Goiter (enlarged thyroid) in mother and cretinism in son. Note the mountainous background emphasized by the artist to underscore the relationship of lack of iodine in the soils of such regions and the impact on women (goiter and hypothyroidism), their pregnancies (embryopathies conducive to characteristic malformation syndromes and mental deficiency known as cretinism).
Three points need emphasis: the artist is Dr. Josef Warkany who interpreted this association as a demonstration of an environmental cause of congenital anomalies; that besides goiter and cretinism, maternal hypothyroidism or iodine deficiency as well as postnatal dietary iodine deficiencies are a major cause of mental subnormality; and that these disorders can be prevented by iodine supplementation programs.
Iodine deficiency, till proven otherwise, must be suspected in all Alpine regions such as those in the Carpathian area of Europe (Ukraine, Austria, Czechia, Slovakia, Hungary, and Poland). The same is true for other mountainous regions (illustrated in the figure is the Appalachia region which is very extensive – Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia, where 20% of the population of the US reside).