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

The abnormal growth of the endometrium tissue outside the uterus is known as endometriosis. Ideally, the abnormal tissue is supposed to break down and exit the body. However, in this condition, the tissue is unable to pass out of the body. As a result, the surrounding tissue tends to get irritated and leads to the formation of scar tissues.

The various causes of endometriosis include:

Immune system disorder: Complications in the immune system might render it incapable of destroying the endometrial tissue that grows outside the uterus.
Surgical scar implantation: Certain surgeries such as a C-section may result in the attachment of endometrial cells to the incision area.
Embryonic cell transport: These cells may be transported to other parts of the body by the blood vessels which may lead to endometriosis.
Retrograde menstruation: Instead of passing out of the body, under this condition, the blood flows back into the pelvic region via the fallopian tubes. When these cells attach themselves to the pelvic cavity, it causes endometriosis.
Symptoms
1. Pain during sexual intercourse
2. Pain during periods including pelvic pain, especially during periods, lower back pain and abdominal pain.
3. Excessive bleeding during periods
4. Fatigue
5. Constipation
6. Bloating

The major complication that results is fertility problems. Endometriosis may prevent the combination of the egg and the sperm and thus, impairs your ability to conceive. It is recommended not to delay pregnancy if you have endometriosis. This disorder also tends to increase the risk of ovarian cancer in some women.

How can it be treated?

Endometriosis is usually done using surgery or medications. 

Medication: It usually involves painkillers.
Hormone therapy: Some of the hormonal therapies include:
Hormonal contraceptives
Progestin therapy
Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists
Conservative surgery: If a patient wants to become pregnant, surgery is done as much as possible without harming the uterus and ovaries. Suggested procedures include laparoscopy and traditional abdominal surgery.
Assisted reproductive technologies: An example of this form of treatment is In Vitro Fertilization.
Hysterectomy: Under severe circumstances, total hysterectomy is conducted in order to facilitate the removal of cervix and uterus. If you wish to discuss about any specific problem, you can consult a gynaecologist and ask a free question.

Endometriosis - 4 Reasons Behind it!

Infestation on the skin caused by a tiny insect called sarcoptes scabiei, which live on the skin up to 2 months, is called scabies. Reproduction occurs on the surface of the skin and later they tunnel into the skin and lay eggs. This forms an extremely irritated, pimple-like rash structure on the skin.

Despite the fact that scabies can be troublesome, the infestation can usually be dealt with successfully. Treatment commonly comprises of drugs that eliminate the scabies parasites and their eggs. Since scabies is so infectious, specialists usually prescribe treatment for a whole gathering of individuals who come in successive contact with people having scabies.

Symptoms
Typical symptoms such as rashes and intense itching, appear up to 6 weeks since initial exposure. Infected sores, which may require additional treatment, are formed due to continuous scratching. Common sites for occurrence in babies are head, neck, face and hands while in adults, it occurs on the wrist, elbow, waist, penis, armpits, etc. The rash comprises of small blisters or pimple-like knocks which are the tunnel tracks of the mite apparent on the skin.

A more severe form of the condition, called crusted scabies may be developed in some people. This condition which is highly contagious is marked by thick crusts containing thousands of eggs and mites which developed on the skin. It usually occurs in people with weak immune systems. The mites are capable of overpowering the immune system and multiplying at a higher rate.

Treatment

Typical treatment includes disposing of the infestation with medicine balms, creams, and moisturizers. It is advisable to apply the cream all over the body and at night, when the mites are active.
Amid the main week of treatment, it might appear as though the symptoms are worsening. Nonetheless, after the initial week, you'll see less tingling and you should have recovered by the fourth week of treatment.

Precautions should be taken to prevent re-infestation as the mites are capable of living up to 72 hours after being abolished from the body. All clothing must be washed with hot water (122f). This should be followed by drying of the items at a high temperature for half an hour. Finally, the dried items should be vacuumed.

Symptoms and Treatment of Scabies

"While the reasons of those embarassing whilte flakes on your shirt range from dry weather, hormonal imbalance, imperfect diet to stress or health conditions. Here are some handpicked methods that work best, to get rid of Danduff-
1. Regular hair wash, preferebly with an antidandruff shampoo with gentle head massage and cold water
2. Adopt diet rich in Zinc and Vitamin B. Try cold-water fish, flax seeds, walnuts, eggs and leafy green vegies.
3. Easy home remedies like tea tree oil, lemon, green tea, curd etc help immensely in the treatment of dandruff.
4. Hair styling products can aggravate the problem of dandruff. Avoid use of hair styling gel or spray.
"

5 ways to dust off Dandruff

Dandruff is a very common hair condition which affects the hair follicles and the scalp of thousands of people. Dandruff tends to weaken the hair strands and also causes numerous hair related problems. White flakes in small numbers are not an issue to be considered because the dried out cells tend to fall off that way. But when you see that the white flakes are increasing at a rapid rate, you should understand that you have the problem of Dandruff.

