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

Plastic Surgery is a speciality that deals with reconstruction, alteration and restoration of certain parts in the human body. It improves a person's appearance and may also help in improving the functionality of various body parts. It can be classified as either re-constructive or cosmetic Surgery:

    Re-constructive Surgery: These type of surgeries are used to correct various defects in the body such as injuries as a result of trauma, physical birth defects, deformities in the ear and cleft lips.
    Cosmetic Surgery: Cosmetic Surgery is used to modify a part of the body for cosmetic reasons. The most common cosmetic surgery procedures are reconstructing the nose, removing fat from certain parts of the body and reshaping the breasts.

Outlined below are 5 facts about plastic surgery:

    Liposuction is popular among males: The most common plastic surgery among men is liposuction. So far, out of the 1 million plastic surgeries that men have undergone, most have been liposuction. The other popular cosmetic surgeries for men are face lifts and Rhinoplasty.
    35-50 year old undergo the maximum number of plastic surgeries. In 2014, over 4 million procedures were performed on people whose ages were in the range of 35-50 years. The most common concerns were sagging skin and fine lines. Liposuction was the most popular surgery in this age group.
    Most women opt for breast augmentation: Breast augmentation often requires correcting various issues such as post-op sagging and various other tweaks like modifying the size of the implants. The number of revisions in breast surgeries has actually gone up compared to the initial breast surgeries.
    Asian double eyelid surgery: A surgery where the eyelids are altered to make your eyes look bigger and attractive. It is a popular surgery among Asian women.

5 Facts You Never Knew About Plastic Surgery

The term  skin disorders  is used to describe different skin problems- from widespread rashes to red small bumps on certain portions of the skin. While some conditions can be harmless but unsightly, others may be infectious and even life-threatening in rare cases.

Some skin conditions have a genetic component, while others may result from allergic reactions. Allergic skin problems occur when certain allergens stimulate an immune response such as itching or redness. Bacteria, fungi, viruses can also lead to skin problems. The most common types of skin problems are psoriasis, eczema, acne, rosacea, warts etc. Let s take a closer look at these disorders-

Psoriasis- This is an autoimmune chronic skin condition which causes a rapid increase in the number of skin cells. Due to this rapid accumulation of cells, the surface of your skin becomes dry and flaky. The white scales are usually seen in the joints of your knees and elbows. You will most likely notice redness and inflammation around the scales.
Eczema- Eczema is a medical condition that causes your skin to turn red and become inflamed and itchy. Eczema occurs in many forms, the most common among which is Atopic dermatitis. This condition begins usually in childhood, and gradually fades away or becomes milder as you age.
Acne- This is perhaps the most common skin problem particularly prevalent between the ages of 15 and 35. Almost every other person develops small raised bumps known as acne breakouts due to infected or blocked hair follicles. When the skin pores become clogged due to excess oil secretion or accumulation of dirt and dead skin cells, acne can appear anywhere in the skin. Most commonly, these are noticed on the face- cheeks, chin or the nose.
Rosacea- Rosacea is often mistaken as acne because it induces acne-like inflammatory symptoms. But this particular skin condition can occur due to a combination of genetic and environmental factors. Rosacea produces red, pus-filled small bumps on the skin, and usually affects fair-skinned middle-aged women. Visibly broken blood vessels, swollen skin, itchy dry eyes, rough patches on the skin- all these signs indicate you may have rosacea.
Warts- These are slightly raised bumps or patches on the upper layer of your skin caused by the Human Papillomavirus (HPV) infection. Warts come in different shapes and sizes and can occur in any part of your body- hands, palms, feet, knees, or face.
Role of Ayurveda in curing skin disorders-
The Ayurveda school of treatment aims to restore your body s doshic balance- kapha, vata and pitta. Treatment methods include self-care practices such as a balanced lifestyle, healthy diet, exercise and meditation. There are several Ayurvedic therapies including Abhyanga and Panchakarma that are designed to promote healthy skin.

