The THYROID GLAND AND GOITER: Ating Alamin

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The THYROID GLAND AND GOITER Ating Alamin
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• Butterfly-shaped organ
• in front of the neck

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What Does Your Thyroid Gland Do for You?

• Produces Two Hormones Called
• Thyroxine (T4)
• Thyronine (T3)
• Regulates Metabolism so Your Cells Function
  Properly
• Affects Every Cell in the Body

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Thyroid Hormone AffectsMany Organs and General
Health
Eyes
Lungs
Brain
Heart
Liver
Kidney
Skin
GI Tract
Uterus
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Iodine
Thyroid Hormone

• Brain function, memory, concentration
• Muscle movement
• Cholesterol melting
• Normal heart beat

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GOITERS

• Any enlargement of the thyroid gland
• Bosyo

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G O I T E R
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GOITERS

• Function
• - Euthyroid
• - Hyperthyroid
• - Hypothyroid

• Structure
• - Diffuse
• - Nodular

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When the Thyroid Doesnt Work
Hyperthyroidism
Hypothyroidism
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When the Thyroid Doesnt Work

• Hyperthyroidism
• Too Much Thyroid Hormone
• Metabolism Speeds Up

• Hypothyroidism
• Too Little Thyroid Hormone
• Metabolism Slows Down

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Two Common Types of Thyroid Disease

• Hyperthyroidism

• Hypothyroidism

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Signs and Symptoms of Hyperthyroidism
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Signs and Symptoms of Hypothyroidism
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What causes Thyroid Diseases ?

• The Hidden Health Problem

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What causes thyroid diseases ?

• Iodine deficiency disorder
• Surgical
• Radioiodine therapy
• Autoimmune diseases

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Clinical Expression of Iodine Deficiency
Fetus
Neonate

• Miscarriages
• Stillbirths
• Neurological cretinism
• Impaired intellectual function
• Increased perinatal mortality

• Increased infant mortality
• Neonatal goiter
• Cretinism
• Impaired intellectual function

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Clinical Expression of Iodine Deficiency
Child adolescent
Adult

• Goiter
• Hypothyroidism
• Impaired intellectual function
• Retarded physical development

• Goiter
• Hypothyroidism and poor intellectual and physical
  performance

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Sources of Dietary Iodine

• Iodine in soil, water and crops
• Seafood
• Dairy Products
• Iodised salt and other fortified foods
• Medicines/health foods/supplements
• Other adventitious sources

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Myths and Factson Thyroid Diseases
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ON FOODS

• Myth
• Eating carrots, cabbage, root crops can cause
  goiter.

• Fact
• These foods have goitrogens.
• But you have to eat a truckload of these foods in
  a short time before you develop goiter.

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ON FOODS

• Fact

• Myth
• Drinking cold drinks is bad if you have goiter.

The temperature of the food or drink has no
effect on the thyroid gland since it is not
located in the alimentary tract
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ON FOODS

• Myth
• Eating seafoods can cure goiter.
• Not eating seafoods can cause goiter

• Fact
• Seafoods are important for their iodine content
  but can not cure goiter.
• A person with iodine deficiency may develop
  goiter.

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ON FOODS

• Myth
• Herbal medicines are effective in treating goiter
  and other thyroid problems.

• Fact
• Contents of herbal medicines are often not
  specified their efficacy to treat is still in
  question.

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ON FERTILITY

• Myth
• A person with goiter becomes infertile

• Fact
• Simple goiter does not affect fertility of both
  sexes.
• It is abnormal thyroid function that affects
  fertility

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ON FERTILITY

• Myth
• Radioactive iodine treatment for hyperthyroidism
  will lead to infertility.

• Fact
• Radioactive iodine only concentrates in the
  thyroid gland and does not affect other organs

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ON PREGNANCY

• Myth
• Bearing down during labor can cause goiter

• Fact
• Iodine deficient pregnant women develops goiter
  to compensate for thyroid hormone deficiency. It
  is noted after delivery when increased weight is
  resolved

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ON PREGNANCY

• Myth
• Goiter, if present, indicates caesarean section

• Fact
• Bearing down during labor does not affect the
  size of goiter

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ON PREGNANCY

• Myth
• Any drug for the treatment of thyroid problem
  should be discontinued once the patient becomes
  pregnant

• Fact
• If the medication is for hyperthyroidism or
  replacement therapy, the patient should be
  referred to an endocrinologist for dose adjustment

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ON PREGNANCY

• Fact
• There is an increased risk for miscarriage if
  medications are discontinued

• Fact
• Patients with inadequate replacement therapy have
  abnormal platelet function which may lead to
  prolonged bleeding during labor

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ON PREGNANCY

• Myth
• All mothers with thyroid diseases will deliver
  infants with thyroid problems

• Fact
• Mothers with circulating thyroid antibodies are
  more likely to have infants with thyroid problems
• Antithyroid medications traverse the placenta and
  may cause transient hypothyroidism in the baby

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ON VARIOUS TREATMENT MODALITIES

• Myth
• Radioactive Iodine Treatment can cause cancer

• Fact
• There has been no report that it can cause cancer
• There is no chromosomal abnormality in children
  born to mothers who received the treatment

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ON VARIOUS TREATMENT MODALITIES

• Myth
• Radioactive Iodine Treatment cannot be given to
  individuals in their reproductive age

• Fact
• 131 Iodine concentrates only in the thyroid gland
• Fertility is affected by the abnormal thyroid
  functional status (hyperthyroidism or
  hypothyroidism)

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ON VARIOUS TREATMENT MODALITIES

• Myth
• Radioactive Iodine Therapy leads to hypothyroidism

• Fact
• Even without intervention, the gland will shrink
  in gt 10 yrs time, due to continuous inflammation
  and fibrosis eventually leading to hypothyroidism

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ON VARIOUS TREATMENT MODALITIES

• Myth
• Patients who receive Radioactive Iodine uptake
  and therapy should be isolated

• Fact
• No isolation is necessary for 131 Iodine uptake
  and therapy for hyperthyroidism
• Only patients who receive high dose treatment for
  cancer should be isolated in a leaded room

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SURGERY

• Myth
• Surgery is the ultimate treatment for all thyroid
  diseases

• Fact
• Surgery is indicated for thyroid cancer,
  multinodular goiter, and in big goiters causing
  compression symptoms

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SURGERY

• Myth
• Patients who get operated on for goiter lose
  their voice

• Fact
• This is rare if thyroidectomy is done by an
  experienced surgeon
• Laryngeal nerve damage is higher on reoperation

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• Kaya lumalaki ang leeg at nagka-bosyo ang buntis
  e dahil hindi ito marunong umire.
• Bawal magbuhat ng mabigat habang buntis dahil
  magkaka-Goiter sya.

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When you have GOITER

• Visit your doctor or an endocrinologist
• Blood tests and other tests like ultrasound may
  be requested for evaluation
• Medications given should be taken regularly as
  prescribed

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• The Philippine College of Physicians wishes to
  acknowledge the following for their invaluable
  efforts in the preparation of this module
• Nemesio Nicodemus, MD
• Bien Matawaran, MD
• Aimee Andag-Silva, MD
• Leilani Mercado-Asis, MD
• Gabriel Jasul, MD
• Rosa Allyn G. Sy, MD
• Committee on Advocacy Public Relations
• Philippine Society of Endocrinology and
  Metabolism