Twenty-nine amino acids were analyzed in the sera of 105 adult Senegambian goitrous patients classified as stages I, II, and III according to World Health Organization recommendations. Mean serum concentration of all essential amino acids revealed highly significant drops (p less than 0.001) as goiter stage increased, except for methionine (Met). Most nonessential amino acids (NEAA) and intermediary metabolites were similarly characterized by a general decrease to the subnormal range, although some resisted depression in stages II and III. Homocystine (Hcy) demonstrated a unique pattern in that it was the only NEAA distinguished by regularly rising serum levels. These data are consistent with the view that endemic goiter is associated with overall stepwise downregulation in protein metabolism. In addition to iodine restriction, generalized malnutrition may aggravate the goitrogenic processes. Serum levels of Met and Hcy strongly suggest that the first step of the transsulfuration pathway is impaired in protein-depleted states due to cystathionine beta-synthase (EC 4.2.1.22) deficiency.