The Panchakarma vidhi uses medicated herbs, natural ingredients like rice, sand, medicated powder on your body to soothe your senses and flush out the toxins from your body. Once your body is detoxified, your skin feels rejuvenated and nourished.
Essential rosemary oil and olive oil act as excellent moisturizers, especially for dry flaky skin resulting from psoriasis.
Ashwagandha, one of the most essential, powerful herbs packed with anti-inflammatory properties, helps remove rosacea puss. To fetch best results, apply or drink extracts of this wonder herb every alternate day.
Fenugreek seeds, or what is more commonly known as  methi , are rich in essential vitamins like C and K, folic acid and iron. This medicinal plant helps remove dry red patches on the skin. It also prevents the formation of rosacea puss and helps reduce itching.
Skin problems can be mild or severe. Sometimes a conventional treatment method that may work for one condition, may not work well for the other. Ayurveda is a holistic approach to treatment and uses natural ingredients to cure the root cause behind the apparent condition.

Psoriasis And Skin Disorders - What All Should You Know

In medical science, the term used to refer white patches on the skin is vitiligo. This can appear on various parts of the human body. These are commonly found to develop on hands, feet, arms, legs, face, lips, and around the eyes and mouth. Researchers are not aware of the exact cause behind this skin disease. Some experts believe that it could be an instance of any kind of an autoimmune disorder.

The immune system attacks the melanocytes or the cells that produce skin coloring pigment i.e. melanin. It can also be caused due to genetic factors, excess exposure to sunlight, stress and deficiency of vitamin B12. The white patches are also caused due to infection caused by fungus like tinea versicolor.

Whatever be the cause, the problem is quite embarrassing for all. It mars your beauty and makes you look ugly. There are cosmetics and medicines to treat the condition. 

But you can also choose some home-based remedies from the list below to get rid of the white patches:

Babchi: It is an effective remedy for the problem of hypopigmentation or white patches. It has antipsoriatic properties. You must soak the seeds of this herb in the juice of ginger for at least three days. You must replace the ginger juice timely. It is thereafter advised to remove the husk from the seeds and dry them under the sun to make a powder out of it. Mix the powder with 40gms of milk a day and consume it. You can also put babchi oil on the skin and stay under the sun for 15 minutes.
Ginkgo Biloba: It has antioxidant properties to fight against the white patches. It hampers the spread or progress of the disease. You should consume 40-80mg of this three times in a day.
Coconut Oil: It helps in soothing the skin and cures inflammation. It helps in re-pigmentation. It is antifungal in nature.
Ginger: It benefits the blood. It boosts the production of melanin. Place a slice of ginger on the white patch and let it dry. You must repeat this twice daily for a week to see the best result.
These are just a few of the home-based remedies. You must consult your dermatologist for expert advice. Your treatment may vary on the gravity of the situation. Your doctor will be in the best position to tell you what suits you the most.

Vitiligo - Home Remdies to Treat Vitiligo on Body

Gynecomastia is a hormonal condition that causes swelling of the breast tissues in men and boys. This condition usually arises as a result of hormonal imbalance. Breasts do not form in the same pattern in males as they do in females but all males are naturally born with tiny quantities of the breast tissues. The male body produces the testosterone hormone, which plays an important role for growth during the stage of puberty. However, they also make the hormone estrogen that is instrumental for developing sexual growth in females.

When a male passing through the stage of puberty makes lesser amounts of testosterone then there is an imbalance of the hormones. As a result of the higher amount of estrogen present in men leads to swelling of the breast tissues.

