The Goitre Effect

Words: Dr Rajgopal NIDAMBOOR

The puffy enlargement of your thyroid gland is called goitre. It may have a tendency to hamper your swallowing, or breathing, activities.

The causes of goitre are sundry.

Hormones produced by your thyroid gland regulate your metabolism, including the rate at which you burn calories. The presence. or emergence, of goitre doesn’t essentially mean your thyroid gland isn’t producing hormones normally.

An enlarged thyroid may produce less-than-normal, normal-or higher-than-normal amounts of hormones. In like manner, enlargement of the gland can be uniform. The condition is called diffuse goitre. In certain cases, the gland may be enlarged due to one, or more nodules, or lumps, within a normal thyroid gland. This is called nodular goitre.

The word goitre comes from the Latin, guttur — for ‘throat.’ Prior to the early part of the last century, the most common cause of goitre was lack of iodine in the diet — especially in areas where the soil was wanting in the non-metallic chemical element. Simple equation. Without adequate dietary iodine, your thyroid gland cannot manufacture and release enough of the two essential iodine-containing hormones.

Goitre became uncommon when iodised salt was introduced after the end of World War I, in the United States, and across the world. Iodine occurs naturally in food, dairy products and seafood, and also water; it may get into some foods unintentionally during processing too.

Yet, goitre remains a common disorder in some parts of the world, because of iodine insufficiency. There’s also a clear, established link between hard, fluoride-containing drinking water and the incidence of goitre. The incidence is unusual in areas with soft water and lower fluoride levels.

Signs & Symptoms 

  • Extensive enlargement of the thyroid gland, resulting in puffiness of the neck
  • A constricted feeling in your throat
  • Cough
  • Hoarseness of voice
  • Difficulty in swallowing
  • Breathing difficulty.

People with any of the following conditions may be more likely to develop goitre:

  • Obesity
  • Insulin resistance
  • Metabolic syndrome.

Prevention  

A goitre caused by iodine deficiency [simple goitre] is usually the only type of goitre you’d, perhaps, prevent. A diet that includes fish, dairy and a healthy amount of iodised table salt is evidenced to prevent certain types of goitres.

Treatment 

Ayurveda 

Multinodular goitre [MNG] is one of the most common endocrine disorders affecting the thyroid gland with a higher prevalence in the female population. It may be due to abnormalities of iodine supplies, or metabolism, or dyshormonogenesis, resulting in nodules of different sizes filled with colloid-rich material.

This case report documents the successful management of galaganda [colloid MNG Bethesda Grade 2] with Ayurvedic oral medicines.

A 60-year-old female, with chief complaints of galashotha [swelling in the throat], sankocha [tightness and tense feeling in the neck], amlapitta [hyperacidity], vibaddhata [constipation], and aadhmana [gas formation] visited for Ayurvedic treatment for her condition in September 2018. She was administered Ayurveda treatment based on the principles of deepanapachana [improving the digestion and metabolism], sroto shodhana [cleansing of the bowel and circulatory channels], sanshamana [pacifying treatment], and satwavajaya chikitsa [patient counselling].

Based on her condition, amarasundari vati, vridhivadhika vati, kanchanara kashayam and a herbo-mineral compound in capsule form, along with a regulated diet and lifestyle, were prescribed for the initial three months.

The patient showed improvement in subjective and objective parameters with improvement in quality of life. However, since recurrences are commonly reported in MNG, the medicines were continued for a period of 12 months. No side-effects were observed during the therapeutic period.

The patient was followed up for another 12 months and no recurrences were noted — even after stopping treatment.

  • Sharma A, Rai S, More A. “A Report on the Management of Galaganda [Colloid Multinodular Goitre] Through Ayurveda Approaches.” J Ayurveda Case Rep. 2022; 5:74-9.

Homeopathy

Goitre refers to an enlarged thyroid gland caused by a number of factors, such as biosynthetic defects, iodine deficiency, autoimmune disease and nodular diseases.

This is a case of a woman with colloidal nodular goitre treated successfully with homoeopathy.

Her thyroid profile was within normal range, and fine-needle aspiration cytology was clearly suggestive of colloidal nodular goitre.

She was treated with homeopathic medicines following holistic concepts of homeopathy, and the result was a significant reduction in size of thyroid nodule. Lycopodium clavatum initiated the action, and Sulphur potentiated the cure.

  • Bindu Sharma, Retika Saxena, “Case Report on Colloidal Nodular Goitre,” Homeopathic Links 2019; 32[02]: 112-117.

