Abstract
<h3>In Reply.</h3> —These data from Japan by Tajiri et al, again demonstrate a dramatic difference in the incidence of silent (painless) thyroiditis between geographic locations. Our observation<sup>1,2</sup>that silent thyroiditis is not frequently seen outside Japan and parts of the Great Lakes area of North America has been confirmed by brief reports from Rochester, NY,<sup>3</sup>and Philadelphia.<sup>4</sup>Similarly, a recent study by Freeman et al<sup>5</sup>showing a low incidence of postpartum thyroiditis in the Bronx, NY, contrasts with the Japanese experience in which postpartum thyroiditis is common.<sup>6</sup> Although Nikolai has suggested a recent decrease in the frequency of silent thyroiditis in Wisconsin,<sup>7</sup>the data from Tajiri et al, suggests a continuing problem, at least in Japan. As mentioned in their letter, Toyama and Kumamoto are coastal areas of high iodine intake, as is Osaka, where post-partum thyroiditis is common.<sup>6</sup>The association of silent
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