[Resolution based on the results of the interdisciplinary expert council "Cognitive health of a comorbid patient"].

On September 29, 2023, a meeting of the interdisciplinary expert council "Cognitive health of a comorbid patient" was held in Vladikavkaz. To reduce the social and economic burden of cognitive impairment, which is increasingly being detected in comorbid patients in the Russian Federation, it is necessary to introduce socially significant initiatives for the timely diagnosis and prevention of these diseases, as well as update modern approaches to treatment, taking into account their multifactorial pathogenesis and the risk of complications. Based on the results of scientific reports and discussions held during the expert council, experts made decisions on a further plan within the framework of socially significant initiatives for the prevention of obesity.

[Assessing of iodine consumption with iodized salt in organized nutrition of children of preschool and school age in the Tyumen region].

The territory of the Tyumen region is an endemic region with insufficient iodine content in the environment, in which, since the early 1990s, active preventive measures have been taken to increase the use of iodized salt (IS) in households, catering and the food industry. The purpose of the research was to assess the consumption of iodine with IS used in the organized nutrition of children in the Tyumen region. Material and methods. The assessment of iodine intake was carried out in preschool institutions and schools randomly selected the city of Tyumen and rural areas (village of Isetskoye). Modeling of iodine consumption in organized groups was carried out for children aged 1-3, 3-7, 7-11 and 12 years and older in urban and rural areas, respectively, using a standard menu and a technological map of dishes. Iodine intake was estimated based on the content of 40 µg of iodine in 1 g of salt and its 30% loss during cooking. Model 1 assumed the mandatory use of IS in the preparation of all salt-containing meals for preschoolers and schoolchildren. Model 2, in addition to the mandatory use of IS in school and preschool meals accounted the consumption of iodine with bakery products (BP) produced with IS. Results. The modeling showed that the average intake of iodine with meals (model 1) in preschool institutions in Tyumen was 89±16 µg/day for children aged 1-3 years. When BP with IS were included in the menu (model 2), iodine intake increased to 101±14 µg/day. In children aged 4-7 years iodine intake was 115±18 and 126±18 µg/day, respectively. In rural areas, iodine intake was lower: in children aged 1-3 years, under model 1, iodine intake was 66±3 µg/day, under model 2 - 76±4 µg/day. In children aged 4-7 years, these figures were 83±3 and 92±4 µg/day, respectively. Iodine consumption in a school in Tyumen under model 1 in children 7-11 years old was 24±5 µg/day, and in children 12 years and older - 27±6 µg/day. When BP with IS were included in the menu (model 2), iodine intake increased to 32±5 µg/day in children 7-11 years old and to 39±6 µg/day in children 12 years of age and older. In rural areas, when using model 1, iodine intake in children aged 7-11 years was 37±15 µg/day, in children aged 12 and over 40±21 µg/day. When BP with IS were included in the menu (model 2), iodine intake increased to 44±15 µg/day in children aged 7-11 years and to 50±21 µg/day in children 12 years of age and older. Conclusion. The use of IS in the preparation of salt-containing meals in preschool educational institutions of the Tyumen region fully covered the iodine requirements of preschool children, which confirms the effectiveness of the chosen strategy for the prevention of iodine deficiency and can be considered as an important part of the concept of universal salt iodization. The use of IS in preparation of school breakfast meals provides 23.5-36.9% of the recommended nutrient intake for iodine in rural schools and 15.4-26.4% of the recommended nutrient intake in urban schools, which can be a significant contribution to the total intake of this micronutrient.

[Neonatal thyrotropin - indicatior of monitoring of iodine deficiency severity. What's level is considered a «cutoff point¼?]

