Symptom Management: Goiters

Introduction 

Hey! Welcome back to the Thyroidcafe. Goiter. GOI-tur. It just sounds gross. When I had one, I freaked out. But there’s more to this word than its goopy sound. Goiters come in four forms and can be non-issues. But what causes goiters and how do we treat them? More importantly, when should we be concerned? Today on the blog, we address a common issue for those with all types of thyroid disease, goiters. 

So what is it?

Goiters are an enlarged thyroid gland and there are four different types. When the whole thyroid swells to form an obese butterfly, you have a Diffuse-Smooth goiter. If you have many “Lovely lady humps” all over your thyroid, it’s called Multinodular and if your goiter is hiding behind your breastbone, it’s a Retrosternal goiter. The most common form, and what I had, is a nodule. It’s just one random bump on your thyroid. 

And what causes goiters?

Ugh. You know the number one cause… thyroid disease. But there are other factors. The main one is too much, or too little, iodine. In most countries, salt contains added iodine. So if you’re like me, it’s not too little iodine. But it could be the Costco sized bag of salty chips I frequently devour. But aaanyways. Other causes are smoking, changes in hormones, lithium in some medications and radiation treatment. In my experience, stress causes goiters as well. 

Okay, okay. So how do we treat it?

For seventy years, doctors have known that thyroid replacement therapy reduces the size of goiters. So if you are having goiters, it’s a good time for your doctor to check your TSH, T3, and T4 levels.  In fact, ⅔ of all goiters reduce in size or eliminated by hormone treatment. Even if the goiter remains, we simply monitor them, unless they are accompanied by other symptoms, such as difficulty breathing or pain. 

When my goiter was treated, the doctor simple felt my neck. Then I went for an ultrasound and a needle biopsy. While “needle” makes it sound cringey, it was simple and pain free. After they studied the sample, there was no follow up needed. 

The “C word”

Only 13.7% of goiters  operated on are cancerous. While symptoms of thyroid cancer are very similar to goiters, (tight throat, voice changes etc.) there are some differences. If the soreness in the throat doesn’t change and you have difficulty breathing, or there is pain in your neck, your goiter may be more serious and needs to be looked at by a doctor. Even if it’s cancer, the five year survival rate for thyroid cancer is 98%.  So while it’s serious, there are treatment options.

Conclusion

While goiters can seem scary, they are like most things, the more you know the less you fear. I take comfort in knowing that goiters are a normal part of thyroid disease and very much treatable. If we make small lifestyle changes, we can prevent goiters from forming. Even if you’re like me, and have a propensity for chips, you can rest assured knowing goiters are probably nothing to worry about. I’m thankful that they are treatable part of this complex disease. 

“Womans world” and Thyroid Rescue

Introduction

Hi, welcome back to the Thyroidcafe. I wanted to review a  “Woman’s world” article today.  Many in the thyroid community find these articles frustrating. I have read they are misleading and harmful to those who have thyroid disease, so I thought I would look for myself. Amist recipes of bright berry cobbler and Meringue cake, is a two page spread, declaring “Thyroid rescue!” It promises to “reactivate your thyroid to melt thirty pounds in thirty days.” I was cautiously curious.

The Good 

A bold red banner declares “Thyroid Rescue” on July’s front cover, putting our disease literally front and center. At 600,000 copies sold a month, I’m thankful to raise awareness about thyroid disease. Inside the article, it “encourages everyone” to try eliminating sugar and gluten from their diet. It’s great to make the dangers of processed foods known. Giving further hope, the author highlights the importance of diet for thyroid patients by giving the testimony of thyroid warrior who gained health and lost weight on her diet. Excellent! To the right of her picture is a small paragraph. It is the only place in which they outline actual thyroid symptoms and advice. 

The Bad 

While the dietary advice is sound, the article isn’t about thyroid disease. It misleads people into thinking diet either causes or cures thyroid disease. The reader may think those who gain weight because of their thyroid disease can loose weight by changing their diet alone. This is not entirely true. For more information, click here. While diet plays a role in thyroid disease; I hate to think of people judging others based on this articles misinformation. 

The Ugly

What was great about this article, is crammed into the bottom corner. Symptoms are a one sentence synopsis, and medical treatments are an afterthought. If the article is about “Thyroid Rescue,” it’s pertinent to explain the disease and other treatments available. This would be of use to us fighting the disease and to promote understanding and sympathy.  The article places too much focus on one symptom, weight gain. Simplifying symptoms to a weight issue, misleads the reader to play on common insecurities of women. This disease has a dynamic and fundamental effect on its sufferers and the article misses that point.

