By Penelope A. Domogo, MD
Simple goiter was a common sight in the Cordillera about 40 years ago so I guess many of us are familiar with it. Goiter is an enlargement of the thyroid gland. The thyroid gland is a butterfly-shaped tissue in front of our throat at the base of our neck, about two inches long and soft so you can’t feel it. So when you can feel it, it is enlarged. The thyroid gland is produces the thyroid hormones that are important in many of our body functions.
There are many types of goiter. It can be classified by the way it grows such as:
1. Simple or diffuse goiter- the entire thyroid gland enlarges and feels smooth to touch.
2. Nodular goiter – there’s a solid or fluid-filled lump that grows within the thyroid gland and it feels lumpy.
3. Multinodular goiter – many lumps develop within the thyroid gland. These lumps are usually visible but some may only be discovered through examination or scan.
Goiter can also be classified based on the thyroid hormone levels it produces, as follows:
1. Toxic goiter – the thyroid gland is enlarged and it produces too much thyroid hormone.
2. Nontoxic goiter – the thyroid gland is enlarged but the thyroid hormone it produces is at normal levels.
In diagnosing goiter, we combine these two types. For example, we would say “nontoxic nodular goiter” or “toxic nodular goiter”. Goiter is usually not cancerous.
Simple nontoxic goiter is due to lack iodine in the diet, like mountain peoples in the world. This kind of goiter is just an enlargement of the thyroid gland but function is not affected. It could be treated with proper diet. I had a small one when I was in college and it shrunk to normal when I shifted to the right diet. Surgery is not necessary unless it becomes too big as to obstruct breathing or for aesthetic reasons. Iodine, just like any other mineral, is found in plants like the “puket”/”burburtak” but because of top soil depletion, our vegetables may not contain enough iodine. This iodine is washed down to the sea along with zinc, manganese, gold and other mineral that is why sea salt is naturally iodized and using raw sea salt gives enough iodine for our thyroid gland. In places like the Philippines where we use sea salt and we eat sea fish and seas weeds are available, iodine supplementation is not necessary. Research shows that excess iodine can also cause goiter.
Toxic goiter is a hyperactive thyroid with or without goiter that produces the medical condition called hyperthyroidism. There’s too much production of thyroid hormones. Thus symptoms of toxic goiter are usually rapid heart rate, fast metabolism so the person keeps slim despite eating much (some women like this), but there is also anxiety, restlessness, heat intolerance and could have hand tremors and exopthalmus (“pumutlag nan mata”). This could result from an autoimmune disease called Grave’s disease. This could also be from the synthetic chemicals and hormones in the modern diet that disrupt the thyroid function. Treatment could be surgery, radioactive iodine or antithyroid drugs and medicines to treat the symptoms. Diet change is necessary for long-term wellness. In surgery, not all the thyroid gland is removed as much as possible as it is a vital component of our body.
Hypothyroidism could also be with or without goiter. It is caused by an underactive thyroid gland which, in turn, is commonly caused by another autoimmune disease called Hashimoto’s disease where thyroid cells are destroyed or antibodies interfere with hormone production. Common symptoms are lethargy, slow heart rate, depression, constipation. Treatment is usually a daily dose of a synthetic thyroid hormone called levothyroxine. Don’t forget to eat right. Again, the unhealthy modern-day diet is implicated in autoimmune diseases.
Goiter is not cancerous but thyroid cancer could also manifest as a “bukol” or lump at the base of the throat. Thyroid cancer is rare. Just like any cancer these can be treated with any or some or all of the following – surgery, radiation, chemotherapy and diet.
Just like in all problems in life, prevention is better than cure. Preventing thyroid problems is the same as preventing other diseases. God is good. Use raw sea salt, eat well, physical exercise, drink enough water, be cheerful and trust in the Divine.***
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“A cheerful heart is good medicine but a crushed spirit dries up the bones.” Proverbs 17:22