BACKGROUND: The issues of monitoring the effectiveness of iodine deficiency prevention programs are an important component in the process of iodine elimination. Neonatal thyrotropin (TSH) has been used as a criterion for the severity of iodine deficiency since 1994, however, the question of the "cut-off point" of the neonatal TSH level has been widely discussed in the recent literature. AIM: Evaluate the criterion for neonatal hyperthyroidism above 5 mIU/l from the perspective of monitoring iodine deficiency and establish a «cut-off point¼ on the model of healthy pregnant women with adequate iodine status. MATERIALS AND METHODS: A prospective study was conducted in a population of pregnant women in the city of Tyumen, with the formation of observation groups according to the level of iodine excretion in the urine - the main group (with adequate iodine status throughout the entire gestation period) and the comparison group (women with iodine levels less than 150 µg/l). The results of neonatal screening for congenital hypothyroidism in children of women participating in the study were evaluated. The frequency of neonatal TSH above 5mIU/l was assessed in the observation groups. ROC-analysis was performed and a «cut-off point¼ of the level of neonatal TSH was established as an indicator of iodine deficiency. RESULTS: The median urinary iodine concentration in the population of pregnant women in Tyumen was 159.05 µg/l, the incidence of goiter was 0.38%, the incidence of neonatal hyperthyroidism above 5 mIU/l was 2.88%, which characterizes adequate iodine intake in the pregnant population women. The frequency of neonatal TSH above 5 mIU/l in newborns from women from the main group was 1.47%, and in the comparison group - 9.3% (p = 0.076). ROC analysis revealed a threshold value of neonatal TSH of 2.77 mIU/l at the cut-off point, which corresponded to the highest value of the Youden index. Urinary iodine concentrations greater than 150 µg/l were predicted for nTSH values below this value. CONCLUSION: Analysis of databases of neonatal screening for congenital hypothyroidism makes it possible to effectively, quickly and at minimal cost annually assess the iodine status in the population. The established «cut-off point¼ of neonatal TSH in the model of healthy pregnant women with adequate iodine intake in our work is 2.77 mIU/l, the absence of statistically significant differences in the incidence of neonatal hyperthyroidism above 5 mIU/l from women with different iodine status during pregnancy indicate the need to revise the existing threshold of 5 mIU/l and may be an incentive to conduct large-scale studies in regions with different iodine supply.

[Resolution on the results of the interdisciplinary expert council "Prevention and treatment of obesity. How to Achieve a Healthy Metabolic Balance].

On September 30, 2022, a meeting of the interdisciplinary expert council "Prevention and treatment of obesity. How to Achieve a Healthy Metabolic Balance. To reduce the social and economic burden of obesity and its consequences in the Russian Federation, it is necessary to introduce socially significant initiatives to prevent obesity and increase its detection rate, as well as to update modern approaches to the treatment of this chronic disease, taking into account its multifactorial pathogenesis, comorbidity, risk of complications and patient disability. Based on the results of the scientific reports and discussions held during the expert council, the experts made decisions on a further plan within the framework of socially significant initiatives for the prevention of obesity.

[Vitamin D deficiency in Russia: the first results of a registered, non-interventional study of the frequency of vitamin D deficiency and insufficiency in various geographic regions of the country].

BACKGROUND: In Russian Federation, there are no large-scale cross-sectional multicenter epidemiological studies assessing the prevalence of vitamin D deficiency and insufficiency in different geographical latitudes. Insufficient solar insolation and inadequate vitamin D content in food dictate the need to study the epidemiological structure of low vitamin D status in Russia. AIM: To assess the incidence of vitamin D deficiency and insufficiency among the population living in the regions of the Russian Federation located at latitudes from 45 ° to 70 °. MATERIALS AND METHODS: The first stage of the Russian multicenter non-interventional registry study using the «crosssectional¼ method was carried out from March 2020 to May 2020. RESULTS: In regions that represent a geographically representative sample of regions of the Russian Federation with a high risk of developing low levels of vitamin D, it's deficiency was noted in 55.96%, and the level of deficiency and insufficiency was recorded in 84.01%. CONCLUSION: Close attention to the wide scale of the problem of vitamin D deficiency and insufficiency in the Russian Federation will contribute to the progressive formation of various educational and preventive programs necessary to strengthen health and improve the quality of life of the population.

[The first Russian multicenter non-interventional registry study to study the incidence of vitamin D deficiency and insufficiency in Russian Federation].

