The present paper deals with the sanitary evaluation of goiter endemia and with a rationale for principles in its prevention in areas exposed to natural and industrial chemical factors (in case of the Perm Region). The findings suggest that the elevated levels of some toxic metals and organic compounds in the body and zinc deficiency are strumogenic factors that maintain and aggravate the severity of goiter endemia in the presence of iodine deficiency. Comprehensive programs for prevention and correction of goiter endemia should be worked out differentially, by taking into account a combined influence of natural and industrial chemical factors on the population.