Endemic goitre and its response to orally administered iodized oil has been studied in seven villages 25–30 km south of Velingara, Eastern Casamance, Senegal. In 502 adults aged > 15 years goitre prevalence was 62% with 18.2% having goitre grade 2 or 3. Mean free T4 (FT4) was 11.9±3.5 (sd) pmol/l and iodine deficiency was confirmed by noting median urinary I of 0.079 μmol/l (14.9 μmol 1/mol creatinine) with elevated free T3 (FT3)FT4 ratios. Serum selenium concentrations were normal. The response to 480 mg of oral iodized oil assessed at 6 and 12 months was characterized by a 35.8% increase in FT4, a 25% decrease in FT3 and a 50% decrease in TSH (all p<0.01) at 12 months associated with a significant decrease in goitre size measured in 70 persons when compared to 65 controls not receiving iodine. Urinary iodine rose from 0.071 μmol/l to 0.189 μmol/l (p <0.01) during this time and no adverse effects on thyroid antibodies (anti-thyroid peroxidase and anti-thyroglobulin) were observed. A variation in goitre prevalence between villages was noted which, in such a small geographical area, suggests that etiological factors in addition to iodine deficiency may be important in goitre pathogenesis. Oral iodized oil administration is an effective treatment for iodine deficiency goitre in the short term.