p e c i a l l y s a lm o n , a s a s o u rc e of
io d in e (5 5 ).
M o n ta n a . - - M c C le n d o n re p o rte d th a t th e re w a s a le v e l o f
0.015 m ic ro g ra m s o f io d in e p e r k ilo g ra m o f w a te r in B o ze m a n , M o n tan a
-2 0 -
..
TABLE I
RECOMMENDED DAILY DIETARY ALLOWANCES
FOR IODINE
Age (y e a rs)
From
In fa n ts
C h ild re n
M a le s
F e m a le s
P re g n a n c y
L a c ta tio n
S o u rce:
Io d in e
Up to
' (ug)
0-1/6
V e -V z
V z-i
.
1 -2
' ‘
2 -3
3.-4.', ' .
4 —6
6 -8 :■
8 -1 0
N O -12 ,
1 2 -1 4
1 4 -1 8
1 8 -3 5
3 5 -5 5
5 5 -7 5 +
1 0 -1 2
112-14
1 4 -1 6
1 6 -1 8
1 8 -3 5
'3:5-55
5 5 -7 5 +
25
40
45
55
60
70
80
.100
HO
-
125
135
150
140
125
110
no
115
120
115
100
90
80
125 .
150
Food an d N u tritio n B o a rd , N a tio n a l A cadem y o f S c ie n c e s —
N a tio n a l R e s e a rc h C o u n c il. 19 68. R ecom m ended D ie ta ry
A llo w a n c e s . 7 th e d . W a s h in g to n , D . C .: N a tio n a l
A cadem y o f S c ie n c e s , P u b lic a tio n 1694.
—2 1 —
(2 9 ). W a te r i s n o t, th e r e f o r e , a v e ry good s o u rc e o f io d in e in
.B o zem an . The le v e l o f io d in e re p o rte d w a s th e fo u rth lo w e s t.c o n c e n ­
tr a tio n o f th e m any c i t i e s in th e c o u n try th a t w ere ta b u la te d .
The r e s u l t s o f a g o ite r s u rv e y in M o n ta n a w e re re p o rte d in 1929
b y O le s e n (3 2 ), b u t no d a ta w a s fo u n d to in d ic a te th a t a g o ite r s u rv e y
h a s b e e n c o n d u c te d s in c e th e n . Food tr a n s p o r ta tio n a n d p a c k a g in g
m e th o d s h a v e im p ro v ed s in c e 1929 , so M o n ta n a r e s id e n ts m ay b e c o n .
su m in g e n o u g h good s o u r c e s o f io d in e to p re v e n t th e fo rm a tio n o f
g o i t e r s . The fo llo w in g c h a p te r s w ill d i s c u s s a p ilo t s tu d y th a t w a s
c o n d u c te d to d e te rm in e th e n e e d fo r a n e x te n s iv e g o ite r s u rv e y in
M o n ta n a .
K im ball (43) m e n tio n e d th a t th e c o n su m e r n e e d s to b e c o n s ta n tly
e d u c a te d a b o u t th e n e e d fo r u s e o f io d in e - r ic h food s o u r c e s in th e
g o ite r b e l t s . T h e re fo re th e fo llo w in g s tu d y w ill a ls o a tte m p t to i n d i - ■
c a te w h e th e r o r n o t e d u c a tio n i s n e e d e d in th e p o p u la tio n th a t w as
s a m p le d .
CHAPTER III
METHOD
■
S u rv ey In s tru m e n t
A s tr u c tu r e d in te r v ie w form w a s d e v is e d w ith th e a s s is ta n c e - o f
g ra d u a te c o m m itte e m e m b e rs . The form (A ppendix A) w a s u s e d to o b ­
ta in in fo rm a tio n from th e m em ber o f th e h o u s e h o ld c o n c e rn e d w ith food
b u y in g .
The a g e o f th e f o o d - b u y e r , w h e th e r o r n o t th e fa m ily had m em ­
b e rs e a tin g b a b y fo o d a n d /o r fo rm u la , a n d w h e th e r o r n o t th e re w e re
h o u s e h o ld m em b ers on a lo w s a l t d ie t w a s d e te rm in e d to in d ic a te th e
c h a r a c t e r i s t i c s o f th e s a m p le f a m ilie s . In fo rm a tio n a b o u t th e u s e o f
io d iz e d s a l t w h ile d in in g , c o o k in g , a n d p ic k lin g w a s o b ta in e d by th e
.
in te r v ie w . The form w a s a ls o u s e d to d e te rm in e r e a s o n s fo r u s e or
n o n - u s e o f io d iz e d s a l t , if th e re w a s a w a re n e s s o f th e p r a c tic e o f
u s in g io d iz e d s a l t , a n d w h e re o r from whom in fo rm a tio n c o n c e rn in g th e
u s e o f io d iz e d s a l t w a s o b ta in e d . The fre q u e n c y w ith w h ic h th e h o u s e ­
w ife s e r v e d o c e a n f is h an d s h e l l f i s h w a s d e te rm in e d b y th e in te rv ie w
q u e s ti o n s .
The o rig in a l q u e s tio n n a ir e w a s a d m in is te r e d to te n h o u s e h o ld s
from th e s a m p le . As o n ly m in o r r e v is io n s w e re n e c e s s a r y , th e s e te n
fa m ilie s w e re in c lu d e d in th e s a m p le .
-23-
An a n s w e r s h e e t (A ppendix B) w a s u s e d to m ark r e p lie s to q u e s ­
t i o n s , a s d a ta ta b u la tio n w o u ld b e e a s i e r from o n e p a g e o f d a ta p e r
h o u s e h o ld .
S am p lin g P ro c e d u re
An a lp h a b e tic a lly o rd e re d l i s t o f m a rrie d s tu d e n t h o u s in g r e s i ­
d e n ts d u rin g S p rin g Q u a r te r , 1 9 7 0 , w a s 'o b ta in e d from th e H o u sin g
O ffic e a t M o n ta n a S ta te U n iv e r s ity . A sa m p le o f 83 f a m ilie s , from a
to t a l o f 4 4 4 , w a s s e l e c t e d from th is l i s t w ith th e u s e o f c o n s e c u tiv e
o n e - d i g i t n u m b ers in a ta b le o f random n u m b e rs . The f i r s t n u m b er in
th e ta b le w a s th e n u m b er o f th e f i r s t sa m p le h o u s e h o ld , b e g in n in g
w ith th e to p o f th e l i s t .
