Salt has been iodized in Taiwan since 1967. To understand goiter status after salt iodization, we studied the prevalence of goiter in school children in rural areas where tap water or underground water are used. To further elucidate the prevalence of goiter in urban areas where tap water is used, we studied school children from the Tong-Yuan and Lao-Song elementary schools located in the Wan-Hwa District of Taipei. Thyroid enlargement was examined by palpation as recommended by the World Health Organization. Thyroid antibodies and hormones were determined in school children with goiter and in age- and sex-matched normal control children using particle agglutination methods and radioimmunoassay. A total of 4,623 school children were examined. Of these, 129 children (2.8%) had goiters of grade I or above, or nodular goiters. The prevalence of goiter was similar to that of Putai and Peimen in southern Taiwan where tap water is used, but less than that of Tachia and Chingshuei in middle Taiwan where underground water is used. The prevalence of goiter was much lower than recent studies in Tung-Lo, an oil-bearing area in middle Taiwan, where there was a 12.9% prevalence in school children residing in hill districts who relied on underground water for drinking purposes, and 8.2% in school children residing on lower plains, who depended upon tap water for drinking purposes. The prevalence of goiter is highly related to the quality of drinking water.(ABSTRACT TRUNCATED AT 250 WORDS)