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. In the United States, goitre was found in the Great Lakes, Midwest, and Intermountain regions. The condition now is practically absent in affluent nations, where table salt is supplemented with iodine. However, it is still prevalent in India,^[1] Central Asia and Central Africa.

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.

New research indicates that there may in fact be a tendency to inherit an increased vulnerability to goitre.

Iodine is necessary for the synthesis of the thyroid hormones triiodothyronine and thyroxine (T3 and T4). In conditions producing endemic goitre, 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 increase synthesis of T3 and T4, but it also causes the thyroid gland to grow in size by increasing cell division.

Goitre is more common among women, but this includes the many types of goitre caused by autoimmune problems, and not only those caused by simple lack of iodine.