SCRIPT NUMBER 149
GOITER - 2
(TWO SPEAKERS)
PROGRAM NAME: HEALTH NUGGETS
PROGRAM TITLE: GOITER - 2
PROGRAM NUMBER:
149
SUBJECT: CAUSES, SYMPTOMS, DIAGNOSIS, TREATMENTS OF GOITER
KEY WORDS: THYROID GLAND, HORMONES, DIETARY IODINE, IMMUNE,
RADIATION
DATE OF SCRIPT: JANUARY 31, 2014
AUTHOR: RICHARD YUKL, MD, FACS
SPEAKER 1:
Anna is 55 year old woman. She looked into a mirror one
day to see if aging was causing the skin of her face to wrinkle, and she noticed
swelling in the lower part of her neck just above her breastbone. The swelling
enlarging over the next several months, and it seemed to harden as it enlarged.
She sought the advise of a doctor when she began having some trouble
swallowing. The doctor diagnosed Anna as having a goiter, an enlargement of
her thyroid gland.
SPEAKER 2:
Your thyroid is a butterfly-shaped gland located in the front
part of your neck just above your breastbone. Doctors call any enlargement of
the thyroid gland a goiter, whatever its cause. A goiter may be particularly
obvious to a man when he shaves, or to a woman when she puts on makeup.
Large goiters can be seen as a swelling at the base of the neck. They usually
cause no symptoms, not even pain, although they can cause distressing
symptoms such as tightness in the throat, trouble swallowing, coughing,
scratchiness of the voice, and even problems with breathing.
SPEAKER 1:
What does a thyroid do?
SPEAKER 2:
The thyroid was created to regulate some essential functions
of our body. It makes chemicals called hormones that control our heart rate, our
temperature, and the rate at which our body converts the food we eat into
energy. Many people think that if they are developing enlargement of their
thyroid, there is something wrong with the gland. However, their thyroid may be
working properly even if a goiter develops. It may still be producing normal
amounts of hormones.
SPEAKER 1:
Who develops a goiter and why does it happen?
SPEAKER 2:
Goiters can develop in anyone at any time. They can be
present at birth, although they most commonly develop after age 50. The most
common cause is a lack of iodine in the diet. The thyroid needs iodine to produce
its hormones, and that Iodine is found in seawater and in soil found near the
oceans of the world. People who live far from an ocean or at high elevations
often don’t get enough iodine in their diet, and their thyroid enlarges in an effort
to make normal amounts of hormones. Iodine is routinely added to the table salt
sold in many countries today, as well as to many foods. Still, there are areas of
the world in which people don’t get enough iodine to satisfy their body’s needs,
especially in the countries of central Asia, central Africa, and in the Andes
Mountains of South America.
SPEAKER 1:
In addition to a lack of iodine, what other conditions could
cause me to develop a goiter?
SPEAKER 2:
We were created with a sophisticated immune system
designed to destroy foreign proteins that attack our body – proteins such as
those found in invading bacteria and viruses. There are times when, for reasons
scientists still do not understand, this immune system is tricked into thinking our
thyroid gland is a foreign invader, so it attempts to kill it, causing a goiter to
develop. Other risk factors include being a woman, pregnancy and aging. Risk
also increases if you are a heavy smoker, or if you've had radiation to your neck
or chest as a treatment for cancer.
SPEAKER 1:
How is a goiter treated?
SPEAKER 2:
Treatment is not always necessary. It depends on the size of
the goiter, your symptoms, and the underlying problem that caused your thyroid
to enlarge. Someone who develops serious symptoms will need treatment of
course, but small goiters that aren't noticeable and don't cause physical
symptoms usually don't need treatment. The main concern related to a small
goiter causing no symptoms is to be certain the swelling is not a cancer. Most
goiters are noncancerous, and they don't lead to cancer. In one study, only one
in 13 patients with thyroid enlargement was found to have cancer.
SPEAKER 1:
How is a goiter diagnosed?
SPEAKER 2:
Your doctor will test your blood to determine if your thyroid
produces normal amounts of hormones, and if your immune system is producing
chemicals that destroy your thyroid. If worrisome abnormalities are felt on
examination, a needle will be used to take a sample of the abnormality for
microscopic examination.
SPEAKER 1:
Will I need surgery?
SPEAKER 2:
Surgery will be required if cancer is found, but your doctor
will usually recommend thyroid hormone replacement pills as treatment for noncancerous goiters, even if they are large or causing distressing symptoms. That
will allow your thyroid to rest, and it may become smaller. If replacement pills
don’t relieve the symptoms, the doctor will then recommend surgery to remove
part or all of the enlarged gland, making for more room in your neck. That will
make breathing and swallowing easier. People who need but cannot tolerate
surgery can be given radioactive iodine to destroy the thyroid gland.
SPEAKER 1:
How was Anna’s goiter treated?
SPEAKER 2:
It was developing worsening symptoms. It showed no
evidence for cancer, but it didn’t respond to her taking thyroid replacement pills,
and removal of a portion of her gland was required to relieve her swallowing
problem. She did not need to take thyroid replacement pills following her surgery.
SPEAKER 1:
How can I prevent developing a goiter?
SPEAKER 2:
If you live at a distance from the ocean or at high altitude,
buy and use salt to which iodine has been added, or eat seafood or seaweed
about twice a week. Since too little iodine in the diet is the major cause of
developing a goiter, this simple change may be very helpful. Otherwise, your
doctor is best qualified to decide on the proper treatment.
SPEAKER 1:
Health Nuggets is written by Dr. Richard Yukl, a medical
doctor working in the United States. The medical views expressed in this
program are his and may differ for your particular health needs. If you need
medical advice, please consult a medical professional in your area.