AIM: To assess the incidence of vitamin D deficiency and insufficiency among the adult population living in the regions of the Russian Federation located at latitudes from 45 to 70. MATERIALS AND METHODS: Russian multicenter non-interventional registry study using the "cross-sectional" method. RESULTS: In this study, 72.1% of the examined have the status of vitamin D deficiency and insufficiency, while an adequate level was diagnosed in 27.8% of cases. When assessing the degree of vitamin D deficiency depending on the season, statistically significant differences (p0.00001) were found between the periods: vitamin D deficiency or insufficiency was observed in 84.2% of autumn and in 62.4% of spring. The highest incidence of vitamin D deficiency and insufficiency was recorded in males compared with females (p=0.013, 79 and 70.3% respectively). Vitamin D deficiency is observed in young people in the age subgroup of 1825 years (p0.001, 54% in the study as a whole) much more often than in older people Conclusion. The widespread high prevalence of vitamin D deficiency in the Russian Federation is not related to geographic region of residence, but to some extent depends on the season. The high-risk group for vitamin D deficiency and insufficiency is young men. The significant role of vitamin D in the human body justifies the need to supplement and clarify a single concept for the prevention, diagnosis and treatment of conditions associated with deficiency, so higher implementation of National Clinical Guidelines is needed.

[The role of food in prevention and correction of iodine deficiency in the endemic territory].

Iodine supply remains the global problem due to the wide prevalence and a wide range of clinical manifestations in all age groups of population. However, iodine deficiency is a nutritional deficiency and the solution of this problem lies in the organization of rational nutrition of the population. The purpose of this study was to examine the food features of the population of the mild iodine-deficient region from the standpoint of adequacy of iodine sufficiency. The analysis of nutrition of the population of Tyumen Region in 2005 and 2016 was carried out according to official statistics of Tyumenstat; results of sanitary-hygienic and biomedical monitoring for the period from 1994 to 2016. A sociological study was conducted on a representative nested sample using the questionnaire method. The study involved schoolchildren (n=744) and their parents (n=677), students and full-time students (n=623). Probabilistic was sampling and nesting. Statistical sampling error does not exceed 4%. Analysis of the level of food consumption by residents of the Tyumen region over the period from 2005 to 2016 showed an increase in consumption per capita of fish and fish products (from 23.8 kg in 2005 to 33.1 kg in 2016 at recommended level of 22 kg). At the same time, a sociological study showed that only 1-4% of the population consumed iodine-rich products daily and only 53% of respondents regularly used iodized salt. The analysis of the results of biomedical monitoring over the 20-year period of the existence of preventive programs in the Tyumen region showed significant improvements in the situation in the region: median of ioduria increased significantly from 77 to 125 µg/l and the incidence of goiter in pre-pubertal children decreased from 85% in 1994 to 6.8% in 2016 (р=0,001); the incidence of neonatal hyperthyrotropinemia significantly decreased from 44.3% in 1994 to 3.9% in 2017 (р=0,001). However, most indicators did not reach the target values recommended for iodine-rich region, which indicated the insufficient effectiveness of the existing voluntary prevention system. The solution of this problem is using of iodine-enriched foods of mass consumption, such as bread and bakery products.

The carriage of risk variants of CDKAL1 impairs beta-cell function in both diabetic and non-diabetic patients and reduces response to non-sulfonylurea and sulfonylurea agonists of the pancreatic KATP channel.

On chromosome 6q22.3, a cluster of single-nucleotide polymorphisms located in intron 5 of the cyclin-dependent kinase 5 (CDK5) regulatory subunit-associated protein 1-like 1 (CDKAL1) gene were shown to confer susceptibility to type 2 diabetes in multiple ethnic groups. The diabetogenic role of CDKAL1 variants is suggested to consist in lower insulin secretion probably due to the insufficient inhibition of the CDK5 activity. In this study, we assessed the association of several SNPs of CDKAL1 with T2D in 772 Russian affected patients and 773 normoglycemic controls using a Taqman-based allelic discrimination assay. We showed association of the minor allele C of rs10946398 (Odds Ratio (OR) = 1.21, 95% CI = 1.04-1.4, P = 0.016), allele C of rs7754840 (OR = 1.18, 95% CI = 1.01-1.37, P = 0.038), and allele G of rs7756992 (OR = 1.21, 95% CI = 1.04-1.42, P = 0.017) with higher diabetes risk thereby replicating the predisposing role of CDKAL1 in etiology of T2D. These alleles contribute to three haplotypes (CCA, CGG, and CCG) related to higher diabetes risk (OR = 1.48, 2.12, and 1.95). Combinations of these haplotypes between each other form the group of high-risk haplogenotypes whose carriers had decreased HOMA-ß compared to other CDKAL1 variants in both diabetic (38.6 ± 19.3 vs. 48.2 ± 21.2, P(adjusted) = 0.019-0.044) and non-diabetic (91.8 ± 42.1 vs. 108 ± 47.2, P(adjusted) = 0.0054-0.01) patients. The carriage of the risk haplogenotypes of CDKAL1 was associated with reduced response to non-sulfonylurea and sulfonylurea agonists of the pancreatic KATP channel. These data suggest that CDKAL1 is involved in the pathogenesis of T2D through impaired beta-cell function.

