The fight against Goiter

THE Philippine Health Department, together with other agencies and health organizations, had worked in collaborative efforts for the issuance of Presidential Proclamation No. 118 last December 2006 declaring every fourth week of January as the Goiter Awareness Week.

For this year, the national health theme is “Goiter Sugpuin, Isip Patalinuhin, Iodized Salt Gamitin.”

A Goiter is defined by the Merck Manual of Medical Information as an enlargement of thethyroid gland that generally results from a lack of iodine, inflammation and benign or malignant tumors.

“Goiter is associated with hypothyroidism and hyperthyroidism,” it adds.

A hypothyroidism is “a condition that arises from inadequate amounts of thyroid hormone in the bloodstream,” states The Lippincott Manual of Nursing Practice.

In contrast, hyperthyroidism is the exact opposite.

Anatomically, a thyroid gland, according to Dr. Gerard Tortora, author of Principles of Anatomy and Physiology, is a butterfly-shaped gland located below the larynx.

Dr. Totora maintains that among the functions of the thyroid gland is to produce thyroid hormones that help regulate our body’s metabolic processes.

Considering its location, “the thyroid gland [during goiter] may become so large that respiratory complications arise as a result of compression to the neck and chest,” explains Dr. Joseann Helmes Dewitt, a contributor of Pathophysiology: Reviews and Rationales.

Generally, there are two major forms of simple goiter: endemic and sporadic.

“Endemic goiter is principally caused by nutritional iodine deficiency,” writes Dr. Allen Hanberg in her Medical-Surgical Nursing: Clinical Management and Positive Outcomes.

Meanwhile, “sporadic goiter may be caused by any of the following: genetic defects; ingestion of large amounts of cabbage, soybeans or spinach; and ingestion of medicines like corticoids, dopamine or lithium.”

According to an article of New York Times, goiters are most common to anyone aged 40 years and above, people with family history of goiter and females.

How goiter develops is a matter of our body’s way of compensating to maintain homeostasis, which is a state of internal balance as far as our bodily functions are concerned.

As Dr. Hamber puts it: “If there is a lack of sufficient dietary iodine or if production of thyroid hormone is suppressed, the thyroid enlarges in an attempt to compensate for hormonal deficiency.”

A goiter can be medically diagnosed by the physician by way of meticulous patient history-taking, observation of clinical manifestations and confirmation of laboratory tests.

“Collectively, these laboratory tests are called Tests of Thyroid Function,” informs The Lippincott Manual of Nursing Practice.

Other tests that can aid in diagnosis, writes Dr. H. Harold in his Problem Oriented Medical Diagnosis, include ultrasonography, thyroid scan, RAI uptake and needle aspiration of the thyroid gland.

Since goiter is associated with hyperthyroidism or hypothyroidism, its signs and symptoms are largely dependent on its association with the two.

However, “many patients with goiters are asymptomatic (no manifestations),” informs Dr. Harold. “The mass on the neck may be the presenting complaint, having been discovered by the patient or brought to his attention by a relative or friend.

A patient with goiter, said Dr. Dewitt, that is leaning towards hyperthyroidism may experience weight loss, heat intolerance, an increase in metabolic function, oxygen consumption by the cells and heat production.

Patients whose goiter is associated with hypothyroidism will have the following manifestations: decreased metabolic rate, weight gain, cold intolerance and possibility of having edema or fluid retention

The World Health Organization (WHO) classifies goiters caused by iodine deficiency into two grades.

In Grade 1 goiters, a mass in the neck is consistent with an enlarged thyroid that is palpable but not visible.

In Grade 2 goiters, the swelling on the neck becomes visible.

In 1998, the Philippine Food and Nutrition Research Institute and the Department of Science and Technology conducted a nutritional survey to assess the extent of iodine deficiency among 10,616 Pinoy school children aged six to 12 years. It was then found that the Philippines as a whole had a mild iodine deficiency.

In 1995, Republic Act No. 8172 or “An Act for Salt Iodization Nationwide (ASIN) was enacted to promote the nutritional fortification of food and combat micronutrient malnutrition including iodine deficiency in the country.”

“Iodine deficiency is the world’s greatest single cause of preventable brain damage,” states the Food and Nutrition Bulletin of the United Nations.

Treatment for goiter is largely dependent according to its cause. According to ADAM Health Inc., a patient with goiter that is producing too much thyroid hormone will be given radioactive iodine to shrink the gland.

If goiter is caused by iodine deficiency, the doctor may opt to give small doses of iodine in the form of Lugol’s solution.

If the goiter is induced by an underactive thyroid, the physician prescribes thyroid supplements.

Dietary management for goiter is also dependent on the disease’s etiology or cause.

“A low caloric diet with increased protein is prescribed for patients with hypothyroidism,” explains Dr. Adela Ruiz, a registered nutritionist-dietician and author of Basic Diet Therapy for Filipinos.

On the other hand, “the basic aim of diet therapy for patients with hyperthyroidism is to compensate for the increased metabolic rate, prevent destruction of body tissues and consequent rapid loss of weight.”

For Dr. Ruiz: “A high calorie, liberal protein, liberal carbohydrate diet with calcium, phosphorus, vitamin D and B complex supplementation is recommended for hyperthyroidism.”

In very severe cases, the doctor may decide to perform thyroidectomy or the surgical removal of the thyroid.

Should a patient undergo a thyroidectomy, the medical doctor that will be performing the surgical procedure is an otorhinolaryngologist (formerly known as the Ears-Nose-Throat doctor) co-managing with a surgeon and anesthesiologist.

(Comments may be sent to: polo.journalist@gmail.com, or follow me on Twitter at polo_socio).