ROJoson PEP Talk: GOITER - MYTHS and TIPS Zoom lecture - Feb 26, 2022

1. Empowerment
objective - for
laypeople to have an
understanding of
the issues involved
in GOITER.
Health Issue:
GOITER:
Myths & Tips
February 26, 2022
1400H - 1500H
Via Zoom
Welcome all!
MUTE yourself but always
show your video picture.
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account, or email address in
the Chat Box! Include names
of companions attending.
Use the Chat Box to ask
questions and make
comments while the PEP TALK
is on.
Group pictures at start and
end of PEP TALK – show your
face in video.

2. Empowerment
objective - for
laypeople to have an
understanding of
the issues involved
in GOITER.
Health Issue:
GOITER:
Myths & Tips
Reminder:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

3. Empowerment
objective - for
laypeople to have an
understanding of
the issues involved
in GOITER.
Health Issue:
GOITER:
Myths & Tips
Reminder:
50 OLETE Certificates = 1
Voucher for ROJoson
Telemedical Consultation

4. Empowerment
objective - for
laypeople to have an
understanding of
the issues involved
in GOITER.
Health Issue:
GOITER:
Myths & Tips
Welcome all!
Mabuhay!
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START IN 2 MINUTES!
Pls. turn on your
video!
Show your face!

5. Empowerment
objective - for
laypeople to have an
understanding of
the issues involved
in GOITER.
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.
Health Issue:
GOITER:
Myths & Tips

6. There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.

7. From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.

8. Empowerment
objective - for
laypeople to have an
understanding of
the issues involved
in GOITER.
Health Issue:
GOITER:
Myths & Tips
My PEP TALK today
is entitled: GOITER:
Myths and Tips.
This is part of the
Health Issue
Courses.

9. Operational Definitions of Terms in Title:
ISSUES
Mindsets and practices of people (both lay
and health professionals) in the
community regarding a certain topic that
are open to question as to their validity
and may be considered MYTHS or widely
held but false beliefs and ideas.
TIPS - advice
Health Issue:
GOITER:
Myths & Tips

10. Operational Definitions of Terms in Title:
ISSUES
Mindsets and practices of people (both lay
and health professionals) in the
community regarding a certain topic that
are open to question as to their validity
and may be considered MYTHS or widely
held but false beliefs and ideas.
TIPS - advice
Health Issue:
GOITER:
Myths & Tips
THESE ISSUES,
MINDSETS AND
PRACTICES HAVE
CREATED A LOT OF
CONFUSIONS
AMONG LAYPEOPLE
AND HEALTH
PROFESSIONALS IN
TERMS OF HEALTH
CARE AND MEDICAL
MANAGEMENT.

11. Operational Definitions of Terms in Title:
ISSUES
Mindsets and practices of people (both lay
and health professionals) in the
community regarding a certain topic that
are open to question as to their validity
and may be considered MYTHS or widely
held but false beliefs and ideas.
TIPS - advice
Health Issue:
GOITER:
Myths & Tips
UNWANTED ANXIETY
AMONG LAYPEOPLE
AND
UNNECESSARY
AND ERRONEOUS
MEDICAL
MANAGEMENT BY
HEALTH
PROFESSIONALS.
need for

12. There are lot of issues involved in GOITER.
From the perspective of laypeople as well
as health professionals.
I will just tackle some, at least 5, issues
and give tips or advice.
Health Issue:
GOITER:
Myths & Tips

13. Issues involved in GOITER:
• Concept of goiter
• Bawal this and that foods in relation to
goiter
• Sa loob o sa labas na goiter
• Interpretation of TSH
• Low dose of suppressive therapy for
colloid goiter
Health Issue:
GOITER:
Myths & Tips

14. • Concept of goiter
Health Issue:
GOITER:
Myths & Tips
A lot of laypeople and health care professionals
have the concept that goiter is a benign
condition. This mindset have arisen from the
encounter in the olden days when iodine-
deficiency or endemic goiter was prevalent.
Nowadays, even in the Philippines, iodine-
deficiency goiter is not common anymore.
However, this mindset is a carry-over of old
mindset.
TIPS:
A GOITER IS USED
NOWADAYS TO
INCLUDE ANY AND
ALL DISORDERS OF
THE THYROID GLAND,
BOTH BENIGN AND
MALIGNANT
CONDITIONS.

15. • Concept of goiter
Health Issue:
GOITER:
Myths & Tips
The most common presenting sign (initial or first
cue) of GOITER is the visible increase in size of the
thyroid gland.
A lot of laypeople and health care professionals
just call the visible increase in size as
ENLARGEMENT, without qualifying whether the
enlargement is DIFFUSE or NODULAR.
This mindset or
practice has NOT
facilitated the
formulation of a
clinical diagnosis and
it has led to non-
specific diagnosis and
shotgun approach in
ordering diagnostic
procedures.

