533 J. Endocrinol. Invest. 32: 533-537, 2009 DOI: 10.3275/6135 ABSTRACT. Objective: The aim of the study was to deter- mine the iodine status in Albania following 11 yr of iodine prophylaxis and to evaluate factors influencing the outcome. Design: Eight hundred and forty children, aged 6-13 yr, liv- ing in 4 different regions and 365 pregnant women living in the same areas, were enrolled for the study. The prevalence of goiter was assessed by palpation and ultrasound imaging and the urinary iodine and the iodine concentration in the salt of different commercial brands were evaluated. Presence of goiter in the family and their eating habits were also in- vestigated as well as the use of iodized salt in the household. Main outcome: In children, the prevalence of goiter was 57.6% by palpation and 24.4% by ultrasound imaging. Me- dian urinary iodine was 86.2 μg/l, with pronounced geo- graphical variations (range 3.52-1079 μg/l). In particular, 29.1% of the children had urinary iodine <50 μg/l and 57.1% <100 μg/l. In pregnant women, the median urinary iodine was 85 μg/l. Median iodine concentration in household iodized salt was 21.2 mg/kg, with 60.3% of the brands being adequately and 39.7% non-adequately iodized. Almost all families (99.6%) claimed to use iodized salt. Conclusion: De- spite the introduction of iodine prophylaxis, there is still a mild iodine deficiency in Albania, particularly in the inner mountainous areas. (J. Endocrinol. Invest. 32: 533-537, 2009) © 2009, Editrice Kurtis INTRODUCTION Albania is a country with limited environmental sources of iodine. In 1980, a national survey indicated that iodine deficiency (ID) was endemic in the country with a goiter prevalence between 41% and 92% (1, 2). Other surveys confirmed the severity of ID disorders (IDD) in the coun- try (2). In 1994, goiter, determined by ultrasound, was present in 28.9% out of 241 children in 4 villages in the north. In 1993 a survey in 32 clusters among 2395 chil- dren 8-10 yr old found a urinary iodine (UI) excretion be- tween 2 and 49 μg/l (3). In the same year, 33% out of 227 newborns in the capi- tal, Tirana, had a TSH level >5 mU/l (3). A more recent study carried out in March 2003 among 826 school chil- dren in 7 schools in Korce, Southern Albania, reported a median UI of 45 and 17 μg/l for urban and rural children, respectively (4). In Albania iodine prophylaxis was started in 1995; how- ever, a recent survey has revealed that only 56% of the people were taking an adequate amount of iodized salt (≥15 mg I/kg) (4). Furthermore, there is no information on the iodine status among pregnant women. The aim of our study was therefore to re-evaluate the io- dine status in Albania following 11 yr of iodine prophy- laxis by assessing the urinary iodine concentration in school children and pregnant women, the prevalence of goiter in children and finally the iodine content in the commonly employed iodized salt brands. SUBJECTS AND METHODS Subjects A total of 840 (50.8% males, 49% females) school children, aged 6-13 yr and 365 pregnant women in the first 6 months of preg- nancy were enrolled for the study. Seven children were exclud- ed from the final evaluation due to lack of data; statistical anal- ysis therefore was based on 833 subjects. Male to female ratio was around 1:1. The data were collected lasted from October to December 2006. Study protocol The study was carried out as a scientific collaboration project between Italy and Albania and was supported financially by both Countries. The study protocol was drawn up by some ex- perts in the field from the Health Authority and the Province of Bolzano, Italy, and from the Institute of Public Health of Tirana, Albania. The children involved in the study attended the pri- mary schools of 4 territorial areas: coastal-villages, costal-cities, internal-villages, and internal-cities supposed to be homoge- nous in relation to the study protocol. The following cities and villages of the coastal and internal area were selected: Shkoder, Lezhe, Kurbin, Durres, Kavaje, Lushnje, Fier, Vlore, and Sarande. For every territorial zone, 30 clusters were cho- sen in order to have a proper estimation of the prevalence (5). In Figure 1 the sampling sites and the iodine deficency areas are shown. Two teams were set up to carry out the study: in each team there was an endocrinologist, a pediatrician, and a local coordinator (public health specialist). They were supplied with an electronic scale (LAICA), a portable stadiometer (SECA), and portable ul- trasound equipment (SonoSite 180 Plus, Esaote) using a 7.5 MHz 5 cm linear transducer. In order to improve the team quality-standard, special training was organized for each member. The aim of this training was the accurate identification of the selected sample group and the standardization of the measurements in order to collect the da- ta in the most accurate way. Key-words: Albania, goiter, iodine deficiency, iodized salt, schoolchildren. Correspondence: F. Franzellin, MD, Department of Nuclear Medicine, Regional Hospital of Bolzano, via Lorenz Boehler 5, 39100 Bolzano, Italy. E-mail: franzellin.fabrizio@asbz.it Accepted Janaury 12, 2009. First published online April 1, 2009. A national study of iodine status in Albania F. Franzellin 1 , J. Hyska 2 , E. Bushi 2 , A. Fanolla 3 , L. Luisi 4 , L. Bonetti 4 , G. Morosetti 5 , and G. Radetti 6 1 Department of Nuclear Medicine, Regional Hospital of Bolzano, Bolzano, Italy; 2 Institute of Public Health, Tirana, Albania; 3 Epidemiological Observatory; 4 Water Analysis Laboratory of the Environment Agency; 5 Department of Health; 6 Department of Pediatrics, Regional Hospital of Bolzano, Bolzano, Italy © 2009, Editrice Kurtis FOR PERSONAL USE ONLY