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Our thyroid, small but mighty

By on June 26, 2021 in Columnist with 1 Comment
Jim Brown

By Jim Brown, M.D.

I have been thinking about the thyroid gland lately. 

Not long ago, a friend had thyroid surgery for cancer of the thyroid. She did well, thank goodness. 

According to the National Institutes of Health, there are over 56,000 new cases of thyroid cancer in the United States each year. Females get thyroid cancer three times as often as males. 

The other thyroid issue that stimulated me to write about thyroid is the impact COVID-19 has on our thyroid gland and also how underlying thyroid disease might affect COVID. 

There have been 114 publications on this subject alone in the past year. The good news is being on thyroid replacement medication did not change the rate of hospitalization, mechanical ventilation or mortality from COVID. 

On the other hand, studies have shown 15-30 percent of hospitalized COVID-19 patients will have detectable new thyroid dysfunction. 

The thyroid endocrine gland is only about two inches long and lies at the base of the neck below our “Adams apple.” 

It may seem surprising such a small organ can have such a large impact on our health and on medical history as well. 

Thyroid hormones regulate much of your body’s metabolism including breathing, heart rate, the central nervous system, body weight, muscle strength, menstrual cycles, body temperature and more. 

If you have too little thyroid hormone or too much hormone, it will affect how you feel and how you function. 

If you have too little thyroid hormone, the symptoms include fatigue, low energy, weight gain, inability to tolerate cold, a slower heart rate, dry skin and even constipation. 

Hyperthyroidism occurs when one has too much thyroid hormone. In this condition, the symptoms can include irritability, anxiety, weight loss, inability to tolerate heat, diarrhea, difficulty sleeping and an enlargement of the thyroid gland. 

A simple blood test can detect one’s level of thyroid hormone. Approximately 20 million Americans are affected by thyroid disease. 

I find the history associated with thyroid disease quite fascinating. 

I did my residency in internal medicine at the Mayo Clinic in Rochester, Minnesota after I served my internship at the Hennepin County Hospital in Minneapolis. At Mayo it became apparent the impact of the work done there early in the 19th Century having to do with thyroid disease was ground breaking as well as life saving. 

Dr. William Mayo had migrated from England to the United States in 1846. He was appointed surgeon for the Union Army in the Civil War. After the war, he settled in Rochester, Minn., and opened an office advertising in the local newspaper, “All calls answered day and night.” There were no ERs then. 

Eventually his two sons, Charles and William became surgeons and joined their father’s practice. The Sisters of St. Francis approached them, telling them they would try to raise the money to build a hospital there if they would provide the medical and surgical care. 

At this time thyroid disease, particularly goiter, an enlargement of the thyroid, was very common in the upper Midwest, Appalachia and the Great Lakes region. This became known as the “goiter belt” with over 26 percent of children there having recognizable goiters. 

Much later goiters were found to be due to insufficient iodine intake. 

Charles Mayo developed an early interest in thyroid surgery, which was considered by many to be too risky to operate. He and his brother William surgically removed a massive goiter in 1890. In 1904, he reported his experience with thyroidectomy in 40 patients. After performing thousands of thyroid surgeries, he became known as the “Father of American Thyroid surgery.” 

The Mayo’s reputation spread throughout this country, and patients also came from as far away as Europe for thyroid surgery. The Mayo brothers recruited researchers and medical specialists in thyroid issues as well as other challenging medical issues. This was the beginning of the “group practice” concept. 

The discovery that iodine is so important in treating goiter as well as other thyroid maladies has been life saving to many. 

Iodine is a micronutrient we now know is required for thyroid hormone production. It is a trace element distributed in the earth and found in soil and water especially in coastal areas. 

I find it interesting early Chinese writings in 3,600 B.C. reported a decrease in goiter size upon ingestion of seaweed and sea sponge, which we now know contain iodine. 

Even though Iodine had not been discovered, these remedies were being used globally and were even mentioned in Hippocrates’s writings. The discovery of iodine was incidentally made in the 19th Century 

From the humble beginning in a small town in southern Minnesota, the Mayo Clinic is now recognized worldwide. When I was a resident there, we would have patients from several European and Arabic counties come for specialty care. 

In 1924, iodized salt became available on grocery shelves and became the prime reason goiter incidence has been significantly reduced. 

Iodine deficiency is still a major health issue globally with over 2 billion people still living in iodine deficient areas. 

In 1990, the United Nations World Summit for children set a goal of eliminating iodine deficiency worldwide. This has primarily been accomplished by universal salt iodization. Considerable progress has been made. 

Iodine deficiency can lead to brain disorders in infants in utero, so the American Thyroid Association in the U. S. and Canada urge prenatal vitamins contain adequate iodine during pregnancy and lactation. 

Jim Brown, M.D., is a retired gastroenterologist who has practiced for 38 years in the Wenatchee area. He is a former CEO of the Wenatchee Valley Medical Center.

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  1. James S Russell says:

    Good information, but I have a question. How do I get iodine in my diet if my doctor tells me to cut way back on iodized salt?

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