16. • Concept of goiter
Health Issue:
GOITER:
Myths & Tips
DIFFUSE ENLARGEMENT or DIFFUSE GOITER has
diagnostic implications different from
NODULAR ENLARGEMENT or NODULAR GOITER.
TIPS:
DETERMINE
WHETHER GOITER IS
DIFFUSE OR
NODULAR AS IT WILL
FACILITATE
FORMULATION OF
MORE SPECIFIC
DIAGNOSIS AND
AVOID SHOTGUN
APPROACH IN
DIAGNOSTIC
PROCEDURES.
Diffuse Goiter –
Hyperthyroidism vs hypothyroidism
(functional disorders)
Nodular Goiter –
Tumor – benign vs malignant
(structural disorders)

17. • Bawal this and that foods in relation to
goiter
Health Issue:
GOITER:
Myths & Tips
Oftentimes, laypeople ask whether eating
cabbage, cauliflower, cassava and other foods are
prohibited or BAWAL as they can cause or
aggravate an existing goiter.
Oftentimes, health professionals answer the
laypeople YES.
SOME FOODS OF
CONCERNS ON
GOITER:
• Cabbage
• Cauliflower
• Broccoli
• Cassava
• Soy
• Kelp

18. • Bawal this and that foods in relation to
goiter
Health Issue:
GOITER:
Myths & Tips
MYTH – Bawal cabbage, cauliflower, cassava, etc.
for thyroid – can cause or aggravate an existing
goiter.
SOME FOODS OF
CONCERNS ON
GOITER:
• Cabbage
• Cauliflower
• Broccoli
• Cassava
• Soy
• Kelp
TIPS:
• THEY ARE NOT BAWAL.
• THE BOTTOMLINE IS EVERYTHING IS FINE IN
MODERATION AND FOOD WILL NOT CAUSE
GOITER FOR THE MOST PART.
• EXCESS CAN CAUSE HYPOTHYROIDISM OR
HYPERTHYROIDISM.
DIET WILL NOT MAKE YOUR
THYROID DISORDER GO AWAY
AND WILL NOT CAUSE THYROID
DISORDERS.

19. • Sa loob o sa labas na goiter
Health Issue:
GOITER:
Myths & Tips
Oftentimes, laypeople use these terms – “sa
loob” , “sa labas” ang goiter.
I don’t really know the origin of these terms as
well as the exact meanings and significance.
I surmise:
“Sa loob” – laypeople may be referring to
hyperthyroidism when they feel symptoms and
the thyroid is not yet very big.
“Sa labas” – laypeople may be referring to bulging
masses visibly seen on the neck and without
symptoms.
TIPS:
Don’t use these terms if
there are no good bases
and they have no effect in
the medical management.
In the medical world, we
don’t use these terms as
goiters grow in size within
the neck first (sa loob) and
most of the time, then
outwards (palabas) –
whether toxic or non-toxic
goiter!

20. • Interpretation of TSH
Health Issue:
GOITER:
Myths & Tips
Oftentimes, nowadays, physicians place greatest
reliance on the TSH to assess hyperthyroidism
and hypothyroidism. The other tests are T4 and
T3.
Some experts said:
“TSH is the best and oftentimes, the only test
needed” to assess hyperthyroidism and
hypothyroidism.
My experience is that there is a lot of “errors” in
the TSH determination.
TIPS:
Always correlate the
TSH results with the
clinical picture of
the patient before
acceptance.
Correlate = check if the
clinical picture is
compatible with the TSH
result.
Do not just accept the
TSH results hook line
and sinker (without
reservation).

21. • Interpretation of TSH
Health Issue:
GOITER:
Myths & Tips
Case in point:
25-year-old female diagnosed to have
hyperthyroidism in 2019
Bases for diagnosis of hyperthyroidism:
• Diffusely enlarged thyroid (NO nodules even on
ultrasound)
• Pulse rate FAST – more than 100 / min
• With fine tremors on the hands
• FT4 – 39.96 (High) ; TSH – 0.022 (Low) [ELISA]
TIPS:
Always correlate the
TSH results with the
clinical picture of
the patient before
acceptance.
Correlate = check if the
clinical picture is
compatible with the TSH
result.
Do not just accept the
TSH results hook line
and sinker (without
reservation).
TSH value jibed with clinical picture of patient –
hyperthyroidism – thus ACCEPT TSH.