Conclusion

Sadly, the “Woman’s World” article reflects a common ignorance towards our disease. The simplified suggestions of dietary changes and “sleep 7 hours” belittle the disease and treatments thyroid sufferers face. While I recognize this is no medical journal, it is one way the public sees our disease. I wish the author was more diligent in her studies. Despite this, it puts thyroid illness on display; it promotes a healthy diet and it motivates me to keep telling the truth about our disease. 

Gluten and the Thyroid Warrior

Introduction

Hey, I’m glad to see you at the Thyroidcafe. I’ve been looking forward to this topic for weeks. I know many thyroid patients suffer from the tummy troubles, as I have. So coming across this study fascinated me. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2111403/#!po=9.25926 In it, the correlation between thyroid illnesses and celiac disease is explained, as well as the symptoms of celiac disease, and testing options. But mostly, I was excited to see who was statistically most at risk of developing celiac disease, silencing critics with science. The study is thorough, but long winded, so I will summarize it here. 

Symptoms of celiac disease

I know you could just Wiki this, but here are a few:

Okay, plot twist! There aren’t necessarily any symptoms.

Seriously?!

This table outlines other symptoms that are often associated with silent celiac disease.

Thyroid Disorders and celiac disease

Yeah… so even though celiac disease was first described in the 19th century, it is underdiagnosed because some people with celiac disease show few symptoms.

Celiac disease isn’t common in the general population; only about 1% have it. However, there is a fivefold increase amongst Hashimoto’s sufferers. Those with hypothyroidism also have a slightly higher chance of having celiac disease, and those with Graves’ disease have a normal chance. The interesting thing is, both celiac disease and Hashimoto’s share the same genetic markers. It’s no wonder so many thyroid warriors suffer from sensitive tummies!

The Table below shows the prevalence of celiac disease in autoimmune thyroid disorders as shown in multiple different studies.

Author (year of publication)Population screenedPrevalence of CD
Collin et al (1994)4183 autoimmune thyroid disease4.8%
Sategna-Guidetti et al (1998)76152 autoimmune thyroid disease3.3%
Cuoco et al (1999)7822 Hashimoto’s disease
23 Graves’ disease
4.3%
Valentino et al (1999)77150 autoimmune thyroid disease3.3%
Berti et al (2000)79172 autoimmune thyroid disease3.5%
Volta et al (2001)80220 autoimmune thyroid disease3.2%
Larizza et al (2001)8190 Pediatric autoimmune thyroid disease7.8%
Meloni et al (2001)82297 autoimmune thyroid disease4.4%
Mainardi et al (2002)83100 autoimmune thyroid disease2%
Ch’ng et al (2005)42115 Graves’ disease4.5%

How to test for celiac disease

A simple blood test can determine if you have celiac disease. This test is both inexpensive and relatively painless. Eating gluten for a few weeks is the only preparation needed. The other testing option is surgical, in which a sample of the small intestine is taken and tested.

Who should test for celiac disease?

Given the increased prevalence and genetic links, testing is reasonable for those with Hashimoto’s disease, hypothyroidism, and any autoimmune disease. If you are experiencing any symptoms or have a family history of celiac disease, it’s reasonable to be tested as well. 

Why Bother?

I was diagnosed with celiac disease years before reading this study… but also there’s cookies. Before reading this study, I didn’t know that keeping a gluten-free diet can reduce the complications of thyroid disease. Some symptoms which are minimized when celiac’s keep a gluten-free diet are, malabsorption of vitamins, osteoporosis, lymphoma and aiding in absorption of thyroid medication. (See study linked above for details) While I knew anecdotally that I felt better gluten-free, I didn’t understand the depth of damage done.  

Conclusion 

It’s important to note that a gluten-free diet doesn’t prevent autoimmune or thyroid diseases, but it can help improve them. If you are a thyroid patient, and especially one with Hashimoto’s disease, testing for celiac disease is the obvious choice. A simple blood test and change in diet can be an easy step towards a healthier you. I will be posting some gluten-free food choices on Instagram if you are interested. Now off to brush up on my baking as it looks like we will be serving gluten-free goodies at the Thyroidcafe.