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

Genital warts are a sexually transmitted disease caused by the human papillomavirus (HPV) and affects both men and women. Genital warts are treatable but can come back if the underlying infection is not treated properly.

Genital Warts appear as soft growths on the genitals and are known to cause itching, pain and discomfort. Although the disease affects both men and women, it causes more complications in women as some strains of HPV can cause cancer of the cervix and vulva.

Warts can appear on the penis, scrotum, groin, thighs, inside or around the anus for men. These can appear inside of the vagina or anus, outside of the vagina or anus or cervix for women. They can also appear on the mouth, lips, tongue, throat of the person who engages in oral sex with an infected person. Sometimes the warts may be invisible to the eye and still cause symptoms like vaginal discharge, itching, bleeding or a burning sensation.

Symptoms of Genital Warts: HPV is very common and nearly 70 pc of the people are infected around the genital area. The Center for Disease control (CDC) says that most sexually active people, are affected by the disease at some point of there life. It is important to note that although the disease is transmittable through skin-to-skin contact, it doesn't spread from the hand to the genitals or vice versa.

Diagnosis: 

Genital Warts can be diagnosed by performing a physical examination of the infected areas by a medical professional. Since some warts can be inside a woman's body, a doctor may have to conduct a pelvic exam. While conducting the test they use a mild acidic solution which makes the Genital Warts more visible.
A Pap smear test may also be conducted, in which a swab of the area is taken from inside your cervix. Apart from that doctors may also ask questions about a person's sexual history as well as health as ask if they have participated in unprotected sex, including oral sex.

Treatment: Visible Genital warts go away with time; however treatment is essential to prevent their return. The virus cannot be eliminated once it is in your bloodstream, which makes it possible that an infected person will have many break outs in their life. Managing the symptoms of Genital warts is important as they can be easily passed on to your sexual partner, even if there are no visible symptoms.

Genital Warts - How They Can be Diagnosed?

Losing weight for an obese person is a big achievement, but mere weight loss may not give them the desire look. Dramatic weight loss often causes excess skin to hang in folds. This can be both embarrassing and unappealing. While exercising and dieting can reduce fat, there is no way to deal with this excess skin other than surgery. Body contouring refers to plastic surgery procedures that address this. 

There are many type of body contouring surgeries. Face lifts, tummy tucks and breast lift procedures are common examples of such surgeries. Body contouring surgeries that follow weight loss usually address more than one area.  The lower body lift, which focuses on the tummy, midsection and thighs is one of the most common procedures. Though such a surgery is usually performed by a team of surgeons who simultaneously focus on different parts of the body, a body contouring surgery can take up to 8 hours. People who have undergone drastic weight loss may still need multiple surgeries to achieve the desired look. 

The risks of such a surgery are similar to other procedures that are performed under anesthesia. The most common complications experienced after this surgery are infections of the wound, seroma formation, slow healing of the wound, excessive bleeding and reopening of the wound. Patients may also notice a difference in the quality of their skin. This can lead to slow wound healing, skin laxity and issues related to scarring. For the overall cosmetic results to be appreciated, the patient must wait for at least 3 months. The scars can take up to a year to heal and blend with the rest of the skin. Body contouring is also a surgery that is not covered by most insurance policies and can be quite expensive. 

If you are considering this surgery, ensure that your weight remains stable for 3 to 6 months before the surgery. This will ensure that the surgery has long lasting results. Weight fluctuations, both gain and loss can lead to the need for additional procedures. If your weight loss is a result of bariatric surgery, you may need to wait a year before undergoing a contouring procedure. Instead of opting for an overall contouring procedure, prioritize your problem areas and address these first. You may realize that you do not need additional surgeries. You should also be aware that though this surgery removes excess skin, it will not leave you with flawless skin. the scars caused by this surgery may lighten over time but are permanent.

Facts About Body Contouring Surgery

The process of breast augmentation, popularly known as breast enlargement or implants, effectively increases the size of the breasts through insertion of silicone gel implants or saline implants. It is known to be popular among women and is frequently done and shows quite satisfying results.

Why do women opt for breast augmentation?

Some women opt for implants to enhance their figure
Others opt for implants, when they experience some sort of sagging or alteration to their breast after a pregnancy or after losing some weight and even due to old age.
Some women also choose enhancement surgery, if they feel that one breast is smaller than the other.
What does a breast augmentation procedure involve?

Breast augmentation surgery is generally performed, while the patient is under the influence of general anaesthesia. In case of enhancement with the help of implants, an incision is made in the breast tissue and a pocket is created to place the implants. Once these implants are successfully placed the incision is closed and is allowed to heal.