For e x a m p le , i f th e f ir s t n u m b er w a s t h r e e ,
th e th ird fa m ily o f th e l i s t w a s th e f i r s t fa m ily s a m p le d . E ach s u b s e ­
q u e n t n u m b er in th e ta b le in d ic a te d th e nu m b er o f f a m ilie s , from th e
l a s t o n e s a m p le d , th a t w e re c o u n te d b e fo re a n o th e r h o u s e h o ld w a s
c h o s e n . For e x a m p le , i f th e n u m b er s ix w a s th e n e x t o n e in th e t a b l e ,
th e s ix th fa m ily a f te r th e o n e p r e v io u s ly s a m p le d w a s s e l e c t e d a s th e
n e x t s a m p le h o u s e h o ld .
I f , d u rin g th e s u r v e y , i t w a s fo u n d th a t th e s e le c te d fa m ily h a d
m o v e d , an d a n o th e r fa m ily w a s in r e s i d e n c e , th e fa m ily a t th e r e s i ­
d e n c e w h e n th e in te r v ie w e r m ade h e r v i s i t w a s u s e d in th e s a m p le . If
th e r e s id e n c e w a s v a c a n t , i t w a s c o n s id e r e d a n o n - r e p ly .
—2 4 “
S u rv ey M eth o d
The h o u s e w ife o f e a c h sa m p le h o u s e h o ld w a s s e n t a l e tte r o f i n ­
tr o d u c tio n (A ppendix C ) . T his l e t t e r m e n tio n e d th e s u b je c t o f th e
s u r v e y , d e s c r ib e d th e c ir c u m s ta n c e s u n d e r w h ic h th e s u rv e y w as b e ­
in g c o n d u c te d , a n d a s k e d fo r c o o p e r a tio n w h en th e in te rv ie w e r
a rriv e d .
S tru c tu re d in te rv ie w s w e re c o n d u c te d w ith th e m em ber o f th e
h o u s e h o ld r e s p o n s ib le for c h o o s in g th e food th a t th e fa m ily p u r c h a s e d .
The f i r s t v i s i t w a s m ade d u rin g th e m orning h o u rs . If th e d e s ir e d
h o u s e h o ld m em ber w a s n o t a t h o m e , up to tw o m ore tr ip s w e re m ade
d u rin g e v e n in g h o u r s . I f th e s u b je c t s t i l l c o u ld n o t b e r e a c h e d , a
m axim um o f tw o te le p h o n e c a ll s w e re m ad e to try a n d e s t a b l i s h s u i t ­
a b le h o u rs fo r a n in te r v ie w . T h e s e te le p h o n e c a ll s w e re m ade d u rin g
th e e a r ly e v e n in g . If th e h o u s e h o ld c o u ld n o t be re a c h e d by te le p h o n e ,
a d d itio n a l v i s i t s w e re m ade to try an d c o n ta c t th e h o u s e h o ld m e m b e r.
In te rv ie w s w ith m em bers o f 66 h o u s e h o ld s w e re c o n d u c te d , a
re tu rn o f 79.5% on th e o rig in a l s a m p le . O f th e 17 h o u s e h o ld m em bers
th a t c o u ld n o t be in te r v ie w e d , fo u r(23.5%) w e re u n c o o p e r a tiv e , fiv e
(29.4%) c o u ld n o t be r e a c h e d by p e r s o n a l v i s i t s o r te le p h o n e c a l l s ,
a n d e ig h t (47.0%) h a d m o v e d , le a v in g a v a c a n t r e s i d e n c e .
-2 5 -
S u rv ey o f G ro c e ry S to re s
An in fo rm a l s u rv e y w a s m ad e o f fiv e g ro c e ry s t o r e s , tw o la rg e
an d th re e s m a ll o n e s , to d e te rm in e : (I) i f th e re w a s any. d iffe re n c e in
p ric e b e tw e e n io d iz e d an d u n io d iz e d s a lt; an d (2) a p p ro x im a te ly how
m uch io d iz e d s a l t w a s s o ld c o m p ared to u n io d iz e d s a l t .
The s to re
m a n a g e r, o w n e r, o r p e rs o n r e s p o n s ib le fo r o rd e rin g ite m s s o ld b y th e
s t o r e s , w a s c o n ta c te d fo r a n e s tim a te o f th e s a le s v o lu m e s for io d iz e d
a n d u n io d iz e d s a l t .
' T re a tm e n t o f D a ta
" The in te r v ie w a n s w e r s h e e ts w e re t a llie d o n to sum m ary a n s w e r
s h e e ts fo r th e to ta l sa m p le (A ppendix D) an d for e a c h a g e group (Ap­
p e n d ix E ). B e c a u se th e n u m b ers o f r e s p o n d e n ts from th e 31 to 40 an d
41 to 50 a g e g ro u p s w e re s m a ll, t h e s e tw o g ro u p s w e re co m b in ed in to
o n e a g e group o f 31 to 50 y e a r s .
P e r c e n ta g e s w e re a lw a y s u s e d to co m p are d a t a . In som e i n ­
s ta n c e s th e c a te g o r ie s u s e d in ta b u la tio n s w e re s u c h th a t th e to ta l
n u m b er o f r e s p o n d e n ts in e a c h c a te g o ry w a s n o t th e s a m e , for e x a m p le ,
th e c o m p a ris o n o f a tre n d b e tw e e n io d iz e d an d u n io d iz e d s a l t u s e r s .
In th o s e c a s e s , b o th n u m b e rs an d p e r c e n ta g e s w e re g iv e n .
D a ta is n o t ta b u la te d in a g e c a t e g o r i e s , a s a n a ly s is in d ic a te d
th a t th e re w e re no tr e n d s th a t d e p e n d e d on th e a g e o f th e r e s p o n d e n t.,
A ls o , o n e a g e group d o m in a te d th e sa m p le (C h a p te r IV), so c o m p a ri­
s o n s b e tw e e n a g e g ro u p s w o u ld be u n r e a l i s t i c .
CHAPTER IV
RESULTS AND DISCUSSION
C h a r a c te r is tic s o f th e S am ple
S i x t y - s i x h o u s e h o ld m em b ers r e s p o n s ib le fo r th e c h o ic e o f food
th a t is p u rc h a s e d b y th e ir fa m ilie s w e re in te r v ie w e d . The m a jo rity o f
r e s p o n d e n ts (62.1%) w e re in a n a g e ra n g e o f 21 to 25 y e a r s (F igure 4 ).
Few h o u s e h o ld s h a d m em b ers on s p e c i a l d ie ts (F ig u re 5): a b o u t o n e fifth (21.2%) o f th e h o u s e h o ld s in c lu d e d in f a n ts e a tin g b a b y food o r
fo rm u la , a n d 12.2% o f th e fa m ilie s h a d m em b ers o n a lo w s a l t d ie t.
