Goitre and pregnancy

Aisha, a boisterous young lady, and an epitome of beauty, as usual, entered her office that Tuesday. Business public relations executive that she is, she was always cutely dressed. That morning, she was to represent her company at a corporate event and when receiving briefs from her superior officer, Anita, due to the close range they maintained, pointed out to Aisha the surgeons of a swelling on her neck.
Though not obvious, Aisha became disturbed and kept checking on her look everyday to know if there was an increase in the size of the swelling.

Coincidentally, that same week, Aisha ran into one of the doctors who attended to her mother-in-law sometimes ago, who also pointed it out to her that she should check on her doctor as regards the swelling.

Healthy pregnant womanAnd to Aisha’s surprise, when she visited the hospital, the doctor said it was goitre, though in its early stage. Several probings were made into her past - where she grew up, her salt intake level and marital status, among others. The outcome showed clearly that she grew up in mountainous part of the country, where the level of iodine in the plant and water is very low, due to the washing away of the topmost part of the soil, reducing its iodine content. Aside that, Aisha did not have any choice in terms of table salt they make use of at home because awareness about iodised salt was not prevalent when she was growing up. And in her marriage, she had a still- birth at her first attempt, which the doctor said owned to the goitre in her.

After series of test, she opted to have an operation, to totally remove the goitre, because, if she did not remove it, her subsequent children stand the risk of being stunted in growth, have low IQ, among others. The operation was a success and Aisha had given birth to two healthy intelligent kids after, while she no longer stands the risk of loss of memory, reduced sexual urge and performance.

Goitre, though taken often times with levity, in the belief that it does not have anything to do with pregnancy could be deadly, if not taken serious, as was evident in Aisha’s case. In an explicit interview with Dr. Adefemi Afolabi, a Consultant General and Endocrine Surgeon, University College Hospital, Ibadan, on what goitre is to a layman’s understanding, he said, goitre is a swelling in the lower part of the neck due to the enlargement of the thyroid gland. The gland, as described by the practitioner, sits astride the trachea (windpipe) and is shaped like a shield.

The thyroid gland, as explained further by him, is charged with the responsibility of producing thyroxin, a hormone which regulates the metabolic activity of the body; for instance, the production of energy from the food we eat, being one of the so many functions. Breaking the causes of goitre into three broad categories, (normally functioning, under-functioning, and over-functioning) the expert said, the commonest cause of goitre in the world is iodine deficiency and is called endemic goitre.

According to him, iodine is necessary for the production of thyroid hormones. In endemic goitre, when iodine is not available, the hormones cannot be made, and the result is that the gland gets bigger to produce the hormone for the body to function. Goitre resulting from lack of or inadequate iodine in the body, he said is mostly common in highly mountainous regions, where the rain easily wash away the top of the soil, reducing the nutrients and iodine content of the plants and sea foods in such areas.

Another category of goitre, hyperthyroidism, can occur when the body produces antibodies against itself, which stimulate the gland to produce an excess amount of thyroxin. It is this production of the antibodies or of another hormone called thyroid stimulating hormone from the brain in excess, that forces the gland to get bigger. People in this category, according to the doctor, experience symptoms like inability to tolerate heat and lose weight despite eating too much (increase in their appetite). He stated that they may also have bulging of the eyes, resulting in prominent eye balls.

The most common symptom (patient’s complain) of goitre is the swelling in the front of the neck, which gets bigger with time and starts pressing the airways and the oesophagus (throat), making breathing and swallowing of food difficult. A change in voice may also be noticed.

The other category as explained by the expert are those whose glands enlarge due to the gland’s inability to produce the expected amount of hormone needed (hypothyroidism), resulting in goitre. As against those in the other hyperfunctioning group, people in this class will not be able to tolerate cold and will generally be slow in their activities.

Goitre, the swelling of the neckNow, concerning goitre and pregnancy, Dr. Afolabi pointed out that goitre is about ten times commoner in women than in men. This, according to him, is because during pregnancy, the demand of pregnancy on the mother for the well being of the foetus, puts more demand on the thyroid gland. The foetus, being an added responsibility on the mother, depends on the her hormone before its thyroid gland is formed while in the womb. The inability of the pregnant woman to produce enough thyroxin for her baby and herself (hypothyroidism) or if she produces more than needed (hyperthyroidism), places the foetus in a state of high risk.

For instance, if the woman is hypothyroid, she will not have enough thyroxin to support the baby’s life. This can result in abnormal development of the brain of the baby, who is then born with a low functioning thyroid and general low function of the body systems, a condition known as Cretinism. A cretin will get unduly cold i.e. have low cold tolerance, a low IQ, be stunted in growth, such that a nine-year-old child can look like a five-year-old child. In view of the fact that the damage done to the brain due to the low production of hormone cannot be reversed, Dr Afolabi advocated that thyroid hormone test should be performed routinely like other tests currently performed during pregnancy, so as not to give birth to cretins.

In his words, women with hypothyroidism and hyperthyroidism find it difficult to get pregnant and when those with hyperthyroidism eventually get pregnant, they may have a miscarriage. Dr. Afolabi therefore advised that if a pregnant woman has goitre, she should not hesitate to go to her doctor, not taking it for granted, but should see it as a serious issue which if not well managed by her doctor, can result in the earlier mentioned defects in her baby.

He, therefore added that the issue of balanced diet cannot be overemphasised. Balanced diet, according to him does not have to be expensive or be canned foods, as they are readily available and affordable by all. Included in the balanced diet is salt, and this is to further emphasize the need for people to make sure they consume only iodized salt. This is affordable and available readily in the market in small sachets with the effort of NAFDAC.

Dr. Afolabi also advised people to discourage the erection of masts by telephone providers near their houses, as the benefit they intend to derive cannot measure up to the hazards they are being exposed to. The masts emit radiations that are harmful to the body, as they may trigger thyroid cancer and other cancers in the future. Thyroid cancer is also a cause of thyroid gland enlargement.

The surgeon concluded that, for a woman who has undergone a surgical operation on her thyroid gland, (especially if the whole gland is removed), which of course is most effective, she should be placed on thyroxin tablet for the rest of her life. The dosage should be increased during pregnancy progressively, so as to cater for her and her baby. Stoppage of the drug can result in weight gain, loss of memory, with the stated harm to the foetus, among others. But if the gland is partially removed, there may be a recurrence of the goitre. This will require another operation, with more risk of complications.