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A goitre (or goiter) (Latin struma) is a swelling in the neck (just below adam's apple or larynx) due to an enlarged thyroid gland. They are classified in different ways: more...

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  • A "diffuse goitre" is a goitre that has spread through all of the thyroid (and is contrasted with a "simple goitre", "single thyroid nodule" and "multinodular goitre".
  • "Toxic goitre" refers to goitre deriving from inflammation, neoplasm, or malfunction of the thyroid, while "nontoxic goitre" refers to all other types (such as that caused by lithium or an autoimmune reaction.)


The most common cause for goitre in the world is iodine deficiency (E01). Other causes are:

  • Hashimoto's thyroiditis (E06.3)
  • Graves-Basedow disease (E05.0)
  • juvenile goitre due to congenital hypothyroidism (E03.0)
  • neoplasm of the thyroid
  • thyroiditis (acute, chronic) (E06)
  • side-effects of pharmacological therapy (E03.2)


Iodine is necessary for the synthesis of the thyroid hormones, triiodothyronine and thyroxine (T3 and T4). When iodine is not available, these hormones cannot be made. In response to low thyroid hormones, the pituitary gland releases thyroid stimulating hormone (TSH). Thyroid stimulating hormone acts to try and increase synthesis of T3 and T4, but it also causes the thyroid gland to grow in size as a type of compensation.

Goitre is more common among women. Treatment may not be necessary if the goitre is not caused by disease and is small. Removal of the goitre may be necessary if it causes difficulty with breathing or swallowing.

History and future

Goitre was previously common in many areas that were deficient in iodine in the soil. (For example, in the English Midlands, the condition was known as Derbyshire Neck). The condition now is practically absent in affluent nations, where table salt is supplemented with iodine.

Some health workers fear that a resurgence of goitre might occur because of the trend to use rock salt and/or sea salt, which has not been fortified with iodine.


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Please pass the iodine! How a brilliant biologist, a group of schoolchildren, and a school of baby trout shrank America's goiter problem down to size -
From Saturday Evening Post, 5/1/97 by Woods Hutchinson

How a brilliant biologist, a group of schoolchildren, and a school of baby trout shrank America's goiter problem down to size.

Synopsis: In the first installment of his 1925 Post article (March/April '97 issue), Dr. Woods Hutchinson explained how scientists in the early part of this century discovered iodine's crucial role in human health. Minuscule amounts of iodine in the diet could prevent goiter, cretinism, and hypothyroidism, which were endemic in areas where soil and water were deficient in this vital element. But how can you get iodine to the millions of people who don't even know they need it? Dr. Hutchinson takes up that question in the second part of his classic iodine article.

Part II of III

Three Ways of Eating Iodine

But of course all this, fascinating as it is to the goiter enthusiast, would have been merely a rather melancholy triumph over a puzzling problem if we had not at the same time been able to give it a practical turn, and "with the bane provide the antidote." But this, thank heaven, we can now do, and the hair of the dog that didn't bite you will cure 90 per cent of all cases of simple goiter and greatly improve even the severest exophthalmic forms.

But perhaps someone will ask in the language of the day, How come does iodine get into the human system of dwellers along the coasts from sea water? They certainly don't swallow enough of that when they are in swimming, although some of us have felt that we had swallowed half the Atlantic Ocean at times; nor do they or any of their domestic animals habitually drink sea water.

There are three ways of eating iodine along the beaches. First and most obvious, by the free consumption of fish, clams, lobsters, and all other forms of sea food, which are not merely dripping with but soaked in sea water and its contained iodine. Second and more important, by the fact of the tide rising over the extensive salt marshes all along our coasts, whose iodine-soaked grass is either pastured directly by cattle or consumed later in the winter in the form of salt hay. A curious illustration of the inborn craving for iodine is that the earlier settlers along the New England coast just north and east of Boston, where the great salt meadows come down to the shore, insisted upon having for every forty acres which they took and cleared up in the hills, ten acres of salt meadow; and these holdings are still attached to the hill farms in many parts of Massachusetts and New Hampshire today. Coming down to the coast to cut the salt hay was one of the great outings and picnics of the year, during which they also got a good taste of iodine in various ways.

Last and probably the most important of all forms of iodine distribution is by sea spray. Everyone who has enjoyed the exhilaration of fighting his way along the sea sands or over the dunes in the teeth of an autumn gale will well remember the prickling of his cheeks and the distinctly salty taste on his lips brought by his battle with the storm wind.

Health in the Sea Breezes

But we have little idea how far inland this spray, treatment of the country and its inhabitants with iodine extends. In the great Quaker school where I was a boarder in my schoolboy days, in the North of England, it was no uncommon thing to find the windows of our dormitory on the seaward side after a great storm so thickly encrusted and caked with sea salt that we could write our names on them with a slate pencil or the end of a finger; and yet those windows were forty miles in land on one side and sixty on the other. This is a fair illustration of the distance inland to which sea salt can be driven on the howling blasts of the fall and winter storms. And appreciable salty deposits have actually been recorded two hundred miles from the surf.

