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

Do you know that dandruff causes acne?

Acne is a skin condition that happens when pores get clogged with dead skin cells and oil, giving rise to pimples. It can be caused by numerous reasons like hormonal changes, improper diet, stress, consumption of specific drugs, excessive use of cosmetic products etc. In addition to these factors, acne can be caused by dandruff too, which may not be known to most of you. It has been observed that people who suffer from dandruff problems are more prone to getting pimples.

How does dandruff cause acne?

Dandruff has been associated with presence of yeast or fungi, it is also associated with abnormal skin ultrastructure. Dandruff makes the skin on your scalp flaky. These dry flakes of skin are often responsible for clogging the pores on your face, mostly affecting your forehead. In this way, dandruff triggers appearance of acne and can worsen the condition of your skin if you already have pimples. Though acne is more common among teenagers, acne due to dandruff is mostly experienced by people above the age of 20.

How can you prevent acne due to dandruff?

Eradicating dandruff from your scalp is the best way to prevent acne breakouts on your skin due to dandruff. Here are some simple ways to keep acne due to dandruff away from your skin.

1. Ensure that your hair stays off your face

Keeping hair off your face will ensure that dandruff doesn't come in contact with your skin and clog pores, preventing pimples. For this, you can use hair bands or tie your hair in a ponytail or braid.

2. Brush your hair at least twice a day

Brushing your hair at least two times a day will ensure that the dead cells on your scalp are removed and don't get a chance to clog pores. This option is highly beneficial in getting rid of acne caused by dandruff.

3. Use medicated anti-dandruff shampoo

Topical medicated solutions like a medicated shampoo should be used as a treatment. Short contact period of shampoo with scalp is important for more benefit. Good conditioner should also be used after head wash with shampoo.

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

Do You Know that Dandruff Causes ACNE?

 Hives  or  urticaria  can be defined as an outbreak of reddish swollen bumps on the skin surface. This happens because of the body s response to involuntary histamine release by the skin s blood vessels (which in turn, cause a leakage of blood plasma). The infection generally lasts for about 5-6 weeks, varying significantly in sizes and shapes. Although it is not a serious medical condition, hives can posit considerable discomfort to the affected person (coupled with severe itching and a constant burning sensation near the spot).

Although the exact reason behind the development of this condition is still unknown, researchers suggest that there are some factors that initiate the disorder.

Hives can occur as a result of insect or parasite bites.
In some cases, this disorder might occur as a side effect of painkillers or anti-inflammatory drugs.
Excessive intake of alcohol or foods rich in proteins such as eggs, fish, nuts, chocolate, berries etc. might also cause hives.
Excessive exposure to the harmful UV rays of the sun or high levels of stress can also result in hives.
Also, suffering from serious underlying medical conditions such as cancer, hepatitis or thyroid disorders might drastically aggravate chances of chronic hives as well.
Symptoms

Development of numerous reddish welts around the face or the arms along with a severe itchy sensation, recurrent feeling of tightness around the chest and constant dizziness.
Oral inflammation
If not treated immediately after diagnosis, this disorder might cause life- threatening allergic reactions such as Anaphylaxis (a condition which narrows down the bronchial tubes and causes significant breathing troubles) and auto-immune disorders such as rheumatoid arthritis.

The homeopathic preparations useful for treating hives have been mentioned below:

Apis mellifica: This medication works best for a case of hives that has resulted from insect or parasite bites. Other symptoms that are taken care of by this medication include severe itching and a stinging sensation that worsens at night or with exposure to cold, coupled with mild fever.
Arsenicum album: This homeopathic preparation is effective to cure hives that include symptoms of a burning sensation, abnormal swelling, and constant restlessness.
Ichthyolum and Astacus: This preparation is effective to cure chronic hives caused due to serious medical conditions such as uric acid, tuberculosis, or excessive alcohol consumption. People suffering from this particular type exhibit symptoms such as a large appetite, irritability, and a constant itchiness.

Can Homeopathy Treat Hives?

Burn surgery is very common these days. Burn surgery is usually done on people who suffer from major burns. Reconstructive burn surgery is usually required in the last stages when the initial burns have healed to a certain extent. Usually reconstructive burn surgeries are done on patients who have suffered from huge accidents and have burnt their face, neck and hands to a great extent. Patients requiring this surgery usually become unrecognizable after an accident.

When is reconstructive burn surgery recommended?

If you have been involved in a household accident and the scars have not healed completely. Surgery might not totally heal the face, but it can improve your basic functions like breathing, smelling, seeing or tasting (if most of your senses are burnt and disfigured).
Reconstructive burn surgery is also very useful for acid attack victims. Sometimes, burns are not only caused by fire, but it is also caused by chemicals and acidic substances which are worse and can completely burn and disfigure your face. When hydrochloric acid, nitric acid and sulfuric acid come in contact with your skin it seeps into the skin and burns off your nose, cartilage and sometimes even causes blindness. It disfigures your face completely, reconstructive burn surgery can do miracles, though it cannot bring back your previous features and skin texture, but it does make you look more recognizable.
After a burn, facial scarring occurs which leads to the loss of eyelids, hair, nose and lips. In this case burn surgery is required.
How to take care of yourself after a burn surgery?

