The THYROID The THYROID GLAND AND GLAND AND

GOITER: GOITER: Ating AlaminAting Alamin

Butterfly-shaped organ

in front of the neck

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

Thyroid Hormone AffectsMany Organs and General Health

UterusUterus

HeartHeart

LiverLiverKidneyKidney

BrainBrain

SkinSkin GI TractGI Tract

LungsLungsEyesEyes

Iodine

Thyroid Hormone

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

Any enlargement of the thyroid gland

“Bosyo”

GOITERS

G O I T E R

• Function- Euthyroid

- Hyperthyroid

- Hypothyroid

GOITERS

• Structure Structure -- DiffuseDiffuse

- - NodularNodular

When the Thyroid Doesn’t Work

Hyperthyroidism Hypothyroidism

When the Thyroid Doesn’t Work

Hyperthyroidism• Too Much Thyroid Hormone• Metabolism Speeds Up

Hypothyroidism• Too Little Thyroid Hormone• Metabolism Slows Down

Two Common Types of Thyroid Disease

• Hyperthyroidism • Hypothyroidism

Signs and Symptoms of Hyperthyroidism

Bulging Eyes/Unblinking Stare

Menstrual Irregularities or

Light Period

Excessive Vomiting in Pregnancy

First-Trimester MiscarriageFamily History of

Thyroid Disease

or Diabetes

Nervousness

Irritability

Difficulty Sleeping

Swelling (Goiter)

Frequent Bowel Movements

Warm, Moist Palms

Hoarseness orDeepening of Voice

Difficulty Swallowing

Rapid or Irregular Heartbeat

Infertility

Weight Loss

Heat Intolerance

Increased Sweating

PersistentSore or Dry Throat

Tiredness

Forgetfulness/Slower Thinking

Moodiness/ Irritability

Depression

Inability to Concentrate

Thinning Hair or Hair Loss

Loss of Body Hair

Dry, Patchy Skin

Weight Gain

Cold Intolerance

Elevated CholesterolMuscle Weakness or Cramps

Constipation

Infertility

Menstrual Irregularities/

Heavy Period

Slower Heartbeat

Difficulty Swallowing

Persistent Dry or Sore Throat

Hoarseness/

Deepening of Voice

Swelling (Goiter)

Puffy Eyes

Signs and Symptoms of Hypothyroidism

What causes Thyroid Diseases ?

The “Hidden” Health Problem

What causes thyroid diseases ?• Iodine deficiency disorder

• Surgical

• Radioiodine therapy

• Autoimmune diseases

Clinical Expression of Iodine Deficiency

• Miscarriages• Stillbirths• Neurological

cretinism• Impaired

intellectual function

• Increased perinatal mortality

• Increased infant mortality

• Neonatal goiter• Cretinism• Impaired

intellectual function

Fetus Neonate

Clinical Expression of Iodine Deficiency

• Goiter• Hypothyroidism• Impaired

intellectual function

• Retarded physical development

• Goiter• Hypothyroidism

and poor intellectual and physical performance

Child & adolescent Adult

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

Myths and Factson Thyroid Diseases

ON FOODS

Myth

Eating carrots, cabbage, root crops can cause goiter.

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

Myth

Drinking cold drinks is bad if you have goiter.

Fact

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

ON FOODS

Myth

Eating seafoods can cure goiter.

Not eating seafoods can cause goiter

FactSeafoods are

important for their iodine content but can not cure goiter.

A person with iodine deficiency may develop goiter.

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.

Fact

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

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

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

ON PREGNANCY

Myth

Bearing down during labor can cause goiter

FactIodine deficient

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

ON PREGNANCY

Myth

Goiter, if present, indicates caesarean section

Fact

Bearing down during labor does not affect the size of goiter

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

ON PREGNANCY

Fact

There is an increased risk for miscarriage if medications are discontinued

FactPatients with

inadequate replacement therapy have abnormal platelet function which may lead to prolonged bleeding during labor

ON PREGNANCY

Myth

All mothers with thyroid diseases will deliver infants with thyroid problems

FactMothers 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 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

ON VARIOUS TREATMENT MODALITIES

Myth

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

Fact131 Iodine

concentrates only in the thyroid gland

Fertility is affected by the abnormal thyroid functional status (hyperthyroidism or hypothyroidism)

ON VARIOUS TREATMENT MODALITIES

Myth

Radioactive Iodine Therapy leads to hypothyroidism

FactEven without

intervention, the gland will shrink in > 10 yrs time, due to continuous inflammation and fibrosis eventually leading to hypothyroidism

ON VARIOUS TREATMENT MODALITIES

Myth

Patients who receive Radioactive Iodine uptake and therapy should be isolated

FactNo 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

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

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

“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.”

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

The Philippine College of Physicians wishes to acknowledge the following for their invaluable efforts in the preparation

of this module

Nemesio Nicodemus, MDBien Matawaran, MD

Aimee Andag-Silva, MDLeilani Mercado-Asis, MD

Gabriel Jasul, MDRosa Allyn G. Sy, MD

Committee on Advocacy & Public RelationsPhilippine Society of Endocrinology and

Metabolism