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

Eczema is a skin condition marked by eruptions that are often pus filled boils. It is also known as atopic dermatitis. It is known to aggravate during damp monsoon months and can lead to dryness and scaly patches. It is very commonly found in patients who are young children and babies. The flare up can also relapse again. Reddish brown patches and oozing boils characterise this skin ailment. Let us look at the ways in which it can be treated effectively:

 Anti allergy medication: one of the first and foremost methods of treatment includes the prescription of medication. Medicines like anti allergy drugs and anti-histamine drugs are known to be useful, especially in the early stages of the ailment which starts as an allergic reaction. Cetrizine is one of the most favoured anti histamine drugs in this case. Other medication like diphenhydramine, fexofedaine and loratidine can also be prescribed to soothe the pus filled boils and painful symptoms as well as itching sensation. 
 Creams and lotions: the dermatologist can also prescribe cortisone creams as well as ointments that can be procured over the counter. Also, hydrocortisone and similar low potency steroids can be used for this condition. 
 Immunosuppressants: these are also prescribed to ensure that the flare up and spread of the condition does not happen. This can also prevent the risk of cancer, kidney disease and high blood pressure by numbing the immune system when it comes to reactions toward certain prescription drugs.
 Phototherapy: this kind of therapy is used for severe cases. In this method, ultraviolet lights are trained on the site of the flare up so that the immune system's responses that lead to eczema may be contained and prevented. This treatment requires a few sessions for the eczema to clear up completely and also, in order to ensure that bacterial infections do not strike in its aftermath due to the accumulation of debris or bacteria.
 Alternative ways: there are other ways of treating this condition. One of the methods includes making lifestyle changes like using deep breathing and meditative techniques that can bring the stress level down so that the flare up does not happen and the immune system continues to function properly. Also, patients would be advised to use a cold compress every night as this is when the itching increases by leaps and bounds. Further, green tea, primrose oil, aromatherapy and other such methods can also be used to soothe the skin and treat the condition.

There are various ways to deal with eczema and hygiene is one of the top methods along with a good lifestyle.

How to Treat Eczema

Over the past decade, many women have opted for Breast Augmentation Surgery. It is a surgical process to improve the aesthetics of one's breast. Apart from giving a much needed lift to the bust size, the augmented breasts can lift up your confidence. Breast Augmentation Surgery, if gone wrong, can create a havoc. The outcome of the surgery can be influenced by a number of factors. Thus, before going under the knife, some important and vital points need to be taken care of.

1. It is advisable to avail the services of an experienced surgeon, who has a higher success rate. A lot of confusions and apprehensions may arise during course of the surgery. An experienced surgeon will ease out the tension to a great extend and guide you better.

2. Breast Augmentation is no child's play. Do not embark on breast augmentation surgery if you are below 18 years of age. It can result in serious health complications. Surgery can wait, but health once lost, will be gone forever.

3. Know the type of implants to be used. Saline and Silicone implants are commonly used in breast augmentation. Both the implants come with their own sets of merits and demerits.

Being softer and smoother, Silicone implants give the augmented breasts a very natural feel. The chances of scalloping (the skin around the breasts appear wavy) are negligible in case of Silicone implants. However, the Silicone implants come pre-filled. Thus, a bigger incision is needed to get it inserted. Though approved by the FDA, leakage of the silicone implants into the body has been reported. The leakage can affect the health seriously. Interference of Silicone implants with the mammogram can also pose a serious threat.

The Saline implants, on the other hand, are not pre filled. Thus, a small incision is all it takes to get the implants inserted. Once inserted, the implants are filled with saline solution. The saline implants can also leak into the body, without any serious implications. The biggest limitation of saline implants is in the fact that it gives the breasts a very hard feel. Scalloping cannot be ruled out either.

Things to take care of:
 
1. Do not go for breast augmentation surgery if you are planning to start a family in 1-2 years of time. A weaning or lactating lady should also avoid the surgery.

2. The exact location of the implant is an important factor to ponder upon. One can go for an under the muscle or over the muscle implants.

3. One can opt for a round implant or a tear shaped implant. The biggest USP of tear shaped implant lies in the fact that it gives a very natural feel to the augmented breasts. The round implants, on the other hand, are much safer to use.

4. Go for the surgery only when you are physically, mentally and emotionally fit and healthy.

Considerations Before Having Breast Augmentation Surgery 

Loss of hair from the scalp, one of the most common problems plaguing the world today, can be caused by a variety of factors such as genetics, disorders and environmental factors. There are a number of homeopathic treatments that are used to treat hair loss. These treatments focus on the cause of the disease rather than just treating the symptoms. 

