Goitre and its dietary management

Definition of goitre

Goitre is a swelling of the neck or larynx resulting from enlargement of the thyroid gland (thyromegaly), associated with a thyroid gland that is functioning properly or not. Worldwide, over 90.54% cases of goitre are caused by iodine deficiency. (Babademez, et al, 2010)

British Thyroid Foundation (2008) defines goitre is an enlarged thyroid gland. Goitre can mean that all the thyroid gland is swollen or enlarged, or one or more swellings or lumps develop in a part or parts of the thyroid. The thyroid gland is in the lower part of the front of the neck. It lies just in front of the windpipe (trachea). It has a right and left lobe which are connected together by a narrow band of thyroid tissue. It is roughly the shape of a butterfly. You cannot usually see or feel a normal thyroid gland. If the thyroid enlarges, it causes a swelling in the neck which you can see.

The thyroid gland makes thyroid hormones – called thyroxine (T4) and triiodothyronine (T3). These hormones are carried round the body in the bloodstream. Thyroxine and T3 help to keep the body’s functions (the metabolism) working at the correct pace. Many cells and tissues in the body need thyroxine and T3 to keep them working correctly. (Temple, 1986).

Types of goitre

There are two types of goiter. They are;

1. Diffuse small goitre – the whole thyroid gland swells. When touched it feels smooth.
2. Nodular goitre – certain parts of the thyroid gland – nodules – swell. The gland may feel lumpy when touched.

Causes of goitre

Mitchell, et al in Robbins Basic Pathology highlighted the following causes of goitre;

1. A diet poor in iodine – may affect people who live in areas where there is not much iodine, or those who don’t have access to iodine supplements. In many countries iodine deficiency used to be the main cause of goitre. It still is in some countries, and areas within some countries. Iodine, a trace element, exists in the soil and sea. Fish, seafood, many vegetables and dairy products contain iodine. Our thyroid gland needs iodine in order to make thyroid hormones. If there is not enough iodine in a person’s body their thyroid gland will get bigger so that it can produce more hormones. In the UK, USA and many other countries iodine deficiency used to be common until iodine was added to salt in the early 1900s. As more people these days are opting for low salt and low dairy diets, the number of cases of iodine deficiency has started to rise in the UK and USA.
2. Gender – women are more likely to develop goitre compared to men.
3. Age – people over the age of 50 are significantly more likely to have goitre compared to younger people.
4. Autoimmune disease – individuals with a medical history of autoimmune disease, as well as those with a close relative who have/had autoimmune disease have a higher risk of developing goitre.
5. Pregnancy and menopause – goitre is more likely to happen after a woman becomes pregnant, or goes through the menopause.
6. Some medicines – antiretrovirals, immunosuppressants, amiodarone (heart medication), and lithium increase a patient’s risk of developing goitre.
7. Radiation – people whose neck or chest areas have been exposed to radiation have a higher risk. This could be due to radiation treatment (radiotherapy), or having worked in a nuclear facility, being involved in a nuclear test or accident.
8. Hyperthyroidism – if the thyroid is over-active it can become over-stimulated and expand.
9. Hypothyroidism – an under-active thyroid gland can also result in goitre. If the body does not have enough of the hormones produced by the thyroid gland it will stimulate the gland to produce more, which can lead to swelling of the gland.
10. Smoking – some studies suggest that there is a link between regular smoking and goitre risk. A person who smokes and has a low-iodine diet has a significantly higher risk of developing goitre.
11. Some infections – there are some parasites, bacteria and fungi which are known to increase goitre risk of the patient becomes infected with them.
12. Some foods – some foods are known to suppress the function of the thyroid gland if too much of them is consumed – these are known as goitrogenic foods. They include peanuts, soybeans, tofu and spinach.
13. Too much iodine – consuming too much iodine can raise the risk of developing goitre.
14. Thyroid cancer – people who have thyroid cancer have a higher risk of developing goitre.

Symptoms of goitre

According to Nabipour (2003), the symptoms of goitre as stated below.

• In many cases there are no symptoms apart from the appearance of a swelling in the neck. The size of a goitre can range from very small and barely noticeable, to very large.
• Most goitres are painless. However, an inflamed thyroid (thyroiditis) can be painful.
• If your thyroid makes too much or too little thyroxine or T3, this can cause a range of symptoms.
• A large goitre may press on the windpipe or the gullet (oesophagus). This may cause difficulty with breathing or with swallowing.

Dietary management of goitre

In the opinion of Lawrence and Altman (1991), the successful treatment of goiter calls for a multi disciplinary approach. Along with thyroid medications, exercise and diet play a pivotal role in the handling of the disease symptoms.

• Some foods are particularly harmful for the thyroid gland, and must be steadily avoided, these are: refined flour, white sugar, processed foods, refined food packets and stimulants. A low carbohydrate meal plan is considered beneficial.

• Prevention of goiter through dietary measure such as: including iodized salt in diet, eating sea food as it contains more iodine. Shrimp, shellfish, seaweeds are rich source of iodine.

• Eliminate flesh foods and milk from your diet.
• Foods that support and enhance normal thyroid function ought to be included in the diet. Food rich in iodine: celery, tomatoes, strawberries, carrots, onions, garlic, and asparagus help reinstate thyroid functioning.

Follow these dietary guidelines for at least a 1 year. The successful management of thyroid disorders will take time, so you must have patience. Cure won’t be immediate and quick, and there could even be reappearance of the symptoms.

Conclusion

As stated above, goitre is an enlargement of the thyroid gland. Symptoms of goitre include enlargement of the throat, ranging from a small lump to a huge mass, swallowing problems and breathing problems. Causes include iodine deficiency and thyroid conditions, such as hyperthyroidism, hypothyroidism, nodules and cancer. It can be managed by the intake of iodine through the use of iodized salt and other food which include tomatoes, carrots, garlic etc.

References

Babademez, M. A.; Tuncay, K. S.; Zaim, M.; Acar, B.; Karaşen, R. M. (2010). “Hashimoto Thyroiditis and Thyroid Gland Anomalies”. Journal of Craniofacial Surgery 21 (6): 1807–1809.

British Thyroid Foundation (2008). Goitre (Thyroid Swelling) Retrieved on March, 28, 2014 from  http://www.patient.co.uk/health/Goitre-%28Thyroid-Swelling%29.htm Lawrence, K. & Altman, M.D. (1991) “Doctors Say Bush Is in Good Health.” The New York Times. September 14, 1991.

Lawrence, K. & Altman, M.D. (1991) “Doctors Say Bush Is in Good Health.” The New York Times. September 14, 1991.

Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. Robbins Basic Pathology (8th ed.). Philadelphia: Saunders.

Nabipour, I. (2003). “Clinical Endocrinology in the Islamic Civilization in Iran”. International Journal of Endocrinology and Metabolism 1: 43–45 [45].

Temple, Robert. (1986). The Genius of China: 3,000 Years of Science, Discovery, and Invention. With a forward by Joseph Needham. New York: Simon.