Goiter

 

Iodine deficiency is well-known to cause enlargement of the thyroid, known as a goiter. It is commonly seen in places far from the sea, where little iodine-rich food (such as fish and seafood) is consumed.

Goiters can be any one of several types of growths in the thyroid gland, located at the base of the front side of the neck just below the Adam’s apple. Basically, it is any enlargement of the thyroid gland.

Types

In the case of Graves’ disease, the entire thyroid gland becomes enlarged.

Another type, called toxic nodular goiter, results when one or more nodules develop in the thyroid and trigger excess production of thyroid hormone resulting in an enlarged thyroid gland.

A simple goiter may be a temporary problem that will remedy itself over time without medical intervention, or a symptom of another, possibly severe, thyroid condition that requires medical attention.

This above picture depicts the typical appearance of a goiter with an entire neck swollen because of the large thyroid. The mass compresses the trachea (windpipe) and esophagus (swallowing tube) leading to symptoms, such as coughing, waking up from sleep feeling breathless, and the sensation that food is getting stuck in the upper throat. Once a goiter gets this big, surgical removal is inevitable to relieve the symptoms.

Causes


It seems that the first side effects of the "imbalances" in the hormones are menopause, weight gain and thyroid problems appearing simultaneously. By itself, the thyroid can be affected by poor diet, fluoride in the water, excessive consumption of unsaturated fats, endurance exercise, pesticide residues in fruits and vegetables, x-ray radiation, alcohol and drugs. Auto-immune response due to the body becoming allergic to thyroid hormones and produces antibodies against the thyroid tissue, resulting in swelling of the thyroid gland is possible too.


Iodine is a critical nutrient for the proper functioning of the thyroid and production of thyroid hormones, failing which goiter develops. The most plentiful thyroid hormone is thyroxine (also known as T4) which stimulates the metabolism. Some thyroxine is converted into a related hormone known as triiodothyronine (T3), which is more metabolically active.

+ Goiters can occur when the thyroid gland produces high levels of thyroid hormone (hyperthyroidism) and may become toxic in some instances. Hence T4 tends to be above average.

+ However, for most sufferers is due to deficiency of thyroid hormone (hypothyroidism). For such cases, the master gland naturally compensates with an increase in thyroid stimulating hormone (TSH) in response to a defect in normal hormone synthesis within the thyroid gland that causes the thyroid to enlarge. This enlargement usually takes many years to become apparent. The reading should indicate low T4 and high TSH (Thyroid Stimulating Hormone).

+ Problem may arise when the pituitary gland fails to boost production of the hormone. This is indicated by a low T4 reading and a low TSH.


The following table summarizes some examples of typical test results and their potential meaning:

TSH	Free T4	Free or total T3	Probable Interpretation
High	Normal	Normal	Mild (subclinical) hypothyroidism
High	Low	Low or normal	Hypothyroidism
Low	Normal	Normal	Mild (subclinical) hyperthyroidism
Low	High or normal	High or normal	Hyperthyroidism
Low	Low or normal	Low or normal	Non-thyroidal illness; pituitary (secondary) hypothyroidism
Normal	High	High	Thyroid hormone resistance syndrome (a mutation in the thyroid hormone receptor decreases thyroid hormone function)

+ Enlargement could also occur with normal production of thyroid hormone, such as a nontoxic multi-nodular gland.

+ A sporadic goiter can form if you eat too many goiter-promoting foods, such as soybeans, rutabagas, cabbage, peaches, peanuts and spinach. These foods can suppress the manufacture of thyroid hormone by interfering with your thyroid’s ability to process iodide. It may also occur in people who live in areas with iodine-poor soil not getting enough iodine in their diet. This problem can be resolved by taking in iodine containing foods.

+ The BBC report makes the point that iodine deficiency can impair brain development in the foetus too. Ensuring adequate iodine intake does appear to be a matter of considerable importance, particularly for women of childbearing age.

+ It should be borne in mind that vegetarians and vegans are at a significantly increased risk of eating a diet deficient in iodine.

