The upper Midwest and Great Lakes regions were once known as the “Goiter Belt” because of the prevalence of enlarged thyroid glands that gave the afflicted visibly swollen necks. The goiter problem was widely noted during World War I when Army physicians recognized the condition in recruits.
In the U.S., for example, the area around the Great Lakes used to be known as the goiter belt because the soil is particular iodine-deficient, and this resulted in higher incidence of goiter among residents of the area.