S a lt U s a g e
A la rg e p e r c e n ta g e (83.3%) o f th e in te r v ie w e e s in d ic a te d th a t
th e y u s e d s a l t o n ly fo r c o o k in g a n d a t th e ta b le (F ig u re 6): o n ly o n e fifth (21.4%) o f th o s e h o u s e h o ld s w ith in f a n ts a d d e d s a l t to th e ir i n ­
f a n ts ' food; a n d 12.1% o f th e h o u s e w iv e s in th is p o p u la tio n h a d c a n n e d
fo o d t h a t re q u ire d th e u s e o f s a l t .
F ig u re 7 s h o w s th e p e r c e n ta g e o f h o u s e h o ld s th a t u s e io d iz e d
s a l t (72.7%) w h e n c o o k in g an d e a ti n g . I t sh o u ld b e n o te d th a t o f th e
27.3% th a t w e re u s in g u n io d iz e d s a l t w h en in te r v ie w e d , 3.3% s a id th e y
u s u a lly u s e d io d iz e d s a l t , b u t h a d p u r c h a s e d th e w ro n g k in d (A ppendix
D ). The r e s u l t s o f t h i s s u rv e y a re c o m p a ra b le to th o s e o f a n a tio n w id e
s u rv e y in 1957, w h ic h in d ic a te d th a t 76% o f th e h o u s e h o ld s u s e d
io d iz e d s a l t e x c l u s i v e l y , 20% n e v e r u s e d i t , an d 4% u s e d i t p a rt o f
-2 7 -
16 -2 0 y e a rs
13.6%
2 1 -2 5 y e a rs
62.1%
41-50 y e a r s
31-40 y e a r s
2 6 -3 0 y e a rs
15.2%
F ig u re 4 — Age D is trib u tio n o f S am ple
Per c e n t
21 . 2 %
12. 1 %
In fa n ts
Low S a lt
D ie t
F ig u re 5 — P e rc e n ta g e o f H o u s e h o ld s w ith M em b ers
on S p e c ia l D ie ts
—2 8 —
P er c e n t
25-
21.4%
12.1 %
In f a n ts
Food
Home
C a n n in g
F ig u re 6 — P e rc e n ta g e o f F a m ilie s U sin g S a lt O th e r
T han a t th e T a b le o r D u rin g C o o k in g
Per cen t
27.3%
a
io d iz e d
m
u n io d iz e d
75.0%*
72.7%
72.7%
T ab le
27.3%
25.0%
C o o k in g
P ic k lin g
F ig u re 7— P e rc e n ta g e o f H o u s e h o ld s U sin g Io d iz e d or
U n io d iz e d S a lt fo r V ario u s P u rp o se s
* T o tal n u m b er o f th o s e w ho p ic k le d food is e ig h t.
-2 9 -
th e tim e (3 ). H o w e v e r, th e U n ite d S ta te s D e p a rtm e n t o f A g ric u ltu re
(57) re p o rte d th a t in th e ir 19 65 H o u se h o ld Food C o n su m p tio n S u rv ey
85% o f th e f a m ilie s th a t b o u g h t s a l t , in th e w e ek th a t h o u s e h o ld s w e re
s u r v e y e d , b o u g h t io d iz e d s a l t . The a b o v e d a ta p o in ts o u t th a t e v e n
th o u g h a g r e a t d e a l.o f M o n ta n a i s in a g o ite r b e l t , th e p e rc e n ta g e o f
io d iz e d s a l t u s e r s is l e s s th a n th a t sa m e p e rc e n ta g e in th e m o st r e -
-
c e n t s u rv e y o f th e U n ite d . S t a t e s .
T h r e e -fo u r th s o f th o s e h o u s e w iv e s w ho d id so m e c a n n in g w ith
s a l t s a id th e y u s e d u n io d iz e d s a l t — e ith e r ta b le o r r o c k - s a l t .(F igure 7).
Rock s a l t c a n b e b o u g h t in la rg e b a g s , s o w h e n la rg e b a tc h e s o f
p ic k le s a re b e in g m a d e , i t is p ro b a b ly th e m o st c o n v e n ie n t form o f
s a l t . In 1952 th e n e e d to u s e u n io d iz e d s a l t w h en c a n n in g w a s r e ­
fu te d by th e U .S . C a n n e r 1s A s s o c ia tio n , w h ic h h a s s t a t e d th a t th e re is
no d is a d v a n ta g e to th e u s e o f io d iz e d s a l t in a ll c a n n in g o p e ra tio n s
( 5 8 ) ..
A c o m p a riso n b e tw e e n th e p e r c e n ta g e o f h o u s e h o ld m em b ers w ho
u s e io d iz e d s a l t (72.7%) an d th o s e w ho h a v e h e a rd o f u s in g io d iz e d
s a l t (80.3%) c a n b e s e e n in F ig u re 8 . T h at th e re is a d is c r e p a n c y b e ­
tw e e n k n o w le d g e a n d a p p lic a tio n o f th a t k n o w le d g e is e v id e n t in th is
su rv e y .
A lth o u g h F ig u re 9 sh o w s t h a t a m a jo rity (54.5%) o f th o s e w ho
b o u g h t io d iz e d s a l t p u r c h a s e d in b e c a u s e th e y f e lt i t w a s b e tte r for
th e ir h e a l t h , th e re w a s a la rg e p e r c e n ta g e (42.4%) o f h o u s e h o ld
-3 0 -
80.3%
72.7%
Io d iz e d S a lt
H e ard o f
Io d iz e d S a lt
F ig u re 8 — H o u s e h o ld s U sin g Io d iz e d S a lt C o m p ared to
T h o se W h ic h H av e Heard of U sin g Io d iz e d S a lt
B e tte r for
H e a lth
54.5%
B e tte r T a s te
18.2%
I
I Io d iz e d
U n io d iz e d
F ig u re 9 — R e a s o n s for P u rc h a s e o f Type o f S a lt U se d
-31-
m em b ers w ho b o u g h t s a l t , w h e th e r io d iz e d or n o t, b y p ic k in g up th e
f i r s t p a c k a g e th e y s a w . E ven th o u g h io d iz a tio n o f s a l t d o e s n o t a l t e r
i t s t a s t e (34), tw o re s p o n d e n ts s a id io d iz e d s a l t w a s to o " s a lty " , a n d
o n e s a id io d iz e d s a l t t a s t e d b e tte r (A ppendix D ). O n e re s p o n d e n t a ls o
c o m m e n ted t h a t s h e c o u ld n o t u s e io d iz e d s a l t w h e n c a n n in g . T here
w e re no re s p o n d e n ts t h a t in d ic a te d p r ic e w a s th e r e a s o n fo r b u y in g th e
s a l t th e y p u r c h a s e d , a n d r e s u l t s o f th e s u rv e y o f g ro c e ry s to r e s a ls o
p o in te d o u t a la c k o f p r ic e d iff e r e n c e b e tw e e n th e tw o ty p e s o f s a l t .
