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

Holi is one of the most enjoyable festivals in India. It is one that everyone looks forward to and is usually known as the festival of colours because we use colours and coloured water to douse our friends and family in a great display of pomp and show. Also, we tend to get doused and remain that way for many hours, mostly in the sun. As such, Holi can also take a toll on our skin by causing discolouration, rashes and insensitivity. So what should one do in order to avoid coming down with bad skin the day after Holi? Here are our secrets, which will leave you with shining skin even after you have had a great time at the festivities!

Hydration: It is very important to keep yourself well hydrated before you plunge into the festivities. Remember to drink lots of water and ensure that you have a bottle in hand so that you can easily fill up on fluids even as you enjoy yourself with all the sun rays and the colours. This will ensure that your skin does not become too dry.
Full sleeve clothing: Another good idea to keep your skin protected is to wear full-sleeved clothing so that you do not tan indiscriminately and you do not end up with too much discolouration and rashes on your skin. Wear light fabrics that will dry fast so that the water does not get absorbed by the clothing and into your skin. This will keep your skin relatively dry, even if you enjoy yourself for hours at an end. Avoid synthetics clothes and denim as they would stick to your skin. 
Organic colours: With the whole world going the organic way, why should our Indian festivals remain behind? So, you can now opt for organic colours that have been produced in a safe way with safe ingredients. These natural pigments will ensure that you do not have to scrub and endure rashes and irritation after the festival. It is a good idea to opt for such colours, which can be washed off easily and are bereft of synthetic materials that can harm the skin in the long run. This can also help in avoiding problems like eczema and other skin conditions.
Oil your hair: India is a land of rich cosmetic tradition. No matter which direction you look in, you will always find that you have a weapon of choice in terms of oils and other ingredients that are absolutely great for keeping your skin and hair in good shape. So our advice is to oil your hair well, preferably with coconut oil, olive oil, or vitamin E oil, so that the colours and the water does not get absorbed onto your scalp. This will also help in keeping your hair moisturised as the colours can make the strands very dry. Always oil the whole body before playing holi.
Lips: Apply plenty of lip balm before joining the play of colours.
Nails: Apply a thick coat of dark nail paint before Holi. 
It is important that you must apply oil behind your ears, between your finger tips and even near your fingernails. It is ideal that you don't wax or thread or do any facial treatment, at least, three-four days ahead of Holi.

Holi Special - 6 Tips to Keep Your Skin Rash Free!

An often painful condition usually involving the bowel, ovaries or the tissue lining the pelvis, endometriosis is characterized by the abnormal growth of the endometrial tissue beyond the premises of your uterus or your pelvic region. The endometrium, in fact, functions perfectly normal with each menstrual cycle, but because of it being displaced, it cannot exit the body and consequently gets trapped.

Besides causing severe pain and distress, endometriosis can also adversely affect fertility. When the ovaries get involved, certain cysts known as endometriomas tend to develop which often result in the formation of scar tissues and adhesions.

Complications associated with it

Infertility: Impaired fertility is the most common kind of complication arising from endometriosis, with approximately one-third to one-half women having problems with pregnancy. During endometriosis, the fallopian tube gets obstructed, thereby restricting the union of the egg and sperm.
Ovarian cancer: Women with endometriosis are more likely to suffer from ovarian cancer. Moreover, they are also more susceptible to acquiring endometriosis related adenocarcinoma, which is another variant of cancer, but a comparatively rarer phenomenon.
How best to treat it?

Depending upon how severe your symptoms are, endometriosis can be treated via the use of medications or through the advent of surgery.

Pain medications: Certain medications, including pain relievers and anti-inflammatory drugs, are particularly useful in providing relief to painful menstrual cramps.
Hormone therapy: Undergoing hormonal therapy can help ward off or reduce the pain of endometriosis, but it should be kept in mind that it is only a temporary fix and that symptoms might reoccur. Hormonal therapies include:
Hormonal contraceptives
Medroxyprogesterone
Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists
Danazol
Conservative surgery: This can either be done through laparoscopy or, in more extensive cases, through traditional abdominal surgery.
Assisted reproductive techniques: These include in-vitro fertilization, and are sometimes more preferable over conservative surgery.
Hysterectomy: This is usually done in more severe cases of endometriosis whereby ovaries are also removed with uterus and cervix

Complications and Treatment of Endometriosis

7 anti-beauty habits that kill your looks the most!

You might be spending a lot to add to your beauty. But there are many bad habits which affect your beauty. Here is the list of the most common terrible habits which might be damaging your skin and health.

1. Squeezing pimples: when you pop a pimple, clogged pore is burst open releasing bacteria. These bacteria come in contact with your rest of the skin and increase the acne. Moreover, habit of squeezing pimples may also leave scars and pock marks. The best way to get rid of pimples is to use medicated/ antibacterial soap and let it heal itself.