 Integrative Medicine 

Goitre with euthyroid function, or with subclinical, or mild hyperthyroidism due to thyroid autonomy is common. In anthroposophic medicine various thyroid disorders are treated with Colchicum autumnale [CAU]. We examined the effects of CAU in patients with goitre of both functional states.  

Patients and methods. In an observational study, 24 patients with goitre having suppressed thyroid stimulating hormone [TSH] levels with normal, or slightly elevated free thyroxine [fT4] and free triiodothyronine [fT3] [group 1], or normal TSH, fT3, and fT4 [group 2], were included. After 3 months and after 6 to 12 months of CAU treatment, we investigated clinical pathology using the Hyperthyroid Symptom Scale [HSS], hormone status [TSH, fT4, and fT3], and thyroidal volume [tV].  

Results. After treatment with CAU, in group 1, the median HSS decreased from 4.5 [2.3-11.8] to 2 [1.3-3] and fT3 decreased from 3.85 [3.5-4.78] to 3.45 [3.3–3.78] pg/mL]. In group 2 tV [13.9 per cent [18.5-6.1 per cent] and TSH were reduced. Linear regression for TSH and fT3 in both groups indicated a regulative therapeutic effect of CAU.  

Conclusions. CAU positively changed the clinical pathology of subclinical hyperthyroidism and thyroidal volume in patients with euthyroid goitre by normalisation of the regulation of thyroidal hormones. 

  • Christian Scheffer, Marion Debus, Christian Heckmann, Dirk Cysarz, Matthias Girke, “Colchicum autumnale in Patients with Goitre with Euthyroidism, or Mild Hyperthyroidism: Indications for a Therapeutic Regulative Effect — Results of an Observational Study,” Evidence-Based Complementary and Alternative Medicine, Vol 2016, Article ID 2541912, 8 pp, 2016. [https://doi.org/10.1155/2016/2541912]. 

Nutrition 

A healthy gut microbiota not only has beneficial effects on the activity of the immune system, but also on thyroid function. Thyroid and intestinal diseases prevalently co-exist — Hashimoto’s thyroiditis [HT] and Graves’ disease [GD] are the most common autoimmune thyroid diseases [AITD]. They often co-occur with Celiac disease [CD] and non-celiac wheat sensitivity [NCWS].

This can be explained by the damaged intestinal barrier and the following increase of intestinal permeability, allowing antigens to pass more easily and activate the immune system, or cross-react with extraintestinal tissues, respectively. Dysbiosis has not only been found in AITDs, but has also been reported in thyroid carcinoma, in which an increased number of carcinogenic and inflammatory bacterial strains were observed.

Additionally, the composition of the gut microbiota has an influence on the availability of essential micronutrients for the thyroid gland. Iodine, iron, and copper are crucial for thyroid hormone synthesis; selenium and zinc are needed for converting T4 to T3, and vitamin D assists in regulating the immune response. These micronutrients are often found to be deficient in AITDs, resulting in malfunctioning of the thyroid.

Bariatric surgery can lead to an inadequate absorption of these nutrients and further implicates changes in thyroid stimulating hormone [TSH] and T3 levels.

Supplementation of probiotics showed beneficial effects on thyroid hormones and thyroid function in general. A literature research was performed to examine the interplay between gut microbiota and thyroid disorders that should be considered when treating patients suffering from thyroid diseases. Multifactorial therapeutic and preventive management strategies could be established and more specifically adjusted to patients, depending on their gut bacteria composition.

  • Jovana Knezevic,Christina Starchl, Adelina Tmava Berisha, Karin Amrein, “Thyroid-Gut-Axis: How Does the Microbiota Influence Thyroid Function?” Nutrients 2020, 12[6], 1769; [https://doi.org/10.3390/nu12061769].
Dr RAJGOPAL NIDAMBOOR, PhD, is a wellness physician-writer-editor, independent researcher, critic, columnist, author and publisher. His published work includes hundreds of newspaper, magazine, web articles, essays, meditations, columns, and critiques on a host of subjects, eight books on natural health, two coffee table tomes and an encyclopaedic treatise on Indian philosophy. He is Chief Wellness Officer, Docco360 — a mobile health application/platform connecting patients with Ayurveda, homeopathic and Unani physicians, and nutrition therapists, among others, from the comfort of their home — and, Editor-in-Chief, ThinkWellness360.

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