R e s p o n d e n ts o f a s u rv e y (58) in 1952 s a id u n io d iz e d s a l t w a s u s e d b e ­
c a u s e io d iz e d s a l t w a s " b a d " fo r s k in d i s e a s e s , e s p e c i a l l y a c n e . The
A m erican D e rm a to lo g ic a l S o c ie ty h a s s ta t e d th a t io d iz e d s a l t d o e s n o t
in c r e a s e a te n d e n c y to w a rd s a c n e (5 8 ).
I f c o m p u ls o ry s a l t io d iz a tio n c a n n o t be i n s t i t u t e d , e d u c a tio n
m ay a id in in c r e a s e d io d iz e d s a l t u s a g e b y th e c o n s u m e r. M any o f th e
s u rv e y r e s p o n d e n ts r e a liz e d io d iz e d s a l t w a s " b e tte r " fo r th e ir h e a l t h ,
b u t th e y d id n o t k n o w w h y , s o th e re is a q u e s tio n a s to w h e th e r o r n o t
th e y w o u ld p a s s on th e ir " k n o w le d g e " to th e ir c h ild re n c o r r e c tly . The
e x i s t e n c e o f f a l l a c i e s c o n c e rn in g th e d e trim e n ta l e f f e c ts o f io d iz e d
s a l t , d e s p it e p u b lis h e d s ta te m e n ts to th e c o n tr a r y , a l s o p o in ts o u t a
n e e d fo r e d u c a tio n , a s d o e s th e la rg e p e rc e n ta g e o f c o n su m e rs who
b u y s a l t by p ic k in g up th e f i r s t p a c k a g e th e y s e e . In a d is c u s s io n o f
io d iz e d s a l t u sa g e ,.K im b a ll s a id t h a t " . . . e d u c a tio n s e e m s to l a s t o n ly
a fe w y e a r s , a n d e a c h g e n e r a tio n h a s to b e to ld a g a in " (43: 81).
-32-
W h en a s k e d a b o u t th e ir s o u rc e o f k n o w le d g e c o n c e rn in g th e u s e
o f io d iz e d s a l t , m o s t o fte n (43.6% o f th e tim e) r e s p o n d e n ts r e p lie d t h a t
th e ir m o th e rs w e re th e ir s o u rc e o f in fo rm a tio n (T ab le 2 ). E ven i f a ll
s c h o o l g ra d e s a re p u t in to o n e c a te g o r y , m o th e rs w o u ld h a v e a s m a ll
m a rg in o v e r e d u c a tio n (43.6% an d 40.0% , r e s p e c tiv e ly ) a s th e m ajo r
s o u rc e o f in fo rm a tio n . N o m a tte r w h a t th e s o u rc e w a s , th e in te rv ie w e r
in fo rm a lly n o te d th a t in fo rm a tio n c o n c e rn in g io d iz e d s a l t u s a g e w a s
v e ry v a g u e . If th e r e s p o n d e n ts s a id th e y k n e w io d iz e d s a l t w a s b e tte r
fo r th e m , th e y d id n o t know w hy i t w a s b e n e f ic ia l.
W h en a n e d u c a tio n a l c a m p a ig n i s in th e p la n n in g s t a g e , i t is
h e lp fu l to kn o w w ho s h o u ld be th e ta r g e ts o f th e p u b lic ity . If p u b lic ity w a s d ir e c te d a t m o th e rs a n d s c h o o ls w e re a s k e d to p a r tic ip a te in
th e c a m p a ig n , a la rg e s e g m e n t o f th e p o p u la tio n s h o u ld be r e a c h e d . It
h a s b e e n s u g g e s te d (58) t h a t S ta te D e p a rtm e n ts o f H e a lth , an d m e d ic a l
a n d p a ra m e d ic a l s o c i e t i e s c o u ld e d u c a te w ith n e w s a r t i c l e s , p la c a r d s
an d h e a lth t a l k s . T h e s e m e th o d s c o u ld p e rh a p s b e g e a r e d to m o th e rs
■by: (I) p u ttin g a r t i c l e s in n a tio n a l m a g a z in e s re a d b y h o u s e w iv e s ;
(2) p la c in g p la c a r d s in g ro c e ry s to r e s ; (3) p r e s e n tin g h e a lt h ta lk s to
a d u lt o r g a n iz a tio n s ; a n d (4) u s in g ra d io p ro g ram s a im e d a t th e h o u s e ­
w if e . The s c h o o l a s a s o u rc e o f k n o w le d g e c o u ld b e u s e d b y g iv in g
g r a d e - s c h o o l c h ild re n a s im p le ta lk o n io d iz e d ..s a lt, a n d g iv in g th em a
l e a f l e t to ta k e hom e to th e ir m o th e r s .
—33 — ■
' Ata b le 2
RESPONDENTS' SOURCE OF KNOWLEDGE
ABOUT IODIZED SALT
S o u rc e o f
K now ledge
G ra d e an d
J u n io r H igh S c h o o l
H igh S c h o o l
R e s p o n d e n ts
N o.
%
5 ■
9.1
12
21.8
5
9.1
24
43.6
H u sb a n d
3
, 5.4
O th e r*
6
10.9
U n iv e rs ity
M o th e r
* In c lu d e s o n e from e a c h o f th e fo llo w in g
s o u r c e s : m a g a z in e , b o o k , o th e r r e l a t i v e ,
p h y s ic i a n , P e a c e C o r p s , an d o n e " d o n 't
k n ow ".
-34-
The tw o la rg e g ro c e ry s to r e s th a t w e re s u rv e y e d s o ld th re e tim e s
a s m uch io d iz e d s a l t a s u n io d iz e d . Two o f th e s m a lle r s to r e s s o ld
tw ic e a s m uch io d iz e d s a l t . The o th e r s m a lle r s t o r e , w h ic h is c lo s e
to th e U n iv e r s ity 's m a rrie d s tu d e n t h o u s in g , s o ld fo u r tim e s a s m uch
io d iz e d s a l t a s u n io d iz e d s a l t . The a v e r a g e r a tio o f io d iz e d to u n ­
io d iz e d s a l t s a l e s i s , th e r e f o r e , 2 .7 5 :1 . U sin g th is r a t i o , e x p e c te d
u s a g e o f io d iz e d s a l t w o u ld b e 73.4% to 26.7% fo r u n io d iz e d s a l t .
T h e se fig u re s a re v e ry c lo s e to th e p e r c e n ta g e s o b ta in e d b y th e s u rv e y
o f h o u s e h o ld s (72.7% an d 27.3% ).
