Endemic goitre and iodine deficiency — MSF Clinical guidelines — Médecins Sans Frontières 2026

Q: Does goitre mean the thyroid is not functioning properly?

No. Endemic goitre is an adaptive process where the thyroid gland enlarges to compensate for iodine deficiency, but thyroid function usually remains normal. Normal function is typically restored within 2 weeks of iodine supplementation.

Q: What are the risks of iodine deficiency during pregnancy?

Iodine deficiency in pregnant women has serious consequences for the child including foetal and perinatal mortality, physical and mental retardation, and cretinism. This is why pregnant and lactating women are priority populations for supplementation.

Q: Will goitre go away with treatment?

In children, goitre disappears after several months of iodine supplementation. In adults it disappears more slowly or may never fully resolve, despite restoration of normal thyroid function within 2 weeks.

Q: When is surgery needed for goitre?

Surgery is only indicated for patients with local mechanical dysfunction such as compression or deviation of the trachea or oesophagus. These mechanical complications are rare. Medical treatment with iodised oil is sufficient for most cases.

MSFClinical guideline (chapter)Current edition

From Clinical guidelines — Diagnosis and treatment manual › Chapter 12: Other conditions · Médecins Sans Frontières, Current online edition, 2026

MSF clinical guideline on diagnosis, classification and iodine supplementation for endemic goitre in iodine-deficient populations.

In one sentenceEndemic goitre in iodine-deficient areas is prevented and treated with annual iodised oil (190 mg capsules): 1–3 capsules for children by age, 2 capsules for pregnant/lactating women; iodised salt programmes are preferred.

Issuer: Médecins Sans Frontières
Edition: Current online edition, 2026
Audience: Field clinicians and healthcare workers in resource-limited settings
Evidence: Expert consensus based on WHO recommendations
Reviewed: 22 Oct 2026 · GMJ

Read the original on MSF Whole guideline (PDF)

Summary by GMJ Guidelines Desk•Reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD•Record updated 22 Oct 2026•Next check Apr 2027

What this guideline says

GMJ summary

This MSF guideline addresses endemic goitre caused by iodine deficiency, which leads to compensatory thyroid gland enlargement whilst thyroid function typically remains normal. Iodine deficiency in pregnant women poses serious risks to the child including foetal and perinatal mortality, physical and mental retardation and cretinism.

The guideline uses the WHO simplified classification system: Group 0 (no goitre), Group 1 (palpable but not visible) and Group 2 (clearly visible). Prevention through national iodised salt programmes is the recommended strategy. Where iodised salt is unavailable, iodised oil supplementation is indicated for prevention and treatment.

The primary target populations for supplementation are pregnant and breastfeeding women, women of childbearing age and children. Treatment with iodised oil provides both curative and preventive benefits, with goitre disappearing after several months in children. Surgery is reserved only for cases with mechanical complications such as tracheal or oesophageal compression.

Key points

For clinicians — doses and thresholds as stated in the guideline

Endemic goitre is classified by WHO into Group 0 (no goitre), Group 1 (palpable but not visible) and Group 2 (clearly visible with neck in normal position)
Children under 1 year: 1 capsule (190 mg) iodised oil PO once yearly
Children 1 to <6 years: 2 capsules (190 mg each) iodised oil PO once yearly
Children 6 to 15 years: 3 capsules (190 mg each) iodised oil PO once yearly
Pregnant or lactating women and women of childbearing age: 2 capsules (190 mg each) iodised oil PO once yearly
Curative and preventive single-doses are identical; oral treatment is preferred
In children, goitre disappears after several months; normal thyroid function is restored in 2 weeks
Surgery is indicated only for patients with local mechanical dysfunction (compression or deviation of trachea or oesophagus)

Iodised oil dosing by population group

Table extracted from the guideline

Population	Iodised oil PO once yearly (190 mg capsule)
Children under 1 year	1 capsule
Children from 1 to < 6 years	2 capsules
Children from 6 to 15 years	3 capsules
Pregnant or lactating women or women of childbearing age	2 capsules

Source: Médecins Sans Frontières, Endemic goitre and iodine deficiency — MSF Clinical guidelines. Reproduced in summary form.

From the guideline

Verbatim

“Iodine deficiency in pregnant women has serious consequences for the child (foetal and perinatal mortality, physical and mental retardation, cretinism).”

— Médecins Sans Frontières, Endemic goitre and iodine deficiency — MSF Clinical guidelines, Clinical features section (2026)

Editor’s perspective

Why this matters for Georgia and the region

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration

As Editor-in-Chief of the Georgian Medical Journal and Chair of the Public Health Institute, I recognise that whilst Georgia has made progress in salt iodisation since the 1990s, mountainous regions and vulnerable populations may still face micronutrient gaps. This MSF guideline provides clear, implementable dosing schedules for iodised oil supplementation that can be integrated into our maternal-child health platforms and primary care protocols. I would stress to Georgian clinicians the critical window for preventing irreversible neurodevelopmental harm in offspring of iodine-deficient pregnant women—2 capsules annually is a simple, high-impact intervention. The main implementation challenge will be ensuring supply chain reliability for iodised oil capsules in remote areas and training primary care teams to identify at-risk populations beyond routine antenatal contacts, particularly women of childbearing age not yet pregnant and school-age children in endemic zones.

ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 22 Oct 2026

Applicability

Georgia and the South Caucasus

Iodine deficiency remains relevant in mountainous regions of the South Caucasus and Eastern Europe where access to iodised salt may be inconsistent despite national fortification programmes. National health authorities should assess population iodine status through urinary iodine surveys, ensure universal salt iodisation and identify high-risk areas requiring supplementation programmes. In Georgia and neighbouring countries, primary care physicians and maternal-child health services need clear protocols for identifying at-risk populations—especially pregnant women in remote areas—and delivering annual iodised oil supplementation where dietary iodine remains insufficient. Integration with antenatal care and school health programmes would optimise coverage of target populations.

Questions this guideline answers

Quick answers

Does goitre mean the thyroid is not functioning properly?

No. Endemic goitre is an adaptive process where the thyroid gland enlarges to compensate for iodine deficiency, but thyroid function usually remains normal. Normal function is typically restored within 2 weeks of iodine supplementation.

What are the risks of iodine deficiency during pregnancy?

Iodine deficiency in pregnant women has serious consequences for the child including foetal and perinatal mortality, physical and mental retardation, and cretinism. This is why pregnant and lactating women are priority populations for supplementation.

Will goitre go away with treatment?

In children, goitre disappears after several months of iodine supplementation. In adults it disappears more slowly or may never fully resolve, despite restoration of normal thyroid function within 2 weeks.

When is surgery needed for goitre?

Surgery is only indicated for patients with local mechanical dysfunction such as compression or deviation of the trachea or oesophagus. These mechanical complications are rare. Medical treatment with iodised oil is sufficient for most cases.

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Endemic goitre and iodine deficiency — MSF Clinical guidelines

What this guideline says

Key points

Iodised oil dosing by population group

From the guideline