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

Also known as contact dermatitis or contact eczema, allergic eczema is a condition wherein one experience symptoms of skin rash on coming in contact with an allergen. Other symptoms include a burning sensation in the eyes, coughing and a runny nose.

Causes-

This condition is caused when you come in contact with an allergen. Some common triggers that cause your immune system to react in this manner are:

Perfumes in cosmetics

Hair dyes

Metals such as nickel found in jewelry

Latex based products

Chemicals present in soaps and other cleansing agents

Certain antibiotic creams and lotions

Adhesives

Symptoms-

With allergic eczema, the most common symptoms include itching and pain around the affected area, and tender skin. Inflammation and dry skin are some other common symptoms that one may experience. Pus-filled red bumps are common occurrences along with this disorder. The skin may start to thicken and turn scaly. The symptoms may show up when one is exposed to sunlight.

Treatments-

The treatment for this disorder begins after a thorough diagnosis of the symptoms. Based on how severe the symptoms are, the treatment is prescribed accordingly. The first step is usually to wash the affected area with warm water to wash away the allergens. In case of mild symptoms, you may not need any treatment. It is also advised to use apply moisturizing cream to maintain hydration of the skin. To reduce inflammation and itching, use of corticosteroid creams is recommended.

In case of severe symptoms, strong corticosteroid pills may be prescribed.

If the treatments are carried out properly, the symptoms tend to clear up within 15-20 days. However, it is important to remember that the condition may erupt again if you come in contact with the allergen once more. Thus identification of the allergen is very important for long-term treatment and preventive measures. By seeing an allergist contact dermatitis can be ruled out by doing an Allergy Patch Testing.

Allergic Eczema: Causes, Symptoms and Treatments

The metatarsal and tarsal bones form two different types of arches at the bottom of the foot. These are known as the transverse and longitudinal arches. These arches act as springs and help support the body. The arch of a foot influences the person s posture as well. Longitudinal arches can be further categorized as a medial arch, lateral arch, and fundamental longitudinal arch. The amount a person s foot arches, can also determines the type of injuries the person is susceptible to.

Low Arch
A person with minimal foot arch is also said to be flat-footed. Up to 20% of people across the world are flat-footed. Low arches make feet very flexible and also increase the risk of making the foot roll inwards. People with low arched feet have a high risk of heel pain, plantar fasciitis, heel spurs, bunions and arch pain. It can also increase the risk of medial knee problems. Arch support and rearfoot posting can help align the foot and control over-pronation.

Medium Arch
This is an example of a biomechanically efficient foot. It can be described as a defined arch and a moderately flexible foot. The most common foot problems such people are susceptible to are metatarsalgia and heel pain. This is triggered by wearing improper footwear. People with a medium arch in their feet should ensure that they wear footwear that fits them properly. The right footwear for a person with a medium arch has extra cushioning, good support and it absorbs shock well. This can help prevent injuries and align the body properly.

High Arch
A high arch is defined as a well-defined arch that sits higher from the ground than the average foot. This type of an arch makes the foot very rigid and puts extra pressure on the forefoot and rear foot. This can affect up to 20% of the worldwide population. People with high arches have a very little surface area to absorb impact while walking or running. This can make them very susceptible to heel pain, pain in the forefoot and plantar fasciitis. It can also increase the risk of calluses, arch strain, heel pain syndrome, and claw toes. The good news is that it can be treated. Wearing shoes with the right arch support, good cushioning, and metatarsal pads to provide forefoot relief can help disperse the shock and help you prevent injuries.


Arches Of Foot And Its Effect On Body!

Everyone wants to have a bright and radiating skin. But blemishes and skin abnormalities are common and can occur due to lifestyle, diet or hormonal imbalances. Moles and warts are typical skin issues. But how do you tell them apart?

Moles   What are they?

Hardly ever causing pain, they appear in many different colours and can be bumpy or flat. Most often of red, brown or black colour, they occur as a result of skin pigmentation called melanocytes. They can be caused due to direct exposure to sunlight or due to genetic factors as well. They can appear in any part of the body and form slowly, taking a long time to grow.

Warts   What are they?

Small bumps or rough growth on the skin that appear in hands, legs, fingers, soles of the feet, face or in the genital area manifest as warts. They are white or pale. They occur as a result of harmful virus infection of Human Papilloma Virus (HPV) and hence, can be contagious. As opposed to moles, warts need to be removed quickly since a virus causes them.

