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

Eczema is an autoimmune disorder wherein the skin overreacts to certain triggers in or outside the body resulting in inflammation and lesions. Eczema is also known as atopic dermatitis. The skin becomes dry, patchy and rough, and it tends to form itchy and red blisters. Eczema is usually caused due to inflammation; in most cases, allergy triggers eczema. It has been observed that quite often, patients who suffer from eczema have a family history of allergy. In some cases, patients having other allergies, may also develop eczema. Apart from this, low immunity triggers this disease.

Symptoms

Red patches over skin
Dry rough skin with blisters
Intense itching on skin, with occasional bleeding
Formation of a thick leather-like layer over the affected areas of the skin
Discharge of an oozing watery and sticky liquid from the affected area, in case of wet eczema (In case of dry eczema, there is no watery discharge; the skin stays rough and dry.)
Treating eczema with homeopathy
Treating eczema might be possible by taking several medications. But treating doesn't mean curing. People who suffer from eczema know how irritating the disorder is. So they want a cure for eczema, which is possible with homeopathic medicines. Homeopathy is known for curing eczema, from the root. Basically, homeopathy helps to improve the immune system, as low immunity is responsible for causing allergies. When immunity is built, and low immunity quits from overreacting to several reactions, eczema is cured.

Here are five homeopathic medicines suitable for treating eczema:

Graphites: Graphites is one of the finest homeopathic medicines for treating wet eczema, when there is thick, oozing watery and sticky discharge. In most cases, the patient with this type of eczema suffers from constipation and obesity. He or she might be sensitive towards cold. Their usual skin becomes hard and cold, but the affected area remains dry and rough. The remedy is prescribed mostly to women with menstrual disorders.
Mezereum: This is the suitable for patients with eczema, which tends to form a leathery crust on the head. The patient might feel intense itching especially at night.
Hepar sulphur: This is suitable for eczema with formation of pus. The patient is usually too sensitive to cold. Intense itching, sneezing and sensitivity towards cold are the symptoms, which indicate the need for this medicine.
Dulcamara: This is one of the finest homeopathic medicines for eczema, which aggravates in damp or cold weather. Thick formation of yellowish crust and intense itching are the symptoms, which clearly indicate the need for this remedy.
Sulphur: This one is suitable for eczema with burning sensation along with intense itching. Symptoms usually worsen in summer and the skin feels rough and dry.

Eczema - 5 Best Homeopathic Remedies to Treat It

Diet and other lifestyle factors such as lack of exercise and high waist-hip ratio are seen to be the significant contributing factors of certain medical conditions, gallstones one among them. Gallstones have become a highly prevalent issue in India, with an increasing number of patients reporting abdominal pain and discomfort. And it is also seen to be more common in females than in males. If your doctor suspects this problem, then he would proceed with the diagnosis and treatment as applicable.

How are gallstones treated?
If gallstones are not leading to any signs or symptom, then in such cases the treatment is not required. However, if an individual suffers from any symptoms or a gallbladder attack, then the health care provider normally recommends undergoing surgery. This surgery is used for removing the gallbladder. Sometimes, the individual may not be in a condition to undergo surgery and, in such cases, conventional treatment may be used for curing the disorder.

The surgery for the removal of the gallbladder is known as the cholecystectomy and is one of the most common surgical interventions performed for people with gallstones. The gallbladder is not considered to be a significant organ in the human body. This means that an individual can easily survive without the gallbladder. As the gallbladder is removed, bile starts flowing out of the liver through common and hepatic bile ducts without creating any issues.

What are the surgical options required for removal of gallstones?
There are two types of surgeries used for removal of stones in the gallbladder. These are explained below.

Laparoscopic cholecystectomy: In this surgery, the surgeon makes small incisions in the abdomen for the insertion of a laparoscope, which has a tiny camera attached to it. This camera enables a magnified image to be sent to the video monitor so that the surgeon can see the tissues and organs clearly. At the same time, the surgeon uses certain instruments for carefully separating the gallbladder from the liver, bile ducts and other organs. Then the gallbladder is carefully removed through one of the small incisions. This is the most suitable options for the removal of the gallbladder since it is performed on an outpatient basis, which means that the patient can go home the same day.
Open cholecystectomy: This is done when the gallbladder has severe inflammation or infection or scars from different operations. This may also be performed at the time of the laparoscopic cholecystectomy. In such cases, the surgeon switches to open cholecystectomy as a safety means for the patient.
What to expect after the procedure?
A small percentage of the patients have softer and more frequent stools after the removal of the gallbladder. These changes in bowel habits are normally temporary, and they are required to be consulted with the expert.
Since the incidence of gallstones is found to be related to gallbladder cancer, it is essential to work with your doctor to avail proper treatment and avoid such dire complications.

