Goiter in Nigeria: What you need to know

 

By: Doreen Udoudom. Datelinehealth Africa Volunteer Freelance Writer, with editorial support from The DLHA Team

 

 

KEY FACTS

• Goiter is an abnormal enlargement of the thyroid gland.
• It is a common symptom of other thyroid disorders.
• The most common cause is lack of iodine in diet.
• As of 2020, 20 million Nigerians are estimated to be affected with iodine deficiency.

 

 

What is a goiter?

A goiter is an abnormal swelling of the thyroid gland in front of the neck which is visible while swallowing. The enlarged mass can vary in size and moves from top to bottom.

A goiter can develop due to certain conditions like hyperthyroidism (when the thyroid gland produces too much of its hormone) and hypothyroidism (when the thyroid gland produces fewer amounts of its hormone).

 

 

Location of the thyroid gland and how it works

The thyroid gland is a small butterfly-shaped organ located in front of the windpipe (trachea) and at the base of the neck below Adam's apple. It is larger in males than in females.

It weighs approximately 10 - 25g and has two lobes (right and left) joined by an isthmus (a bridging part). It secretes two hormones that are called: Triiodothyronine(T3) and Thyroxine (T4). These hormones are responsible for metabolic processes in the body.

 

The pituitary gland and hypothalamus in your brain regulate the production of T3 and T4. 

When T3 and T4 levels are low, the hypothalamus produces thyrotropin-releasing hormone (TRH)  which signals the pituitary gland to produce thyroid-stimulating hormone (TSH).  The TSH signals the thyroid gland to produce more T3 and T4. When T3 and T4 levels are high, the pituitary gland stops producing TSH.

 

 

Types of goiter

There are three types of goiter:
 

• Simple goiter: The thyroid gland is enlarged and smooth to touch.

• Nodular goiter: The goitre is filled with nodules. The nodules may be solid or filled with fluid.

• Multinodular goiter: as the name implies, this goiter has numerous nodules.

 

 

How common is goiter in Nigeria?

A UNICEF survey of goiter in Nigerian school children, reported a goiter rate of 20% and over 20 million Nigerians were estimated to have iodine deficiency.

Another study reported an estimated 40.2% goiter rate among primary school children in Ibadan.

The variation in rates are most likely due to differences in study methodologies.

 

 

Economic Impact of goiter in Nigeria

The economic impact of goiter in Nigeria is significant, particularly in areas where iodine deficiency is common. This disease can lead to reduced productivity and increased absence from work due to it's symptoms such as swelling, difficulty breathing and difficulty swallowing.

In cases where surgery might be needed, the money may not be easily accessible, especially in low-income areas.

To deal with the economic impact of goiter in Nigeria, it is important to educate the public about goiter and carry out measures that can prevent the condition from occurring in the first place, such as promoting the use of iodized salt.

Early detection and treatment of goiter can help to reduce the negative economic impact of the condition, by preventing the development of more serious health problems and reducing the need for expensive medical treatments.

 

 

What causes goiter?

The major cause of goitre worldwide is lack of iodine in the diet. This is also the commonest cause of goiter in Nigeria. Note however, that other substances (goitrogens) that interfere with iodine uptake by the third gland may also play a role in the development of endemic goiter. In Africa, goitrogens of note include thiocyanates that are often found in poorly detoxified cassava, a staple food that is commonly eaten as a source of carbohydrate.

 

Other causes of goiter include:

• Inflammation of the thyroid.
• Postpartum thyroiditis.
• Thyroid cancers.
• Hashimoto's thyroiditis: In Hashimoto's disease, the immune system attacks the gland and this leads to hypothyroidism.
• Graves disease: This disease causes swelling of the thyroid gland and secretion of too much thyroid hormone.

 

 

Risk factors for goiter

The risk factors for goitre include:

• Sex: By a ratio that is close to 10: 1, women have more risk of getting goiter and other thyroid disorders than men.

• Age: Most common in people over 40.

• Medical history: Taking medication like lithium can put you at risk of goiter.

• Inherited risk: If you have relatives who have/ had goiter, you are also at risk.

• Pregnancy.

 

 

What are the symptoms of goiter?

