Dr Adefemi Afolabi is an expert in thyroid disorders at the University College Hospital (UCH), Ibadan, Oyo State. In this interview by SADE OGUNTOLA, he x-rays issues on goiter and other thyroid disorders, asking that Nigerians need to be thyroid healthy.
What are thyroid diseases?
The thyroid gland is a gland located in the frontal part of the neck that produces hormones that control how the body uses energy. Thyroid diseases occur due to the abnormal functioning of the gland and for different reasons. There are two hormones produced that control how the body uses energy from food, and it affects all the functions of the body.
Basically, there are diseases that affect the functions of the thyroid organ and likewise, there may be growth in the organ, like a cancer. If the hormones produced are not enough for one reason or the other, we call that hypothyroidism. The other side is hyperthyroidism, when the gland is functioning excessively.
Also, the function of the thyroid gland is controlled by another hormone from the brain called the thyroid stimulating hormone. If for any reason the brain is not producing enough stimulating hormone, the thyroid gland will not be able to produce enough hormone.
The inadequate functioning of the thyroid gland can occur for different reasons. It can occur in pregnancy, which contributes to why more cases occur in women than men; diet poor in iodine, especially in persons living in hilly and mountainous areas, due to an autoimmune disease; exposure to radiation and radioactive substances,
Studies have shown that thyroid disorders appear to be commoner in areas where there are many of hills and mountains because the top soils are not rich in iodine. So, goitre, a form of thyroid disorder, is common in areas like Ondo and Ekiti States, and even in Oke Ogun area in Oyo State. It is also noticeable in the goitre belts spread from West Africa to East Africa.
Children with congenital hypothyroidism are described as “cretins”. They are short for age, they are not well developed; their brain function may not be adequate as well.
Where the thyroid organ is targeted by antibodies, it can manifest as thyroid disease. Also, the same auto antibodies in such individuals make some substances to be deposited behind the eye. As a result, such people have protruding eyes. Prominent eyeballs may be a sign of Graves’ disease, the commonest type of thyrotoxicosis in which the thyroid gland produces excess hormones. Most of these cases of goitre, enlargement of the thyroid gland, are due to iodine deficiency, but many people neglect it. They don’t seek treatment.
Now, a growth can occur in the thyroid gland like in any other part of the body and it may be noncancerous or cancerous. The gland becomes enlarged, but it is not as if the new growth in the thyroid gland will be so big; the size of the thyroid gland does not determine whether there is a growth in it or not.
How common is the problem in Nigeria?
A community study can help to know how commonly thyroid disorders occur. Now, if one out of 10 people in a community have the thyroid disorder, we say that it is endemic. Otherwise, where they are not so many, we say that it is sporadic. It just occurs by chance.
However, it is not as common as hypertension, diabetes or even malaria. In the endocrine surgical clinic, most of the patients who are referred to us undergo surgical removal of the goitre. Also, it is commoner in women than men.
Will you say cases of thyroid disease are on the rise in Nigeria?
Certainly, awareness on the disease in the country is on the rise. This doesn’t mean that cases are on the increase. If anything, we should expect it to be decreasing because, for many years now, the government’s policy is that people should only sell iodized salt. Most goitre is due to iodine insufficiency. However, consumption of iodized salt in our food will not reduce the cases due to autoimmune disease like Graves disease or those due to cancer.
Are there factors that contribute to thyroid disease in Nigeria?
Dietary cause will be the commonest contributory factor in Nigeria to individuals having goitre and that is why the directive to use iodized salt became a policy in the country. But iodized salt consumption should be moderate.
What are the common symptoms of this condition?
The commonest manifestation is the swelling in the frontal part of the neck due to insufficient intake of dietary iodine. Prominent eyeballs are a common feature in those who have Graves’ disease. However, people without goitre but whose glands are functioning excessively experience such symptoms as heat intolerance, restlessness, and loss of weight.
Along this line, drugs like some cough syrups and some used in the treatment of heart condition that contain iodine can stimulate the thyroid gland in a normal person. Such thyroid gland in a person already on the borderline of inadequate thyroxine can also develop hyperthyroidism.
Of course, such things as trouble sleeping, loss of weight and irregular menstrual cycle are manifestation of the deranged thyroid function and such symptoms should not be overlooked.
In the social media, some cases of overweight and infertility are likened to hypothyroidism, how is this so?
That is the other side of the coin to hyperthyroidism. People who have hypothyroidism have opposite symptoms to those with hyperthyroidism. These are people whose hormones are not adequate; they may gain weight; they will be clumsy, have memory loss, and will not be active as usual. Their voice will be like a man’s voice.
There will be some skin and hair changes, aside from the swelling in the frontal part of their neck because they have low thyroxine level. The brain tries to produce the thyroid stimulating the hormone to fire it up. The way it responds is to enlarge. The excessive production of thyroxine also disrupts the hormonal system as well as those hormones that control infertility. That is why some experience abnormality in menstruation and so on.
Do individuals need to get screened for this condition?
Indeed, we have discovered that it is familial in some, because people in the same family eat the same food, and because the condition may be genetic or inherited. We have described families that have Graves’ disease run in them. Usually for thyroid disorders assessment, two tests are usually prescribed. It is the hormone assay and ultrasound of the neck.
What are the things that people can look out for to know that their thyroid is malfunctioning?
What people will notice is that the thyroid gland is enlarged; it may be through their photographs; they look at the photograph they took about 5 years ago and compare with a recent one. They see that something is bulging in their neck.
What are the common myths and misconceptions around thyroid disorder?
A common one is the cause of the swelling in the neck; they say it is caused by witchcraft or that it is due to collection of blood in their neck and as such they can go for traditional healing. That is why they don’t come to the hospital early, but later with a big goitre. Also, some people believe that treating it with operation will lead to death.
Some are of the opinion that you should not open a goitre because cutting the neck is the same way by which animals are slaughtered. But not all goitres need operation. Some only need medication or radioiodine therapy. Also, the form of treatment required is determined also by such things as its cause, size and how soon the person comes to the hospital.
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