How do you differentiate a mole from a wart?
Below are some common characteristics of each that can help you identify the skin problem:

Moles

Either flat or elevated from the skin, they are commonly referred to as beauty marks or birth marks.
At times, they have hair growing from them.
Usually, they have one colour   mostly on the darker side.
It cannot be transmitted between people.
They are generated by a collection of pigment cells in the body and darken during hormonal changes.
They tend to become cancerous and lead to melanoma.
Warts

They are harmless, yet contagious.
They have small black or dark dots in the centre that are tiny blood vessels, which provide them with nutrients.
They grow outwards on the skin with a scaly or bumpy deposit.
They can grow anywhere on the body, but are commonly found in feet, hands or fingers.
How to treat warts and moles?

The good news is that both warts and moles do not pose a grave risk to your health, but they are annoying and can turn dangerous in the long run. Especially with warts, you can give it to someone or acquire from someone, since it is a type of virus infection. So, seek medical assistance if you want them to be removed from your skin.

Be aware of the difference between warts and moles to know what you are dealing with. Consult a dermatologist to decide the right steps to remove it or not.

Warts vs. Moles - All You Need To Know!

Toenail fungus is a medical condition that begins as a yellow or white coloured spot under the tip of your toenail but goes on to discolour, thicken and crumble your toenail as the infection grows. If left untreated, the condition can go on from being mild to severely painful. Here are some sure-shot ways that can help you to get rid of your toenail fungus.

Non-surgical methods

1. Oral anti-fungal medications

Such drugs not only replace the infected part in the old nails but also help new nails to grow free from infection. The treatment may be time-consuming but it is definitely reliable. Oral anti-fungal drugs when combined with topical anti-fungal therapies serve to solve your ailment in the best possible manner.

2. Medicated nail polish

Anti-fungal nail polish is another non-surgical medical treatment for toenail fungus. It can be applied and re-applied on the infected nail at regular intervals.

3. Medicated nail cream

Topical anti-fungal creams prescribed by the doctor can be used to get rid of toenail fungus. It works best on thin nails.

Surgical treatment

1. Nail removal

Severe and painful toenail fungus can be best treated by removing the infected nail altogether. A new nail naturally and gradually grows in its place.


How to Rid Yourself of Toenail Fungus?

Warts show up in all shapes and sizes. Caused by the human papilloma virus (HPV), they are exceedingly contagious and while they can show up in anybody of all ages, they will probably trouble children and teenagers.

About all warts are harmless however once they appear on conspicuous places such as the face or hands, most individuals will do almost anything to dispose of them.

Contemplating Warts-

Warts are frequently seen as simply a minor nuisance   to expel the wart is to evacuate the issue. Yet, is this totally genuine? No, say homeopaths.

Their presence on top of the skin warns of a more profound weakness or susceptibility that allows them to proceed and flourish. While expelling the wart creates a sans blemish skin, it does nothing to right this fundamental weakness   the person is still defenseless against future medical issues.

Homeopathic Remedies For Warts-

At the point when using homeopathy for warts, great results are accomplished when the cure corresponds to the characteristics of the person as well as the shape and appearance of the wart.

On account of that, three remedies are prescribed more regularly than whatever other   Antimonium crudum (Ant-c.), Nitricum acidum (Nit-air conditioning.) and Thuja occidentalis (Thuj.) (under strict supervision of the experts). Perused on for the descriptions of these three and other regular wart remedies.

Antimonium crudum (Ant-c.) (under strict supervision of the experts): Hard, smooth warts that frequently show up in groups. Crabbiness and a thickly covered white tongue also suggest the requirement for this cure. The person may also gorge and have various complaints regarding the digestion problem.
Calcarea carbonica (Calc.) (under strict supervision of the experts): Round, hard, solitary warts. Frequently useful for endophytic warts that have a horny divider surrounding a focal depression. Shown in individuals with sticky hands and feet who incline toward routine and the well known as opposed to change and the obscure.
At long last, a Warning About Warts

Some skin cancers such as squalors cell carcinomas appear to be similar to warts so it is critical to get a firm diagnosis if there is any uncertainty.

In case genital warts are present it is also imperative for ladies to have a PAP smear to watch that pre-cancerous changes have not occurred on the cervix.

Treating Warts with Homeopathy

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