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1. It was very interesting to hear from a physician currently practicing in an area near Gandhara. It is difficult to compromise Dr. Frewing's findings on goiter frequency with those recorded by the investigators cited in the communication. It is conceivable that there has been some change in the frequency in these areas described by Dr. Frewing since the original studies. Another explanation is that the frequency may be lower in those individuals who present themselves for employment; those with very large goiters or with symptoms may not be as frequently represented in the labor pool as in the general population. Goiter is generally more common in females than males and most of the subjects seen by Dr. Frewing were males. In reference to the dependent female group seen by Dr. Frewing, they may also have a lower frequency than females in the general population, since goiter is thought to be familial. As noted above, the
Blumberg BS. Goiter in Gandhara-Reply. JAMA. 1965;191(9):770. doi:10.1001/jama.1965.03080090083043