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ObjectiveTo assess the iodine status of Sherpa residents living in Kunde village, Khumbu region, Nepal.DesignPrevalence of goitre was determined by palpation. Urinary iodine concentrations (UIC) were determined in casual morning samples, and thyroid-stimulating hormone (TSH) in finger-prick blood samples on filter paper. Dietary and demographic data were obtained via questionnaire, and selected foods analysed for iodine.SettingKhumbu region is an area of low soil iodine in Nepal, where the prevalence of goitre was greater than 90 % in the 1960s prior to iodine intervention.SubjectsTwo hundred and fifteen of 219 permanent residents of Kunde were studied.ResultsOverall prevalence of goitre was 31 % (Grade 1 goitre, 27·0 %; Grade 2, 4·2 %). When adjusted to a world population, goitre prevalence was 27 % (95 % CI 23, 32 %); Grade 2 goitre prevalence was 2·8 % (95 % CI 1·0, 4·6 %). Median UIC was 97 μg/l, but only 75 μg/l in women of childbearing age. Thirty per cent had UIC < 50 μg/l and 52 % had UIC < 100 μg/l, while 31 % of children aged 300 μg/l. Ten per cent of participants had TSH concentrations >5 μU/ml.ConclusionsThe prevalence of severe iodine deficiency has decreased since the 1960s, but mild iodine deficiency persists, particularly in women of childbearing age. The consumption of high-iodine uncooked instant noodles and flavour sachets by school-aged children contributed to their low prevalence of goitre and excessive UIC values. This finding may obscure a more severe iodine deficiency in the population, while increasing the risk of iodine-induced hyperthyroidism in children. Ongoing monitoring is essential.