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The problem of iodine deficiency disorders (IDD) is hypothesized to be aggravated by the prevalence of malnutrition, environmental goitrogens and microbial pollution in these areas. 

Environmental goitrogens(e.g., Thiocyanate) may act directly on the thyroid or indirectly by altering its regulatory mechanisms.

Water pollution with goitrogenic substances(e.g; lithium) have been found in areas with high prevalence of endemic goiter and cretinism.