Imagine how just over one hundred years ago, nearly ⅓ of people in the upper Great Lakes and upper Midwest regions walked around with a goiter on their neck. A goiter is a lump on the throat, which could be as big as an orange, a grapefruit, or larger. Actually an enlargement of the thyroid gland, a goiter can come from an overactive thyroid gland, an under-active thyroid gland, or an autoimmune condition, but in the United States before the 1920s, the reason was almost always deficiency of iodine.