Goiter in PH: Experts unveil 'key culprit,' emphasize vital role of early detection

About 9 percent of adult Filipinos have goiters, a thyroid-related enlargement, by physical examination.

Data from the Thyromobile of the Philippine Thyroid Association revealed that out of almost 5,000 tested patients, 8.53 percent had thyroid function abnormalities.

Additionally, in a survey involving 7,227 volunteers, 8.9 percent were found to have goiter.

Recognizing the need to promote awareness of the disease, the Department of Health (DOH) held a "Kapihan with the Media" on Goiter Awareness Week on Feb. 2.

The DOH, in line with Presidential Proclamation No. 1188, has designated Goiter Awareness Week with the theme for this year, "Leeg kapain, goiter sugpuin: Isip ay patalinuhin, iodized salt ay gamitin" (Check the neck, eliminate goiter, sharpen the mind, use iodized salt).

Understanding goiter

Goiter, as explained by Internal Medicine-Endocrinology, Diabetes, and Metabolism Expert Dr. Nenuel Angelo B. Luna, is an "enlargement" of the thyroid gland.

He pointed out that not all cases of goiter indicate hyperthyroid or hypothyroid conditions, as various factors can contribute to its development.

"Hindi porket may goiter ay may hyperthyroid or hypothyroid na. Maraming uri at sanhi ng goiter (Having goiter doesn't necessarily mean having hyperthyroid or hypothyroid. There are many types and causes of goiter),"

Luna noted the ancient origins of the term "goiter," tracing it back to the Latin word "guttur," meaning "throat" or "neck," and its Filipino translation, "Bosyo."

He said that the thyroid gland, shaped like a butterfly and located in the lower part of the neck, plays an important role in producing thyroid hormones.

"Ito ay factory ng hormones na tinatawag na thyroid hormones. Ito ang mga mollecule na hormones na nanggagaling sa thyroid na napakaraming trabaho sa ating katawan. Mula ulo hanggang paa ay may role ang hormones (This is a factory of hormones called thyroid hormones. These are molecules of hormones that originate from the thyroid, and they perform numerous functions in our body. From head to toe, hormones play a role)," he explained.

Luna highlighted its role in diverse bodily functions, including calorie metabolism, follicle and embryo development, body temperature regulation, digestive system function, fetal brain development, sperm and testosterone production, muscle contraction, cell replacement rate, and cardiac function.

Goiter attributed to iodine deficiency

Experts pointed out that iodine deficiency can lead to hypothyroidism, where the thyroid works double time, enlarges, and results in goiter. 
Iodine deficiency disorder, a condition affecting thousands of Filipinos, has also been identified as one of the primary causes of goiter in the Philippines.

Dr. Antonio Pescador Jr., a member of the Thyroid Council and the Philippine College of Endocrinology, Diabetes, and Metabolism, emphasized the “importance of iodized salt” and iodine-rich foods in preventing iodine deficiency.

Citing data gathered by Thyromobile of the Philippine Thyroid Association, it was identified that 15 provinces in the country have the "lowest" iodine levels including Mountain Province, Benguet, Pangasinan, Palawan, Western Samar, Biliran, Capiz, Antique, Cebu, Bukidnon, Davao Occidental, South Cotabato, Zamboanga Del Sur, Del Norte, and Basilan.

"Kapag may iodine deficiency, maaaring maging hypothyroid. Kapag kulang ang iodine ay magdo-double time magtrabaho ang thyroid, lalaki ito at magiging goiter (When there is iodine deficiency, it can lead to hypothyroidism. If iodine is insufficient, the thyroid will work double time, enlarge, and result in goiter)," he explained.

Pescador emphasized that a mere 1/4 teaspoon of iodized salt already provides a substantial amount of iodine content.

By incorporating iodine-rich foods into their diet, individuals can attain the recommended daily iodine dose, with specific age-based guidelines—150 micrograms (mcg) for teenagers aged 14 to 18 years old and adults, as highlighted by the expert.

Pregnant teens and women are advised to ensure a daily iodine intake of 220 mcg while breastfeeding teens and women should aim for a slightly higher intake of 290 mcg.

Moreover, Luna highlighted another factor contributing to goiter— "Hashimoto's Thyroiditis,” an autoimmune disease characterized by the body's immune system causing destruction or damage to the thyroid gland.

Emphasizing the condition, he stated: "The enlargement of Hashimoto's thyroiditis is inflammation, and it doesn't function well."

Additionally, the expert stressed another cause of thyroid complications—"Graves' Disease,” also known as “toxic goiter,” which falls under the category of autoimmune diseases.

Luna noted that one of its common effects is the development of protruding eyes or eye enlargement in affected individuals.

Meanwhile, he also identified the third common cause of goiter as "Nodular Goiter," involving the presence of lumps or multiple lumps leading to thyroid enlargement.

Luna emphasized the importance of examining patients with nodular goiter to determine whether the condition is cancerous or not.

Goiter symptoms

Moreover, Pescador said that the symptoms of goiter may vary, from asymptomatic cases to noticeable swelling, difficulty swallowing or breathing, and potential symptoms of hyperthyroidism or hypothyroidism, depending on the underlying cause.

He emphasized that "anybody" can develop a goiter but it is more common in "women" than men, increases in frequency with age, and commonly runs in the family or is hereditary.

Difference between hyperthyroidism and hypothyroidism

In distinguishing between hyperthyroidism and hypothyroidism, Luna clarified that "hyperthyroidism" entails an overly active thyroid gland, leading to an excessive production of thyroid hormones.

Individuals with this condition may experience a rapid heartbeat, increased appetite without weight gain, feelings of shakiness or nervousness, and frequent diarrhea.

On the other hand, "hypothyroidism" denotes a sluggish thyroid function, with Luna drawing parallels to iodine deficiency and Hashimoto's thyroiditis.

Symptoms of hypothyroidism include constant fatigue, irregular periods, sensitivity to cold, constipation, brittle hair and nails, dry and scaly skin, feelings of depression, weight gain, and muscle aches and cramps.

Goiter diagnosis and prevention 

In connection with this, Pescador urged individuals with goiter to consult an "endocrinologist," an internist with specialized training in endocrinology, a branch of medicine that focuses on hormones and endocrine glands, for proper diagnosis and management.

Tests for thyroid diseases include blood tests, thyroid examinations, scans, and biopsies.

Highlighting the significance of self-examination, he emphasized the importance of facing a mirror to check the neck, looking up, and thoroughly examining it.

He advised individuals to check for any bulges in the thyroid area while drinking water and swallowing and to palpate using their fingers to detect any potential lumps.

Treatment options for thyroid diseases include surgery for severe cases, radioactive iodine for hyperthyroidism, levothyroxine for hypothyroidism, and specific medications for hyperthyroidism, the expert added.