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

Home remedies for skin allergies 

Skin allergies are often indicated by redness, scaly, itchy, chapped or bumpy skin. These may occur due to a variety of factors. Usually, when an allergen or a foreign element comes in contact with skin, it triggers an immune system response leading to an allergic skin condition. Other factors may include climatic changes like heat and cold, infections, cosmetics, specific foods or even medications resulting in skin allergies. Often, mild skin allergies do not sustain for long even if these are not treated. However, to get relief from the pain and added discomfort caused by these skin allergies, these home remedies are a lot easier and safe bet.

Cool down the itch

Use typical ice packs or cold running water over the infected part to treat itching. Using a cold water cloth over infected area relieves from suffering. Do not try using hot water as it relaxes in the beginning but makes the condition worse later.

Scare the scar

Aloe vera is the best bet in almost all skin ailments due to its remarkable anti-bacterial, anti-inflammatory and anti-fungal properties. Regular oral intake of 2-4 teaspoons of aloe vera gel or the application of its pulp on areas of dark spots or scars eradicates scars and rashes from the face and other skin areas.

Act on acne with apple cider

The best option to treat the most irritating yet much prevalent skin ailment is apple cider vinegar. Add one part of apple cider vinegar to three parts of water. Mix it well. Use cotton balls to apply this solution on acne directly and leave it for 10-15 minutes. Then rinse with water. Apply this three times a day to seek optimum results.

Coconut oil sways away eczema

First, wash your hands with utmost care. Then, pat them dry. Use your fingers to slowly rub coconut oil on the affected area. Leave it for some time to get it dry. Use it as many times as you want to get the benefits. Actually, application of this oil on the affected portion is recommended for a longer duration for best results.

Bye-bye to rashes with baking soda

Baking soda is to be applied on the rashes directly. Then, to get better results, press the skin softly and see the rashes disappear soon.

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


Quickie Home Remedies for Skin Allergies

What are dermal fillers + how different it is from botox?

Dermal fillers are an artificial or naturally-derived material used for directly injecting into the skin. These soft tissue fillers are used with the aim to restore your facial appearance to address issues related to facial aging. Depending on the kind of filler that you opt for, the effects can vary from 6 months to 5 years. Nonetheless, they are used for a number of problems associated with facial aging such as:

  for smoothen out and add volume to creases known as laugh lines

  for enhancing thin lips

  for providing shape and fullness to cheeks so as to provide a youthful appearance

  for enhancing the under eye areas to the point that depressions or hollows are no longer visible

  for merging scars from chicken pox or acne with surrounding skin

  for adding volume to your temple or lower cheek area when shifting of fat pads (masses of tightly packed fat cells) underneath your skin surface occurs.

How are these fillers different from botox?

Even though both these procedures involve the use of injections, they are completely different from one another. Botox or botulinum (a purified, natural protein) works by numbing muscles that contract to create facial lines. It is mostly used around the eye and forehead areas for stopping the movement of muscles that cause wrinkles to form. Moreover, it treats active lines, which are visible when you smile, frown or squint.

Dermal fillers, on the other hand, treat wrinkles that are very deep and static, which you can only be seen when the face is in a restful state. Furthermore, it serves to enhance the skin while lightly swapping the collagen (a protein that helps connective tissue in the body to remain strong) that gets lost as you age. When it comes to swelling and bruising, botox reports minimal effects and dermal fillers a certain amount of swelling and bruising that disappear within 7-10 days.

If you would like to consult with me privately, please click on 'consult'.
Related Tip: 6 Face Washing Mistakes that are Damaging Your Skin, Every day!

For Your SKIN: What are Dermal Fillers + How Different it is from Botox?

5 horrible things you do to your hair everyday

Hair today, gone tomorrow. That might be your condition if you are not taking care of your hair properly. There are a lot of things you do almost daily that are adversely impacting your hair health. You might not even be aware of the damage you are doing to your tresses by indulging these activities. Read on to find out about the 5 worst things you do to your hair on a daily basis.

1. Excessive hair brushing: Here’s why brushing your hair excessively is bad for your hair: it causes breakage and strips your hair of its natural nourishing oils. To avoid this, try limiting the use of your hair brush to about just two times in a day. Brushing right after you wake up is a good idea, as it helps in distributing the oils produced by your scalp down your hair shaft, which act as a natural conditioner for your hair.

2. Tying your hair in a ponytail everyday: If you tie your hair in a ponytail everyday then chances are you are applying consistent pressure to on the same hair shafts, resulting in brittle and weaker hair. In fact, doing so continuously can even retard hair growth. Try to leave it open as much as you can, but if you absolutely must tie a pony tail, then tie a loose one. Maybe even use booby pins to keep your hair in place instead of scrunchies. Alternating between high and low ponytails helps too.

3. Using a pre-used hairbrush: Your hairbrush contains a lot of germs, which can severely damage your hair. Using an unclean brush is one of the main reasons of damage hair, as these brushes contain dirt gathered from your hair which you’re giving back to your hair by using. It’s best to clean it once in a while to maintain proper hair health. The same holds true for other styling agents such as combs, curlers, rollers, straighteners etc.