A clear indication that you have a goiter is swelling at the base of your neck. Most people don't notice an enlarged thyroid because it grows slowly over a long time.

Other symptoms (especially at advanced stages) might include:

• Coughing.
• Hoarseness of voice.
• Difficulty breathing.
• Difficulty swallowing.

 

Symptoms due to hypothyroidism are:

• Hair loss.
• Weight gain.
• Memory loss.
• Stomach upset.

 

Symptoms due to hyperthyroidism are:

• Fatigue.
• Weight gain.
• Changes in appetite.

 

 

How do doctors diagnose goiter?

Doctors diagnose goiter by physical examination. They will ask about your family history, medical history and the symptoms you've experienced.

To make a more reliable diagnosis, your doctor may ask you to undergo a combination of the following tests:

• A blood test to check the levels of thyroid hormones and thyroid-stimulating hormone (TSH).
• Radioactive iodine scan.
• Thyroid ultrasound: Your doctor may use an ultrasound or CT scan to check the size of the thyroid gland and any nodules or lumps.
• Fine needle aspiration biopsy: If your doctor suspects thyroid cancer, they may order a biopsy to test a sample of the tissue for cancer cells.

 

 

What are the treatments for goiter?

You might not need treatment if your goiter isn't too large and not causing any complications. Treatment depends on the cause of the swelling.

Some treatment options include:

• Antithyroid drugs.
• Iodine replacement. 
• Radioactive iodine treatment.
• Thyroid hormone replacement drugs.
• Thyroidectomy (Surgical removal of all or part of the thyroid gland).

 

 

How can goiter be prevented?

Prevention of goiter will be discussed at two levels: Individual and Public.

At the individual level

• Increase iodine intake:  Goiter can be prevented by consuming foods rich in iodine. Examples of such foods are seafood, seaweed, dairy products, and eggs.

 

• Avoid goitrogenic foods: Some foods such as cassava, corn, cabbage, soybeans, and peanuts can interfere with the absorption of iodine by the thyroid gland which can cause goiter. Limiting the consumption of these foods may help prevent goiter. 

 

• Consult with a doctor: If you are concerned about goiter, it's important to talk to your doctor. They can assess your risk factors and recommend appropriate treatment and lifestyle changes.

 

• Manage stress:  Stress can affect thyroid function and increase the risk of goiter. Managing stress through activities such as exercise, yoga, or medication may help prevent goiter.

 

• Avoid exposing yourself to radiation.

 

At public health level

Preventing goiter at the public health level involves the following processes:

• Targeting primary and secondary schools, higher institutions, churches, mosques, banks, etc., with awareness information and training of school health workers with skills for the early identification and management of goitre in pupils.

 

• Public Service Announcement (PSA) on Television, Radio and Social Media also for awareness raising and prevention education.

 

• Engaging local agents of influence in community awareness raising about the condition and how to eliminate it.

 

• Requiring and monitoring food producers/manufacturers to add iodine supplements to certain staple food that are highly consumed in the community.

 

• Training frontline Community Health Workers to screen for and identify goitre in at risk attendees at primary health centres regardless of their primary presenting complaints. Such individuals should then be offered treatment and patient-centered information about managing the condition. 

 

 

Sources

Ogbera AO, Kuku SF. Epidemiology of thyroid diseases in Africa. Indian J Endocrinol Metab. 2011 Jul;15(Suppl 2):S82-8. doi: 10.4103/2230-8210.83331. 

 

Sanusi, RA and Ekerette, NN. Nutrition and Goiter Status of Primary School Children in Ibadan, Nigeria. African Journal of Biomedical Research. 2008. 12 (1), 37-41. (Downloads PDF document)

 

Jimoh AK, Ghazal MS, Adeleke AB, Adeniyi AA, Adebara IO, Babalola FO, Ajani GO, Agboola MS, Busari OA. Biochemical pattern of thyroid function test and clinical impression of thyroid disorder in a rural tertiary health institution in Nigeria. Ann Afr Med 2020; 19:89-94. 

 

Can, AS and Rehman, A. Goiter. NIH. National Library of Medicine. 2023. 

 

 

 

 

Published: April 17, 2023

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