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Why developing countries should be concerned about Thyroid Disease

19 July 2016 at 04:13 | 2599 views

By Dr. Nanah Sheriff Fofanah-Sesay, USA.

Non-toxic goiter is not predominant in the United States due to a readily available diet that is fortified with iodine and tight control of the thyroid stimulating hormone (TSH).

This disease however, remains problematic in developing countries resulting in major complications and premature deaths to those affected. The purpose of this article is to educate readers about thyroid disease in relation to its causes, prevention, diagnosis, and management modalities.

The term non-toxic goiter refers to enlargement of the thyroid gland that is not associated with overproduction of thyroid hormones or malignancy. It is simply an enlargement of the thyroid gland that can be seen as a mass in the anterior neck.

For clarity, the thyroid regulates metabolism which is the body’s ability to break down food and convert it to energy. The two main thyroid hormones are Triiodothyronine (T3) and Thyroxine (T4). Disorder of the thyroid gland can cause any of the three thyroid diseases (goiter, hyperthyroidism, and Hypothyroidism).

Goiter is enlargement of the thyroid gland resulting in dysphagia, cough, shortness of breath, and stridor in severe cases. Hyperthyroidism is over activity of the thyroid gland resulting in a rapid heartbeat, and increased rate of metabolism.

In contrast to hyperthyroidism, hypothyroidism is abnormally low activity of the thyroid gland resulting in retardation of growth and mental development in children and adults.

The causes of thyroid disease are multifaceted but for this article, causes are synthesized in each of the three listed categories. Goiter or enlarged thyroid gland is caused by iodine deficiency in the diet and the existence of hypothyroidism or hyperthyroidism. Hyperthyroidism or overproduction of the thyroid hormone can result in toxic adenoma whereby, nodules develop in the thyroid gland and begin to secrete thyroid hormone, upsetting the body’s chemical balance.

Hyperthyroidism can also result in subacute thyroiditis whereby, inflammation of the thyroid gland causes the gland to leak excess hormones. In addition, hyperthyroidism can cause pituitary gland malfunction or cancerous growth in the thyroid gland. Hypothyroidism by contrast, stems from an underproduction of the thyroid hormone resulting in lower energy levels.

Further consequences of hypothyroidism include Hashimoto thyroiditis which is an autoimmune disorder that cause the body to attack thyroid tissues. Removal of the thyroid gland (thyroidectomy) is another cause of hypothyroidism. Other causes of hypothyroidism include chemical destruction of the thyroid gland, exposure to excessive amount of iodine from cold and sinus medications, heart medications such as Amiodarone, certain contrast dyes given before some radiological procedure such as CAT scans with contrast, Lithium intake for Bipolar disorder, and underlying thyroid diseases.

There are no evidence-based strategies for preventing thyroid disease however, people who have family history of thyroid disease may benefit from early testing that could lead to early, more effective treatment. Further prevention strategies include avoiding radiation exposure to the neck, adoption of sensible lifestyle choices such as abstinence from smoking and avoiding environmental toxin.

Diagnosis of thyroid disease starts with a thorough evaluation by a trained practitioner where he or she palpate the neck, listen to the thyroid, test reflexes, check heart rate, rhythm and blood pressure, measure weight and temperature, examine the face and eyes, observe the general quantity and quality of hair, skin, nails, hands, and review other clinical signs.

In addition, thyroid blood tests such as thyroid stimulating hormone (TSH), total thyroxine (T4), free thyroxine (T3), free triiodothyronine (Free T3), thyroglobulin/thyroid binding globin, T3 resin uptake (T3RU), reverse T3, thyroid peroxidase antibodies (TPOAb), antithyroid peroxidase antibodies, antithyroid microsomal antibodies, antimicrosomal antibodies, thyroidglobulin antibodies, antithyroglobulin antibodies, thyroid receptors antibodies (TRAb), and thyroid-stimulating immunoglobulin (TSI).
In addition, thyroid imaging tests such as nuclear scans/radiation iodine uptake (RAI-U) to evaluate for Graves’ disease, and toxic multinodular goiter or thyroiditis. Further radiologic imaging include cat scans, to help detect and diagnose a goiter, magnetic resonance imaging (MRI) to evaluate the size and shape of the thyroid gland, and thyroid ultrasound to evaluate nodules, lumps, and enlargement of the gland. Other diagnostic tests and procedures include thyroid biopsy or aspiration to evaluate for cancer, iodine patch tests, saliva testing, urinary testing, and basal body temperature testing.

For the sake of simplicity, management of thyroid disease will be briefly described in each of the three causes of thyroid disease as listed above. According to Lee et al. (2013), non-toxic goiter usually grow very slowly without causing obstructive symptoms such as difficulty swallowing, cough, shortness of breath, stridor, or thyrotoxicosis. In this case, therapy is considered if growth to the entire goiter or a specific nodule is present. The three currently available therapies for goiter include thyroidectomy (removal of the thyroid gland), radioactive iodine therapy (non-surgical intervention often done in Europe), and medication management with Levothyroxine (Synthroid) (Lee et al. 2013).

Hyperthyroidism is usually managed with antithyroid medications such as Methimazole (Tapazole) and Propylthiouracil (Propyl-Thyracil or PTU). Management of hypothyroidism which is the most common disorder of the thyroid gland include use of medication such as Levothyroxine (Levothroid, Levoxyl, or Synthroid). This oral medication restores adequate hormone levels, reversing signs and symptoms of this disease (Mayo Clinic, 2011).

Due to inability of in-depth diagnostic work-up, non-prevalence of preventive testing for individuals with family history of the disease, decrease diet and life-styles modification for people in developing countries, this disease often results in higher morbidity and mortality rates in these countries as such, these countries should be concern about thyroid diseases.

For more information about thyroid disease and its treatments, contact the American Thyroid Association at www.thyroid.org or the National Endocrine and Metabolic Disease Information Service (NEMDIS) (U.S.) at www.endocrine.niddk.nih.gov.
This article is dedicated to all individuals suffering from thyroid disease and to those who have lost loved ones from thyroid disease.

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