A little story about Swiss doctors who eradicated goiter

When Johann Wolfgang von Goethe visited Switzerland in 1779, he did not particularly like the residents of the canton of Valais. Purely external. “The horrible goiters have given me a completely bad sense of humor,” he wrote in a letter. Back then, goiters were ubiquitous not only in Valais, but in many parts of Switzerland and the Alpine region. Goiter is the colloquial term for the enlargement of the thyroid gland. The medical term for this is struma. And in 90 percent of cases, goiter is caused by dietary iodine deficiency.

Goiter was not a new phenomenon in Goethe’s time. Reports on this have been handed down since ancient times. But in Switzerland, thyroid swelling was one of the most pressing health problems affecting large parts of the population. A goiter can cause difficulty swallowing or shortness of breath if the enlarged thyroid presses on the windpipe. In some Swiss areas in the 1920s, a quarter of the men were decommissioned because of this.

When there is an iodine deficiency, the body produces too few thyroid hormones. For this reason, those affected feel exhausted and weak. The consequences of iodine deficiency for unborn children or small children are more serious. They develop iodine deficiency syndrome, also known as cretinism, which was widespread in Switzerland. The consequences: massive developmental disorders as well as neurological damage, shortened extremities and speech disorders. But more than 100 years ago, three Swiss country doctors managed to successfully treat the gland swelling. With iodized salt.

Goiter – really a deficiency symptom?

The first reports that the administration of iodine reduced the swelling of the thyroid appeared shortly after the discovery of the trace element in the 1820s, as the medical historian Pascal Germann writes in the journal “Swiss Journal of Nutritional Medicine”. In 1820, the Geneva doctor Jean-François Coindet (1774–1834) suggested administering iodine as a cure for goiter. The idea of ​​iodized salt came up at that time: the French chemist Jean Baptiste Boussingault (1802–1887) suggested administering iodized salt to combat the goiter problem. But the medical breakthrough of this therapy was a long time coming. Also because most doctors were initially not convinced that a deficiency would actually cause illness.

And this was at a time when medicine was making significant scientific advances. The standard work on thyroid diseases from 1909 stated that it was absurd that a substance deficiency would cause goiter. In addition, most doctors at that time focused on infectious diseases. Since Robert Koch and Louis Pasteur created bacteriology in the late 19th century, scholars have been furiously searching for pathogens and declaring them to be the cause of many diseases. And so doctors explored all of Switzerland’s waters for goiter pathogens – without success. As a result of the decades-long search for bacteria or viruses, the idea of ​​iodine deficiency faded into the background. Although the solution to the health problem had been known for a long time.

That changed in the 1910s. Scientists began to study nutrients more closely, especially vitamins. In 1914, the US researcher Edward Kendall (1886–1972) succeeded in isolating the thyroid hormone thyroxine. He found that it contains iodine. Today it is known that the two hormones of the thyroid gland – thyroxine and triiodothyronine – contain iodine. They are involved in almost all processes in the body, especially in the metabolism and growth of cells. Iodine, which cannot be produced by the body itself, is therefore vital and is one of the essential trace elements.

The iodine deficiency of the Swiss

Because the soil in Switzerland contains hardly any iodine, the country was particularly badly affected by iodine deficiency. It is therefore no coincidence that the iodine deficiency theory and iodized salt prophylaxis celebrated their breakthrough there – away from the large research institutes and universities. And there were three country doctors who dealt with the problem.

It started with Heinrich Hunziker (1879–1982), a family doctor from the village of Adliswil in the canton of Zurich. In a lecture in 1914, he showed that goiter occurs because the body adapts to a diet low in iodine. Hunziker suggested therapy with low doses of iodine.

However, the question remained as to how long-term small amounts of iodine could be distributed among the population. Constantly taking medication would probably not have become widespread. Salt therefore turned out to be an ideal alternative. Humans have a natural need for salt and consume it daily. Furthermore, it is essential for life. In addition, iodine can simply be mixed into salt and was available almost everywhere at the time.

While Heinrich Hunziker publicized iodized salt prophylaxis, Otto Bayard (1881–1957), a Valais general practitioner from Zermatt, put it into practice. From 1918 onwards he systematically carried out tests on the effects of iodine in salt. In a remote village severely affected by iodine deficiency, he selected several families to supply with iodized salt. A few months later he checked the results and found that the measure had worked; the affected people’s thyroids were significantly less swollen than before.

The Swiss success story of iodized salt

So it worked on a small scale, but could the method also be transferred to larger parts of the population? Bayard now selected two more villages and supplied them with iodized salt. The result after six months: the goiters disappeared.

Now the Swiss federal authorities began to take an interest in the iodine experiments. A goiter commission discussed whether and how the iodized salt should be distributed throughout the country. Implementing a government health measure on this scale was new, and it was important to clarify whether the population should be informed about it and perhaps have the choice to buy salt with or without iodine. Ultimately, it was recommended that iodized salt should now be purchased.

Now the third Swiss country doctor came into play: the surgeon Hans Eggenberger (1881–1946) from the canton of Appenzell. He started a campaign advocating the iodization of table salt. In this way he initiated a successful popular initiative in Appenzell for the introduction of iodized salt. In 1922 the majority of the population approved the idea.

That was the start of an unprecedented success story, as journalist Jonah Goodman explains in the Swiss “Tages-Anzeiger” magazine in 2022. The Goitre Commission had recommended that the cantons introduce iodized salt. Iodized salt has been available everywhere in Switzerland since 1930. And since then, goiter and cretinism have hardly played a role in the country.

The success of this prevention measure led to the iodine microdosing model spreading to many parts of the world. Iodized salt has been mandatory in Austria since 1963. It’s different in Germany: There is no legal regulation, but since 1981 iodized salt has been allowed to be sold without the statement “only if iodine deficiency has been diagnosed by a doctor.” Since 2007, Germany has no longer been considered an iodine deficiency area, but around a third of Germans now suffer from iodine deficiency again. The World Health Organization (WHO) estimates that around 750 million to one billion people worldwide are affected. Apparently the world urgently needs a renaissance of Swiss iodized salt therapy.