[Polymorphic markers TCF7L2 rs12255372 and SLC30A8 rs13266634 confer susceptibility to type 2 diabetes in a Russian population].

Genes 7CF7L2 and SLC30A8, encoding transcription factor-4 and transmembrane zinc transporter-8, respectively, play an important role in the regulation of development, proliferation, and pancreatic beta cell function. In the present study we examined polymorphic markers of genes rs12255372 [NT_03359.12:g33557428G --> T] of 7CF7L2 gene and rs13266634 [NP_776250.2:p.R325W] of SLC30A8 in groups of Russians with type 2 diabetes (T2D) (n = 588) and healthy normoglycemic controles (n = 597). Significant association of allele T(rs12255372) and allele R (rs13266634) with a higher risk of T2D development has been found (OR = 1.37 and 1.22, respectively). Adjustment for the effect of potential nongenetic risk factors resulted in a further increase in the OR values, from 1.54 (P = 0.24) to 1.89 (P = 0.046) for homozygous carriers of the T allele and from 1.29 (P = 0.035) to 1.35 (P = 0.019) in the individuals homozygous for the R allele. The patients homozygous for predisposing allele T (rs12255372) or R (rs13266634) had significantly lower insulin concentrations in the blood 2 h after glucose tolerance test (GTT) as well as lower values of HOMA-beta, beta cell homeostasis indicator compared to the carriers of other genotypes. Thus, we have shown that the rs12255372 and rs13266634 markers are independent genetic T2D risk factors in a Russian population.

[The reference values of 17-hydroxyprogesterone and dehydroepiandrosterone in the gestational period].

Hyperandrogenism has a considerable negative impact on the course of pregnancy. The measurement of the levels of 17-hydroxy-progesterone and dehydroepiandrosterone sulfate as markers of adrenal hyperandrogenism, without taking into account the gestational metabolism of the hormones, promotes the hyperdiagnosis of nonclassical forms of congenital adrenal cortex dysfunction and involves inadequate treatment policy. The isolated elevation of dehydroepiandrosterone sulfate is not attended by an increase in the incidence of androgen-dependent complications of pregnancy.

[Association of goiter endemic and latent iron deficiency in Western Siberia].

The purpose of the investigation was to study the prevalence of latent iron deficiency and goiter endemic and their association in prepubertal children in Western Siberia. A total of 2238 prepubertal children (8-12 years) living in 3 subjects of the Tyumen Region were examined in 2005-2006. The classical criteria for Iodine deficiency (ID), such as iodurla, the frequency of goiter at palpation and ultrasonography, were studied. Serum ferritln was determined by enzyme-linked immunosorbent assay using the DRG-Diagnostics ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИ. 2007. Т. 53, № 5. kits (USA). There was normalization of the median ioduria, which was 117,', in the implementation of the ID prevention program in Western Siberia. By taking into account the 2003 WHO standards, the severity of goiter endemic in 2006 is regarded as moderate in the southern districts of the region and as severe in its autonomous areas. In terms of a serum ferritin level of less than 15 a high frequency of latent iron deficiency was found in the everywhere. Hence it follows that the association of the serum ferritin levels with the thyroid volumes is caused by a concomitance of two significant conditions: severe goiter endemic and frequent latent iron deficiency.

[The problem of osteopenia in a iodine-deficit area].