What sort of implants is available?
There are basically 4 types of implants that are recommended on the basis of the body type:

Saline filled breast implants: These implants contain sterile water and are either pre-filled or filled during the surgery.
Silicone filled breast implants: These implants contain soft elastic gel and come prefilled. These types of implants also require an incision which is longer in size.
Cohesive gel silicone implants: Commonly known as 'form stable'implants, they contain cohesive gel that is more firm and thicker than normal silicone implants.
Autologous fat transfer: It consists of fat that has been removed through liposuction from a part of the body, like the abdomen or thighs. The fat is then refined and injected into the breasts. However, implants done through this method is not very common and is currently under research.
Breast implants are generally supposed to last for life, but on occasions they may need replacement. Thus regular check ups are essential, so as to monitor the condition of the implants.

All About Breast Augmentation

Eczema is a common skin problem that appears as red, raised rashes on the skin, commonly the face, neck, elbows, hands, and feet. Considered as an allergic response, it is often seen in people who have a predisposition to other allergies like asthma, hay fever, hives, etc.

The good news is that these have identified patterns, and there are things that can be easily done which can prevent flare-ups.

Reduce soap: Soaps are known to dry the skin up and irritate the skin, so eczema flare-up is common in those who love to lather themselves up. If possible, switch to soap or body wash that contains moisturizer as reduce the bacterial load on the skin. People who live in hot and humid locations, such as Mumbai it is important that they cleanse their face completely, else it can lead eczema eruption. 
Moisturize: Keep a moisturizer handy at all times. Eczema is common when the skin is dry, so keep applying moisturizer at regular intervals and keep eczema at bay. Make it a habit to apply moisturizer soon after the bath. The moist skin soaks it in nicely and provides maximum benefit when applied this way.
Avoid artificial fragrances: While deodorants and skin care creams which contain fragrances smell appealing, they also cause irritation and are harsh on the skin. This exacerbates eczema, and so avoiding these products is advised.
Know your trigger: This could be anything from a dishwasher liquid to a bath soap or a deodorant to some plant in your garden. Over a period of time, you will be able to identify the trigger, and avoid it so that eczema does not flare up. Remember, it is a type of allergy after all.
Detergents for washing clothes: Using milder detergents, especially for undergarments, greatly helps. Also, wash these twice to get rid of all the soap. Avoid fabric softeners as they are fragrant and can cause irritation.
Avoid hot baths: While a hot bath at the end of a long day sounds very relaxing, it also leaves your skin dry. This can worsen the condition of eczema. Add to this the irritation from your bedspread and pillow covers. Unless you have the habit of applying copious amounts of moisturizer before going to sleep.
Cover up your hands and face: When possible, use gloves and a mask especially when washing dishes and using laundry detergents. This way, you can prevent dryness and irritation of the skin on the hands and prevent eczema.
Soak it in the tub: When you stay for about 20 minutes in a tub (no hot water though, but lukewarm), the skin absorbs moisture which prevents it from drying. This greatly helps prevent eczema.
Cut down stress: Like any allergy, eczema acts up when stressed, so manage it. There is no point stressing anyways!

Eczema - How To Prevent Its Flare-ups?

Burning your skin is a very traumatic experience and can leave behind scars that remind one of the traumatic incident. Scarring caused by burns may fade a little with time but are usually permanent. Apart from affecting your appearance severe burns can also affect the functioning of the body. Burns can make a person withdraw socially by making him or her afraid of how people will accept them with their scars as well as make them depressed about their appearance.

Burn repair surgery can be categorised under two headings: Acute and Reconstructive

Acute repair surgery happens immediately after the burn and deals with large burns and burns that affect critical areas. The focus here is to close the skin in case of open burns and help the skin heal.
Reconstructive burn surgery addresses the skin after the initial burn wounds have healed. The goal here is to improve the appearance of the scars and ensure no lasting loss of functioning. Reconstructive burn surgery has a high success rate.
There are many types of reconstructive surgeries for burns and the type of surgery best suited to a patient is based on the location of the scar, the extent of scarring and the patient s personal goals.

Skin grafts: This involves the removal of healthy skin tissues from one part of the body and transplanting it to the burn site. This skin graft may include only a few outer layers of skin or may involve the entire dermis. This is used in cases of severe burns where a large section of the dermis is affected.
Microsurgery: This is a procedure where the surgeon reattaches or reconstructs severed fingers, toes, ears etc by sewing together blood vessels and nerves. This is often used alongside other surgical procedures.
Free flap procedure: In this procedure, muscle, bone or skin is transferred from one part of the body to another to reconstruct the area. This type of surgery is often accompanied by microsurgery.
Tissue expansion: This involves the insertion of a balloon expander under the skin near the burn site. As the balloon is filled with saline, the skin stretches and grows. Once the skin has stretched enough, the expander is removed and the skin can then be used to repair burn scars.
This procedure has many advantages as the skin colour and texture are a near perfect match thus reducing scarring to a large extent. However, it is a very slow procedure and can take a few months.

Burn Repair Surgery - How Effective It Is?

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