The THYROID GLAND AND GOITER: Ating Alamin

1. The THYROID GLAND AND GOITER: Ating Alamin

2. Butterfly-shaped organ in front of the neck

3. 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

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

5. Iodine Thyroid Hormone • Brain function, memory, concentration • Muscle movement • Cholesterol melting • Normal heart beat

6. GOITERS Any enlargement of the thyroid gland “Bosyo”

8. G O I T E R

9. GOITERS • Function - Euthyroid - Hyperthyroid - Hypothyroid • Structure • -Diffuse • - Nodular

10. When the Thyroid Doesn’t Work Hyperthyroidism Hypothyroidism

11. When the Thyroid Doesn’t Work • Hyperthyroidism • Too Much Thyroid Hormone • Metabolism Speeds Up • Hypothyroidism • Too Little Thyroid Hormone • Metabolism Slows Down

12. Hyperthyroidism Hypothyroidism Two Common Types of Thyroid Disease

13. Hoarseness orDeepening of Voice Nervousness Persistent Sore or Dry Throat Irritability Difficulty Sleeping Difficulty Swallowing Rapid or Irregular Heartbeat Bulging Eyes/Unblinking Stare Infertility Swelling (Goiter) Menstrual Irregularities orLight Period Weight Loss Heat Intolerance Increased Sweating Frequent Bowel Movements First-Trimester Miscarriage Warm, Moist Palms Family History ofThyroid Diseaseor Diabetes Excessive Vomiting in Pregnancy Signs and Symptoms of Hyperthyroidism

14. Signs and Symptoms of Hypothyroidism Puffy Eyes Tiredness Forgetfulness/Slower Thinking Swelling (Goiter) Moodiness/ Irritability Hoarseness/Deepening of Voice Depression Persistent Dry or Sore Throat Inability to Concentrate Thinning Hair or Hair Loss Difficulty Swallowing Loss of Body Hair Slower Heartbeat Menstrual Irregularities/Heavy Period Dry, Patchy Skin Weight Gain Infertility Cold Intolerance Constipation Muscle Weakness or Cramps Elevated Cholesterol

15. What causes Thyroid Diseases ? The “Hidden” Health Problem

16. What causes thyroid diseases ? • Iodine deficiency disorder • Surgical • Radioiodine therapy • Autoimmune diseases

17. Miscarriages Stillbirths Neurological cretinism Impaired intellectual function Increased perinatal mortality Increased infant mortality Neonatal goiter Cretinism Impaired intellectual function Clinical Expression of Iodine Deficiency Fetus Neonate

18. Goiter Hypothyroidism Impaired intellectual function Retarded physical development Goiter Hypothyroidism and poor intellectual and physical performance Clinical Expression of Iodine Deficiency Child & adolescent Adult

20. 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

21. Myths and Factson Thyroid Diseases

22. 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. ON FOODS

23. Myth Drinking cold drinks is bad if you have goiter. Fact ON FOODS The temperature of the food or drink has no effect on the thyroid gland since it is not located in the alimentary tract

24. Myth Eating seafoods cancure 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. ON FOODS

25. 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. ON FOODS

26. 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 ON FERTILITY

27. 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 ON FERTILITY

28. 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 ON PREGNANCY

29. Myth Goiter, if present, indicates caesarean section Fact Bearing down during labor does not affect the size of goiter ON PREGNANCY

30. 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 ON PREGNANCY

31. 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 ON PREGNANCY

32. 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 ON PREGNANCY

33. 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 ON VARIOUS TREATMENT MODALITIES

34. 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) ON VARIOUS TREATMENT MODALITIES

35. Myth Radioactive Iodine Therapy leads to hypothyroidism Fact Even without intervention, the gland will shrink in > 10 yrs time, due to continuous inflammation and fibrosis eventually leading to hypothyroidism ON VARIOUS TREATMENT MODALITIES

36. 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 ON VARIOUS TREATMENT MODALITIES

37. 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 SURGERY

38. 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 SURGERY

39. “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.”

40. 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

41. 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