22. • Interpretation of TSH
Health Issue:
GOITER:
Myths & Tips
Case in point:
25-year-old female diagnosed to have
hyperthyroidism in 2019
Patient given PTU tabs – taken religiously but TSH
had not changed in low value despite 1 year of
PTU (Sept 2020).
Decided to change meds to methimazole – taken
religiously for 6 months but still without
improvement in TSH value.
TIPS:
Always correlate the
TSH results with the
clinical picture of
the patient before
acceptance.
Correlate = check if the
clinical picture is
compatible with the TSH
result.
Do not just accept the
TSH results hook line
and sinker (without
reservation).
What was happening?

23. • Interpretation of TSH
Health Issue:
GOITER:
Myths & Tips
Case in point:
25-year-old female diagnosed to have
hyperthyroidism in 2019
WHAT WAS HAPPENING – no improvement in TSH
for one year and a half despite change in
medications already.
Requested RIA method of testing (instead of
original ELISA method)
Low and behold – NORMAL TSH value.
TIPS:
Always correlate the
TSH results with the
clinical picture of
the patient before
acceptance.
Correlate = check if the
clinical picture is
compatible with the TSH
result.
Do not just accept the
TSH results hook line
and sinker (without
reservation).
ERROR in initial TSH [ELISA]

24. • Interpretation of TSH
Health Issue:
GOITER:
Myths & Tips
Case in point: (Another patient)
30-year-old female diagnosed to have
hyperthyroidism by a physician on the basis of
one TSH determination and value – below normal
value.
The other thyroid function tests were normal.
With no symptoms and signs of hyperthyroidism.
Prescribed and taking anti-thyroid drugs for one
year before consulting me. I doubt the diagnosis
of hyperthyroidism.
TIPS:
Always correlate the
TSH results with the
clinical picture of
the patient before
acceptance.
Correlate = check if the
clinical picture is
compatible with the TSH
result.
Do not just accept the
TSH results hook line
and sinker (without
reservation).

25. • Interpretation of TSH
Health Issue:
GOITER:
Myths & Tips
Case in point: (Another patient)
30-year-old female diagnosed to have
hyperthyroidism by a physician on the basis of
one TSH determination and value – below normal
value.
I asked patient to stop the medications and
monitor oneself. Repeat TSH after 6 months of no
medications showed normal TSH and FT4 values.
TIPS:
Always correlate the
TSH results with the
clinical picture of
the patient before
acceptance.
Correlate = check if the
clinical picture is
compatible with the TSH
result.
Do not just accept the
TSH results hook line
and sinker (without
reservation).
ERROR in TSH
Condemning / consigning patient to have thyroid disease –
hyperthyroidism – if error not corrected!

26. • Low dose of suppressive therapy for
colloid goiter
Health Issue:
GOITER:
Myths & Tips
Oftentimes, physicians advise patients to undergo
surgery for benign colloid adenomatous goiters
even if they are still small and /or after no
response to treatment with medications.
Oftentimes, the dosage given is inadequate and
monitoring duration of response is not enough.
Common pitfalls by physicians.
Possible reasons for
pitfalls:
Mindset that it is
always dangerous to
give high dosage of
levothyroxine.
Mindset that colloid
adenomatous
goiters usually do
not respond to
medical treatment.

27. • Low dose of suppressive therapy for
colloid goiter
Health Issue:
GOITER:
Myths & Tips
I have saved a lot of patients
with colloid adenomatous
goiters
from unnecessary operations
with my approach.
TIPS:
I usually give a high-
dose of suppressive
therapy in the form
of levothyroxine for
colloid goiter for
about 6 months or
longer.
If there is response,
I gradually decrease
the dosage.

28. Issues involved in GOITER:
• Concept of goiter
• Bawal this and that foods in relation to
goiter
• Sa loob o sa labas na goiter
• Interpretation of TSH
• Low dose of suppressive therapy for
colloid goiter
Health Issue:
GOITER:
Myths & Tips
Summary
Take Away

29. Be always in touch with reliable medical
information on issues on GOITER.
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
managing GOITER.
Take Away in
relation to
Patient
Empowerment
Health Issue:
GOITER:
Myths & Tips

30. Empowerment
objective - for
laypeople to have an
understanding of
the issues involved
in GOITER.
Health Issue:
GOITER:
Myths & Tips

31. Empowerment
objective - for
laypeople to have an
understanding of
the issues involved
in GOITER.
Health Issue:
GOITER:
Myths & Tips
Reminder:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

32. Empowerment
objective - for
laypeople to have an
understanding of
the issues involved
in GOITER.
Health Issue:
GOITER:
Myths & Tips
Reminder:
50 OLETE Certificates = 1
Voucher for ROJoson
Telemedical Consultation

33. Empowerment
objective - for
laypeople to have an
understanding of
the issues involved
in GOITER.
Health Issue:
GOITER:
Myths & Tips
Welcome all!
Mabuhay!
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START Q&A AND
INTERACTIONS!
Pls. turn on your
video!
Show your face!