February 26, 2022

1400H - 1500H
Via Zoom
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Health Issue: objective - for account, or email address in
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GOITER: understanding of the Use the Chat Box to ask
Myths & Tips issues involved in questions and make
comments while the PEP TALK
GOITER. is on.

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 Reminder:

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Empowerment Exercise (OLETE) for
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Health Issue: objective - for have a perfect score to get
laypeople to have an a Certificate.
Link is in Chat Box.
GOITER: understanding of the
Myths & Tips issues involved in
GOITER.
 Reminder:
50 OLETE Certificates = 1
Voucher for ROJoson
Telemedical Consultation
Empowerment
Health Issue: objective - for
laypeople to have an
GOITER: understanding of the
Myths & Tips issues involved in
GOITER.
 Welcome all!
Mabuhay!

Empowerment LET’S NOW HAVE A

Health Issue: GROUP PICTURE
objective - for
TAKING BEFORE WE
laypeople to have an START IN 2 MINUTES!
GOITER: understanding of the
Myths & Tips issues involved in Pls. turn on your
GOITER. video!
Show your face!
 ROJoson PEP Talk
Empowerment
I have a Patient
Health Issue: objective - for Empowerment
laypeople to have an Program in which I
GOITER: understanding of the like to empower the
Myths & Tips issues involved in lay people or
GOITER. patients to take
control in the
management of
their health.
 There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
 My PEP TALK today
is entitled: GOITER:
Myths and Tips.
Empowerment This is part of the
Health Issue: objective - for Health Issue
laypeople to have an Courses.
GOITER: understanding of the
Myths & Tips issues involved in
GOITER.
 Operational Definitions of Terms in Title:
Health Issue:
ISSUES
GOITER: Mindsets and practices of people (both lay
Myths & Tips 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
 Operational Definitions of Terms in Title: THESE ISSUES,
Health Issue: MINDSETS AND
ISSUES PRACTICES HAVE
GOITER: Mindsets and practices of people (both lay CREATED A LOT OF
CONFUSIONS
Myths & Tips and health professionals) in the AMONG LAYPEOPLE
community regarding a certain topic that AND HEALTH
are open to question as to their validity PROFESSIONALS IN
and may be considered MYTHS or widely TERMS OF HEALTH
CARE AND MEDICAL
held but false beliefs and ideas.
MANAGEMENT.

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

TIPS - advice
 There are lot of issues involved in GOITER.
Health Issue:
From the perspective of laypeople as well
GOITER: as health professionals.
Myths & Tips I will just tackle some, at least 5, issues
and give tips or advice.
 Issues involved in GOITER:
Health Issue:
• Concept of goiter
GOITER: • Bawal this and that foods in relation to
Myths & Tips goiter
• Sa loob o sa labas na goiter
• Interpretation of TSH
• Low dose of suppressive therapy for
colloid goiter
 • Concept of goiter
Health Issue:
A lot of laypeople and health care professionals TIPS:
have the concept that goiter is a benign
GOITER: condition. This mindset have arisen from the A GOITER IS USED
Myths & Tips encounter in the olden days when iodine- NOWADAYS TO
deficiency or endemic goiter was prevalent. INCLUDE ANY AND
Nowadays, even in the Philippines, iodine- ALL DISORDERS OF
deficiency goiter is not common anymore. THE THYROID GLAND,
However, this mindset is a carry-over of old BOTH BENIGN AND
mindset. MALIGNANT
CONDITIONS.
 • Concept of goiter
Health Issue:
The most common presenting sign (initial or first This mindset or
cue) of GOITER is the visible increase in size of the practice has NOT
GOITER: thyroid gland. facilitated the
Myths & Tips formulation of a
A lot of laypeople and health care professionals clinical diagnosis and
just call the visible increase in size as it has led to non-
ENLARGEMENT, without qualifying whether the specific diagnosis and
enlargement is DIFFUSE or NODULAR. shotgun approach in
ordering diagnostic
procedures.
 • Concept of goiter TIPS:
Health Issue:
DIFFUSE ENLARGEMENT or DIFFUSE GOITER has DETERMINE
diagnostic implications different from WHETHER GOITER IS
GOITER: NODULAR ENLARGEMENT or NODULAR GOITER. DIFFUSE OR
Myths & Tips NODULAR AS IT WILL
Diffuse Goiter –
Hyperthyroidism vs hypothyroidism FACILITATE
(functional disorders) FORMULATION OF
MORE SPECIFIC
DIAGNOSIS AND
Nodular Goiter – AVOID SHOTGUN
Tumor – benign vs malignant APPROACH IN
(structural disorders) DIAGNOSTIC
PROCEDURES.
 • Bawal this and that foods in relation to SOME FOODS OF
Health Issue: CONCERNS ON
goiter GOITER:
Oftentimes, laypeople ask whether eating
GOITER: • Cabbage
cabbage, cauliflower, cassava and other foods are
Myths & Tips prohibited or BAWAL as they can cause or • Cauliflower
aggravate an existing goiter. • Broccoli
• Cassava
Oftentimes, health professionals answer the • Soy
laypeople YES. • Kelp
 • Bawal this and that foods in relation to SOME FOODS OF
Health Issue: CONCERNS ON
goiter GOITER:
MYTH – Bawal cabbage, cauliflower, cassava, etc.
GOITER: • Cabbage
for thyroid – can cause or aggravate an existing
Myths & Tips goiter. • Cauliflower
• Broccoli
TIPS: • Cassava
• THEY ARE NOT BAWAL. • Soy
• THE BOTTOMLINE IS EVERYTHING IS FINE IN • Kelp
MODERATION AND FOOD WILL NOT CAUSE
GOITER FOR THE MOST PART. DIET WILL NOT MAKE YOUR
THYROID DISORDER GO AWAY
• EXCESS CAN CAUSE HYPOTHYROIDISM OR
AND WILL NOT CAUSE THYROID
HYPERTHYROIDISM. DISORDERS.
 • Sa loob o sa labas na goiter TIPS:
Don’t use these terms if
Health Issue: there are no good bases
Oftentimes, laypeople use these terms – “sa loob”
and they have no effect in
, “sa labas” ang goiter.
GOITER: I don’t really know the origin of these terms as
the medical management.

