Q:I had a goitre removed from my thyroid and in less than a year I have another one on the other side. I wonder if you would answer some questions. Could goitre be due to menopause? Could I just keep having one removed for another to grow? Will this goitre go away on its own? P W., Brentwood.
A:The thyroid gland sits in your neck, straddling your windpipe right below your voice box. Its job is to control your metabolism and and it has some role in bone formation. In babies and children, it produces hormones that aid in growth. When it doesn't operate properly, it can wreak havoc in your body.Goitre is simply an enlargement of the gland, either as a simple smooth enlargement, or one with a batch of lumps, because of a lack or defect in the production of thyroid hormones. This raises an alarm bell in the pituitary gland, which produces more thyroid stimulating hormone (TSH), which then causes the gland to get bigger.
The commonest cause of goitre is a lack of iodine in your diet. Have you investigated whether that is a possibility? If so, you can prevent the recurrence by so simple a measure as adding iodized salt to your diet or taking iodine in a supplement.
However, iodine isn't the entire story. A high level of calcium in your diet interferes with the absorption of iodine. Hence, if you've been taking calcium supplements for the menopause, it may be interfering with your uptake of iodine. High water areas with a high calcium level can also cause this problem.
Underactivity of the thyroid gland can occur in middle age, and it is more common in women.
One cause is a condition called Hashimoto's disease, an auto immune problem in which the body begins producing antibodies to the thyroid tissue as though it were a foreign invader.
It could also be due to a condition called Grave's disease, which causes overworking of the thyroid. Furthermore, all these conditions can work together.
You can also get goitre from a variety of drugs. These include drugs for depression like lithium or those for infections like the sulphonamides. A chemical found in some foods, such as the cabbage family, can block the efficient use of iodine by the thyroid. Cough medicine or any other medication with iodine in it can cause the problem, since too much iodine can also operate to suppress the thyroid gland. (Hence, why you must have your intake of iodine supervised.) Ironically, goitre can also be caused by anti thyroid drugs that is, drugs used to treat hyperthyroidism. Interestingly, anti thyroid drugs are often used with lithium to treat an overactive thyroid.
You do not say whether your goitre was smooth or multi nodular. The former is often due to some problem with iodine uptake and can be controlled by an adequate iodine intake, or, if necessary, the use of thyroid hormone, to stop the pituitary from churning out endless amounts of TSH.
But if you do determine that you are taking enough iodine and your goitre is not caused by excessive calcium or drugs, before you submit to the surgeon's knife again, has your doctor attempted to regulate your thyroid with thyroid hormone (thyroxine sodium or liothyronine sodium), which is also used to treat Hashimoto's disease?
You should know, however, that the drugs used for underactive thyroid can cause a rapid or erratic heart beat, angina and heavy weight loss. They can also affect the insulin dose of diabetics; patients with adrenal glands problems are recommended to take steroids before embarking on this drug.
If you fall into any of these categories, you can take another hormone (tri iodothyronine), which is shorter acting and can more safely be stopped if your angina becomes worse, and then slowly be moved over to the other hormone when your thyroid is no longer underactive.
The point about thyroid medication is to monitor it carefully, since the thyroid can vary in its output of hormone. What was a good level of drug one week can be too much the next. Your thyroid could also improve to the point where you are taking far too much hormone, which can cause a hyperactive condition.
Although the conventional advice is to have checks of thyroid hormone levels annually, many GPs are lazy about bothering with even infrequent monitoring.
It's wise, however, to have your blood levels checked every three to six months and to have your dose of hormone altered if it turns out to be excessive.
There are also a number of complementary treatments you can investigate which could improve your thyroid function. Acupuncture, homeopathy and herbalism have all shown success in improving thyroid function, as has supplementation with vitamins C, the B vitamins, and zinc, calcium and manganese.