Goiter and the thyroid gland

By Penelope A. Domogo, MD

“ 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 and be cheerful and trust in the Divine.“

Simple goiter was a common sight in the Cordillera about 40 years ago and earlier so I guess many of us are familiar with it. It could be very visible when it gets big. I had a small one when I was in college and it shrunk to normal when I shifted to the right diet.
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. It has two lobes that hug the windpipe or trachea ( the hard part that you feel in your throat). It is part of an intricate network of glands called the endocrine system which is responsible for coordinating many of our body’s activities. Wait, we said in the past issues that the brain coordinates all our body’s activities. Well, the brain is the overall commander and under it are various networks like the endocrine system. While the brain uses nerves and neurotransmitters to carry messages, the endocrine system uses chemicals called hormones that it releases to the blood to carry messages.
The thyroid gland uses iodine from food to manufacture at least two hormones, tri-iodothyronine (T3) and thyroxine (T4). It stores them and releases them to the blood as needed. The hypothalamus and the pituitary gland in the brain help control the thyroid gland. The hypothalamus releases thyrotropin-releasing hormone (TRH) which stimulates the pituitary gland to release thyroid-stimulating hormone (TSH). When the brain is working normally, they sense when:
– Thyroid hormone levels are low so they secrete more TRH and TSH to stimulate the thyroid gland to make more hormones.
– Thyroid hormone levels are too high so they secrete less TRH and TSH so the thyroid gland will reduce hormone production. It follows the law of supply and demand and a negative feedback mechanism.
These hormones then swim in the bloodstream to reach every cell of our body. These influence a lot of our vital body functions including but not limited to the following:
1. regulate the rate calories are burned, affecting weight loss or gain.
2. can speed up or slow down heart rate
3. raise or lower body temperature
4. speed up or slow down the rate at which food moves through the digestive tract
5. control the way muscles contract
6. control the rate at which dying cells are replaced (speed of healing)
The thyroid gland can become abnormal as follows:
1. Simple nontoxic goiter is due to lack iodine in the diet, like other 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 iodine supplementation. 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 sea fish and seas weeds are available, iodine supplementation is not necessary. Research shows that excess iodine can also cause goiter.
2. Toxic goiter or hyperthyroidism. This is a hyperactive thyroid with or without goiter. There’s too much production of T3 and T4 resulting in overstimulation of our cells. Thus symptoms of toxic goiter are usually rapid heart rate, fast metabolism so 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 where antibodies are produced to stimulate TSH receptors in the thyroid gland. (more about autoimmune diseases in the future). This could also be from the synthetic chemicals and hormones in the modern diet that disrupt the feedback mechanism. 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.
3. 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 block the TSH receptors. Common symptoms are lethargy, slow heart rate, depression, constipation. T3 and T4 levels are low. 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.
4. Thyroid cancer. 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 and be cheerful and trust in the Divine.***
“A cheerful heart is good medicine but a crushed spirit dries up the bones.” Proverbs 17:22**

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