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

5 Signs of an Unhealthy Heart

The heart is a muscular organ that helps to pump blood through the circulatory system by periodic contractions and relaxations. The heart is one of the most important organs of the body so much so that a single cardiac arrest or a heart attack can lead to fatal consequences. Even so, a heart attack is one of the most leading causes of death in the country. But there are some earlier symptoms that could alert you ahead of time. The following are signs of an unhealthy heart:

1. Sexual problems

Erectile dysfunction (ED) is one of the most predictable reasons for cardiovascular conditions. Today, patients who are diagnosed with ED are also considered as cardiovascular patients. This is because the heart is supposedly not able to pump enough blood to the genital area. In case of women, reduced blood flow can hamper arousal and delay orgasms.

2. Snoring and sleep apnea

If one snores loudly enough to prevent their partner's from sleeping or resort to using earplugs, one may be at a risk of having a weak heart. Restricted breathing during sleep is connected with a host of cardiovascular diseases. Sleep apnea, a condition where breathing stops for a brief span of time, is linked with higher cardiovascular risks.

3. Swollen, sore and bleeding gums

Swollen and bleeding gums are not only symptoms of dental conditions but also of cardiovascular difficulties. Medical experts believe poor circulation of blood arises due to underlying heart conditions. Recent studies are focusing on bacteria that are believed to cause gum disease as well as plaque inside the arteries of the heart.

4. Heart Arrhythmia

Irregular heartbeat or heart arrhythmia is a common sign of a weak heart. It is characterized by both fast and slow beating of the heart. Restricted blood flow to the heart strains the electrical signals that maintain the normal beating of the heart. This is one of the common causes of coronary artery diseases.

5. Chest pain

One of the most apparent signs of coronary artery diseases is chest pain. The cause of the sharp, clutching pain in your chest can be build-up of plaque in the arteries, which could lead to fatal consequences.



5 Signs of an Unhealthy Heart

The habit of thumb sucking is very common in many toddlers and babies, but often disturbs the parents to a great extent. Before dealing with this habit, it is very imperative for parents to understand the cause of this behavior. The tendency of thumb sucking is quite normal for the babies as it makes them feel comforting.

Problems that occur with thumb sucking
There are certain problems that occur if the baby develops the habit of prolonged thumb sucking. The problem that occurs mainly on sucking the thumb for longer time is with the teeth of the toddlers which may result in speech problems. Some babies get over this habit of thumb sucking on their own without any adverse after affects. However, sometimes prolonged thumb sucking may result in irritation on the skin or lead to peeling off of the skin, causing discomfort and pain to the child. There are chances that even the nails on the fingers grow in a crooked manner because of infection caused by thumb sucking.

How to get your child to leave thumb sucking habit?

Parents must in any case not force their toddlers to stop this habit or get upset with them, as it can cause the toddler to develop this habit all the more.
A child mainly sucks his thumb for comfort, and the habit can be stopped by diverting their mind and offering the child a soft toy or giving them a special blanket.
It is better to give the toddler something to hold which makes him feel secure and comfortable.
It is very important to assess whether it is a problem before stopping the habit of thumb sucking. But if the habit continues, it may affect the alignment of the teeth.
It is always better to make use of ways like positive reinforcement and encouraging behavior change in your child. Parents must set up a reward system and take a note of the days the child does not suck his thumb. It is important that parents praise their child verbally and give them some reward at the end of the month.
The best and simple way to quit the habit of thumb sucking is to cover the thumb with a thumb guard or mittens.
The best way to help your child quit the habit would be to distract him or her and involve them in activities that would require the use of both the hands. Parents can keep their child busy by giving them puzzles or blocks to play.

Thumb-sucking Habit - 7 Things to Keep in Mind!

What you need to know about the ring-shaped rash called lupus

Lupus is an inflammatory disease that is chronic in nature. It occurs when your tissues and organs are attacked by your body's own immunity system. The inflammation that this disease causes can affect the other parts of your body as well, like the joints, kidneys, skin, brain etc. It is often difficult to diagnose because it lacks distinct symptoms. However, one of the most identifiable symptoms of lupus is a ring-shaped rash on the face.

Lupus can be caused by a number of factors like:

1. Excessive exposure to sunlight
2. Susceptibility towards infections
3. Certain anti-seizure, blood pressure and antibiotic medicines

Symptoms

The symptoms are neither distinct nor regular. However, some common symptoms could be-

1. Fatigue and fever
2. Pain in the joints, stiffness and swelling
3. Ring-shaped facial rash
4. Skin lesions on exposure to the sun
5. Chest pain and shortness of breath

What else can lupus lead to?