R e s u lts o f a r e c e n t s u rv e y (59) o f a m a jo r g r o c e r y - s to r e c h a in
w ith o u tle ts in m o st M o n ta n a c o m m u n itie s sh o w e d a 2:1 ra tio o f
io d iz e d ta b le s a l t s a l e s co m p ared to u n io d iz e d ta b le s a l t . The h ig h e r
a v e r a g e r a tio o b ta in e d b y s u rv e y in g B ozem an s to r e s m ay b e d u e to a
p o s s ib le h ig h e r e d u c a tio n a l le v e l o f B ozem an r e s i d e n t s . The f a c t th a t
th e s to re c l o s e s t to m a rrie d s tu d e n t h o u s in g h a d th e h ig h e s t ra tio
s e e m s to in d ic a te t h a t th e m a rrie d s tu d e n ts m ay b e m ore k n o w le d g e - a b le , o r th e s to re d is p la y s th e io d iz e d s a l t m ore p ro m in e n tly .
F is h C o n su m p tio n
If f is h w a s s e r v e d in th e s a m p le h o u s e h o ld s o n c e a w e ek o r
tw ic e a m o n th , o c e a n f is h w a s u s u a ll y u s e d (F ig u re 10).. W h en fis h
w a s s e r v e d o n c e a m o n th o r l e s s , r e s p o n s e s in d ic a te th a t s h e llf is h
Per cen t
V / X O c e a n f is h
I
I
S h e ll fis h
53.0%
51.5%
i
CO
Cn
I
25.8%
19.7%
18.2%
13.5%
O n ce a w e e k
T w ice a m o n th
O n ce a m onth '
O n ce e v e ry
th re e m o n th s
H ard ly e v e r
F ig u re 10— P e rc e n ta g e o f H o u s e h o ld s S erv in g F is h a t V ario u s F re q u e n c ie s
—3 6 —
w a s th e f is h o f c h o ic e . T his m ay h a v e b e e n d u e to th e c h e a p e r p ric e
o f m a rin e f i s h , s u c h a s t u n a , c o m p a re d to s h e l l f i s h .
A s u rv e y (42) o f O h io s c h o o l c h ild re n in 1955 r e v e a le d th a t if
fa m ilie s s e r v e d f is h a t l e a s t o n c e a w e e k , th e p e r c e n ta g e o f g o itro u s
c h ild re n d e c lin e d . I f f is h w a s e a te n tw ic e a m o n th , th e in c id e n c e o f
g o itro u s a n d n o n - g o itr o u s c h ild re n w a s e v e n , an d w h e n th e fre q u e n c y
o f f is h c o n s u m p tio n w a s l e s s th a n tw ic e a m o n th , th e p e r c e n ta g e o f
g o itro u s c h ild re n r o s e . T a b le 3 c o n ta in s a b re a k d o w n o f th e fre q u e n c y
o f f is h c o n s u m p tio n in h o u s e h o ld s u s in g io d iz e d an d u n io d iz e d s a l t .
T h ere a re fiv e h o u s e h o ld s , o r o n e - th ir d o f th o s e u s in g u n io d iz e d s a l t ,
in th e p o te n tia lly d a n g e ro u s s itu a tio n o f u s in g u n io d iz e d s a l t an d
s e r v in g f is h l e s s th a n tw ic e a m o n th . T h is is 9.1% o f th e to ta l sa m p le .
TABLE 3
FREQUENCY FISH IS SERVED IN HOUSEHOLDS USING
IODIZED OR UNIODIZED SALT
Io d iz e d S a lt
N o.
%
U n io d iz e d S a lt
N o.
%
O nce a w eek
31
64.6
9
T w ice a m onth
12
25.0
3
5
10.4
L e s s th a n
tw ic e a m onth
.
6
.
550.0
16.7
33.3
CHAPTER V
SUMMARY, C O N C LU SIO N S, RECOMMENDATIONS
Sum m ary o f M e th o d an d R e s u lts
The p u rp o s e o f th is p ilo t s u rv e y w a s to p ro v id e in fo rm a tio n on
th e u s e o f m a jo r io d in e s o u r c e s b y a s e l e c t p o p u la tio n , n a m e ly r e s i ­
d e n ts o f m a rrie d s tu d e n t h o u s in g a t M o n ta n a S ta te U n iv e r s ity ,
B o zem an , d u rin g J u n e an d J u ly , 1970':., A s tr u c tu r e d in te rv ie w form w a s
'
• ■
p e r s o n a lly a d m in is te r e d to a group o f 66 ra n d o m ly s e l e c t e d h o u s e h o ld
.
..
m em b ers r e s p o n s ib le fo r c h o o s in g th e fo o d th e ir fa m ilie s p u r c h a s e d .
M o s t (83.3%) o f th e s a m p le d f a m ilie s u s e d s a l t o n ly fo r c o o k in g
a n d a t th e t a b l e . If s a l t w a s u s e d fo r c a n n in g fo o d , u n io d iz e d s a l t
w a s u s u a ll y th e ty p e a d d e d . The p e r c e n ta g e o f fa m ilie s th a t w ere
u s in g io d iz e d s a l t (72.7%) w a s lo w e r b y 12% th a n th e m o s t re c e n t
n a tio n a l a v e r a g e (85% ).
B e c a u se " i t i s b e tte r fo r me a n d /o r my fam ily " w a s th e r e a s o n
54.5% o f th e s a m p le c ite d fo r th e p u r c h a s e o f io d iz e d s a l t .
H o w e v e r, a
la rg e p e r c e n ta g e (42.4%) o f th e io d iz e d an d u n io d iz e d s a l t w a s b o u g h t
b e c a u s e i t h a p p e n e d to b e th e f i r s t ty p e t h a t w a s s e e n b y th e p u r­
c h a s e r . F a lla c ie s th a t c o n c e rn th e ty p e o f s a l t to u s e , s u c h a s th e
b e tte r t a s t e o f io d iz e d o r u n io d iz e d - s a lt, an d th e d e trim e n ta l e f f e c t o f
a d d in g io d iz e d s a l t to food th a t is b e in g c a n n e d , w e re fo u n d .
—38 —
The h ig h e s t p e r c e n ta g e (43.6%) o f in te r v ie w e e s in d ic a te d th a t
th e ir m o th e rs w e re th e ir s o u rc e o f in fo rm a tio n a b o u t th e u s e o f io d iz e d
s a l t . S c h o o ls ( g r a d e , ju n io r h ig h , h ig h s c h o o l a n d u n iv e rs ity ) w e re a
c lo s e s e c o n d (40.0%) fo r th e s o u rc e o f k n o w le d g e m o s t o fte n q u o te d to
th e in te r v ie w e r .
