Hypothyroidism is a condition in which the thyroid gland is not producing the thyroid hormones adequately. This is a fairly common condition.

What is thyroid gland?

The thyroid gland is a small butterfly-shaped gland located just below Adam s apple. It encircles the windpipe or the trachea. It is about 4 cms in height and weighs about 18 gms. This gland is responsible for the secretion of thyroid hormones. Hormones are chemicals produced by special glands like thyroid, adrenals, ovaries etc. They act as messengers and are carried by the blood to the various target organs.

What are the hormones produced by thyroid gland and what do they do?

The thyroid hormones are of two types   T3 (Tri iodo thyronine) and T4 (Thyroxine). These hormones are mainly responsible for the body s metabolism - a process in which food is converted into energy in the cells. They influence growth and development and regulate various bodily functions which are mentioned below:

Heartbeat
Body temperature
Breathing
Body weight
Metabolism of fat
Menstrual cycles in females
Functioning of Nervous system
Digestion
Burning calories etc.
What is Hypothyroidism?

Inadequate production of hormones by the thyroid gland is termed as hypothyroidism. This is also called Underactive thyroid state. Hypothyroidism can make the body s development to slow down and reduces metabolism rates.

What are the causes of Hypothyroidism?

Hypothyroidism can be caused by a number of factors:

Hashimoto's thyroiditis: This is the commonest cause. This is an autoimmune disorder (normally body s defence system fight against external infections. In autoimmune disorder the defence system attacks the healthy cells of the body by mistake). In Hashimoto s thyroiditis the immune system/defence system produces antibodies that attack the thyroid gland and destroy it.
Iodine deficiency in diet. For the production of thyroid hormones iodine is very important. The body does not produce iodine normally, so it needs to be supplemented from outside. Iodine is mainly present in the food we eat. It is mainly present in shellfish, salt-water fish, eggs, dairy products. If a person does not eat iodine rich foods, he may end up with iodine deficiency leading to hypothyroidism. Currently, this causative factor is on the decline due to government initiative of table salt with iodine.
Surgery: Surgery to remove thyroid gland (for e.g. thyroid cancer treatment, overactive thyroid etc.)
Radiation to the neck (to treat cancer in the neck area): The thyroid gland cells are damaged due to the radiation.
Treatment with radioactive iodine: This treatment is used for managing hyperthyroidism/overactive thyroid, where the thyroid gland produces excessive thyroid hormones. One of the treatment modalities is by radioactive iodine. Sometimes this radiotherapy destroys normal functioning cells which lead to hypothyroidism.
Certain medicines: Certain medicines used to treat heart conditions, cancer, psychiatric conditions etc.   for e.g. amiodarone, lithium, interleukin-2, interferon-alpha.
Pregnancy: Pregnancy (the reason is unclear but it has been noticed that the thyroid may get inflamed after delivery   this is called Postpartum thyroiditis.
Damage to the pituitary gland: Pituitary gland is a gland which is present in the brain. It produces a hormone called TSH (Thyroxine-Stimulating hormone).The TSH tells the thyroid gland how much thyroid hormone it should make. If the levels of thyroid hormone in the blood are low, then the TSH will stimulate the thyroid gland to produce more Thyroid hormone.
Hypothalamus disorders: This is an organ in the brain. This produces a hormone called TRH (Thyrotropin Releasing Hormone) which acts on the Pituitary gland to secrete TSH. So any disorder of Pituitary gland will indirectly effect the production and secretion of Thyroid hormones. These are very rare disorders.
Congenital thyroid defects: Some babies are born with thyroid problems. This is due to the thyroid not being developed normally during pregnancy. Sometimes the thyroid gland does not function normal. This can be identified by screening for thyroid disorders in the first week after delivery. This is usually by a blood test using a small drop of blood from the baby s heel.
What are the different types of hypothyroidism?

