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A CASE REPORT ON INTERNATIONAL COOPERATION IN THE STUDY OF THYROID DISEASE JOHN B. STANBURY* There are now four large scientific organizations devoted exclusively to the study of the thyroid gland. The American Thyroid Association is now in its sixtieth year. The European Thyroid Association held its thirteenth meeting in July 1983. The Latin American Thyroid Association holds its second biennial meeting in November, 1983, in Lima. Every 5 years, there is an international thyroid conference; the next, the ninth, will convene in Säo Paulo in 1985. In addition, all the various national and international endocrine societies devote large sections of their congresses to the thyroid. The reasons for this level of attention to a rather small organ in the base of the neck are the high incidence of thyroid disease and the availability of excellent investigative tools. The thyroid has been a model system for countless scientific studies, and the existence of foci of high prevalence of thyroid disease in many parts of the world, especially in the developing countries, has stimulated a remarkable amount of interaction among members of the medical community . I will describe here a segment ofthis activity in which I have had some personal involvement. The Thyroid Clinic and Laboratory at the Massachusetts General Hospital started in 1923. In the spring of 1950, not long after I was given responsibility for the clinic, Dr. Hector Perinetti of Mendoza, Argentina, appeared at one of the regular Tuesday afternoon clinical sessions and, at its conclusion, showed photographs of a number of his surgical patients with huge goiters. We learned that the region of Mendoza , in common with much of the Andean region, was one with a high prevalence of goiter. We immediately suggested a cooperative study of endemic goiter between our group and our Argentine colleagues. After months of planning, fund-raising, and struggling with the Argentine *Massachusetts Institute of Technology, Cambridge, Massachusetts 02139.© 1986 by The University of Chicago. All rights reserved. 003 1-5982/86/2932/$01 .00 Perspectives in Biology and Medicine, 29, 3, Part 2 ¦ Spring 1986 \ S205 bureaucracy (those were the days ofJuan Perón), we arrived in Mendoza after a spectacular trip by rail from Santiago across the spine of the Andes. All our equipment, which included our counting equipment, had arrived the previous day, having been shipped by sea many weeks earlier. The only breakage was a single thermometer. The American group consisted of Gordon Brownell, a physicist, Douglas Riggs, a pharmacologist and iodine chemist, and myself. Our Argentine colleagues were Dr. Perinetti, chief of surgery at the Central Hospital of the University of Cuyo, Juan Itoiz, clinical chemist, and Enrique del Castillo, a clinical endocrinologist who had come from Buenos Aires to work with us. Within 48 hours, we had our radioactive iodine-detecting devices for in vivo and in vitro measurements calibrated and operating and had demonstrated for the first time the remarkable avidity of the thyroid for iodine of patients with endemic goiter. We spent 2 very busy months accumulating data and samples from a large number of subjects found for us by Perinetti in his busy clinic. They were remarkably cooperative, returning day after day for serial measurements and collecting 24-hour specimens of urine. The propaganda made ofour work by the government in the daily press served a useful purpose in encouraging attendance and participation. We returned to Boston with 1,000 urine samples and a huge collection of data and spent the next 2 years analyzing these and publishing the results with our Argentine collaborators [I]. The findings indicated that a severe degree of iodine deficiency existed in the area and that the appearance of goiter was an attempt at adaptation by the thyroid to that deficiency. Our data, when applied to a kinetic model of iodine metabolism , conformed to iodine deficiency as the single operative etiological element, but we could not exclude other factors which might have enhanced the iodine deficiency by impairing the utilization of iodine by the thyroid. We were gratified to learn that only a few months after our studies were completed and generally known, the government instituted the general use of iodized salt, and since then endemic goiter...

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