Several complications may arise if lupus is left untreated. Some of them are-

1. Kidney damage and failure
2. Hallucination, seizures, strokes and several other problems associated with the brain and the central nervous system
3. Anemia, blood clotting, vasculitis etc.
4. Increased susceptibility to pneumonia
5. Increased risk of heart attacks and other cardiovascular diseases

Treatment

Lupus is a significantly dangerous disease and medical help should be immediately sought if you think that you have symptoms associated with it. Treatment depends on the signs and symptoms of individual patients.

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


What You Need to Know about this RING-SHAPED Rash on Your FACE!

Peyronie's disease is a problem predominantly found in 3-9% of adult men, especially after 40 years of age. In the disease, a scar tissue is formed in the outer layer of the penis called tunica albuginea. Scar tissue is a just plaque inside the penis.

Peyronie's disease causes the penis to bend sideways or upwards and can make sex become difficult due to deformity and erection may be a painful process. It is usually associated with erectile dysfunctions, severe anxiety and reduced testosterone levels. It is worth noting that there are treatments for peyronie's disease, however, the pain often goes away on its own, generally, in 6-18 months of onset, but the deformity stays.

Here is everything you need to know about this disease:

Causes
It is not known exactly what causes peyronie's disease, however, there are some factors, which make it more likely than others. Here are those factors:

1. Trauma: this is the most common factor which causes peyronie's disease. It is believed that when someone suffers from tiny bleeding of the penis, which is very common in patients of diabetes, the plaque starts to build up. The injury or trauma, which causes the bleeding may go unnoticed as well.
2. Genes: genes are also a possible cause of peyronie's disease.

Symptoms
The symptoms of peyronie's disease vary, such as:
1. Pain on erection: there is usually pain in erection during the initial phase.
2. Bent penis: when the penis becomes hard before sex, it may bend downwards or sideways by more than 15 degree, so the vaginal entry becomes impossible or is painful for the partner.
3. Scars: tissue may form on other parts of the body, as well including the hand and feet. In fact, it has been said that men who have scarring in the hand, which affect the fingers are more likely to contract the disease as well.
One may see extensive scarring in hands in a disease called dupuytren's contracture. 

Treatment
1. Wait &amp; watch: it is worth noting the acute phase with pain is treated by wait and watch, controlling contributory factors like diabetes, low testosterone and psychogenic factors. Antioxidants are useful. Large number of cases are relieved of the pain in 1 to 1.5 years.
2. Intralesional injection: if the bend is significant enough to interfere in sexual functioning, it can be treated by injecting medicines in the plaque. The medicine, xiaflex is currently not available in india and other medicines given are not very effective.
3. Surgery: this is a last option when peyronie's disease has not gone on it's own and medicines are not helping either. The two most common procedures performed are removing the plaque and putting a tissue graft in its place and also removing the tissue opposite the plaque to counter the bending effect. The results are fairly good.

Going for a penile implant is the last option, which is a permanent solution and is commonly done in india. And, the success rate for penile implant is also very high.

Peyronie's Disease: About Bent Penis

Cold sores alternatively known as fever blisters is a viral infection, which usually occurs around the mouth.They occur in patches and heal within 2 to 4 weeks usually without leaving behind any scars. Cold sores are contagious and can be spread from person to person via close contact. Read on more to find all about them.

Symptoms
Usually cold sores passes through multiple stages
1. Tingling and itching: People usually experience a tingling, burning sensation around the lips prior to blisters, which may appear within a day or two after such a sensation.
2. Blisters: These blisters are small, filled with fluids and usually break out along the border of the skin and the lips. They can also occur around the nose or cheeks.
3. Oozing and crusting: The blisters have a tendency to burst which leaves shallow open sores which then usually crust over.

Some other symptoms, which accompany cold sores are fever, headache, sore throat, muscle aches and swollen lymph nodes.

Causes
Strands of the herpes simplex virus (HSV-1) typically cause cold sores. In some instances, HSV-2 can also cause cold sores. Cold sores are most contagious when they are in the form of oozing blisters. It can spread by sharing the same utensils, kissing, sharing towels and razors and also oral sex. Cold sores can be triggered due to several factors such as stress, fatigue, fever, hormonal changes and changes in the immune system.

Risk Factors
About 90% of adults worldwide test positive for this virus. People who have a weakened immune system are more prone to be infected by the virus. For example people suffering from eczema, AIDS and severe burns have a higher chance of contracting cold sores.

Complications
In certain cases,cold sores affect other parts of the body. Fingertips, hands, and some other parts of the body are affected by both HSV-1 and HSV-2 in some instances. It can also cause eye infections, which can lead to blindness or may even spread to the spinal cord and the brain in people who have a very weak immune system.

Treatment
Cold sores have no treatment and they usually clear up without any medication within 2 to 4 weeks. However certain antiviral medications are present which speed up the healing process.

All About Cold Sores

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