One classification is based on whether the defect is with the thyroid gland or not:

Primary hypothyroidism: The problem is in the thyroid gland itself and thus there is reduced production /secretion of thyroid hormones.
Secondary hypothyroidism: Here the problem is with the Pituitary gland or the Hypothalamus. This results in abnormal production of TSH or TRH, which indirectly leads to less production and secretion of thyroid hormones.
Another classification is based on the symptoms and levels of the thyroid hormones and TSH:

Overt hypothyroidism: Here the patient is having the symptoms. Further the T3/T4 are low and TSH is high
Subclinical hypothyroidism: Here patient may or may not have symptoms. The T3/T4 levels are normal but TSH is high. In this situation the patient is at an increased risk of developing overt hypothyroidism in the future especially if he has Thyroid peroxidase antibodies on testing.
Who are at risk of developing Hypothyroidism?

Women have a higher risk of suffering from hypothyroidism than men.
Older people are at increased risk.
People suffering from other autoimmune diseases like Coeliac disease, Type-1 Diabetes Mellitus, Vitiligo, Pernicious anemia, Multiple sclerosis, Rheumatoid arthritis, Addison s disease etc.
People with psychiatric conditions such as bipolar disorder
People with Chromosomal abnormalities like Down syndrome, Turners syndrome also have a high risk of suffering from hypothyroidism.
What are the symptoms of hypothyroidism?

Symptoms vary from person to person. They may also mimic other conditions and hence be difficult to diagnose. Symptoms may also develop very slowly over a span of moths-years. Some of the characteristic symptoms of this disease are:

Depression
Constipation
Hair loss
Dry hair
Dryness of the skin
Tiredness
Body pains
Fluid retention in the body
Irregular menstrual cycle
Increased sensitivity to cold
Reduced heart rate
Increase in size of the thyroid gland   called Goitre. This is due to constant stimulation of the thyroid gland by TSH.
Weight gain
Carpal tunnel syndrome
Hoarse voice
Infertility
Loss of libido/sex drive
Confusion or memory problems especially in the elderly
What are the symptoms to look for in a baby if you suspect hypothyroidism?

Infants suffering from congenital hypothyroidism may show no symptoms or exhibit signs of excessive drowsiness, cold hands, cold feet, constipation, hoarse cry, poor growth or absent growth, poor appetite, bloating of abdomen, puffiness of face, swollen tongue, persistent jaundice.

How to diagnose hypothyroidism?

Blood tests:

TSH: This hormone is made in the pituitary gland and it stimulates the thyroid gland to produce thyroxine. If the thyroxine levels are low in the blood, the pituitary gland produces and secretes more TSH into the blood to act on the thyroid gland to produce more thyroxine. A raised TSH level indicates hypothyroidism. Other tests are not usually necessary unless a rare cause of hypothyroidism.
T4: A low level of thyroxine indicates hypothyroidism.
T3: these levels are generally not needed to diagnose hypothyroidism
Anti-Thyroid peroxidase antibodies (anti-TPO antibodies) or Anti- thyroglobulin antibodies are present in 90-95% of patient with autoimmune thyroiditis.
Other blood tests include Creatinine Kinase, Serum Lipids, Complete blood picture etc.
Ultrasound of the neck is done if the patient presents with a thyroid swelling.
What is the treatment of hypothyroidism?

Overt hypothyroidism is treated by synthetic Thyroxin hormone which should be taken every day on an empty stomach at least 30   45 minutes before breakfast. The treatment is continued for the rest of the patient s life. Regular thyroid function tests are done once every 8 weeks-12 weeks to adjust the dose of the thyroxine in the initial period of diagnosis. Once the thyroxine dose is stabilised, the tests can be done even once a year. This treatment is quite effective.

Sub-clinical hypothyroidism is only treated if the patient is a woman and is contemplating pregnancy, in patients with symptoms or if the TSH is quite high.

What are the side-effects of thyroxine medication?

There are few side effects if any. Most people tolerate these medications quite well. An important consideration before starting medication is to check if the patient has chest pain/angina. These people are started on the least available dose. If these patients are started on a higher dose they notice a worsening of their angina pains.

