Thyroid Goiter

Iodine is an essential dietary component that is needed to maintain normal thyroid function. Typical sources of iodine include, breads, chesse, cow’s milk, eggs, frozen yogurt, ice cream, iodized table salt, saltwater fish, seaweed, shellfish, soy milk and soy sauce.(1) Iodine deficiency has been almost completely eradicated in the United States since the introduction of iodized salt in the 1920′s-30′s. In the US, the Recommended Daily Allowance (RDA) for Iodine is 150ug per day.

Approximately 40% of the world remains at risk for iodine deficiency.(1)

The thyroid gland is made up of follicular cells. Thyroxine (T4) and Triiodothyronie (T3) are thyroid homones that are made inside the follicular of the thyroid gland. Dietary iodine is absorbed through the gastrointestinal tract and is then concentrated within the thyroid. It is then used by the follicular cell as an essential component of the thyroid hormones.

T3 and T4 are secreted from the thyroid gland under the regulation of Thyroid Stimulating Hormone (TSH) that is made in the anterior pituitary gland. TSH is released in response to low plasma levels of T3 and T4.

The majority of thyroid hormone is released from the thyroid gland as T4; however, once release from the thyroid, T4 is converted to T3. T3 is the metabolically active form of the hormone. T3 is responsible for increasing the body’s Basal Metabolic Rate (BMR). The BMR is the amount of energy that is expended by a person at rest. An increase in BMR leads to an increase in oxygen and energy consumption. T3 acts on the majority of tissues within the body.

A dietary iodine deficiency results in a deficiency in thyroid hormones (T3 and T4). The result can be hypothyroidism in adults, cretinism in children and in some cases nodular goiter.

A goiter is any swelling of the thyroid gland. Endemic goiter is a type of goiter that is associated with dietary iodine deficiency. Typically endemic goiter can be treated medically, however, in advanced cases where the mass encroaches upon or compresses nearby structures such as the trachea, surgical intervention is necessary.

The Struma Classification of Goiters:

Class I – only found by palpation.

Class II – can be easily seen.

Class III – large, pressure results in compression marks.

  1. The American Thyroid Association (
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Thyroid Cancer

 The Rising Incidence of Thyroid Cancer in The New York Times. (October 14, 2010). The article, written by Carolyn Sayre points out,“…that the incidence has more than doubled since the early 1970s, and for women, it is the cancerwith the fastest-growing number of new cases.”(1)Similarly, Sabiston’s textbook of surgery agrees by saying, “Several studies have shown that the incidence of well-differentiated thyroid carcinoma has increased perhaps as much as 50% since 1990.”

And goes on to point out, that…“Whether this increase is due to enhanced sophistication in screening and diagnostic techniques or possible exposure to environmental factors such as radiation or environmental mutagenic chemicals is not clear.” (2)

Types of thyroid cancer include: Papillary (70-80%), Follicular (10%), Medullary (6%), Anaplastic (< 1%). Let’s concentrate on papillary:

  • Commonly associated with previous ionizing radiation
  • 3x more common in women
  • Typically present as asymptomatic nodule
  • Treatment:
    • <1cm: lobectomy & isthmectomy
    • 1-2cm: Controversial. total thyroidectomy vs. lobectomy & isthmectomy
    • 2cm: total thyroidectomy
    • Can metastasize to local lymph node
      • Spread to lymph nodes of the neck present in more than 50% of cases
      • Stage II-IV patients also undergo lymph node resection
  1. Sayre C. The Rising Incidence of Thyroid Cancer. The New York Times. October 14, 2010. FULL ARTICLE
  2. Hanks JB, Salomone LG. Thyroid. Townsend: Sabiston’s Textbook of Surgery. 18th Edition. Saunders. 2008. Chapter 36.
  3. Miccoli et al. Modified lateral neck lymphadenectomy: Prospective randomized study comparing harmonic scalpel with clamp-cut-tie technique. Otolaryngology-Head and Neck Surgery. 2009; 140; 61-64. (Abstract)
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Yes, Chef. From Ethiopia to NYC

YesChef_TP_300x250_FINALGreat book that starts out with a little boy in Ethiopia….

It begins with a simple ritual: Every Saturday afternoon, a boy who loves to cook walks to his grandmother’s house and helps her prepare a roast chicken for dinner. The grandmother is Swedish, a retired domestic. The boy is Ethiopian and adopted, and he will grow up to become the world-renowned chef Marcus Samuelsson. This book is his love letter to food and family in all its manifestations. Yes, Chef chronicles Samuelsson’s journey, from his grandmother’s kitchen to his arrival in New York City…

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Required Reading on The Obesity Epidemic

saltsugarfatSalt, Sugar, Fat is a must read book for anyone who has ever wondered why we are getting bigger.  Michael Moss explains the reasons behind the obesity epidemic.  

Every year, the average American eats thirty-three pounds of cheese and seventy pounds of sugar. Every day, we ingest 8,500 milligrams of salt, double the recommended amount, almost none of which comes from the shakers on our table. It comes from processed food, an industry that hauls in $1 trillion in annual sales. In Salt Sugar Fat, Pulitzer Prize–winning investigative reporter Michael Moss shows how we ended up here. Featuring examples from Kraft, Coca-Cola, Lunchables, Frito-Lay, Nestlé, Oreos, Capri Sun, and many more, Moss’s explosive, empowering narrative is grounded in meticulous, eye-opening research. He takes us into labs where scientists calculate the “bliss point” of sugary beverages, unearths marketing techniques taken straight from tobacco company playbooks, and talks to concerned insiders who make startling confessions. Just as millions of “heavy users” are addicted to salt, sugar, and fat, so too are the companies that peddle them. You will never look at a nutrition label the same way again.

How to Read a Label

How the Government Got You To Eat More Cheese

You Really Can’t Eat Just One and Here’s the Reason

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Senate Passes Food Allergies Awareness Bill in Md.

Senate Passes Food Allergies Awareness Bill in Md.  ANNAPOLIS, Md. — County governments may soon have authority to make restaurants accommodate customers with food allergies.

A new bill would let counties require each restaurant to have a staff member trained on food allergens, ready to advise customers. The bill would also require restaurants statewide to encourage customers to notify servers about their food allergies.

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15th Anniversary Medical Design Excellence Awards

2013 MDEA Jurors discuss the 15th Anniversary of the MedTech Industry’s Premier Awards Program. UBM Canon is proud to celebrate a long tradition of innovation and design in medical device products. The MDEA program recognizes achievements of medical device manufacturers, their suppliers, and the many people behind the scenes who are responsible for the groundbreaking innovations that are changing the face of healthcare. Since the MDEA’s inception in 1998, the program has honored over 500 groundbreaking products. We have prepared a video to commemorate the MDEA program and the impact it has had in the industry.

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Life is Short, Why Not Make a Difference

Life is short…why not make a difference, stand for something, follow your passion…fill in the blank. Once you do, tell someone else about it – because when you do, Cancer Free Kids benefits. Check out this new site developed by a friend of mine – Life is Short, Why Not. What do you think?

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