Every 4th week of the month of January, we observe the “Goiter Awareness Week,” by virtue of the Presidential Proclamation No. 1188 signed on 11 December 2006. This year, we are celebrating the Goiter Awareness Week with the theme: Isip Patalinuhin, Iodized Salt, Gamitin on January 20-26, 2020.
Goiter is defined by the World Health Organization as a health condition which is exhibited by the enlargement of the thyroid gland[1] characterized by a swelling in the neck due to the formation of a lump. The thyroid gland is a small butterfly-shaped gland located in front of the trachea (windpipe) responsible for the production of the thyroid hormone, which helps regulate the body’ metabolism[2]. The most common cause of goiter is iodine deficiency, but other causes include nodules, inflammation, hyperthyroidism, smoking, hormonal changes, and Grave’s disease (an autoimmune disease). It may also be caused by the overconsumption of goitrogen-rich foods[3]. Goitrogen is a substance that enlarges the thyroid gland that causes toxic goiter.
Iodine is a mineral that has an integral part in the thyroid hormone. With iodine deficiency, the thyroid hormone production declines and the hypothalamus of the brain, which is responsible in regulating the thyroid hormone production in the body, responds by signaling the pituitary gland to secrete more Thyroid-Stimulating Hormone (TSH) in an attempt to accelarate iodide (form of iodine that is adsorbed in the body) intake in the thyroid gland. If a deficiency persist, the cells of the thyroid gland enlarge to trap as much iodide as possible until a visible lump is seen in the neck3. Goiter that is caused by iodine deficiency may be referred to as “simple goiter,” as it is the earliest and most obvious sign of iodine deficiency. Symptoms of goiter are as follows:
- Swelling at the front side of the base of the neck that ranges from a small lump to a general enlargment, which is the most common sign of goiter;
- Coughing;
- Difficulty in breathing;
- Hoarsness and change in one’s voice;
- Difficulty in swallowing;2
- Tiredness;
- Dryness of skin & hair;
- Sleepiness;
- Diarrhea or constipation;
- Menstrual irregularities;
- Depression;
- Decrease or increase in weight; and
- Low or increased appetite[1]
According to Pinna et al. (2011), 96% of the 200 million people worldwide suffering from goiter are caused by iodine deficiency while the remaining 4% is due to over-consumption of goitrogen-rich foods.) Goiter may affect all ages and both sexes but is most frequently obeserved in females and after puberty. According to a study conducted by The Philippine Society of Endocrinology and Metabolism (PSEM) PhilTiDes Working Group in 2012, 8.53% or 417 out of 4897 individuals who underwent thyroid function tests had thyroid function abnormalities with 5.33% having subclinical hyperthyroidism. A larger survey conducted by the same group, it was found that 8.9% had goiters[1]. Also, results from the 2013 National Nutrition Survey[2], it was found that the population groups of school-aged children (6-12 years old), adolescents, and adults (20-59 years old), had adequate iodine intake based on median UIE levels ranging from 100 to 199 µg/L, 168 µg/L, and 116 µg/L respectively, while those of lactating mothers, elderly, and pregnant women were considered insufficient in iodine intake with median UIE below 100 µg/L and 155 µg/L, respectively. Particularly, in the region of Central Luzon, iodine intake of the population group of school-aged children were noted to be of adequate levels with median UIE ranging from 112-258 µg/L in all provinces. Conversely, the Provinces of Bataan and Aurora recorded a 25.5% and 26.1% frequency distribution of UIE values <50 µg/L respectively, among the same age group which indicates moderate iodine deficiency.
Iodine Deficiency may be prevented through the adequate intake of iodine through consumption of iodine-rich food sources but the safest, most cost-effective , and sustainable strategy in the prevention and control of iodine deficiency worldwide is through Salt Iodization. In the Philippines, the passage of the Republic Act 8172 or ASIN Law or otherwise know as an Act on Salt Iodization Nationwide and for Related Purposes, made it possible for the control and prevention of iodine deficiency in the country. Iodine is mainly found in soil but is washed up to seas due to repeated flooding and glacier displacement which then makes seawater, seaweed, marine fishes, and seafood rich in iodine.
Here are some ways on how to prevent goiter and iodine deficiency:
- Consume foods rich in iodine like: seaweed (kelp, nori, etc) fish and seafoods, dairy products like milk, meats, breads and grain produce, and eggs.
- Make sure that the salt you are using at home is iodized salt.
- Avoid over-consumption of goitrogen-rich foods such as cabbage, spinach, radishes, soybeans, peanuts, kale, brussels sprouts, cauliflower, and broccoli.
- For pregnant and lactating women, iodine supplementation is also reccomended.
- Make sure to visit your physician for check-ups regularly.
[1] The Philippine Society of Endocrinology and Metabolism (PSEM) PhilTiDeS Working Group. (2012, May 1). The Philippine Thyroid Diseases Study (PhilTiDeS 1): Prevalence of Thyroid Disorders Among Adults in the Philippines. Journal of the ASEAN Federation of Endocrine Sciences, 27.
[2] Food and Nutrition Research Institute. (2013). Philippine Nutrition Facts and Figures 2013 : 8th National Nutrition Survey Overview. Taguig City: Food and Nutrition Research Institute.
[1] The Philippine Society of Endocrinology and Metabolism (PSEM) PhilTiDeS Working Group. (2012, May 1). The Philippine Thyroid Diseases Study (PhilTiDeS 1): Prevalence of Thyroid Disorders Among Adults in the Philippines. Journal of the ASEAN Federation of Endocrine Sciences, 27.
[2] Food and Nutrition Research Institute. (2013). Philippine Nutrition Facts and Figures 2013 : 8th National Nutrition Survey Overview. Taguig City: Food and Nutrition Research Institute.
[1] DOH. (2019, January). DOH Leads Observance of Goiter Awareness Week (GAW) 2019. Retrieved from Department of Health Official Website : https://www.doh.gov.ph/node/16406
By:
Antoinette Gaile B. Garcia
Nutrition Officer I
