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

Foot problems can occur due to a number of causes that, in most cases, are easily diagnosed. An orthopedic is a specialized doctor whose advice you should seek if you have any kind of discomfort in one or both of your feet. Discomfort may include chronic or regular pain, difficulty in movement and/or disfigurement. These are generally a result of arthritis, physical injury or a genetic or hereditary condition. In some of the cases, the pain and discomfort can be treated without any surgery, by using medications. However, in extreme cases, where medication, physical therapy, and other such non-surgical methods fail to have any impact, surgery is the only way to go.

These surgeries are less invasive and require a limited recovery time. They are also one of the most successful types of surgery. The surgical procedure is successful in dealing with the main complaints of a foot problem. It successfully treats a foot by,

Relieving pain: The pain in your feet interferes with your work, making it difficult to carry on with your daily life, affecting your personal and social relationships. Pain often indicates an underlying problem, and it is easier and effective to treat the problem with a surgery, as it relieves you from the chronic pain.
Restoring function: If your feet do not function properly, it will be impossible for you to move, as they are necessary for mobility. When a simple stride becomes a problem, your whole lifestyle is affected. Accepting defeat is not an option. A good orthopedic can help you to get back to your normal daily life by surgically treating your feet thus ensuring they function properly.
Improving appearances: Foot deformity, due to a number of reasons such as polio or bone spurs, can lead to a restricted lifestyle. Movement is hampered and so is freedom. Surgically it can be treated and the appearance of your feet can be improved.
Arthritis is also a cause of a number of foot problems. In more cases than not, surgery becomes a necessity to treat your foot. Here are some of the surgeries that cater to arthritis-related foot problems:

Repairing Fracture: If the fracture is beyond repair by non-surgical methods, surgery is the last refuge for an orthopedic surgeon. Surgery will include repositioning of the bone and the use of supports to keep them in position.
Arthroscopic debridement: This surgical procedure helps to remove inflamed tissues or spurs from the joint.
Arthrodesis: Also known as joint fusion, it involves the removal of the ends of the bones at the joint and replacing them with metal pins or screws.
Osteotomy: The surgical procedure involves realignment of a joint by cutting the bone.

Foot Problems - Can They Be Treated By Surgery?

A common form of skin inflammation brought about by the fungal infection is called as Athlete's Foot and is most commonly seen among the athletes. In medical terms, this condition is called "tinea pedis". This generally starts in between the toes and gradually moves towards the toe nails, if left untreated. In the later stages, this infection has the tendency to move towards the palm region of the hands and other body surfaces, if left unchecked. Most often, this condition is referred to as the ringworm of the moccasin feet. 

Statistics have shown that about 15% of the population is affected by this condition. It is important to note that men have a higher chance of contracting this contagious condition than women. Young adults or old children are most likely to take the hit for this condition.

After a serious research, the National Health Service has come out with the finding that, Athlete's foot can be transmitted from one person to another either by direct or indirect contact. Any environment that is warm and moist serves as the perfect breeding place for the fungal species to cause this condition.

Getting them treated before the condition spreads to other parts of the body is a very important step that has to be taken by the person who has been diagnosed with this disease. Instead of worrying about the condition after it has set in, a few remedial precautions can be taken to prevent the onset of this disease. 

Some preventive measures are:

1.  Clean shoes and socks: The socks have to be changed at least twice a day and these must be able to absorb the sweat from the feet.

2.  Using a medicated powder: Normal talcum powder or an anti-fungal powder can be applied to the skin where the irritation prevails and this kills the fungi that might form on the surface.

3. Precaution after swimming and going for walk: The region between the toes has to be wiped clean after swimming, bathing or going for a long walk. The basic idea is to remove the excessive moisture from the skin.

4.  Using socks and sandals: The sandals must allow some breathing space for the skin on the legs and when at home, socks without shoes can be worn. 

Preventive measures help a great deal in avoiding the complications that arise out of this Athlete's foot.

Athlete's Foot - How To Prevent It?