Regular stretching should be done, especially if the areas of your burn include your hands, legs, joints, etc. Do as much as activities as possible like getting dressed and grooming yourself. It will also make you more self-reliant and give you confidence.
Depression is very common after a burn surgery. A reconstructive burn surgery will not magically make you look the way you used to. A lot of sittings is required and remember, appearance and looks do not matter much. The wounds will fade away with time.
Itching is also very common after a burn surgery. If this problem persists, you should consult your doctor for a moisturizer.
Avoid sun exposure. Don t go out in the sun, because the U.V rays are extremely harmful and can singe your already sensitive skin; you can also get skin cancer.
Custom pressure garments should be worn to protect your skin.

Reconstructive Burn Surgery - How Can You Take Care Of It?

Facial surgery can be opted for by people for a number of reasons, and these include being born with facial impairments like cleft lip, birthmark or other birth defects, the effects of aging, sun damage, or other facial traumas that are noticeable on the face as well as a sense of general dissatisfaction with your facial features. Depending on these factors, facial plastic surgery can be divided into two categories:  reconstructive and cosmetic.

Reconstructive plastic surgery is performed for correcting conditions that may be present from birth, including birthmarks on the face, cleft lip and palate, protruding ears, and a crooked smile. Conditions resulting from accidents, traumas, or burns are also corrected by this type of surgery.

Cosmetic facial plastic surgery is performed to enhance the visual appearance of facial structures and features which include facelifts, eye lifts, rhinoplasty, cheek and chin implants, and liposuction. 

If you are planning to get facial surgery done, there are certain things you need to do to prepare yourself for it. These are:

Choose a qualified surgeon: It's important to choose a board-certified plastic surgeon or facial plastic surgeon who has experience performing the specific procedure you are considering. You should also ask to see before-and-after photos of the surgeon's previous patients.

Understand the risks: As with any surgery, facial surgery carries some risks, including infection, bleeding, and scarring. Make sure you understand the potential risks and complications of the procedure before making a decision.

Have realistic expectations: While facial surgery can produce excellent results, it is not a magic cure-all. It's important to have realistic expectations about what the surgery can and cannot do.

Follow post-surgery instructions: After your surgery, it's important to follow your surgeon's instructions for care and recovery. This will help ensure that you get the best possible results and minimize the risk of complications.

Schedule a surgery when you are healthy: If you are planning for either of the surgeries, try to schedule it during a period of relatively good health. Your immune system will have the best chance of a speedy recovery. Scheduling the surgery at the year-end is ideal when you can take a few days of paid leaves. 
Get enough essential nutrients: Your diet, before and after the surgery, should be rich in vitamin A, vitamin C, zinc, copper, and selenium. They help the wound to heal quickly and build immunity, thereby reducing the chances of an infection. You can recover from more comprehensive procedures like tummy tuck, facelift or liposuction by including the requisite nutrients in your diet.
Stay hydrated: Consuming 6-8 glasses on the day prior to the surgery is very important to help cleanse and hydrate the body. Since fluid intake is reduced on the day of surgery, water intake is especially important prior to the surgery. To avoid complications during surgery, ensure that you do not drink anything after midnight on the night prior to your surgery unless advised by your surgeon.
Overall, it's important to do your research and consult with a qualified surgeon before making a decision about facial surgery. Good luck!

Related Tip: "Causes and Risks of Craniofacial Surgery"

7 Things To Keep In Mind For Facial Surgery

The skin is the largest organ in the body and is one of the five sense organs, helping us with  touch.  The first outer layer is called the epidermis and the underlying layer is called the dermis. The skin has a protein known as keratin, which protects it from various external toxins and infections.

In some people, due to unknown reasons, there could be pile up of this protein in the deeper layers, producing small bumps, which feel like sandpaper. Literally, the term keratosis pilaris (KP) refers to piling up of keratin pigment. It can block the hair follicle that would normally open into the skin. When there are multiple blocks in the same area, there could be a sandpaper-like rough feeling to the touch. This gives this condition other names including goosebumps, chicken skin or chicken bumps. Though it is a cosmetic issue, it is medically a benign and very common condition.

Cause

KP, as it is popularly known as, is believed to be a genetic disorder with faulty genes leading to excessive accumulation of keratin. These appear as red, small bumps that are usually seen on the hands, arms, thighs, buttocks, and rarely on the face. The surrounding skin may be inflamed if there is a buildup of skin under the pile of keratin.

The onset of KP is usually in the first decade of life, worsens during puberty, and reduces during adulthood. There are, however, instances where the onset happens during adulthood. Twins and people with atopic dermatitis are more likely to have KP.

KP is more common in people with dry skin as oily skin seems to offer some protection.

There are also studies that give it a correlation with weather, with winter seeing more of this condition than summer. This is because our skin tends to dry more in winter than in summer. There could be some people who are completely normal during the summer months but will develop these bumps during the winter, which again subsides with the season.

Signs and Symptoms

As noted above, KP is a medically benign condition. There is a cosmetic concern if it is in the visible areas like arms and hands. Also, the area could feel rough and dry, but the affected person may not experience any itching or other harm. People with atopic dermatitis and eczema are more likely to develop KP; hence these other skin conditions require proper management.

Management

Patient education is the most important. This disease does not require any treatment and is usually self-limiting. It is very rare for KP to affect the whole body. Creams containing alpha hydroxy acid, salicylic acid, lactic acid, or vitamin A may be required to remove dead skin cells and to prevent clogged follicles from the bodies of the affected people.

Keratosis Pilaris: Signs, Causes, Treatment, and Prevention

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