4. Delaying a hair cut: Most of us are guilty of this crime. What with your jam-packed schedule and work overload, you often ignore that much needed trip to the salon. Prolonging a haircut is never a good idea as it can lead to a bad case of split ends, which can result in hair that tangles a lot and causes hair fall. Regular trimming sessions, once every 6 weeks, are a must.

5. Shampooing in excess: Some of you prefer your scalp to be squeaky clean every single day, believing that daily dust and pollution require you to indulge in this unhealthy habit. Well, it’s best to stop right now as you’re harming your hair by shampooing daily. Daily shampoos can completely strip your hair of its natural oils, causing your scalp to become dry, leaving your hair with a dry, messy and rough feel. However. Delaying hair wash is not good either. It is best to shampoo whenever your hair feels greasy and dirty.

Avoid doing these to your hair, and let your tresses breathe so that they look healthy and shine with a natural glow.



5 Worst Things You Should Stop Doing to Your Hair!

Have you been noticing bumps on your skin surface? Does the top of this growth resemble a cauliflower and feel bumpy or smooth when you touch it? These are the symptoms of a disease known as warts, which is caused by HPV or human papillomavirus. Generally, warts are not very dangerous, but they are ugly, contagious and may cause pain as well. Warts may be caused by more than 100 types of HPV viruses. A certain type of HPV causes warts around the genitals. In women, these are called genital warts and it is a severe disease.

Treatment
All warts do not require treatment and disappear on their own. This is because over time, the body s immune system can destroy the HPV virus which causes warts. A wart needs to be treated when it is painful, embarrassing, gets irritating easily, spreads to other parts of the body or spreads to other people. The goal of the treatment is to eliminate or remove the wart, avoiding a scar tissue. Creating a scar tissue would cause more pain than the wart. The treatment of warts depends upon the type, location and specific symptoms of the disease.

Self-treatment
Warts can be treated at home using salicylic acid and duct tape. Most warts do not require treatment, but in case the symptoms worsen and do not go away on their own, you require proper care.
Medical treatment

The medical treatment for warts prescribed by a doctor includes the following:

Cryotherapy
Certain medicated creams and ointments
Surgical methods such as electrosurgery or laser surgery
Chemical peels with certain acids
Excision or cutting of the warts
Before going for a treatment, it is important to detect the exact type of wart. Treatment for some types of warts may be quite painful with the chances of a scar tissue. Warts which lie beneath the skin are difficult to treat and the doctor might need to make an incision on the skin over the wart to let the medicine penetrate through it.

An HPV vaccine can be taken to protect men and women from the common warts caused by HPV viruses. This vaccine can be taken up to the age of 26. The vaccine should be taken before getting sexually active and is more effective when taken before being exposed to the HPV virus. In order to prevent transmission of the HPV virus, having protected sex is recommended. In case of any severe symptoms of warts, you must consult a doctor immediately.

Warts - Dermatological Treatments For It!

One of the most common cosmetic procedures performed in the world today is that of breast augmentation or reduction. This is a fairly common surgery wherein depending on the requirement of the patients; the breasts are either made bigger with the help of implants or reduced in size by excising fat and tissue. Although a majority of these patients are female, there are an increasing number of male patients, who opt for male breast surgery as well.
The need for male breast surgery-
The requirement for male breast surgery arises due to the occurrence of Gynecomastia or the development of male breasts. In this condition, fat and glandular tissues are stored within the male chest in the pattern of female breasts, thus giving it a feminine look. This is a common occurrence among men and can be a cause of social embarrassment for the man as well as affecting his self esteem. Some of the causes for gynecomastia or male breasts would be  
Excessive Weight Gain.
Hormonal changes within the body where testosterone levels drop due to conditions such as  Hypogonadism  (in men, the inability of the testicle s to function correctly) and estrogen levels increase.
Medications used to treat other disorders such as certain anti -depressants, cancer medication, and anti-anxiety medications among others.
Excess consumption of alcohol and certain drugs.
Hyperthyroidism (excess thyroid secretion by the thyroid gland).
It isn t always just fat!
While many people tend to blame male breasts due to the accumulation of fat, this may not be the case always. Even skinny or people with an athletic build may notice misshapen chest that has more of a feminine appearance and thus would like to correct that. This is obviously caused by hormonal factors and genetics of body shape as well rather than just being obese or overweight.
Types of Male Breast Surgery-
Male breast surgery revolves around breast reduction and contouring to give it a more flat and toned look. This can be achieved in either of these ways:
Liposuction   This is a fairly common procedure and is minimally invasive; meant to suck out the fat through a small opening on the skin. With the help of liposuction, doctors can easily contour your chest to have a more masculine look by removing the excess fat. This procedure is a very popular one as it takes less time to recover and also isn t invasive. However, this is used as an option for male breast surgery when the problem isn t acute.
Surgery to remove excess tissues and fat   If the male breasts have excessive glandular tissue and the problem is acute, a more extensive form of surgery wherein the glandular tissue is excised may be required. However, this is also not very invasive and you can get back to your regular routine within a few days after surgery.


Male Breast Surgery

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