The Adena pipe figurine was found in the 2000 year-old Adena burial mound in Ross County, Ohio, USA by William C. Mills in 1901. The pipe reportedly represents an achondroplastic dwarf male Native American. However, the clinical aspect (swelling of the neck), the environmental/cultural characteristics in this area (iodine-poor soils, absence of seafood and milk consumption, tobacco smoking), and the marked prevalence of goiter among Native American populations favor the diagnosis of a goiter associated to iodine deficiency. Similar indigenous art representations found in South America and Mesoamerica strengthen this hypothesis. To our knowledge the Adena pipe is the first example of goiter depicted in Native North American art and one of the oldest from the continent.