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Epidemic thyrotoxicosis in northern Tasmania: studies of clinical features and iodine nutrition.

Summary 
 
A marked rise in the number of patients presenting with thyrotoxicosis in Northern Tasmania has been documented from August 1966 following iodation of bread in March-April 1966. A peak occurred in October, 1967 since when there has been a significant fall. 
 
 
 
Age distribution of the patients indicates that a significantly higher proportion were over the age of 50 and nearly all had multi-nodular goitres. There was no coincident increase in ophthalmopathy associated with the increased incidence of thyrotoxicosis. Observations on iodine nutrition revealed a rise in urine iodine in 1967 compared with 1965 prior to bread iodation, but the levels were within the normal range and this was confirmed with further studies in 1970. Determinations of plasma inorganic iodine (PIl) in May 1967 confirmed normal values as did determinations of 1131 uptake. Survey of bread intake revealed no excess in thyrotoxic patients. It is concluded that correction of iodine deficiency with iodised bread has been associated with a mild epidemic of thyrotoxicosis. The existence of lod Basedow is therefore demonstrated under these conditions. The apparent absence of od Basedow in other parts of the world may be due to inadequate opportunities for observation, but recent experience in Europe indicates that there has been an increase in incidence of thyrotoxicosis following salt iodation.