Very little, of course, of this salt or iodine is inhaled into the nostrils or even sprayed on the faces of human beings; but every bit of it falls sooner or later upon the leaves and the grass and the soil, sinks down into the drinking water, or is eaten by cattle or sheep and so finally finds its mark in the human thyroid.

No wonder we have such an absolutely unconquerable and irresistible craving for a visit back to the beaches every summer. In the words of the poet--

"Hence in a season of calm weather,

Though inland far we he,

Our souls have sight of that great sea

Which brought us hither."

The habit of going down to the coast in summer, which now extends clear across the country both ways to the Rocky Mountains, and to the California and Florida beaches in winter, is based upon a sentiment nearly as old as the world itself. How powerful and practically effective this impulse is may be glimpsed by the statement of one of our leading real-estaters, that the extraordinary and phenomenal rise in the value of beach properties and shore real estate has been one of the most striking and surprising happenings in the history of real estate. In the past twenty-five years it has exceeded in percentage of rise even that of downtown city real estate and almost equaled it in total volume of sales, and is far more uniform and reliable. As he pithily puts it: "Beach property chosen with any reasonable judgment is the only property which is always a good buy."

Here then was pretty convincing proof, not only from all over the United States but from almost all over the world, that goiter is most intimately associated, in the language of the day, both ways from the ace, with shortage of iodine in our food and drinking water, if not actually caused by it. And the question arose, if the disease goiter is caused by deficiency of iodine, why not cure it by giving iodine to make good this deficiency? But with true scientific and humanitarian caution, before recommending the use of iodine on a nation-wide scale for the cure of goiter, we wanted a further test upon some form of animal life in the state of nature. We had, of course, proved by experiments that goiter could be produced in dogs and then cured by the administration of iodine; also, that by putting a dog under the conditions which would almost invariably induce goiter, and then giving him plenty of iodine in his food, goiter would be prevented from developing.

While we were anxiously sweeping the horizon for the opportunity of such a test, Nature and the United States Government played directly into our hands; the first, by producing a rapidly fatal form of enlargement of the thyroid in fresh-water fishes in the government hatcheries; the second, by its Bureau of Fisheries calling in consultation one of our leading students of the goiter-iodine complex, Dr. David Marine, to see if anything could be done to relieve the condition. After looking the situation over and identifying the disease as a fish goiter, Doctor Marine suggested putting so much iodine salt per day into the stream supplying the hatchery pools. The results were simply miraculous. Within a week or ten days the little troutlets were sitting up and taking notice of flies and worms and things, and within a short time the goiter shrank down and the fish became literally as sound as a trout.

This was a result of great practical importance to the Bureau of Fisheries, because this form of disease of the throat and gills had been a pest of trout hatcheries for years and was so fatal that it was known as trout cancer and had broken up many attempts to hatch and breed trout.

It may seem at first sight a little farfetched, but there is probably a special reason why trout are so susceptible to this shortage of iodine. As everyone knows, the whole group of trout and salmon have one peculiar habit, and that is, like bad boys, they run away to sea in early life. They are all hatched in fresh water, many of them in very tiny streams, indeed; but as long as they stop in fresh water they never attain any considerable bulk or size. Salmon, for instance, run down to the sea about a year after they are hatched, with a length of about six or seven inches. They come back from the sea one to three years later, grown to a weight of from fifteen to thirty pounds, to find their stay-at-home brothers and sisters who were hatched from the same eggs still barely six inches long.

Incredible as it may seem, many of the trout have the same restless habit; and if they can easily run down to a brackish water estuary so as gradually to get accustomed to the salt, and finally get out into the sea or a big salt-water bay, they too, will grow from fingerlings up to ten, twelve, or fifteen pounds' weight. So it is hardly too much to describe a salmon as a trout that has run away to sea or a trout as a salmon that did not have the enterprise to ship before the mast.

Now what do they get in the sea which was not available in the sparkling brook or the little inland lake? In the light of our recent knowledge, it begins to look as if the answer might be iodine, for all the other elements of the food are equally abundant and nutritious in fresh water. In other words, salmon is simply iodide of trout.

Good for Troutlets and Children

Incidentally, this iodine cure throws an interesting light upon the long-drawn rule-of-thumb procedure of those who have the care of goldfish in a bowl, minnows in an aquarium, or any other sort of pet fish, of giving them every few weeks a bath in salt water or--if they can get it--sea water, on account of the tonic and enlivening effect it produces upon them. Even a goggle-eyed goldfish in a bowl may feel the cosmic urge for iodine.