The aim of the study was to evaluate the condition of bone system in 335 subjects with thyroid gland dysfunction (TGD), residing in iodine deficit areas. Among the subjects there were 116 individuals with thyrotoxicosis (TT), and 219--with hypothyroidism (HT). The control group included 200 practically healthy people of comparable age and sex. The examination included: evaluation of pain syndrome intensity using a 4-point scale; revealing of atraumatic fracture background; measurement of serum levels of thyroid stimulating hormone (TSH) andfree thyroxin by immune-enzyme assay; measurement of bone mineral density (BMD) by dual-energy x-ray absorptiometry using a Dexa-Scan DX-10 device (Direx, Israel) with evaluation of the results according to 1994 WHO recommendations. 79.3% of TT patients and 68% of HT patients suffered from pain syndrome. The difference in atraumatic fracture rate between the groups was insignificant. The mean BMD values in subjects with TGD dysfunction corresponded to osteopenia, while in the control group they were within normal limits. The difference in osteopenic syndrome rate between TT and HTpatients was insignificant, although osteopenia was revealed in 25% of TT patients. The frequency of BMD decrease grew with age; however, this parameter was higher in all groups of patients with TGD vs. control. The most prone to osteopenia are postmenopausal women regardless of thyroid dysfunction character; difference in BMD decrease frequency between men and women with preserved menstrual function, was insignificant. Osteopenic syndrome was more frequent in men with TGD then in healthy men. Thus, in residents of iodine deficit areas TGD is a factor of BTMD decrease.

[Results of neonatal screening for congenital adrenal hyperplasia].

The study was undertaken to evaluate the efficiency of the 2003-2004 neonatal screening for congenital adrenal hyperplasia (САН) in Tyumen and to estimate the prevalence of classical forms of 21-OH deficiency in the newborns by the results of the screening. Neonatal 17-OHP levels were determined in 20,011 neonatal infants by bilateral enzyme-linked immunosorbent assay (ELISA) at a sensitivity of 0.13 n/mol/l, by using "Delfia Neonatal 17-OHP" kits. In 124 (0.61%), the level of 17-OHP was greater than 60 nmol/l; retests identified 2 babies with salt-loosing САН. Thus, the Incidence of classical forms of САН was 1:10,005 in the Tyumen population. In low-weight premature infants, 17-OHP levels were significantly higher than those in full-term or normal-weight babies.

[Features of osteopenic syndrome in diffuse toxic goiter].

AIM: To characterize action of thyroid hormones overproduction on bone mineral density. MATERIAL AND METHODS: Pain intensity was graded according to 4-score scale, atraumatic fractures in the past were recorded, mineral bone density (MBD) was studied, TTH and T4 levels and biochemical indices of calcium-phosphorus and bone metabolism were studied, thyroid volume was calculated by J. Brunn (1981) and USI data in 116 patients with diffuse toxic goiter aged 20-65 years compared to 200 healthy controls matched by gender and age. RESULTS: Pain in bones was registered in 79% examinees (1.8 +/- 0.2 scores, on the average). Atraumatic bone fractures were in 9.5% (8% in the controls). MBD reduction was revealed at densitometry in 71% patients with thyrotoxicosis. It was most frequent and severe (in UD--1.78 +/- 0.1 SD, in MD--2.1 +/- 0.1 SD) in patients with severe disease associated with intensive bone remodeling. Loss of MBD does not depend on DTG duration. Mild thyrotoxicosis had no negative effect on bone tissue. Significant differences between patients with thyrotoxicosis and drug euthyrosis by rate and severity of osteopenia were not observed. CONCLUSION: Patients with DTG, especially in severe DTG, demand prophylactic measures concerning osteopenia immediately after diagnosis of thyrotoxicosis.

[Screening for congenital adrenal hyperplasia in pregnancy: results and perspectives].

The purpose of the present study was to study the time course of changes in the levels of dehydroepiandrosterone sulfate (DHEAS) and 17-hydroxyprogesterone (17-HOP) in pregnant women in relation to the gestational time from the results of the screening made in Tyumen. The study analyzed 2,817 medical charts of pregnant women. The levels of DHEAS and 17-HOP had been determined in 1,485 (52%) and 230 (8.2%) women, respectively. Analysis of the results of hormonal tests for DHEAS indicated that this hormone was increased in 71% of the women. At the same time, the elevated levels of 17-HOP were observed only in 15% of the examinees. No correlation was found between the levels of DHEAS and 17-HOP. In all trimesters of pregnancy, the median and 95 percentile were above the normal range with their This study has shown that the level of DHEAS cannot be used as the only diagnostic criterion for the non-classical form of 21-hydroxylase deficiency in pregnant women and that there is some doubt as to whether the normal laboratory value of this parameter is absolute significant throughout the pregnancy.

[Comparative analysis of the efficacy of iodine prophylaxis in pregnant women living in endemic goiter areas]. / Sravnitel'nyi analiz éffektivnosti metodov iodnoi profilaktiki u beremennykh v usloviiakh zobnoi éndemii.