So, how are you going to get rid of this? Ayurveda can be the best way to treat such a problem. Different Ayurvedic remedies have been helping people to get rid of dandruff in a very natural way without any kind of side effects. So, let us have a look at some brilliant ways in which Ayurveda can help you.
Camphor with coconut oil
A small amount of camphor with coconut oil has been helping people to get rid of dandruff for a very long time. Using this mixture will help you to get rid of dandruff and also cool down your scalp.

Lemon with coconut oil
Lemon is a very common ingredient which is used to treat dandruff. So, if you mix lemon juice with coconut oil and apply it on your scalp then you will get rid of dandruff in a very natural way. Apply this oil regularly before you take a bath and you will see some amazing benefits.

Neem leaves with lemon 
Neem is one of the most important Ayurvedic ingredient. Take some neem leaves and turn them into a paste and mix this with some lemon juice. Apply this paste on your scalp and keep it for some time for around 30 minutes. You will see brilliant results within a week or two if you apply this every day.

Fenugreek seeds 
Fenugreek is also a brilliant Ayurvedic ingredient, if used the right way, can provide you with some amazing results. Soak some fenugreek seeds overnight in water and then turn it into a paste. After this apply the paste on your scalp for around 20 to 25 minutes and wash it off. It will not only help you to get rid of dandruff but also increase the strength of your hair follicles.

Amla paste 
You might have heard that consuming amla is beneficial for your health. It is a brilliant dose of antioxidants and also gives your metabolism a much-needed boost. But amla can also help you get rid of dandruff effectively. Make some paste out of Amla powder and apply it on your scalp for 15-20 minutes before you wash it. This will help your scalp to detoxify and remove all dandruff.

So these are some of the best ayurvedic ways which can help you get rid of dandruff from your scalp. Ayurvedic remedies do not have any kind of side effects and therefore, you can choose any of these processes to have a dandruff-free scalp.

Ayurvedic Ways Of Maintaining Dandruff-Free Scalp!

Ringworm of the scalp usually affects children. This is a common type of a fungal infection of the scalp and has nothing to do with the worms as the name suggests. This is treated with antifungal medications and though the antifungal shampo-is not to-effective, it might be advised along with medication.

Causes of scalp ringworm:

 Most of the times a ringworm infection is transfered from person to person through sharing towels and touching. The fungi and its spores can remain alive on brushes, combs, sheets, furniture and unwashed towels for long. Some people are only carriers of fungi, meaning that they carry the fungi and its spores in their hair and skin but do not have any infection and symptoms. But they might pass the fungi to others who may develop the symptoms.
 It spreads from pets like cats and dogs who are very prone to fungal infection of the skin. They easily pass their infection to children and other family members. Farm animals are also a source of fungal infection and if the farm gate is touched from where the infected cattle passes, it is enough to cause infection.
 Also at times there is no reason and fungi infection can just happen out of the blue. Like for example, the fungi spores can get transmitted through air, they might get into the air by an infected person and land on someone else's head. This can develop into fungi and can cause infection.

Symptoms of scalp ringworm:

 The infection looks more like dandruff, a severe form of dandruff in different parts of the scalp. This is often mistaken to be psoriasis.
 In some infection there is loss of hair leading to bald patches. These patches become scaly and inflamed. The patches might have broken off small hair.
 Several painful pustules and boils occur on the scalp
 In severe infection there is boggy swelling on some part of the scalp, which is known as kerion. This might be tender and oozing and if not treated can lead to hair loss and permanent scarring.
 In severe infections like with pustules and kerion, one might develop high fever and the glands of the neck might swell. 

Treatment of scalp ringworm:
The treatment of the fungal infection of the scalp involves the following:

 Antifungal medicines: these are usually taken in the form of tablets and following are advised:
 Griseofulvin: this is often the first choice and a course of 8-12 weeks is required. The tablet can be crushed and taken with water.
 Terbinafine: the course for this is four weeks and is important to complete the course in order to get rid of the infection.

Fungal Infection on Scalp: How to Treat It?

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