Introduction
	The disorders induced by iodine deficiency (Iodine Deficiency Disorders, IDD1) belong to the history of Europe as only 4 European countries, namely Iceland, Finland, Norway and Sweden, were never exposed to this medical and socioeconomic scourge. Endemic cretinism, the most severe consequence of iodine deficiency, has been extensively reported from isolated and mountainous areas, for example from Switzerland, Austria, Italy, Bulgaria and Croatia2. The term «cretin of the Alps» has reached the popular vocabulary. And yet, surprisingly, only limited attention has been paid to IDD in Europe. IDD have been entirely eradicated in Switzerland thanks to the progressive implementation and sustained monitoring of a remarkable program of salt iodization initiated in 19223. Probably because of the impact of this program on the medical world and also because legislations on iodized salt had become available in many additional countries, IDD seem no longer to have been considered an important public health problem in Europe during the next decades. In 1960, the WHO published an exhaustive review on IDD in the world under the heading «Endemic goitre »4. Although this document included preliminary reports on Western countries, the information was scanty for the former USSR and especially for the Central Asia Republics5, which are presently recognized as severely affected6. It is only in the late 1980’s that the European Thyroid Association, in its reevaluation of the problem, clearly indicated that, with the exception of the Scandinavian countries, Austria and Switzerland, most of the European countries or at least certain areas of these countries were still affected, especially in the Southern part of the continent7. This survey confirmed a lack of information on IDD from countries of the Eastern part of the continent. At least in part under the influence of the International Council for Control of Iodine Deficiency Disorders (ICCIDD), a series of major decisive meetings on IDD and their control took place in the early 1990’s, including the World Health Assembly (Geneva 1990) the World Summit for Children (New York 1990), the Policy Conference on Ending Hunger (Montreal 1991) and the International Conference on Nutrition (Rome 1992)8. At these meetings, most affected countries, WHO and UNICEF committed themselves to the virtual elimination of iodine deficiency disorders in the world, including in Europe, by the year 2000. In 1994, WHO, UNICEF and ICCIDD jointly published (and later updated) a technical document entitled «Indicators for assessing iodine deficiency disorders and their control through salt iodization ». It has become the reference document for members of the health system, salt industry and national and international organizations and agencies in charge of the elimination of the disorders9,10. A next crucial evaluation of IDD in Europe took place in 1992: An international workshop entitled «Iodine deficiency in Europe: a continuing concern »11 was organized in Brussels by the author of the present report and his colleagues. One representative from each European country summarized the latest IDD data from his country including the preventive measures. A report on the workshop has been produced in a former issue of Thyroid International12: in 1992, iodine deficiency was under control in only 6 countries, namely Iceland, Finland, Norway, Sweden, Switzerland and Austria. In 1997, a follow-up meeting entitled «Elimination of Iodine Deficiency Disorders (IDD) in Central and Eastern Europe, the Commonwealth of Independent States, and the Baltic States » was organized in Munich under the auspices of ICCIDD, UNICEF and WHO6. It provided an overview of IDD status, control programs and salt supplementation in the 28 countries of this part of the world. It emphasized the severity of the problem in many parts of Eastern Europe, including recurrence of goiter and occasionally of endemic cretinism in some countries such as Russia after interruption of former programs of salt iodization. The governments of the affected countries, their national delegates, the regions and sub-regions, agencies and non-governmental organizations all received appropriate recommendations. This meeting triggered massive efforts in the implementation or restitution of iodized salt programs, mainly by UNICEF with the financial support of Kiwanis International. The objective of the present paper is to provide updated information on the status of iodine nutrition in the European region.