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

Are you experiencing skin itchiness and development of dry, scaly rashes on your skin? This indicates you have eczema, which is a group of skin diseases occurring due to the inflammation and irritation of skin. Atopic dermatitis is the most common form of eczema. The disease can be controlled if proper treatment is undertaken.

Symptoms
Itchy skin is the most common symptom of eczema. In some cases, the itching starts before the development of the rash. The rash appears most commonly on the back of the knees, face, hands, wrists and feet. The affected areas become dry and thickened and in people with a fair complexion, the areas may turn reddish initially and then become brown.

Causes
The specific cause of eczema is yet to be determined. However, the condition is associated with an overactive response by the immune system to an external irritant. This response leads to eczema. The condition is more common in people who have a family history of allergies or asthma.

Treatment

As the condition turns the skin dry and itchy, certain creams and lotions are recommended to be used in order to keep the skin moist. You should apply these products when your skin is damp, ideally after taking a shower. This helps the skin in retaining moisture. You can use a cold compress to ease the itching.
Several creams such as hydrocortisone cream and ointments which contain corticosteroids are prescribed in order to reduce inflammation.
In case the affected area becomes infected, antibiotics should be taken to eliminate the infection-causing bacteria.
Antihistamines are used for reducing the severity of the itching. 
Prevention of Eczema Flare-ups

Moisturize your skin frequently
Avoid sudden changes in humidity or temperature
Abstain from overheating and sweating
Try to reduce stress
Avoid starchy material
Avoid soaps, detergents and solvents, which are harsh
Be aware of food items which trigger eczema flare-ups
It is recommended for you to consult a dermatologist if you experience any symptom of eczema. This will help you with a quick diagnosis so that you can start the treatment without further worsening of the symptoms.

Eczema - How You Can Prevent Its Flare-ups?

Wounds and bruises are both injuries. However, they differ widely in terms of the causing factors, the nature of the injury, the pain they cause and the kind of treatment they require. The following are a few of the myriad ways in which the two injuries differ from each other:

1. A wound causes quick damage - the skin tissue is cut or punctured while a bruise (also called a closed wound) is where the skin is not torn. 

2. A wound is usually caused by a sharp object but bruises are the results of blunt force or trauma.

3. A wound almost certainly bleeds due to ruptured tissue and blood vessels. Blunt injury also damages the blood capillaries of the skin and causes blood to accumulate under the skin tissue, creating a dark patch of skin. Blood vessels can also break due to lifting of heavy objects or overexertion of muscles.

4. A wound carries the risk of infection because the skin is open but a bruise does not get infected.

5. A wound has a burning or stinging sensation but a bruise is characterized by swelling and a blunt throbbing pain.

6. A wound can be healed by antiseptic and antibiotic medication. Large wounds need to be closed by stitching them up to avoid severe infection. On the other hand, a bruise usually heals by itself. A cold compress and pain killers may be used to ease discomfort. Heat can be applied to the injured spot to normalize the blood flow and dissolve the blood clot.

7. A wound can lead to complications like bacterial infections or the healing might be delayed by chronic diseases like diabetes. In case of a bruise, it usually does not cause complications but if there's a blunt injury to sensitive areas like the head, the tailbone or the eyes, medical attention is advised.

8. Wounds and bruises can also be differentiated on the basis of their subtypes. The different types of wounds are:

a. Incision (sharp objects cutting the dermis layer of skin)
b. Abrasion (the epithelial tissue is scraped off)
c. Avulsion (a body structure is torn off)
d. Penetration (a sharp object causes an entry and an exit wound)
e. Puncture (only an entry wound caused by a sharp object)

The different types of bruises are:
a. Hematoma (blood pools under the skin)
b. Purpura (tiny spots of blood on the inside of the mouth)
c. Contusion (similar to hematoma and caused by external trauma)
d. Crush injury (caused due to a large amount of force on the body part for a long time)

Wounds VS Bruises

Immediately after hair transplantation, you need to exercise little extra care to derive the best benefits. This includes immediate postoperative care, some common with most other surgeries and some very specific to hair transplantation. 

