Goitre and Hypothyroidism

Goitre is an enlargement of the thyroid gland, and hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormone. The two commonly occur together, with iodine deficiency being an important preventable cause in many parts of Tanzania.

• Visible or palpable swelling in the front of the neck (goitre)
• Fatigue and weakness
• Weight gain despite normal appetite
• Feeling unusually cold
• Dry skin and hair thinning
• Constipation
• Slowed thinking and low mood
• In children, untreated hypothyroidism can affect growth and mental development

• Iodine deficiency is a leading cause of goitre and hypothyroidism in areas without adequate dietary iodine.
• Autoimmune thyroid disease is another common cause, particularly in adults.
• Certain medicines and, less commonly, prior thyroid surgery or radiation can also cause hypothyroidism.

• Goitre is diagnosed by physical examination of the neck.
• Hypothyroidism is diagnosed with blood tests showing a raised thyroid-stimulating hormone (TSH) level, with a low thyroid hormone (T4) level in more significant cases.
• Thyroid ultrasound may be used to further assess the gland where nodules or asymmetry are found.

Hypothyroidism is treated with daily oral thyroid hormone replacement (levothyroxine), started at a dose based on age and severity and adjusted based on follow-up blood tests.

Treatment is usually lifelong, and periodic monitoring of thyroid function guides dose adjustments.

A goitre without hypothyroidism may simply be monitored, with iodine correction where deficiency is the cause; large goitres causing pressure symptoms (such as difficulty swallowing or breathing) may require specialist and, occasionally, surgical assessment.

Pregnant women with hypothyroidism require close monitoring, as adequate thyroid hormone is important for the baby's development.

• Use iodised salt consistently in cooking and food preparation.
• Ensure adequate iodine intake, particularly during pregnancy.
• Attend routine follow-up and take thyroid medicine consistently once prescribed.
• Seek assessment for unexplained neck swelling, fatigue, or unexplained weight change.