+ Certain medications such as lithium or aminoglutethimide can cause a simple goiter.

Likely sufferers

• Anyone over age 40
• People with a family history of goiter
• Mostly females

Symptoms


The main symptom is a swollen thyroid gland. The size may range from a single small nodule to a large neck lump.


Some people with a simple goiter may have symptoms of an underactive thyroid gland. In rare cases, the swollen thyroid can put pressure on the windpipe and esophagus, leading to:

• Breathing difficulties (may rarely occur with very large goiters)
• Cough
• Hoarseness
• Swallowing difficulties 

Other manifesting symptoms are:

• Dry skin, dry hair and hair loss
• Fatigue and weakness
• Weight gain and difficulty losing weight
• Intolerance to cold temperatures
• Muscle cramps and frequent muscle aches
• Depression and irritability
• Irregular menstrual cycles
• Memory loss, migraine
• Low blood pressure
• Impaired hearing
• Decreased libido
• Constipation
• Visible physical signs like yellow-orange coloration in the skin (eg. palms and bumps on the eyelids), hair loss, swollen eyes

In extreme situations of low thyroid hormone, the patient's metabolic rate can drop drastically to a critical level which may develop into a potentially fatal coma state. 


Exams and Tests


The doctor will require you to swallow and check the neck for any swell.


With very large goiters, there may be swelling in the neck vein, and you may feel dizzy when you raise your arms above your head.

The following blood tests can measure thyroid function: 

Free thyroxine (T4) and T3

Thyroid stimulating hormone (TSH)

If all 3 fall below the clinical range, it is confirmed the hormone level is abnormally low for proper functioning. At personal level, take 5 consecutive readings of the auxillary temperature (underarm) 10 minutes after waking up and if the average falls below 97.8, thyroid hypo-function is suspected. Other possibilities of lower temperature include adrenal stress, thiamine deficiency, diets low in essential fatty acids and protein malnutrition.

If your test results come back ‘normal’ but you have many of the symptoms or risk factors for thyroid disease, consider tests to look for abnormal, and possibly cancerous areas in the thyroid gland include:

• Thyroid scan and uptake
• Ultrasound of the thyroid

If nodules are found on an ultrasound, a biopsy should be done to check for thyroid cancer.

Treatment

A goiter only needs to be treated if it is causing symptoms. Treatments for an enlarged thyroid include:

• Thyroxine medication, if the goiter is due to an underactive thyroid. Mixing with calcium and iron can impair its bioavailability.
• Small doses of Lugol’s iodine or potassium iodine solution if the goiter is due to a lack of iodine.
• Radioactive iodine to shrink the gland, especially if the thyroid is producing too much thyroid hormone.
• Surgery to remove all or part of the gland. (for the vast majority of patients, surgical removal of a goiter for fear of cancer is not warranted).

Other comments

+  Iodine deficiency has been linked to breast cancer and other disorders like extreme fatigue, hypothyroidism and weight gain. You can derive iodine from sea salt and sea foods. However, excessive iodine intake may inhibit the secretion of thyroid hormone and can produce a metallic taste and sores in the mouth, swollen salivary glands, diarrhea and vomiting. Selenium intake is not recommended for goiter patients.


+  In patients with mild to moderate Graves’ disease, selenium supplementation seems to work well as it contributes to the antioxidant defense in the thyroid, by removing oxygen free radicals generated during the production of T4 and conversion to T3.

VIVA corner

Vivashield with 4 antioxidants - Vitamin A, C, E and selenium combined combat free radical damage.
Viva CalMag and D should be added as calcium production may be impeded with the malfunctioning of the thyroid gland.

VIVA Vivaguard offers protection to surrounding tissue from destruction by free radicals and speeds up recovery. VIVA Chloroguard derived from seaweed offers good protection with the ability to compensate for the need for iodine. The idea is that if we were to saturate the thyroid with iodine, then it would not absorb any radioactive iodine that might be present in the atmosphere. Children appear to be at highest risk for this matter.