Myths & Tips well as the exact meanings and significance. In the medical world, we
I surmise: don’t use these terms as
“Sa loob” – laypeople may be referring to goiters grow in size within
hyperthyroidism when they feel symptoms and the neck first (sa loob) and
most of the time, then
the thyroid is not yet very big. outwards (palabas) –
“Sa labas” – laypeople may be referring to bulging whether toxic or non-toxic
masses visibly seen on the neck and without goiter!
symptoms.
 • Interpretation of TSH TIPS:
Health Issue:
Oftentimes, nowadays, physicians place greatest Always correlate the
reliance on the TSH to assess hyperthyroidism TSH results with the
GOITER: and hypothyroidism. The other tests are T4 and clinical picture of
Myths & Tips T3. the patient before
acceptance.
Some experts said: Correlate = check if the
“TSH is the best and oftentimes, the only test clinical picture is
needed” to assess hyperthyroidism and compatible with the TSH
hypothyroidism. result.
Do not just accept the
TSH results hook line
My experience is that there is a lot of “errors” in and sinker (without
the TSH determination. reservation).
 • Interpretation of TSH TIPS:
Health Issue:
Case in point: Always correlate the
25-year-old female diagnosed to have TSH results with the
GOITER: hyperthyroidism in 2019 clinical picture of
Myths & Tips the patient before
Bases for diagnosis of hyperthyroidism: acceptance.
• Diffusely enlarged thyroid (NO nodules even on Correlate = check if the
ultrasound) clinical picture is
• Pulse rate FAST – more than 100 / min compatible with the TSH
• With fine tremors on the hands result.
Do not just accept the
• FT4 – 39.96 (High) ; TSH – 0.022 (Low) [ELISA]
TSH results hook line
TSH value jibed with clinical picture of patient – and sinker (without
hyperthyroidism – thus ACCEPT TSH. reservation).
 • Interpretation of TSH TIPS:
Health Issue:
Case in point: Always correlate the
25-year-old female diagnosed to have TSH results with the
GOITER: hyperthyroidism in 2019 clinical picture of
Myths & Tips the patient before
Patient given PTU tabs – taken religiously but TSH acceptance.
had not changed in low value despite 1 year of Correlate = check if the
PTU (Sept 2020). clinical picture is
compatible with the TSH
Decided to change meds to methimazole – taken result.
Do not just accept the
religiously for 6 months but still without
TSH results hook line
improvement in TSH value. and sinker (without
What was happening? reservation).
 • Interpretation of TSH TIPS:
Health Issue:
Case in point: Always correlate the
25-year-old female diagnosed to have TSH results with the
GOITER: hyperthyroidism in 2019 clinical picture of
Myths & Tips the patient before
WHAT WAS HAPPENING – no improvement in TSH acceptance.
for one year and a half despite change in Correlate = check if the
medications already. clinical picture is
compatible with the TSH
Requested RIA method of testing (instead of result.
Do not just accept the
original ELISA method)
ERROR in initial TSH [ELISA] TSH results hook line
and sinker (without
Low and behold – NORMAL TSH value. reservation).
 • Interpretation of TSH TIPS:
Health Issue:
Case in point: (Another patient) Always correlate the
30-year-old female diagnosed to have TSH results with the
GOITER: hyperthyroidism by a physician on the basis of clinical picture of
Myths & Tips one TSH determination and value – below normal the patient before
value. acceptance.
Correlate = check if the
The other thyroid function tests were normal. clinical picture is
With no symptoms and signs of hyperthyroidism. compatible with the TSH
result.
Do not just accept the
Prescribed and taking anti-thyroid drugs for one
TSH results hook line
year before consulting me. I doubt the diagnosis and sinker (without
of hyperthyroidism. reservation).
 • Interpretation of TSH TIPS:
Health Issue:
Case in point: (Another patient) Always correlate the
30-year-old female diagnosed to have TSH results with the
GOITER: hyperthyroidism by a physician on the basis of clinical picture of
Myths & Tips one TSH determination and value – below normal the patient before
value. acceptance.
Correlate = check if the
I asked patient to stop the medications and clinical picture is
monitor oneself. Repeat TSH after 6 months of no compatible with the TSH
medications showed normal TSH and FT4 values. result.
Do not just accept the
ERROR in TSH TSH results hook line
Condemning / consigning patient to have thyroid disease – and sinker (without
hyperthyroidism – if error not corrected! reservation).
 • Low dose of suppressive therapy for Possible reasons for
Health Issue: colloid goiter pitfalls:

Oftentimes, physicians advise patients to undergo Mindset that it is

GOITER: surgery for benign colloid adenomatous goiters always dangerous to
Myths & Tips even if they are still small and /or after no give high dosage of
response to treatment with medications. levothyroxine.

Oftentimes, the dosage given is inadequate and Mindset that colloid

monitoring duration of response is not enough. adenomatous
goiters usually do
Common pitfalls by physicians. not respond to
medical treatment.
 • Low dose of suppressive therapy for TIPS:
Health Issue: colloid goiter
I usually give a high-
GOITER: I have saved a lot of patients dose of suppressive
therapy in the form
Myths & Tips
with colloid adenomatous of levothyroxine for
colloid goiter for
goiters about 6 months or
from unnecessary operations longer.
If there is response,
with my approach. I gradually decrease
the dosage.
 Issues involved in GOITER: Summary
Health Issue: Take Away
• Concept of goiter
GOITER: • Bawal this and that foods in relation to
Myths & Tips goiter
• Sa loob o sa labas na goiter
• Interpretation of TSH
• Low dose of suppressive therapy for
colloid goiter
 Be always in touch with reliable medical Take Away in
Health Issue: information on issues on GOITER. relation to
Patient
GOITER: Knowledge is power; it gives power. Empowerment
Myths & Tips
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
managing GOITER.
 Empowerment
Health Issue: objective - for
laypeople to have an
GOITER: understanding of the
Myths & Tips issues involved in
GOITER.
 Reminder:

Take the Online Learning

cum Evaluation Test
Empowerment Exercise (OLETE) for
mastery of learning and
Health Issue: objective - for have a perfect score to get
laypeople to have an a Certificate.
Link is in Chat Box.
GOITER: understanding of the
Myths & Tips issues involved in
GOITER.
 Reminder:
50 OLETE Certificates = 1
Voucher for ROJoson
Telemedical Consultation
Empowerment
Health Issue: objective - for
laypeople to have an
GOITER: understanding of the
Myths & Tips issues involved in
GOITER.
 Welcome all!
Mabuhay!

Empowerment LET’S NOW HAVE A

Health Issue: GROUP PICTURE
objective - for
TAKING BEFORE WE
laypeople to have an START Q&A AND
GOITER: understanding of the INTERACTIONS!
Myths & Tips issues involved in
GOITER. Pls. turn on your
video!
Show your face!