M o st o f th e re s p o n d e n ts (83.3%) s e r v e d m a rin e or s h e ll f is h to
th e ir f a m ilie s a t l e a s t tw ic e a m o n th . If f is h w a s s e r v e d a t l e a s t
tw ic e a m o n th , th e g r e a t e s t p e r c e n ta g e o f fa m ilie s s e r v e d m arin e f i s h ,
e s p e c i a l l y tu n a . The p o p u la tio n o f th is s u rv e y h a d 9.1% o f i t s h o u s e ­
h o ld s in a p o te n tia lly d a n g e ro u s p o s itio n fo r g o ite r fo rm a tio n .
C o n c lu s io n s
The d a ta o f th is s tu d y in d ic a te t h a t a n e x te n s iv e g o ite r s u rv e y
w o u ld be o f v a lu e . The in c id e n c e o f th y ro id e n la rg e m e n t c a n n o t be
a c c u r a te ly m e a s u re d b y a s u rv e y o f th e u s e o f io d in e s o u rc e : a m e d i­
c a l s u rv e y o f th y ro id e n la rg e m e n t in c id e n c e m u st be c o n d u c te d . I t is
o n ly w ith th e a c c u r a te in fo rm a tio n w h ic h a m e d ic a l s u rv e y s h o u ld p r o ­
v id e th a t p ro g ram s to in c r e a s e io d iz e d s a l t u s a g e c a n b e c o m p le te ly
ju s tifie d .
C o m p u lso ry io d iz a tio n o f s a l t w o u ld be th e m o s t e f f ic ie n t m e a n s
o f in c r e a s in g io d in e i n t a k e . H o w e v e r, a n a lte r n a tiv e w o u ld b e e d u c a ­
tio n o f th e p u b lic , fo r th e d a ta o f th is s u rv e y in d ic a te a g r e a t n e e d fo r
c o n s u m e r e d u c a tio n on th e n e e d a n d r e a s o n s for io d iz e d s a l t u s a g e .
-3 9 -
R e c o m m e n d a tio n s fo r F u rth e r S tu d y .
A m ore d e ta i le d s tu d y o f m e th o d s o f e d u c a tin g th e c o n su m e r to
b u y io d iz e d s a l t s e e m s to be i n d ic a te d . T his s tu d y c o u ld in c lu d e th e
p o s s i b i l i t i e s p r e v io u s ly m e n tio n e d , an d th e r e s e a r c h e r s h o u ld try to
fo rm u la te som e o th e r i d e a s . A ls o , th e r e is a n e e d to k n o w w h a t o r ­
g a n iz a tio n s w o u ld c o o p e r a te w ith s u c h a c am p a ig n : fo r e x a m p le , p ro ­
f e s s i o n a l g ro u p s c o n c e rn e d w ith h e a l t h , g ro c e ry s t o r e s , s c h o o ls ,
g o v e rn m e n t a g e n c ie s , a n d a d u lt c iv ic g r o u p s .
The n e e d fo r a n e x te n s iv e g o ite r s u rv e y in M o n ta n a h a s b e e n
d i s c u s s e d . As th e p o p u la tio n u s e d in th e s u rv e y t h a t h a s j u s t b e e n
p e rfo rm e d w a s lim ite d , i t w o u ld b e h e lp fu l to c o n d u c t s u rv e y s o f o th e r
p o p u la tio n
g ro u p s to fin d o u t i f th e b e s t ta r g e t p o p u la tio n s fo r a n
e d u c a tio n a l c a m p a ig n w o u ld b e th e s a m e .
APPENDICES
—4 1 —
A PPEN D IX A
SURVEY INTERVIEW QUESTIONNAIRE
H o u se h o ld In fo rm a tio n
1.
H ow o ld is th e p e r s o n in y o u r h o u s e h o ld w ho u s u a ll y b u y s th e
fo o d ?
_____a) 10 to 15 y e a r s
_____b) 16 to 20 y e a r s
_____c) 21 to 25 y e a r s
_____d) 26 to 30 y e a r s
____ ^e) 31 to 40 y e a r s
_____f) 41 to 50 y e a r s
_____g) 51 to 60 y e a r s
_____h) o v e r 60 y e a r s
2.
Are a n y m em b ers o f y o u r h o u s e h o ld e a tin g m o s tly b a b y food a n d /
o r fo rm u la ?
_____a) Y es
_____b) No
3.
I f s o , do yo u e v e r a d d s a l t to th e ir m e a ls ?
_____a) Y es
_____b) No
4.
Is th e re a n y o n e in y o u r h o u s e h o ld on a lo w s a l t o r lo w p o ta s s iu m
d ie t?
_____a) Y es
_____b) No
Type o f S a lt U se d
5.
D o e s th e p a c k a g e you u s e fo r ta b le s a l t h a v e th e w ord IODIZED
o n th e la b e l ?
_____a) Y es
_____b) No
6.
D o e s th e p a c k a g e you u s u a lly u s e d for c o o k in g s a l t h a v e th e w ord
IODIZED on th e la b e l ?
______a) Y es
. .
_____b) No
,
-4 2 -
7 . W h en y o u p ic k le food w h a t k in d o f s a l t to y o u u s e ?
_____a) I d o n 't p ic k le food
_____b) I u s e ro c k s a l t (p ic k lin g s a l t in la rg e b a g s , u s u a lly )
_____c) I u s e io d iz e d ta b le s a l t
_____d) I u s e u n io d iz e d ta b le s a l t
_____e) O th e r ( p le a s e e x p la in )
8 . If a n y o f th e s a l t y o u u s e is IO D IZ ED , w hy d id y o u b uy it ?
a) I t i s b e tte r fo r me a n d /o r my fa m ily
_____b) It w a s th e c h e a p e s t k in d
_____c) It w a s th e f i r s t p a c k a g e I s a w
d ) O th e r ( p le a s e e x p la in )
9 . I f th e s a l t y o u a re u s in g is n o t IO D IZED , w hy d id y o u buy i t ?
a) I t i s b e tte r fo r me a n d /o r my fa m ily . ' .
_____b) I t w a s th e c h e a p e s t k in d
. .
_____c) It w a s th e f i r s t p a c k a g e I s a w
_____d) O th e r ( p le a s e e x p la in ) ■
1 0. If yo u u s e u n io d iz e d s a l t , a n d y ou b o u g h t.it b e c a u s e i t w a s
c h e a p e r , w o u ld you b u y io d iz e d s a l t if th e tw o w e re th e sam e
p r ic e ?
'
_____a) Y es
_____b) No
_____c) D o n 't k n o w
1 1 . H av e y o u e v e r h e a rd o f u s in g io d iz e d s a l t b e fo re ?
_____a) Y es
_____b) No
_____c) D o n 't know
1 2 . If s o , w h e n o r from whom d id y o u le a r n a b o u t i t ?