Side effects mainly occur if the thyroxine dose is high which leads to hyperthyroidism. The symptoms of this could be palpitations 9increased heart beat), weight loss, profuse sweating, anxiety, irritability etc.

There are some tablets which increase with thyroxine tablets. These include carbamazepine, iron supplements, calcium supplements, rifampicin, phenytoin, warfarin etc.

What are the complications of hypothyroidism?

If untreated hypothyroidism can lead to:

heart problems like heart attack due to increased levels of bad cholesterol like LDL, or heart failure due to fluid retention
obesity
infertility
joint pains
depression
A pregnant woman with hypothyroidism is at increased risk of giving birth to a baby with congenital hypothyroidism, also known as cretinism. Further, the woman may have pregnancy related complications like pre-eclampsia, premature delivery, low birth weight baby, anemia, post-partum haemorrhage (bleeding after delivery) etc.
Myxoedema is another complication where the patient has extremely low levels of thyroid hormone. The body temperature drops drastically making the person lose consciousness or go into a coma.
References:

2013 ETA Guideline: Management of Subclinical Hypothyroidism; European Thyroid Association (Nov 2013)
Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee; British Thyroid Association (2015)
The diagnosis and management of primary hypothyroidism; Royal College of Physicians and others (June 2011)
Suh S, Kim DK; Subclinical Hypothyroidism and Cardiovascular Disease. Endocrinology Metabolism (Seoul). 2015 Aug 4.
UK Guidelines for the Use of Thyroid Function Tests; British Thyroid Association (2006)
Gaitonde DY, Rowley KD, Sweeney LB; Hypothyroidism: an update. American Family Physician. 2012 Aug 1 86(3):244-51.
Bindra A, Braunstein GD; Thyroiditis. American Family Physician. 2006 May 15 73(10):1769-76.
Wilson GR, Curry RW Jr; Subclinical thyroid disease. American Family Physician. 2005 Oct 15 72(8):1517-24.
British National Formulary; NICE Evidence Services (UK access only)
Baumgartner C, Blum MR, Rodondi N; Subclinical hypothyroidism: summary of evidence in 2014. Swiss Medical Weekly. 2014 Dec 23 144:w14058. doi: 10.4414/smw.2014.14058. eCollection 2014.

Know Everything About Hypothyroidism

Cellulitis is a serious bacterial infection that is characterized by red and swollen areas on the skin. The condition may spread quickly to other areas of the body. The most commonly affected areas of the body are the lower legs, although it affects other areas of the body as well. 

The disease may affect either the outer layer of the skin or the tissues underneath your skin, from where it may spread to your bloodstream and the lymph nodes. If the condition is not treated on time, it may turn into a life threatening one.

Symptoms:

    You may experience inflammation and redness on your skin
    The affected area may become tender and painful
    The area may feel warm
    Presence of skin rashes around the area
    Pus filled formations on the skin
    The skin may have a tight and swollen appearance
    You may run a fever
    Feeling dizzy and fatigued if the condition turns serious

Causes:
This condition occurs when bacteria such as Streptococcus and Staphylococcus enter the body through cuts or cracks on the skin. Surgical incisions, cuts and insect bites are usually the causes of the infection. Some other risk factors include a weak immune system, diabetes and skin conditions such as eczema and athlete's foot.
The condition is treated by antibiotics. If oral medications do not work, then the medicine may be administered intravenously.  

There are certain preventive measures which you can employ to minimize the risks of cellulitis:

    If you have a wound or cut in the body, make sure to apply ointments that help in killing the germs.
    Always wash your wounds with warm water and soap.
    Apply bandage to the area to prevent exposure to dust and bacteria. Make sure that you replace the bandages on a regular basis.
    On any sign of infection such as redness and pus drainage, consult a doctor.
    Apply moisturizer on your skin to prevent cracks on the skin.
    Take care while trimming your finger and toe nails so as to not injure the skin around the nail.


