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Albania does not yet have a national program for control of iodine deficiency and there are no recent data on the severity of the iodine deficiency disorders (IDD) in the country. The aim of the present study was to assess current IDD status in southern Albania. In primary school children in urban and rural areas urinary iodine concentration (UI) and iodine concentration in salt at retail and household levels was measured. Goiter was graded by palpation and thyroid volume determined by ultrasound. Children aged 5-14 yr (n = 826) were sampled at 2 urban and 5 rural primary schools. In the 2 urban schools, the median UI was 45 micrograms/L, the goiter prevalence was 32%, and salt iodine levels were inadequate (< 15 micrograms/g) in 78% of household salt samples. In the rural schools, the median UI was 17 micrograms/L, the goiter prevalence was 95%, and no household salt samples were adequately iodized. Among children in the rural schools, 73% had grade 2 goiter and 20% had nodular changes detected by thyroid ultrasound. In southern Albania, school children in urban areas are moderately iodine deficient and those in rural villages are severely iodine deficient. These findings suggest that regional distribution of oral iodized oil capsules is indicated to control IDD in vulnerable groups until salt iodization is implemented.