_____a) g ra d e s c h o o l
_____b) ju n io r h ig h s c h o o l
_____c) h ig h s c h o o l
_____d) u n iv e r s ity , o r o th e r h ig h e r le a r n in g in s titu tio n
_____e) c o u n ty e x te n s io n a g e n t
_____f) n e w s p a p e r
_____g) m a g a z in e
_____h) book
_____i) m o th er
_____j ) o th e r r e la tiv e
_____k) frie n d
_____I) d o n 't k n o w
_____m) o th e r ( p le a s e e x p la in )
-4 2 O th e r S o u rc e s o f Io d in e
- 13. H ow o fte n do yo u s e r v e o c e a n f i s h , s u c h a s c o d , h a lib u t, s a lm o n ,
t u n a , f lo u n d e r , b a s s , h a d d o c k , p e r c h , an d s n a p p e r ?
_____a) O n c e a w e ek
_____b) T w ice a m onth
_____c) O n c e a m onth
_____d) O n ce e v e ry th re e m o n th s
_____e) H a rd ly e v e r
_____f) O th e r ( p le a s e e x p la in )
14. H ow o fte n do y o u s e r v e s h e l l f i s h , s u c h a s c r a b , s h r im p , lo b s t e r ,
o y s t e r s , c la m s , o r s c a l l o p s ?
_____a) O n c e a w e e k
_____b) T w ice a m onth
c) O n c e a m onth
_____d). O n ce v e ry th re e m o n th s
_____e) H a rd ly e v e r
_____f) O th e r ( p le a s e e x p la in )
C om m ents
'
..
..
..
—4 4 A PPEN D IX B
INTERVIEW ANSWER .SHEET
I.
a)
-b!
c)
d)
e)
f)
10.
a)
b)
c)
11.
a)
b)
c)
12.
a)
b)
g)
h)
2.
3.
4.
5.
a)
b)
. c)
ab)!
d)
e)
f)
q)
a)
b)
h)
i)
I)
a)
b)
k)
D
m)
6.
7.
8.
a)
b)
1
' ,
13.
a)
b)
c)
d)
e) J
f)
14.
a)
b)
c)
d)
e)
f)
a)
b)
c)
d)
e)
a)
b)
c)
d)
9.
a)
b)
c)
d)
C om m ents
Z
-4 5 A PPEN D IX C
LETTER OF INTRODUCTION
221 S o u th F ifth Ave .
B o z e m a n , M o n ta n a 59715
Ju n e 4 ; 1970
D ear
I am a g ra d u a te s tu d e n t in N u tritio n a t MSU an d w o u ld lik e to ru n a
s u rv e y o n th e u s e o f s a l t in th is a r e a . In o rd e r to g e t v a lid in fo rm a ­
tio n ;and a r e p r e s e n ta tiv e s a m p l e , I am lim itin g my p o p u la tio n to
m a rrie d s tu d e n t h o u s in g w ith th e p e rm is s io n o f th e H o u sin g O ffic e .
Your h o u s e h o ld i s o n e t h a t I h a v e c h o s e n fo r my s a m p le , s o I w o u ld
r e a lly a p p r e c ia te y o u r c o o p e r a tio n . I s h a ll be c a llin g on you w ith in
th e n e x t m o n th to a s k y o u a few q u e s tio n s th a t s h o u ld n o t re q u ire
m ore th a n te n m in u te s to a n s w e r . T here a re no w rong a n s w e r s , an d
y o u r nam e w ill n o t be a v a il a b le to a n y o n e e x c e p t m y s e lf. If I am
u n a b le to r e a c h you in p e rs o n I m ay b e c a llin g y ou o n th e te le p h o n e
to a rra n g e fo r a tim e to m e e t, c o n v e n ie n t to y o u .
I lo o k fo rw a rd to m a k in g y o u r a c q u a i n t a n c e .
S in c e r e ly ,
S/
B etty Kay J a c o b s (M rs . Don)
P h o n e: 5 8 6 -9 1 4 3
Z
-46A PPEN D IX D
TOTAL SAMPLE TALLY SHEET
I.
. a)
9 . b)
41 . c)
10 . d)
2 e)
4 f)
. g)
h)
2.
14 a)
52 ;b)
3.
3 .a )
11 b)
4.
8
58
5.
4 8 '. a)
18 • b)
.6.
48 . a)
18 b)
7.
58
4
2
2
a)
b)
c)
d)
e)
8.
36
a)
b)
c)
d)
12
9.
16
2
10.
11.
.
T o ta l - 66
12.
a)
b)
■
a)
b)
c)
d) b e tte r t a s t e (Io d iz e d
to o s a lty )
a)
b)
c)
53 . a )
13 b)
_ c)
2 .a )
3 b)
12 _ c) .
.
5 _ d)
_ e ).
f)
I g) , :
. I „h)
,
. 24, ' i).
I J )
.k )
I . I)
5 m) H u sb a n d - 3
M .D . - I .
P e a c e C o rp s - I
13.
35 . a)
17 b)
9 . c)
2 d)
2 e)
I f ) A lle rg y
14.
3
4
.13
11
34
I
a)
b)
c).
d)
e)
f)
COMMENTS
U s u a lly b u y s io d iz e d - 2 (3.3%)
U n io d iz e d fo r f is h ta n k - I
U n io d iz e d fo r c a n n in g - I
-
i"
Io d iz e d t a s t e s b e tte r
—4 7 —
APPENDIX E
TALLY SHEETS FOR AGE GROUPS
1 6 -2 0 Y ears
I.
__ a)
x _ b).
__ c)
__ d)
__ e)
_ f)
1 1 . __ 7 _ a)
__ 2 _ b)
_____c)
T o ta l - 9
12.
__ g)
__ L_d)
_ h )
2.
2 a)
7_b)
3.
___ a)
_2_.b)
4.
3 • a)
6 ' b)
5.
_Z_ a)
2 b)
6.
_7_a)
2
7.
b)
9 a)
__ b)
__ c)
_ d )
__ e),
8.
6 a)
__ b)
i _ c)
__ d)
9.
__ a)
__ b)
2 _ c)
__ d)
10.
a)
_ b)
la )
b)
I c)
.
_____e)-.;
■ _____h)
= 3 V
__ 4 _ i )
_____j ) .
_____k)
■
=
J
L
.
1 3 . __ 5 _ a)
__ 3 _ b )
I c)
____ d)
■z=3_
1 4 . _____a)
__ l _ b )
■ I c)
__ 2 _ d)
5 e)
_____f),
COMMENTS
—4 8 —
2 1 -2 5 Y ears
I.
a)
b)
x
11.
c)
d)
11
30
a)
b)
3.