The following things will happen immediately after transplant, throughout the first week: 

Immediately after surgery, like any other surgery requiring anesthesia, there will be slight drowsiness and so it is advisable to arrange for a drive.

Expect some mild swelling and soreness that can be managed with rest and anti-inflammatories.

There will also be a tight and itchy feeling in areas where transplant has been done.

Spray water or saline every half an hour to keep the scalp moist in both the recipient and the donor sites. This promotes healing and also reduces the itchy feeling in these sites.

Thermal shock would be applied to areas to damage the existing follicles and new stem cells would be transplanted. This can also produce a warm feeling, sometimes referred to as 'thermal shock'.

In some people, there could be scab formation which occurs due to fall of the topmost transplanted hair follicles.

If you have undergone a micrograft, then you will have a compression bandage around your head. This should be in place for a day and will cause a tight feeling.

Sleep with your head elevated with a couple of pillows.

The first day after surgery, hair needs to be washed under the supervision of a physician or a nurse. Use a shampoo, which contains tea tree oil.

It is recommended to shampoo your hair regularly from day 2, as it is required to remove the dirt, blood, and oil that often accumulates at the recipient's site. This also helps to controlling infection, which is common post surgery.
Wait for at least 14 days before you resume coloring your hair, use of hair sprays, gels, and other hair care products.

All transplant surgeries require stitches. If the suture material is absorbable, there is no need to follow-up for removal. If it is not of absorbable material, they need to be removed after 2 weeks' time.

Please do not get into a regular exercise routine for up to 6 weeks. Cycling, gymming, swimming, golfing, etc., are to be avoided until the scalp is completely dry and to avoid stretching of the scar.

Everyone's body is unique and responds differently to hair transplantation. Go for periodic review with your doctor to understand how your body is responding.


What To Expect After Your Hair Transplant Session?

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

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

Symptoms:

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

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

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

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


Cellulitis - Causes, Signs & Symptoms and Treatment 

Sunburns are caused due to long stretches of exposure to the sun. People living in tropical countries are more prone to sunburns. The harmful ultraviolet rays of the sun can lead to skin pigmentation that if not treated, can become a permanent skin condition. The worst aspect of sun tanning is that it keeps piling on your skin layer after layer. It is therefore absolutely essential to cover the skin of your face and arms while venturing outdoors. 

Medications are effective in certain cases, but in some other cases, the afflicted person's skin is so sensitive that medicated ointments fail to show improvement. Ayurvedic home remedies can be put to use to avoid alarming side effects. 

Sunburns are characterized by the following symptoms:

 The affected area is usually hotter than other parts of your skin 
 A stinging and itching sensation may develop
 Red and pink patches may be seen on your face and arms or around the neck
 Acute sunburn can even make a person suffer from fevers and fatigue 

 These ayurvedic ways can be followed at home to treat sunburns:

 Use black tea to cure sun rashes and sunburns: refrigerate some black tea if possible. This cold beverage must be applied to the areas that have been harshly affected by the ultraviolet rays of the sun. Applying black tea on your skin multiple times in a day can repair the damage already done.
 Coconut oil is a great way to remove sun tan: coconut oil has been held in high esteem since ages. It is known for its ability to cure rashes. One must use coconut oil on the red patches every night before going to bed.
 Aloe vera gel can do wonders with your affected skin: instead of using creams that contain aloe vera; one should use aloe vera gel by extracting it directly from the plant. Aloe vera can heal the burns and can also soothe the burning sensation.
 Cucumber in combination with lemon juice can remedy sunburns: lemon juice has acidic effects that helps in lightening sun tan. When this juice is used with cucumber paste, the latter cools down an irritated skin area and rejuvenates it from within.

Treating Sunburns with Ayurveda

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