Goiter awareness

CEBU, Philippines - With the help of the Department of Health and the International Council for the Control of Iodine Deficiency Disorders, here are notes published that seek to heighten the public’s level of awareness on this type of ailment:

What is goiter?

Goiter is the term used to describe the thyroid gland which has become enlarged. There are many conditions leading to its enlargement namely, iodine deficiency, autoimmune disease, inflammation, new growth and other causes.

What kind of goiter can a person have?

A person can develop different kinds of goiter. It depends whether there are symptoms of toxicity or not, and whether the goiter is diffusedly or nodularly enlarged. Most commonly, the goiter may be diffused toxic, diffused non-toxic, nodular toxic or nodular non-toxic.

What must I do if I suspect goiter?

An analysis of the symptoms and a physical examination (usually centered on the neck) is done by a physician or a health worker. These should alert them that something is wrong with the iodine nutrition of the patient causing goiter. Some laboratory tests called thryoid function tests, or imaging procedures (thyroid scan, ultrasound) are requested to confirm the suspicion of a goiter. In certain instances, a fine-needle aspiration biopsy is done to determine if there is inflammatory thyroid disease or thyroid cancer.

Can goiter be prevented? Or treated?

Goiter, due to iodine deficiency, can be prevented by the appropriate intake of food rich in iodine (saltwater fish, crabs, shrimps, squid, seaweeds and others); and by the regular use of iodized salt in daily diet. Those goiters due to other causes can be treated medically (by anti-thyroid drugs or thyroid hormones, as the case may be), surgically, or through radioactive iodine depending on the clinical situation.

What is iodine?

Iodine is a micronutrient required by the body for normal physical and mental development. The total lifetime requirement for iodine amounts to no more than a teaspoon. Small as it may be, and to be effective, this amount must be available from conception to adulthood.

What happens if the body lacks iodine?

When the body does not have enough iodine, it cannot function well. This leads to goiter, overt hypothyroidism, physical defects, mental retardation and other manifestations of iodine deficiency disorders. Women with IDD have goiter, infertility, complications of pregnancy, or repeated miscarriages. Children born to these women have low birth weights and decreased child survival, suffer mental retardation (with loss of 13.5 IQ points on the average) and cretinism. These children have poor school performance and reduced potentialities when they grow up. There is loss of productivity by these affected members of communities who become dependent on others for care and support.

What is the status of the Philippines as regards iodine deficiency?

Iodine deficiency is best measured through Urinary Iodine Excretion by representative sampling of clusters of population groups. A median UIE (between 100-200 mcg/L is ideal. However, pregnant women have higher UIE levels (NV = 150 - 249 mcg/L). According to the 2008 National Nutrition Survey, the iodine status of children six to 12 years old is optimal as indicated by the median UIE of 132 mcg/L. However, the iodine status of pregnant and lactating women is lower than desired levels. NNS data show that pregnant women have only a median UIE of 105 mcg/L while lactating women have median value of 81 mcg/L. Thus, their iodine status is of public health concern, considering that their UIEs in the 2003 NNS are 142 mcg/L and 111 mcg/L, respectively, indicating decreasing iodine nutrition among women. They will have to be educated more vigorously on the regular use of iodized salt in their cooking and table consumption, aside from having iodine-rich food for their diet. Women will also benefit from regular check-up of their thyroid gland.

How do we adjust iodine nutrition?

Salt is the best vehicle for adding iodine. Everyone needs salt, everyone eats it, usually in daily amounts, and the technology for iodization is straightforward. The Philippines has regulations calling for 20-40 mcg iodine/g of salt (20-40 parts per million); thus if an individual eats five grams of salt iodized at 30 ppm, she gets 150 mcg iodine from this source alone. Another method for providing iodine to a community is through the administration of iodized vegetable oil. A single administration orally provides adequate iodine for about a year, and if given by intramuscular injection, is satisfactory for about three years. Iodized oil is most useful when the iodine deficiency is severe, when immediate correction is important, and when iodized salt is not available (or its iodine concentration is below recommended levels).

Drinking water is another occasional vehicle for iodine nutrition. Some systems slowly release iodine from a porous basket. Another approach adds an iodine solution to water in a well or flowing through a pipe. A simpler version merely adds a few drops of a concentrated solution manually to vessels containing drinking water in a school or home. If iodine is added, it can also sterilize the water, this property is useful because many regions with iodine deficiency also have contaminated food and water.

Occasionally, iodine is given as tablets of potassium iodide, from 100 to 200 mcg per day or about one milligram per week. Some vitamin/mineral preparations for daily use contain 150 mcg iodine, the recommended amount.

Other vehicles like sugar, bread, and tea have been occasionally used for iodine delivery. However, the many advantages of iodized salt make it the overwhelming favorite for most countries.

Note: Mcg means microgram (which is equivalent to 0.001 milligram), while cretinism means a congenital condition caused by a deficiency of thyroid hormone during prenatal development and characterized in childhood by dwarfism.