Yes, goitre can affect unborn babies

Margaret Maina’s desire to conquer has kept her alive. It is what gives her courage to share her heroic story with the world.

A story that started tragically in a bus, and an ironic rescue that came with the death of her first child.

“In November 2009 while on my way to town, I fainted in a bus. Four hours later, when I regained consciousness, I was in hospital being treated for suspected blood infection,” she says.

Margaret would later learn that her condition was misdiagnosed. Her mother would express concern on an occasional swelling on her neck similar to an Adams apple, whenever she engaged in lengthy conversation.

“I thought it was an innocent bulge because it was painless,” says the 30-year-old ICT instructor from Kiambu.

And it got worse. When she was nine months pregnant, she had an emergency that got her admitted to hospital. Medical investigation revealed a silent health condition taking a toll on her.

“I woke up to swollen eyes, face, hands and legs; my husband said I looked darker and when I could not breathe well, I knew I was in trouble. I lost consciousness on the way to hospital and on arrival I was diagnosed with uncontrollable high blood pressure. I lost my baby,” she says.

Lump in neck

This triggered a battery of tests that led to diagnosis of an overactive thyroid, a medical pronouncement that left her baffled because she had neither seen it coming nor did she understand its meaning.

Consultant Hormone Specialist Paul Ngugi describes goitre as a lump in the neck caused by swelling of the thyroid.

While a healthy thyroid gland is neither visible nor can it be felt in the neck, when a growth appears, it is time to see a doctor.

“The swelling of this butterfly shaped gland in the neck can be caused by multiple reasons, ranging from lack of iodine, inflammation of the thyroid or presence of uneven nodules in the neck area,” says Dr Ngugi, an endocrinologist.

Some signs that should send you to a doctor for detailed examination include tightness around the throat, coughing and hoarseness; others have trouble swallowing and in severe cases difficulty in breathing.

Weighing about 10 to 25 grammes depending on an individual’s age, sex and their general state of health, the thyroid gland produces two hormones that influence the activity of cells and tissues in the body. The word goitre is derived from the Latin word guttur, meaning an enlarged gland.

According to the World Health Organisation (WHO), prevalence of goitre increases with severity of iodine deficiency and becomes endemic in populations where the intake of iodine is less than 10 μg per day.

However, this can be remedied by including iodised table salt in your diet. Its presence can also be found in high-iodine foods like seafood, meat, some breads and eggs.

Before she could deal with the loss of her unborn child, the swelling on her neck became more noticeable and further tests were done.

Her Thyroid stimulating hormone levels were found alarmingly high, and doctors recommended immediate surgery.

Maggie, as friends and kin fondly refer to her, was diagnosed with hyperthyroidism, a condition where excess hormones are produced, affecting the body’s normal functions. The condition is manifested by excessive sweating, increased anxiety and irritability.

“I ate and talked a lot; I became hot tempered and would sweat profusely; I could not sleep,” she says.

Other symptoms of an active goitre include a high heart rate, shaking, inability to sleep and for women, irregular menstruation, making conception difficult.

Denis Maina, Maggie’s husband says though the diagnosis was vague, it took a session with doctors to explain that his wife needed urgent surgery to supplement the critical hormone in her body.

Whereas the normal size of the thyroid gland varies with age and a person’s build, WHO recommends physical examination by palpating the neck as the most accurate. Severity of goitre is graded according to a universally agreed three-point classification.

“It was especially tough when part of her thyroid gland was removed,” says Denis, who affirms that because bravery is contagious, family and friends learnt from Maggie to confidently deal with the condition.

Below optimal

“The mind is powerful, and I was determined to beat the complications that come with my thyroid gland producing excess hormones,” Maggie says.

Soon after removal of the thyroid gland, Maggie was diagnosed with underproduction of the hormones, meaning her body mechanisms operated below optimal, rendering her to an inactive lifestyle.

According to Dr Ngugi, if your thyroid is underactive, a condition known as hypothyroidism, you might feel tired and lazy, experience weight gain, dry skin, muscle aches, constipation and menstrual irregularities.

In some people, the swelling may be small, Dr Ngugi notes, while in others the throat may feel tight and can cause a hoarse voice, thus a proper diagnosis should be done. Treatment and management of an underactive thyroid entails synthetic replacement of thyroid hormone until measurements indicate normal thyroid function has been restored, whereas in case of an overactive one, medication to counter excess hormone production is recommended.

“I was placed on supplements to bring my hormones to normal. At this time I became pregnant, and I was determined to take my baby home,” Maggie says.

Pregnancy has been described as one of the periods when the thyroid gland is under pressure and the organ produces more, largely due to influence of pregnancy hormones: this has been linked to miscarriages.

Dr Ngugi further says treatment of goitre is particularly sensitive to both mother and an unborn child and thus treatment options like radiotherapy and surgery are not advised.

“However, medicines that regulate thyroid hormones to recommended levels are advised, and further treatment can commence after baby is born,” Dr Ngugi adds.

Today, Maggie is a mother of two reaching out to persons too embarrassed to speak about thyroid complications. She believes in the power of social capital - supporting those who are too weak to speak.

“It is initially embarrassing when you explain how your hormonal levels oscillate and people make fun about it, but accepting and seeking treatment is the first step towards restoring an active lifestyle,” she adds.