Cause of imbalance-

Aside from the common reason which is the lesser production of testosterone, there are a few other reasons that can put into effect this imbalance. They are-

  Injury to the testicles that are responsible for producing testosterone
  Obesity which leads to greater production of estrogen
  Taking illegal drugs
  Liver disorder
  Failure of the kidney
  Thyroid problems that result in throwing off your hormonal balance
  Medications that you might be taking for illnesses such as cancer, depression, heart disorders and ulcers

Treatment of Gynecomastia

The treatment of gynecomastia involves a general surgery which reduces the size of breasts by flattening and enhancing the contours of the chest. If in very severe cases the weight of the breast tissue has sagged and stretched the areola region, then the areola size can be improved surgically by reducing the excess skin.

  Mammaplasty

Plastic surgery, known as Mammaplasty, is also sometimes put into effect in order to treat the condition of gynecomastia.

  Liposuction

In the case of liposuction, the procedure of the treatment first starts with a set of medications that need to be consumed. These medications help to reduce pain during the surgery. There are two ways of taking this medication, either through intravenous sedation or via general anaesthesia. The liposuction technique involves the insertion of a hollow tube with the help of several incisions. Liposuction technique is generally prescribed if the cause of gynecomastia is excess of fatty tissues. During the procedure, the cannula or the tube will be moved back and forth in order to loosen up the excess fat. This fat is then removed via vacuum suction.

  Excision Technique

The excision technique is prescribed when the glandular breast tissue needs to be removed in order to rectify gynecomastia. In this procedure, the nipple will either be repositioned to a manlier contour or the areola size will either be lessened. In some other cases, the general surgery of gynecomastia can also involve a combination of both the excision technique as well as the liposuction technique.

Gynecomastia is a condition that can severely damage the emotional balance of a man and lessen their self-confidence. It has been also seen that many men suffering from this condition tend to avoid physical intimacy or sexual activities as a result of body-image issues. Therefore, treatment is highly recommended for those suffering from gynecomastia.

Gynecomastia - Knowing The Causes & Treatment Of It!

6 effective ways to get rid of warts

Warts are small, rough patches on the skin (resembling cauliflowers) that are caused due to the human papillomavirus (hpv- a dna virus that can infect humans). In this condition, only the topmost layer of your skin gets infected and acquires a rough texture. Warts are not fatal (they do not cause cancer), but they are contagious in nature and do not vanish easily. 

Read on to find the most effective ways to get rid of warts. 

1. Over-the-counter wart removers
Over-the-counter wart treatments containing salicylic acid (a type of fungicide) as an active ingredient are commonly used for effective removal of warts. These medications generally eliminate warts by removing the topmost layer of the skin, following the peel-off process.

2. Cryotherapy
Cryotherapy, also known as freezing therapy, is generally performed by a dermatologist and consists of the use of liquid nitrogen for freezing the warts. The application of the chemical results in the formation of a blister around the warts, which shed off after about a week. It takes almost 3 to 4 weeks to have completely wart-free skin. This method proves to be more effective when used with salicylic acid-based wart removers.

3. Laser treatment
Another form of wart removal is pulsed-dye laser treatment. An ablative co2 laser acts by cutting and burning the wart. In this type of treatment the affected blood vessels are burnt, leading to the death of the infected tissue, following which the wart too disappears. However, this method is not commonly used if other treatment methods tend to work as it is painful and may leave behind scars.

4. Vaccine
Sometimes your dermatologist may recommend the use of human papillomavirus (hpv) vaccine to successfully eliminate warts.

5. Bleomycin
In this type of treatment each wart is injected with a shot of bleomycin, a medicine that fights cancer. However, this treatment is not preferred generally as it may be painful and comes with side effects like nail loss if the wart is present on the finger.

6. Immune therapy
When warts refuse to vanish after the use of all common treatments, this method is put into use. This type of treatment involves the use of medications or solutions, which strengthens your immune system so that it can repel warts. In this case your warts may be injected with an antigen or a solution or cream may be applied on them. 

If you would like to consult with me privately, please click on'consult.

6 Effective Ways to Get Rid of Warts - Cauliflower-like Skin Inflammation

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