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!

Sitting or standing slouched does not only look bad but also has a bad effect on your spine. If not addressed in time, bad posture can become a person s second nature. Over time bad posture can change the natural curvature of your spine and lead to a number of health issues. Here are a few tips that could help:

1. Follow the structure of the chair
We spend a lot of time on office chairs. A well-designed chair will follow ergonomic guidelines to support your body. However, this can help only if you sit on the chair properly. Distribute your weight evenly on the chair. Try to align your body to the center of the chair. To do this try keeping your ears, shoulder, and hips in a straight line. Alternate between sitting at the edge of your seat and against the backrest to relieve your back muscles.

2. Change Positions
Though you can t change your desk every few hours, you can change how you sit. Tiredness is one of the leading causes for slumping and bad posture. Thus, to maintain a good posture try changing positions frequently. Stretch every half hour or so. Getting up from your table and walking over to a colleague to tell them something instead of calling them can give your muscles a break.

3. Use posture-friendly props
Along with ergonomic chairs, there are a number of other ergonomic props that could help maintain good posture. This includes footrests, pillows to support the lower back and lumbar back supports. These props can help ease the strain on the back muscles. Using a chair with an adjustable back is also a good idea. While walking, invest in bags and backpacks that are ergonomically designed to distribute their weight evenly over the entire back.

4. Exercise right
Improved posture is one of the many benefits of regular exercise. Cardiovascular exercises such as walking, running, and swimming help condition the body and maintain a good balance. Exercises that strengthen the back muscles are also great for posture. These exercises support the muscles of the upper body and relieve stress on the back muscles.

5. Wear the right footwear
Wear shoes that fit right and support the arches of your foot. This can help you maintain your balance and improve posture. Avoid wearing high heels for extended periods of time as they could have a negative effect on your center of gravity. In case you have a concern or query you can always consult an expert & get answers to your questions!

Tips For Improving Posture And Ergonomics!

Tennis toe is also known as runner s toe since athletes are mostly runners; skiers and tennis players also get this injury often. Due to its ugly appearance, tennis toe is also known as a black toenail. This injury causes bleeding under the toe along with moderate to heavy pain. Although it is not considered to be type 1 serious injury, it can still force an athlete to abstain from participating in any events. The blood from the toenail might take its own sweet time to get out of the way. As a result, the recovery time for this injury can last for weeks together. This, unfortunately, is also an ideal condition for infection to set in.

How does it happen?
This condition may arise because of the friction between the toenail and the running shoes or constant downward pressure on the toe. In case if the shoe is tighter than normal, it can damage the toenail. If on the other hand, the shoe is very loose, it can result in similar condition due to heavy pressure on the nail. Tennis toe can also arise in a situation, if the toe constantly bangs the shoe from inside. Extreme hot weather may also result in toe swelling. Finally, one may encounter tennis toe if a blow is faced on the toe. Irrespective of the cause, the blood clots inside the nail resulting in swelling and pain. Too much damage might result in falling off of the toenail altogether.

Treatment plan:
1. If the tennis toe is minor, the injury resolves all by itself
2. The toenail should be clipped together to ensure that it does not result in any friction with the shoe.
3. During the injury, it is advised that a person wears bigger size shoes with wider toe space so that it does not result in any further irritation.
4. If the toenail is torn, make sure to tap it up so that adequate protection is there from outside forces.
5. In case the injury is serious a doctor might have to intervene and drain the blood with a surgical instrument.
6. Another medical solution is to remove the toenail surgically, drain the blood and tape it up for a good one week until new nail formation takes place.

Precautionary measure:
1. Running shoes should be at least half a size bigger than the normal size.
2. Toenails should be regularly trimmed in order to avoid any injury.
3. If a person has a tendency of sweating too much, it makes sense to wear a pair of socks at all times.
4. While running, shoe laces should be tightened to avoid sudden friction between the toe and the shoe resulting into tennis toe.

Tennis Toe - How it Should be Treated?

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