AIM: To assess efficacy of different methods of iodine prophylaxis in pregnant women living in conditions of goiter endemia. MATERIAL AND METHODS: Standard clinical, laboratory and device tests for iodine deficiency according to WHO criteria were made in 156 pregnant women living in the territory affected by goiter endemia. Of them, 121 examinees had no thyroid pathology, 35 ones had diffuse euthyroid goiter. All of them received different kinds of iodine prophylaxis. RESULTS: The occurrence of neonatal TTH values over 5 iU/l in neonates born by mothers free of thyroid pathology on potassium iodide prophylaxis when pregnant was 9.1%. This is much lower than in conventional iodine prophylaxis--17.24% (p < 0.01). A comparative analysis of the efficacy of potassium iodide-200 in pregnant women with diffuse euthyroid goiter and its combination with L-thyroxine has shown that by the effect on lessening frequency of neonatal TTH over 5 iU/l the above schemes do not differ significantly, thyroid reduction is more prominent in pregnant women on thyroxine with potassium iodide. CONCLUSION: The index of neonatal TTH is an objective criterium to control efficacy of different methods of iodine prophylaxis in pregnancy.

[Comparative analysis of existing criteria in the assessment of iodine-deficiency in dwellers of the Far North areas]. / Sravnitel'nyi analiz sushchestvuiushchikh kriteriev otsenki iododefitsitnykh sostoianii u zhitelei Krainego Severa.

New standards of the thyroid volume proposed by F. Delange (1977) are now being introduced. In view of this, we compared incidence of goiter by F. Delange and by R. Gutekunst (1988) criteria. The examination covered 3920 schoolchildren in 12 settlements of the Tyumen region in 1996. Iodine deficiency was mild to moderate. The greatest deficiency was observed in the North. Ultrasonic investigation of the thyroid by standards of R. Gutekunst (1988) was also indicative of the greatest iodine deficiency in the North. In the Far North, Polar Urals there was severe goiter endemia, in the rest areas the endemy was moderate. By F. Delange (1977) criteria, mild and moderate endemy was in the Far North and Polar Urals, the endemy was absent in the rest areas. As shown by comparison of the palpation data to thyroid ultrasonography, iodinuria, R. Gutekunst criteria are more reliable whereas criteria of F. Delange provide overestimated data.

[Epidemiology of iodine deficiency in the middle Ob regions]. / Epidemiologiia ioddefitsitnykh zabolevanii v srednem Priob'e.

AIM: Epidemiological rvaluation of goiter endemia and iodine deficiency in population of the Middle Ob region. MATERIALS AND METHODS: Thyroid palpation and ultrasonic investigations, iodine measurements in the urine were made in 6256 children and adolescents aged 8-17 years. RESULTS: Euthyroid condition was clinically stated in all the examinees. Palpation discovered thyroid enlargement in 36.78% of the examinees. Age prevalence was: 27.3, 33.28, 42.8, 46.18% in children and adolescents aged 8-10, 11-12, 13-14 and 15-17 years, respectively. Ultrasound detected goiter in 30.6% of the examinees. The occurrence was 34.78, 31.68, 28.2, 19.8% in the above age groups, respectively. No significant differences by thyroid size existed in girls versus boys. Urinary iodine was low in all the age groups. CONCLUSION: The Middle Ob regions belong to zone of goiter endemia with mild to moderate iodine deficiency. This dictates the necessity of introduction of special programs of iodine deficiency control and prevention.

[Endemic goiter in the extreme North of West Siberia]. / Endemicheskii zob na Krainem Severe Zapadnoi Sibiri.

Random examinations covering 8-60-year-old 4345 citizens of 12 settlements of the Yamal-Nenets Autonomic Territory discovered goiter endemia throughout the territory but most evident the endemy manifested in the Far North. The prevalence of endemic goiter among schoolchildren made up 52.8% (enlargement of the goiter of the 1st and 2nd degree), among adults-49.2%. By ultrasound investigation, the above percentages were 29 and 26.4%, respectively. This corresponds to moderate endemia. The median of urinary iodine excretion averaged in the territory 5.1 micrograms%, while overall iodine insufficiency (number of children with urinary iodine < 10 micrograms%) was 81.9%. In the Far North iodine excretion was less but goiter incidence was higher than normal. Thus, in the Far North goiter endemia is rather serious.