2. Licking/ chewing your lips: chewing your lips make them even drier and chapped. It makes you to lick and chew your lips more often. Excessive lip biting also results into bleeding and infection. To avoid this, get yourself a good lip balm and apply regularly to moisturize and protect your lips.

3. Nail biting: nail biting result in ugly hands, fingers and nails due to cuticle biting. It can also result in infections of nails, mouth, finger and dental problems affecting your smile too. Work upon triggers to prevent these issues by yoga, manicure etc.

4. Smoking: smoking affects your skin making it dry and rough. It decreases the blood flow to the skin and damages your collagen and elastic which result into saggy and loose skin. Quit smoking.

5. Sleeping with makeup on: make up clog your skin pores and oil glands, making it difficult to breathe and prone to acne. To avoid this, spare sometime before going to sleep to cleanse your makeup and moisturize the skin well.

6. Ignoring the sunscreen: ignoring sunscreen in summer is exposing your skin to uv rays. Uv rays cause wrinkles and dry your skin giving you the older look. To protect your skin from uv rays, use sunscreen before half n hour of going out.

7. Inadequate sleep: inadequate sleep releases the stress hormone in the body. It also ages your skin by decreasing collagen from skin. Hence try getting enough sleep.

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


7 Anti-Beauty Habits That Kill Your Looks the Most!

How To Take Care Of Nail Health 

Nails significantly reveal about your overall health.When well taken care of, nails not only look good but they also help you stay healthy.
Follow these tips for a shining nails.
1. Moisturize - Use a Hand-Nail cream regularly to avoid ragged cuticles and flakey skin. Moisture keeps your nails in a good shape.

2. Mild Soaps - Use specially formulated hand foams to wash your hands. Certain anti-bacterial soaps can strip away layers of essential oils from your skin, thus leaving your palms dry and even itchy.

3. Massage - Massage your cuticles regularly. This will help improve blood circulation to the tips as well as stimulate the entire nervous system promoting the growth of strong and healthy nails.

4. Manicure - Treating your hands once a month to a relaxing manicure is an excellent idea. Not only do your nails end up looking fabulous but the additional TLC will go a long way in ensuring that your hands don’t look twice their age. Scrubbing off the dead cells, applying a ‘hand mask’ and then some relaxing massage as you close your eyes to some soothing music, is just what ‘nail therapy’ is all about.

5. Maintain - It’s a common knowledge that the skin on our hands tends to age quicker as it is often left exposed to the elements such as the harsh sun or extreme winters. To maintain your manicured nails, use a sunscreen regularly and wear gloves in the winters and even while going about household chores such as doing the dishes or mopping the floor.

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

From Lybrate: If you found this tip useful, please thank the doctor by clicking on the heart icon below. Also, spread good health by sharing this tip with your loved ones over WhatsApp, Facebook and other media.


 Are Your Nails Telling Others About Your Health?

Eczema refers to the changes that occur in the upper skin layer. These skin changes can be thickened and cracked skin, skin redness, crusting of the affected area and swollen raw skin, among others. The exact cause of this skin condition is not yet known but a mix of factors have been found to be behind this health problem.

It is a common chronic skin condition, which is characterized by skin inflammation and irritation. The most prevalent type of eczema is Atopic dermatitis. It is not a communicable disease and is usually caused, owing to immunological alterations within the body.

czema can be cured if the persistent immunological disturbances get corrected by internal medications like homeopathy treatment, which is known for providing safe and effective treatment. The presence of red, inflamed and itchy skin can trigger psychosocial and emotional stress in the patients suffering from eczema and can become a dominant cause of severe discomfort. 

The fundamental characteristic of homeopathy treatment is that it targets with respect to eczema:

Genetic components
Coping mechanism with sentimental triggers
Major advantages of homeopathy include:

It treats the disturbances of immune system and treats the roots of this disease.
In most of the cases its effects are long lasting.
It is non-toxic and causes zero side effects.
The following are effective homeopathic remedies to treat eczema:

Weeping type of eczema: Graphite is an effective homeopathic medication that treats the weeping type of eczema that usually occurs between fingers or toes, behind the ears and scalp. It provides effective relief from eczematous eruptions that discharge sticky fluid and eczema that develops on eyelids.
Dry eczema in knees joints and bents of elbow: Sepia officinalis is an ideal homeopathic remedy for eczema in knees and bends of elbow. It provides relief from severe scratching that occurs due to dry skin.
Excessive itching: Sulphur is a Natural Homeopathic medicine, which is considered one of the most effective remedies for eczema. It provides instant relief from burning sensation and excessive itching. It is also beneficial in the case of eczema that has worsened due to the indiscriminate usage of external ointments.
Gastric or urinary trouble: Lycopodium clavatum is an effective remedy for patients suffering from some sort of urinary or gastric trouble. It is also known to provide effective relief from severe itching and bleeding resulting from eczematous eruptions. It also provides relief in cases of deep fissures and hardening of skin.

Treating Eczema With Homeopathy

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