2
9
a)
b)
4.
5
a ).
a)
b)
c)
T o ta l - 41
e)
f).
g
h)
2.
32
9
12.
I
3
9
4_
a)
b)
c)
d)
e)
f).
g) ■
13 i ) V
I j).:
_k)
I _D
2 m) h u s b a n d - I
P e a c e C o rp s - I
36 b)
'
5.
6.
7.
8.
30'. a)
11 b)
30
a)
11
b)
39
I
I
a)
b)
c)
d)
e)
20
a)
13.
11 _ b)
5 :c )
2 d)
I e)
9 . _____a)
_____ «
I
c)
d) h o tte r t a s t e
1 0 . _____ a)
_____ b)
_____ c)
f)
•
b)
10 c)
_____d)________________________
10
22 _ a)
14. '
2 _ a)
I b)
8 c)
8 d)
22 e)
f)
COMMENTS
Io d iz e d t a s t e s b e tte r - I
U s u a lly b u y io d iz e d - I
-49-
2 6 -3 0 Y e ars
1 . _____a)
1 1 . __ 8 _ a )
2 b)
=
c !
x d)
_____e)
_____f)
____ c )
T o ta l - 10
____ g)
_____h>
2 . __ l_ -a )
9 b)
3 . __ 1_ a)
'
b)
4.
6 a)
4 b)
7 . __ 6_ a)
2 b) .
___ cJ
2 d)
e)
8.
5
I
9.
_L_ g)
I
•
a)
b)
c)
d)
. a)
b)
4 c)
d)
1 0 . _____ a)
_____ b)
_____ c)
h)
■
■
3)
_____k)
___ D
'
a) .
IOV b)
5 . __ 6_ a)
4 ■b)
' 6.
1 2 . _____ a)
_____b)
I c)
, _____d) .
_____e)
• _____f)
1 m) h u s b a n d
, 13.
3
3
2
____
__1_
• I
a)
b)
c)
d)
e)
f ) a lle r g y
1 4 . __ 1_ a)
__ l _ b )
__ 2 _ c)
__ 1_ d)
’ __ 4 _ e)
I f) a lle r g y
COMMENTS
U n lo d iz e d fo r f is h ta n k - I
U s u a lly b u y s Io d iz e d - I
U n io d iz e d fo r c a n n in g - I
-503 1 -5 0 Y ears
. a)
» .
. c)
.d )
. e)
.f )
11.
T o ta l - 6
a)
. b)
c)
d)
e)
f)
. g)
.h )
22
>)
b)
g)
h)
i)
j)
k)
l)
2 m) M .D . - I
husband - I
a)
b)
a)
b)
a)
b)
6.
10.
5 a)
___b)
_ l_ c )
__ d)
__ e)
a)
b)
I
a)
b)
c)
d)
e)
__
a)
b)
c)
d)
_
a)
b)
c)
d) b e tte r t a s t e
___ a)
___b)
___c)
6 a)
__ b)
__ c)
___a)
_L_b)
_2_ c)
_1_ d)
2 e)
f)
COMMENTS
LITERATURE CITED
1
P itt-R iv e r s , R. an d W . T r o tte r , e ds.
19 6 4 . The T hyroid G la n d .
L ondon: B u tte rw o rth s , 1 : 1 .
2
S c h a e f e r , A.
1 9 6 9 . The n a tio n a l n u tritio n s u r v e y . J . A m er. D ie t.
• Assv- 54: 3 7 1 .
3
W ils o n , E ., K. F is h e r , an d M . F u q u a .
1 9 6 5 . P r in c ip le s o f N u tri­
t io n . 2nd e d . N ew York: Jo h n W ile y an d S o n s , p . 165.
4
M c C le n d o n , J .
1 9 3 9 . Io d in e a n d th e I n c id e n c e o f G o ite r.
M in n e a p o lis : U n iv e rs ity o f M in n e s o ta P r e s s .
5
B ourne , G . a n d G . K id d e r, e d s .
1 9 5 3 . B io c h e m istry a n d P h y s i­
o lo g y o f N u tr itio n . N ew York: A cad em ic P r e s s , 11:42 7.
6
S e b re ll, W .
1949 . Io d in e —a fo o d e s s e n t i a l .
P u b . H e a lth R e p .
'6 4 :1 0 7 5 .
7,
P T tt-R iv e rs , R. a n d W . T ro tte r, e d s . 1 :7 1 .
8
I b i d ., I: 87.
9
H a z a r d , J.. a n d D . S m ith , e d s . 1 9 6 4 . The T h y ro id . B altim ore:
W illia m s a n d W ilk in s , p . 5 8 .
10
I b i d ., p . 4 9 .
11
D e is s , W .
19 6 2 . T ra n s p o rt o f th e th y ro id h o rm o n e s .. F e d . P r o c .,
A m er. S o c . E x p . B io l. 21: 6 3 0 .
12
A lb e rt, A. an d F . K e a tin g .
1 9 5 2 . The ro le o f th e g a s tr o in te s tin a l
t r a c t , in c lu d in g th e l i v e r , in th e m e ta b o lism o f r a d io ­
th y r o x in e . E n d o c rin o lo g y , 5 1 :4 2 7 .
13
P itt-R iv e r s , R. an d W . T r o tte r , e d s . I: 163 .
14
I b i d ., 1: 237.
-5 2 -
15
K im b a ll, 0 . 1 9 2 3 . The p re v e n tio n o f sim p le g o ite r . P u b . H e a lth
R ep. 38: 877.
16
P itt- R iv e r s , R. an d W . T ro tte r, e d s . I: 187.
17 . G re e r , M .
1 9 6 0 . The s ig n if ic a n c e o f n a tu r a lly o c c u rrin g a n t i ­
th y ro id co m p o u n d s in th e p ro d u c tio n o f g o ite r in m an .
B o rd e n 's R ev. N u tr . R e s . 21: 61.
18
M a la m o s , B ., D . K outras , S . M a rk e to s , G . R ig o p o u lo s , X.
Y a ta g a n a s , D . B in o p o u lo s , J . S fo n to u ris , S . P h a rm a k io tis ,
R. V o u g h t, a n d W . L o n d o n .
1967. E n d em ic g o ite r in G re e c e :
a n io d in e b a la n c e s tu d y in th e f ie ld . J . o f C lin . E n d o c rin o l.
M e ta b . 27: 1 3 7 2 .
19
P itt-R iv e r s , R. a n d W . T r o tte r, e d s . II: 71.
20
H a z a r d , J . a n d D . S m ith , e d s . p . 1 0 0 .
21
M r in e , D . 1 9 3 3 . The im p o rta n c e o f r e la tiv e io d in e d e f ic ie n c ie s
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22
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