Written By Dr. Gregory Bartha
Goiter is a fairly comm0n condition encountered at the Cross Clinic. Some of the goiters are quite large and at times cause difficulty swallowing and breathing. Certainly most of the people are concerned about the appearance of the growths. The vast majority of the goiters are not malignant, but some contain small nodules which could develop into cancer at some point in the future.
Goiters most commonly develop because of a lack on iodine in the diet. In Africa many of the people buy salt in a local market, and the salt doesn’t have any added iodine. In the U.S. all of the commercial salt has added iodine. Fish is also a source of iodine, but Uganda is a land-locked country, and most people consume fish only rarely.
Most persons with goiter have normal thyroid function, but some have too little thyroid hormone, and some have too much. Persons with low levels of thyroid hormone frequently report cold sensitivity, dry skin, constipation, fatigue, and weight gain. Thyroid hormone is available in pill form which can correct the symptoms. Persons who have high levels of thyroid have fast heart rate, sweating, weight loss, tremor, and anxiety. These symptoms can be treated with a medication which blocks thyroid hormone production or with radioactive iodine which destroys the cells which produce the hormone.
Goiter is best treated with surgical removal of the thyroid gland. The surgery can be quite tricky since the gland is very vascular, and heavy bleeding can occur. Also, the nerve to the larynx passes through the gland and can be damaged, causing a person to have lifelong hoarseness. The surgery is expensive, costing $500 at the hospital nearest to the Cross Clinic where it could be performed. There is a Catholic charity hospital about one hundred miles away where charges are much lower, but patients are often reluctant to travel that far. We continue to refer our patients to this facility.
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