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Connecting the Dots: Iodine and Goiter

Goiter is an enlargement of the thyroid gland. The enlargement is usually due to a shortage of dietary iodine, but it can also be due to excess thyroid hormone production. The thyroid gland is a shield-like structure located at the base of the neck. It is wrapped around the trachea and the esophagus above the sternal notch. (Figure 1). It is the largest endocrine gland in the body of an adult weighing approximately 25 g. It can be palpated by gently moving the fingers over the wind pipe between the hyoid bone and the sternal notch. To feel the gland, the patient should sit relaxed with the head in the normal position (not elevated or with the chin lifted). The patient should be asked to swallow. In healthy individuals, the gland will feel like a soft palpable mass. In goiter, the mass enlarges, and when sufficiently enlarged, palpation is unnecessary as the enlarged thyroid gland will be visible. Before it was realized that iodine deficiency was the root cause of goiter, there were many people with these enlarged glands. Women, in particular, accommodated their enlarged thyroid glands by wearing a necklace (called a goiter choker) to disguise the enlarged gland. In the 1800s, high ruffled collars were part of a woman’s costume, and these collars covered up the bulging gland. In primitive societies where the clothing is likewise primitive, covering up the goitrous neck was not done. So many people had these enlargements that they were considered ‘‘normal.’’ Even today, there are regions in the world where goiter is still prevalent. Populations who do not live near the sea and are also lacking in today’s nutrition knowledge have a large percentage of their population with goiter.