During the recent Liberation Day celebrations, the medical team from Rwanda Military Hospital held a medical camp in Ngenda, Bugesera District, as one of their healthcare outreach activities to treat vulnerable people.

One of the beneficiaries was Eugenie Mukayisenga, 37, who has had goiter for over a decade. But Mukayisenga is just one of many patients suffering from the condition, with most of them not knowing how to go about it.

What’s goiter?

According to medics, goiter is a swelling in the neck caused by enlargement of the thyroid gland. It can be caused by both an underactive and hyperactive thyroid gland, but the associated features and treatment vary.

"Goiter can be caused by consuming diet deficient in iodine. Selenium deficiency can also contribute to it. A pregnant woman with hypothyroidism can produce a baby with thyroid deficiency,” says Dr Rachna Pande, an internal medicine specialist.

She says hyperthyroidism is a cause resulting from an overactive thyroid gland, which produces too much thyroid hormone. This usually happens as a result of an autoimmune disorder in which the body’s immunity turns on itself and attacks the thyroid gland, causing it to swell, thus leading to goiter.

"Goiter can be due to autoimmune disorders (where the body produces antibodies against itself) like grave’s disease, Hashimoto’s thyroiditis. Benign and malignant tumors of thyroid gland or those metastasizing to thyroid gland can manifest as goiter.Also, women over the age of 40 years, as well as people with the family history of the condition are at a higher risk of getting goiter,” Pande explains.

Francis Kazungu, a general practitioner in Kigali, says excess consumption of foods containing goitrogenic agents (chemicals that interfere with the normal function of the thyroid gland) such as soybean and members of the cabbage family like kale, cabbage and broccoli, also leads to one developing goiter, therefore, consuming them in moderation is essential.

Signs and symptoms

"Sometimes it is hard to see the signs and symptoms, but in most cases when they occur, they include difficulty in breathing, swallowing and coughing. A visible swelling at neck could be a sign of goiter too,” says Kazungu.

He adds that signs such as nervousness, palpitations, hyperactivity, increased sweating, heat hypersensitivity, fatigue, increased appetite and weight loss may be an indication of goiter mainly caused by overactive thyroid.

Kazungu points out that injection of radioactive iodine may be administered to the patient to provide a detailed picture of the gland. In addition, in order to assess the gland and the size of the goiter, carrying out ultra sound is ideal.

How to go about it

Pande explains that to avoid developing goiter, maintaining a healthy diet is key.

"Prevention of goiter lies in taking a balanced diet with adequate amounts of fresh fruits, particularly oranges, apples, pineapple and strawberries. Fresh vegetables are also useful. For instance, sea food provides iodine and is a good source of iodine,” she notes.

Pande adds that, it’s advisable to avoid much use of white flour and white sugar.

"One should also keep away from excess use of foods like cabbage, broccoli and cauliflower as they interfere with synthesis of thyroid hormones,” she says.

However, Pande points out that in order to keep the condition at bay, it’s essential to start using iodised salt.

According to a research by Mayo Clinic, the goiter can be managed surgically by removing part of the thyroid gland, especially in cases where one has a large goiter, which in most cases causes discomfort or difficulty in breathing or swallowing. 

The research adds that in cases where one has nodular goiter causing hyperthyroidism, surgery is the best option to treat it.

However, Kazungu says diagnosis of the cause of goiter is made clinically. 

"Whether it is under functioning or hyperactive thyroid gland, it is determined by assessing the level of thyroid hormones in blood. On the other hand, the cause of goiter is determined by biopsy,” he says.

Medics point out that the treatment for hypothyroidism consists of use of thyroid hormone supplements. Hyperthyroidism is treated by antithyroid drugs. 

Surgery is considered in cases where enlarged thyroid gland is compressing adjoining structures, like the wind pipe, sound box or food pipe.

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