• Goiter is an enlargement of the thyroid gland.  The thyroid gland is located in front of and on the sides of the "Adam's apple" on the neck.  The cause of endemic goiter is iodine deficiency in the diet.  Thus the term endemic refers to goiter that is prevalent in a certain part or region of the world, usually mountain areas where the soil is low in iodine content.  Less commonly, goiter is caused by substances in the food or water that increase the likelihood of iodine deficiency.

- Cretinism -- deafness, short stature, and mental retardation

• Thyroxine level usually normal
  
• Thyroid stimulating hormone is usually slightly elevated
  
• Thyroid radioactive iodine uptake is usually elevated
  

• Once dietary supplementation of iodine is re-established, most cases of thyroid problems usually improve.  Unfortunately, the thyroid gland remains enlarged.  The thyroid gland may be surgically reduced in size for cosmetic purposes or if the thyroid is pressing on other structures.
  

• Dietary supplementation with iodine (in the USA most salt is supplemented with iodine)
  

• Toxic multi-nodular goiter
  
• Congenital Hypothyroidism