With this convincing proof of its widespread curative value and wholesomeness, we no longer hesitated about trying iodine out cautiously on our little human troutlets in a school. Doctor Marine and his coworkers, to whom a very large share of the credit of this important discovery is due, with full consent of parents and teachers, put the boys and girls in one of our lakeside schools upon a new course, not of study but of iodine--a few grains of iodide of sodium three times a day. Some of the pupils objected slightly to the bitter salt taste; but they didn't insist upon their opposition when it was discovered that in about three months' time the number of simple goiters among them--that is to say, of enlargement of the thyroid gland, which could readily be seen--had decreased from seventy-five to about twenty; and further trial showed that this improvement could be increased to complete cure by keeping up the remedy in the same doses for about six weeks twice each year.

Not only did the goiters disappear but the general health of the children distinctly improved; and what was of almost equal practical importance, their progress in their studies was unmistakably hastened and the percentage of retardation distinctly diminished. As retardation has been one of the banes of our public-school system for years, estimated to add annually from 10 to 20 per cent to its entire cost, the teachers pricked up their ears at once and became almost as enthusiastic over the new procedure as were the doctors.

Together, they spread the news of one of the most useful and promising of partnerships--Doctor, Teacher & Co.--that has ever been developed, with the result that now literally hundreds of schools, not merely in the goiter belts around the Great Lakes and in the Mississippi Valley but all over the United States, wherever a careful study of the school children has shown a high percentage of goiter, are attacking the goiter problem with iodine with most encouraging results both as to health and scholarship.

The good news spread across the Atlantic and was promptly welcomed in Switzerland, partly because it was the native home of goiter and partly because of its high degree of general intelligence and open-mindedness. The authorities overcame one of its chief objections, the taste--because this led a certain percentage of pupils secretly to "duck" the dose--by coating it over with chocolate, which no schoolgirl can resist, and within a few months similar excellent results were obtained. In Zurich, for instance, the percentage of goiter before iodine was used was from 80 to 90 per cent; after iodine, it was barely 30 per cent; while the schools in the canton of St. Gall fell from 87.6 per cent of goiter to 13.1 per cent three years later. So the Goiter Commission recommended that this method of goiter prevention be instituted as a public-health measure over the entire state.

Of course all these results were carefully checked by what we call controls; that is to say, examinations of other pupils of the same age in the same village or county, in schools in which no iodine was given; and also, more precise and convincing yet, by the proportion of goiter persisting in those children who either themselves, or, from objection on the part of their parents, declined to take the iodine. In ever:y such test the percentage of goiter in the children who did not take iodine remained unchanged, or else increased distinctly, showing that the improvements in those benefited was due solely to the iodine and not to any mental impression or to a better care of their health in other respects.

The only serious objection raised to the method is the claim that in a certain number of cases a simple and comparatively harmless form of goiter has apparently been developed into the exophthalmic, or dangerous, form under or after the iodine. But so far these apparently bad results have been few in number and scarcely at all in excess of the normal 1 to 2 per cent of all cases of simple goiter which experience has shown may take on the more serious forms. Also, it must be remembered that, in the keen attention focused on every form of goiter in all the children of the community by these tests, a number of cases of mild exophthalmic goiter have been discovered which would otherwise have escaped notice.

Gratifying Results

But this relief and clearing up of simple goiter is only a part of the health benefits of the new balanced ration. In the course of the work in various neighborhoods, family histories naturally were widely discussed, children reported other cases of goiter occurring in other members of their families, and finally careful studies of the family history of the goitrous pupils were made exhaustively in certain selected neighborhoods, with the interesting finding that almost universally the percentage of goiter in the mothers of goitrous children was much higher than that in the rest of the community. And curiously enough, in the case of the boys who showed simple goiter the percentage of goiter among the mothers was very high, indeed--in some cases reaching 70 to 80 per cent. And to our delight, when some of the more intelligent and enterprising mothers of the community took, steadily, iodine in small doses through their period of expectancy, they not only had less disturbance and discomfort but their children were born more vigorous and without any trace of goiter; though, of course, it is as yet too early to say how many of them might develop it later in life.

So the situation seems to be that by the taking of three chocolate tablets containing a few grains of iodide daily for six weeks twice each year, the goiter present in both boys and girls can be cured in 90 per cent of all cases; and that by the administration of larger doses to mothers through the period of pregnancy, the development of goiter in their children can probably be prevented in advance.

But this, gratifying as it is, is only, of course, a partial solution of the problem. It reaches only one age group of the population, and not by any means all that, as, of course, the taking of the tablets is entirely voluntary on the part of the children. Thus other methods which will reach the whole community at at all ages and will be more nearly automatic in their action have been eagerly sought for and worked at. One is the increasing in every possible and reasonable way of the eating of sea fish and sea foods of all sorts. This is in itself an admirable step in the promotion of the public health, but is obviously of a somewhat limited and local character, very largely confined to the larger cities. Another is the encouraging of the seaside habit and the back-to-the-beaches slogan. But this, though valuable in many other ways as well, is even more limited in its possible action. But a much more fundamental and far-reaching method is at our disposal.

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