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Goiters can be quite large and need not be symmetrical. Goiters the size of a baseball are not uncommon and ones the size of a football are not unknown. Unfortunately, treating the underlying condition will not always result in a shrinking of the tissues.
As iodine in the diet is generally supplied by iodized table salt, goiters are rare in North America today, although they can be seen in the elderly and in many places in the developing world.