Goitre: Between myth and reality !

In Nigeria, out of every 20 women, three have swellings on their necks. In fact, it is at a ratio of 8:1 compared to men. This is often believed to be the handiwork of witches, or some wicked supernatural forces, a belief rampant among the rural dwellers. Goitre, sometimes called thyroditis, is an abnormal swelling of the thyroid gland, a small butterfly- shaped gland located just in front of the trachea or windpipe in the neck. The gland produces thyroid hormones, which helps in processing foods eaten into energy.

The thyroid gland makes and releases two thyroid hormones, thyroxine (T4 ) and triiodothyronine (T3). Thyroid hormones affect every cell and all the organs of the body. Too much thyroid hormones speed things up and too little of the hormones slow things down. Therefore, apart from controlling the body’s metabolism, they slow down or speed up the heartbeats, raise or lower the body temperature and also determine how quickly the body replaces dying cells. The thyroid hormones also affect muscle strength and changes how fast food moves through the digestive tract.

The thyroid gland is not usually noticeable, but if it swells, it produces a lump in the throat known as goitre. The size varies from person to person, if small, it does not cause any symptoms, but in severe cases, the swelling can increase so dramatically that it affects breathing and swallowing and causes the sufferer to tend to be ashamed of exposing the neck.

 The disease is a common condition, affecting an estimated four- seven per cent of people, most of whom are women. Goitre rate in Nigeria as of 1993 was 20 per cent, but was found to have dropped to 11 per cent in 1999. Girls begin to have signs of goitre and other signs of iodine deficiency at puberty in much larger numbers as compared to boys because the first sign of puberty in a girl is breast enlargement. The breasts are the second major site for glandular iodine storage next to the thyroid gland. So, girls with large breasts have higher risks of developing goitre due to lack of iodine to keep pace with the body’s requirement. Another major reason for the prevalence of goitre in women is their susceptibility to autoimmune disorders compared to men.

Although no definite cause can be found for goitre, in this part of the world, the most common one still remains lack of iodine in diet. Iodine is a trace element found in sea water and soil. It enters the food chain through plants that grow in iodine- rich soil or through fish or plants from the sea e g sea foods such as fish, shellfish or sea weed. Plant foods such as cereals or grains and cow’s milk are other good sources of iodine. The thyroid gland needs iodine to help manufacture thyroid hormones so, if the body does not receive enough, the thyroid gland becomes underactive and will expand in order to produce more.

Another major cause of goitre is known as hyperthyroidism or the overactivity of the thyroid gland resulting in too much of the thyroid hormones being produced. This increased production overstimulates the thyroid and causes it to swell. Hyperthyroidism is mostly due to a condition or disease known as Grave’s disease which causes the body’s immune system to send antibodies to the thyroid gland, causing an increased amount of thyroid hormones to be released into the body.

On the other hand, if the thyroid gland is producing too little hormones or hypothyroidism, the body will stimulate it to produce more resulting in the swelling of the thyroid gland. Smokers are also at risk of developing goitre as a result of a chemical called thiocyanate contained in tobacco. This chemical interferes with the body’s ability to utilise iodine. In addition, Hashimoto’s disease, a condition that interferes with the gland’s ability to produce hormones causes goitre as a result of the body trying to compensate for this, causing the gland to swell.

Changes in hormone levels during pregnancy and puberty-transition to a sexually developed adult- mentioned above-can affect the thyroid gland. Lithium, a drug often used to treat mental health conditions like depression and mood swings, can interfere with how the thyroid gland functions.

In diagnosing goiter, blood tests to determine Total thyroxine (T4), Free thyroxine (FTI or FT4) and Triiodothyronine, to check what is causing abnormalities in the amount of thyroid hormones in the body. The tests are also used to check how well the treatment is working and to screen newborns to find out how well the gland is working.

The treatment of goitre depends on the underlying cause. If small, a wait and see approach is recommended. Thyroid hormone replacement therapy can also be used in case of hypothyroidism and for the goitre caused by lack of iodine, dietary supplement is the ideal treatment through the consumption of food rich in iodine such as shrimps, fish, crayfish, prawn, seaweed, okra, lettuce, strawberries etc reduces the risk of developing goitre. Supplemental iodine like Potassium Iodide and Sodium Iodide are typically used in the treatment of goitre.

Although the United Nations Children Fund has commended Nigeria for attaining 98 per cent Universal Salt Iodisation, the remaining two per cent is as a result of the endemic areas in the country (Benue, Nasarawa, Ebonyi and Taraba states). This is largely due to the aggressive public enlightenment campaign embarked upon by the National Agency for Food and Drug Administration and Control, the agency responsible for controlling and maintaining standards of foods and drugs in the country.

The agency has mandated manufacturers of salt to add small amount of iodine to reduce the number of goitre cases. But with the increase in the number of people preferring low salt diet to fight high blood pressure and other ailments, iodine deficiency may continue to be a problem. On the other hand, if the goitre is very large to the extent that breathing and swallowing are becoming difficult, surgery is the best solution.

It is amazing to note that those residing in the riverine areas like the Niger Delta region and Badagry in Lagos State are in danger of goitre. This is because they overlook the importance of seaweeds which grow around them as a good source of iodine. It is now the duty of health educators to enlighten them on the importance of these plants towards preventing goitre.

In order to sustain the successes so far made to combat this disease, all stakeholders should endeavour to play their parts to make this ailment, which has been eradicated in many countries, a thing of the past in Nigeria.