Cellulitis - Causes, Signs & Symptoms and Treatment 

Liposuction is a type cosmetic surgery that refers to the removal of excess fats from the body through suction.During liposuction, small, thin, blunt-tipped tubes (cannula) are inserted through tiny cuts in the skin.

Liposuction is used to remove fat deposits from:

Thighs.

Hips and buttocks.

Abdomen and waist.

Upper arms.

Back.

Inner knee.

Chest area.

Cheeks, chin and neck.

Calves and ankles.

Different techniques are adopted in liposuction process. Some of them are:

Traditional Liposuction: In traditional liposuction, the surgeon uses a thin tube called a cannula, connected to a powerful suction pump.

Tumescent Liposuction: Tumescent liposuction is similar to traditional liposuction, but experts often hail its innovative use of medication and reduced risks for complications.

Super-wet Liposuction: Super-wet liposuction is a variation of the tumescent technique that uses less fluid injection.

Ultrasonic Liposuction: This popular form of liposuction uses a specialized cannula that emits ultrasonic sound waves into the fat deposits to liquefy fat cells and make them easier to remove.

Power Assisted Liposuction: By employing a cannula that has a vibrating tip, surgeons are able to break up fat cells for easier removal.

More and more people are turning to liposuction to help achieve their aesthetic goals. Patients benefit both mentally and physically from liposuction. In fact, liposuction has become one of the most popular plastic surgery procedures in the world because it is a safe and effective way to remove fat and cellulite in your body. To add to it s effectiveness, liposuction can be paired with a myriad of complementary procedures such as breast augmentation, tummy tuck, and even facial plastic surgery.

The benefits of liposuction include:

Safe removal of fat

Reduction of cellulite or improvement in the appearance of cellulite

Improved health, usually associated with fat loss

Changes the way you look, and the way others perceive you

Boost in self-esteem

Sculpting areas of body that even exercise and diet don t seem to impact

Liposuction Surgery

Vitiligo is a condition in which white patches appear on the skin. It can affect any part of the body. It can affect the inside of the mouth and the hair as well. It happens when the skin cells (melanocytes) that make or produce pigment (colour) of the skin die or stop functioning. This disease is not contagious or life-threatening, it cannot be caught from another person having vitiligo. All types of skin can be affected by vitiligo but it may be more evident in people with darker skin. It develops between the ages 10 to 30 and it often appears before the age of 40.

Causes

The main cause of this disorder is still not clear, why the cells die or fail. For some reason, the colour or pigment-forming cells called melanocytes dies. However, these are the following reasons that can cause this problem:

An autoimmune disorder, where the defences of the body turn on their own cells instead of attacking the germs that destroyed the melanocytes

A trigger or stressful events such as exposure to industrial chemicals, stress, or sunburn

Family history (heredity)

A neural cause

A virus

A genetic oxidative stress imbalance

Symptoms

The one and only symptom of this condition is the appearance of white patches or flat white spots on the skin. Those white patches are irregular in shape. They may stay the same for a while but may get bigger with time on different parts of the body. It generally affects body folds such as armpits, around body openings, or around moles. It can also affect hair and eyelids. It does not cause any irritation, dryness, discomfort, or soreness in the skin.

Treatment

There is no known way to cure or prevent the condition but the appearance of the affected skin can be improved with corticosteroid creams and cosmetics. The doctor can recommend melanocyte transplant surgery which includes a new needling micro-grafting technique. The surgery includes a split-thickness skin graft that is taken from the normal area. Later, it is cut into very small pieces in diameter ranging from 0.1 mm-0.3 mm. The local anesthesia is given to the recipient area to implant the micro-grafts into the dermis by using the needling technique. This new method of treating this condition delivers satisfactory and rapid pigmentation.