Hair loss can be classified as: 
1. Telogen effluvium: This is a disorder of the hair growth cycle where the telogen phase (where the hair falls out) becomes dominant. 
2. Alopecia aorta: This is an autoimmune disorder where the immune cells of the body destroy the hair. Hair loss tends to occur in patches.
3. Androgenic alopecia: This type of disorder is caused by hormonal and genetic factors resulting in a receding hairline. 
The various homeopathic treatments for hair loss are: 
1. Silica: Silica is used to treat a number of diseases in homeopathy. Besides being an effective remedy for hair loss, it also treats symptoms of vitiligo, nail problems and eczema.
2. Phosphorus: Phosphorus is another homeopathic treatment that is used to treat hair loss. It promotes hair growth in spots where hair loss has occurred.
3. Kaliumcarbonicum: This treatment is used for brittle and thinning of hair, as it enhances hair growth. It is usually recommended for people with various forms of alopecia.
4. Lycopodium:This treatment is prescribed for people who suffer from premature balding. It is also recommended for pregnant women if they suffer from hair loss.
5. Natrummuriaticum: This homeopathic remedy is made from sodium chloride and is used to treat hair problems resulting from skin complications. It is also recommended for women who face hair loss from menstrual problems. It treats dandruff and hair disorders due to hormonal imbalances.
6. Sulfur: Sulfur is an excellent homeopathic remedy to treat hair loss as it promotes hair growth. It also eliminates dandruff from the scalp.

Homeopathy and Hair Loss

Gynecomastia is a condition where the tissues of the breasts swell in a boy or men. This is caused by the imbalance of testosterone and oestrogen. It might affect one or both the breasts depending on the level of hormonal imbalance. Although not considered as a serious condition, Gynecomastia can be a difficult condition to cope up with. There are multiple treatment options and surgery is one of them. In many cases, this condition goes as abruptly as it appeared. For cases that are complicated and difficult to get rid of, doctors suggest a medical procedure get rid of the condition.


Symptoms of Gynecomastia:
Some common symptoms of Gynecomastia include tenderness of breasts, swollen breast gland, pain in the breasts, discharge from the nipple etc.


Causes of Gynecomastia:
There could be many causes of this disease. If the condition is witnessed in babies, it could well come from the mother due to an overdose of oestrogen. Gynecomastia also appears during puberty resulting in the breast to swell up. The condition can again crop up after the age of 50 due to hormonal changes.
Certain medications can be a reason of Gynecomastia. Some of the common medications include certain antibiotics, anti-anxiety related medications, chemotherapy shots, HIV patients receiving HAART, cardiovascular medications such as Lanoxin, anabolic steroids etc.
Certain drugs such as heroin, alcohol, methadone, marijuana, Amphetamines etc.
Certain health conditions such as hypogonadism, hyperthyroidism, liver cirrhosis, ageing, certain tumours, failure of the kidney malnutrition etc.


Risk Factors Of Gynecomastia-
Certain risk factors of gynecomastia include older age, use of certain steroids, adolescence and other medical conditions such as Klinefelter's syndrome, tumour related to hormonal fluctuation and disease related to thyroid.
Diagnosis:
A doctor typically checks the history of drugs along with the health condition of the patient. He might also take a look at the health of the extended family. A careful tissue evaluation of the genitals, breast and abdomen are done. This is followed by a physical exam followed by prescribing certain tests such as mammograms, complete blood work, CT scan, biopsy of the tissue, MRI scan etc.


Treatment:
Most people suffering from Gynecomastia see a significant regression with periodic treatment. If however the condition arises from an underlying cause such as cirrhosis and malnutrition, a doctor suggests 2 option- medications and surgery:


Medications: Certain medications that are known to be helpful for breast related cancers are known to be effective in this condition. Some common examples of these drugs include evista, arimidex and soltamox.
Surgery: Only after exploring all medical options a doctor suggests surgery. There are 2 procedures namely mastectomy and liposuction. The latter removes the fat cells of the breast and the former removes the breast gland tissue.     


Gynecomastia - Is Surgery The Best Option?

How your baldness is completely reversible (non-surgically): part-2

I explained in part-1 about prp treatment. Dermaroller treatment follows the prp treatment.

Let's understand how does it work.

What is derma roller

Dermaroller is an instrument with multiple small needles attached to a handle, which is rolled over the treatment area, to stimulate hair follicles.

How does derma roller work?

It activates stem cells in hair bulge region and releases growth factors to stimulate re-growth. It is again a painless procedure and is usually done without anesthesia.

Any risk or side effect of derma roller?

There is no risk for using derma roller as it is used is a completely aseptic and clean environment.

Total number of treatment sessions required?

For most patients 3prp + 9 derma roller (total 12 sessions done every week over 12 weeks) are sufficient.

Are results achieved with prp + derma roller permanent?

This treatment reverses the 'hair loss stage' to 'hair growth stage' and once the bald scalp is covered with hair, the results can be maintained with just a solution. However, some patients may need prp for maintenance every 6 months to 1 year.

Advantages of i-prp


	
	Simple, effective and non-surgical procedure
	
	
	Completely safe, as your own blood is used.
	
	
	Hair regrowth with i-prp gives best cosmetic appearances.
	
	
	It gives a natural density. Number of hair strands is in lakhs as compared to a maximum of 6000 hair follicles that can be grafted when a hair transplant treatment is done.
	
	
	The hair growth direction remains same (giving a completely natural look), which is not the case with hair transplant treatment where the hair growth direction changes (giving an odd look).
	
	
	Cost of i-prp is much less compared to hair transplant
	


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


How Your HAIR LOSS or BALDNESS is Completely Reversible (Without Surgery):  PART-2

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