February 1, 2023

The fourth week of January is designated as Goiter Awareness Week.
Goiter is the abnormal growth or enlargement of the thyroid gland, a butterfly-shaped gland located in the middle of the neck. The growth may be diffused causing overall enlargement of the thyroid or it may be nodular, in which one or more round or oval nodules or lumps form in the thyroid.
The thyroid gland’s function is to produce the hormones called triiodothyronine or T3 and thyroxine or T4. These hormones control how the body uses and stores energy. They have a role in the regulation of blood pressure, heart rate, body temperature. In goiter, there may be no change in the function of the thyroid gland, or there may be an increase or decrease in hormone production. Most thyroid nodules are not cancerous but medical tests should be done to make sure that a thyroid nodule is not cancerous.
The function of the gland is in turn controlled by a specialized region in the brain called the hypothalamus and by another gland, the pituitary gland. This gland produces a hormone called thyroid stimulating hormone or TSH and by regulating the amount of TSH the pituitary gland regulates the production of T3 and T4. In the evaluation of goiter and thyroid function, the level of TSH is always tested.
Goiter may be due to lack of iodine, inflammation due to autoimmune disease in which the body produces antibodies that cause inflammation and damage to thyroid tissue, thyroid nodules, cancer of the thyroid, or inflammation due to infection. Iodine is needed in the production of T3 and T4.
A person with goiter may be asymptomatic and a nodule may just be an incidental finding during medical check-up for other problems or during routine tests.
Symptoms that develop are related to the increase in the size of the thyroid gland or the level of T3 and T4.
The enlarged gland may impinge on the food passageway leading to difficulty in swallowing, or to the airway leading to cough, hoarseness of the voice, or snoring. Low levels of hormones lead to tiredness or fatigue, sleepiness, dry skin, constipation, muscles weakness, sensitivity to cold, forgetfulness, poor mental function or inability to concentrate. High levels of hormones lead to increased appetite, insomnia, excessive sweating, weight loss, sensitivity to heat, irritability, blood pressure elevation and increased heat rate, and increase in frequency of bowel movement. These signs and symptoms are not interpreted alone; they are correlated with a doctor’s findings during physical examination.
Laboratory tests are needed to establish the cause of nodules causing goiter. Blood tests, ultrasound of the neck, needle aspiration, and thyroid scan may be necessary.
The tendency to develop goiter is high if our diet is deficient in iodine. The Cordillera has a high prevalence rate of goiter because of iodine deficiency. We are encouraged to consume food rich in iodine like seafood, milk and other dairy products, meat, bread and eggs. The use of iodized salt is also encouraged.


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