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The THYROID
GLAND AND
GOITER:
Ating 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 Affects
Many Organs and General Health
Eyes
Lungs
Brain
Heart
Kidney
Liver
Skin
GI Tract
Uterus
Iodine
Thyroid Hormone
•Brain function, memory, concentration
•Muscle movement
•Cholesterol melting
•Normal heart beat
GOITERS
Any enlargement of the
thyroid gland
“Bosyo”
G O I T E R
GOITERS
• Structure
- Diffuse
- Nodular
• Function
- Euthyroid
- Hyperthyroid
- Hypothyroid
When the Thyroid
Doesn’t Work
Hyperthyroidism
Hypothyroidism
When the Thyroid Doesn’t
Work
Hyperthyroidism
Hypothyroidism
• Too Much Thyroid
• Too Little Thyroid
Hormone
• Metabolism Speeds
Up
Hormone
• Metabolism Slows
Down
Two Common Types of
Thyroid Disease
• Hyperthyroidism
• Hypothyroidism
Signs and Symptoms of
Hyperthyroidism
Nervousness
Irritability
Difficulty Sleeping
Bulging Eyes/Unblinking
Stare
Swelling (Goiter)
Menstrual Irregularities or
Light Period
Frequent Bowel
Movements
Warm, Moist Palms
Excessive Vomiting in
Pregnancy
Hoarseness or
Deepening of Voice
Persistent
Sore or Dry Throat
Difficulty
Swallowing
Rapid or Irregular Heartbeat
Infertility
Weight Loss
Heat Intolerance
Increased
Sweating
First-Trimester Miscarriage
Family History of
Thyroid Disease
or Diabetes
Signs and Symptoms of
Hypothyroidism
Tiredness
Forgetfulness/Slower
Thinking
Moodiness/ Irritability
Depression
Puffy Eyes
Swelling (Goiter)
Hoarseness/
Deepening of Voice
Persistent Dry or Sore Throat
Inability to Concentrate
Thinning Hair or Hair
Loss
Loss of Body Hair
Dry, Patchy Skin
Weight Gain
Cold Intolerance
Elevated Cholesterol
Difficulty Swallowing
Slower Heartbeat
Menstrual Irregularities/
Heavy Period
Infertility
Constipation
Muscle Weakness or Cramps
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
Fetus
•
• Miscarriages
• Stillbirths
•
• Neurological
•
cretinism
•
• Impaired
intellectual
function
• Increased perinatal
mortality
Neonate
Increased infant
mortality
Neonatal goiter
Cretinism
Impaired
intellectual
function
Clinical Expression of Iodine
Deficiency
Child & adolescent
Adult
• Goiter
• Goiter
• Hypothyroidism
• Hypothyroidism
and poor
• Impaired
intellectual and
intellectual
physical
function
performance
• Retarded physical
development
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 Facts
on Thyroid Diseases
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.
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
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.
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.
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
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
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
Fact
Patients with
There is an
inadequate
increased risk for
replacement
miscarriage if
therapy have
medications are
abnormal platelet
discontinued
function which
may lead to
prolonged
bleeding during
labor
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
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
Fact
Myth
Radioactive Iodine 131 Iodine
concentrates
Treatment cannot
only
in
the
be given to
thyroid gland
individuals in
Fertility is affected
their
by the abnormal
reproductive age
thyroid
functional status
(hyperthyroidism
or
hypothyroidism)
ON VARIOUS TREATMENT
MODALITIES
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
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
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 nagkabosyo ang buntis e dahil hindi ito
marunong umire.”
“Bawal magbuhat ng mabigat
habang buntis dahil magkakaGoiter 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, 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