Background: High prevalence of goiter is regarded a public health problem due to iodine deficiency disorder (IDD). Goiter in spite of urinary iodine sufficiency is also being reported. Even though. Universal iodization of salt (UIS) is mandatory in our country; sale of non iodized salt is still prevailing. Objective: To estimate the presence of goiter, mean urinary iodine excretion (UIE) level among prepubertal school children and also adequacy of salt iodization. Methods: 400 prepubertal school children were screened for goiter, UIE was estimated on every 10th child and 30 salt samples were tested for optimum iodization. Results: There was a high incidence of goiter in 112 (28%); Grade 1 Goiter-14.75% and Grade 2- 13.25%. Mean UIE was 115 ug/L with no samples having <100 ug/L indicating current iodine sufficiency. Among the 30 salt samples tested, 26 (86 %) were optimally iodized, 2 (7%) were suboptimally iodized and 2 (7%) were found to have no trace of iodine, even though all were labelled as iodized salt. Conclusion: Goiter is a public health problem in the study area, but current iodine sufficiency is noted as per UIE. This paradox can be explained by the transition phase during shift from iodine deficiency to iodine sufficiency or may be the result of other confounders. Goiter due to previous iodine deficiency may take several years to resolve. Inadequately iodized salt is still being marketed, getting transported by roadways. Recommendation: There is a need for reappraisal of goiter, UIE and adequacy of salt iodization. Further research on other causes of goiter like consumption of goitrogens and reduced response of iodine due to opposing action by excess fluorine and cobalt and associated iron deficiency is recommended.