Takeaway

Vitiligo is a disorder in which flat white spots or patches appear and can affect any area of the body. It happens when the melanocytes die or stop functioning. The condition can be managed by cosmetics, corticosteroid creams, therapies, and surgeries. Out of all these methods, melanocyte transplant surgery is a new and effective technique to manage this disease. However, it is always advisable to consult a doctor before opting for any of these methods. 

Vitiligo - Its Causes, Symptoms And Treatments!

Get rid of suntan: 6 effective home remedies

Sun tan is a common issue this time of the year. A severe sun tan not only robs the skin of its natural glow, but also makes it itchy, lifeless and unhealthy. Here are six simple remedies you can easily follow to remove your tan and get your glowing skin back:

1. Turmeric face pack
Turmeric is commonly known as the best home medication and it indeed has several beneficial effects. Mix a spoonful of turmeric in a bowl of milk and apply the mixture to your face. Keep for 15 minutes and remove.

2. Lemon juice
Cut a lemon and rub the sliced portion on the tanned areas of the body. Wash off after keeping for 5-10 minutes and follow this procedure on a daily basis.

3. Honey and papaya face pack
Honey helps keep the skin soft and supple whereas papaya contains enzymes that enable whitening of skin and effective exfoliation. Blend the mixture of papaya and honey and apply on your face for at least half an hour to experience effective tan removal.

4. Sandalwood paste
Sandalwood has the capability to soothe the skin and rejuvenate it to return its natural glow. Sandalwood paste should be applied right before bedtime on a daily basis to help reduce the effect of sun tan.

5. Yogurt
Yogurt is the best natural anti-tanning agent. Applying it on the tanned areas of your skin not only cools it off but also helps retain the natural complexion of the skin.

6. Aloe vera gel
Whether you extract it directly from the plant or use a product containing aloe vera, it greatly helps in moisturizing the skin and keeping it hydrated. Regular use of aloe vera gel can remove your tan in a short span of time.

If you have any further questions, ask me by clicking on'consult.

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Get Rid Of SunTan : 6 Effective Home Remedies

Some diseases like chicken pox, measles etc. have definitive symptoms that make it easy to diagnose. However, others like lupus affect each person in a different way making them complex diseases that may take longer to diagnose. Lupus attacks the immune system and causes the antibodies that would normally fight infection to react against the body s own cells and tissues. There are two main forms of lupus; systemic lupus that affects any part of the body and cutaneous lupus that affects the skin. These can occur simultaneously or on their own.

Some of the rashes that can be caused by cutaneous lupus are:

Malar rash or butterfly rash: This affects the face and appears as a butterfly shaped rash over the nose and cheeks. It is triggered by the sun s uv rays and can appear as a faint blush or a severe, scaly rash.
Discoid lupus: Lupus can also cause small. Coin shaped sores or rashes. These are reddish and scaly in appearance and usually affect parts of the body exposed to sunlight and uv radiation. If left untreated, these sores can worsen with time. Though they do not cause pain or itchiness, they can result in scarring. In cases where these sores develop on the scalp, they can cause permanent bald patches.
Subacute cutaneous lesions: These can be described as small, red sores that are shaped like coins. These can be found on the arms, shoulders, neck and chest in patches that resemble psoriasis. These lesions are also triggered by uv exposure. Though they do not cause scarring, these lesions can lighten or darken skin.
Mucous membrane lesions: Sores in the mouth or nose that have been triggered by lupus are known as mucous membrane lesions.
Baldness: Lupus can make the hair follicles near the scalp fragile and brittle. This can destroy the hair follicles and lead to hair fall. In some cases, hair may grow back while in others it could result in permanent baldness.
Cutaneous vasculitis lesions: These refer to purplish spots or lines on the calves and feet. This is caused by the inflammation of skin tissues and can cause severe damage and gangrene.
Raynaud's phenomenon: When exposed to cold, the skin on your fingers and toes may also change colour to red, white or blue due to lupus. This is triggered by the tightening of blood vessels and may be accompanied by a tingling sensation or numbness.

Lupus - 7 Common Types!

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