Surgical Option To Remove Gallstones - Know Which One Will Be Better For You!

Eczema of the scalp, which results in itching, flaking, or crusting of the scalp, is called scalp peeling or is commonly referred to as  dandruff . This condition causes increased shedding of normal scalp skin cells. Dandruff may also be caused by a fungal infection, other than just dehydration of the scalp.

The causes of an extremely dry scalp, thereby causing dandruff or even bigger flakes falling from the head onto shoulders and clothes, may be due to scalp psoriasis, eczema, poor nutrition, generalized dehydration, exposure to too much direct heat, and using too much of shampoo.

The three types of dandruff that need to be treated are those resulting from fungal growth, dry scalp and the one resulting from product build-up.

Fungal growth: This kind of dandruff is a chronic condition, caused by increased oil content on the scalp or an off-balance pH of the scalp. It may also be due to poor cleansing habits, or even an allergic reaction to the hair products one uses. Try switching shampoos, conditioners, or styling products to sulfate-free formulas to cure this condition.
Dry scalp: Sometimes, the skin of the scalp is literally so parched and dry that it is flaky and falls away like snakeskin. People with this kind of dandruff usually have drier hair and notice a tightness in their scalp. To treat dry-scalp dandruff, it is wise to indulge one s hair with moisturizing and hydrating shampoos, cut down on or space out harsh chemical treatments like relaxers, permanents, or dyes, and take in more moisture from the inside - drink at least 8 eight-ounce glasses of water a day, and your skin (including your scalp) will show you results that you want. Eliminating sulfates from your shampoos or other hair care products will also help with dry scalp, since these ingredients help strip away natural oils. Brushing hair or massaging the scalp - either with bare fingertips or a few drops of oil - is another great treatment, since massage helps stimulate circulation and bring blood, nutrients, and oxygen to the scalp and hair.
Product buildup: The most common type of dandruff is due to product buildup. This is what happens when people with otherwise healthy manes and scalps use too many styling products, such as layering gels, hair serum, hairspray, wrap lotions, scalp oils, heat-protecting serum, and so on. Dandruff caused by product buildup usually looks more like small clumps or balls of dirt. It may have a brownish color, since all those products attract and trap plenty of dirt and sweat. Product-buildup dandruff also tends to appear sporadically, only when hair is in need of a wash, whereas other types of dandruff show up more quickly and regularly.
To treat this kind of dandruff, one should wash hair more often or simply aim for using minimum chemical-rich hair products. 

Scalp Peeling - It Can Be Of 3 Different Types?

Surgery using a laparoscope is the most common way to remove the gallbladder. A laparoscope is a thin, lighted tube that lets the doctor see inside our belly. It is a minimally invasive surgery in which small incisions and specialized tools are used to remove a diseased or infected gallbladder.

The gallbladder is a small organ that sits right under the liver and is credited with bile storage, which can help the body in breaking down various kinds of fats that enter it. So, what all do you need to know about this operation? read this list.

Reasons for gallbladder operation
The gallbladder is not a very efficient organ. It can lead to blockages and choking as the bile it stores can become very thick and difficult to handle. Also, this bile can harbour deposits that are hard ball like substances, usually known as gallbladder stones. The size of these stones can vary from the size of a grain to the size of a golf ball. 

Further, these gallbladder stones can cause infections, which can lead to symptoms like nausea, vomiting, bloating and more. Another reason can also be the gallbladder disease known as chloelithiasis, which can cause abdominal pain. Inflammation in the pancreas, also known as pancreatitis, can lead to gallbladder open removal surgery.

Risk
While the gallbladder removal surgery is usually considered a safe one, with little or no complications, there are risks attached to this surgery too. These include sudden and excessive bleeding and the creation of blood clots, allergic reactions to the drugs used as well as anaesthesia, blood vessel damage, accelerated heart rate which leads to an increased risk of contracting a heart attack or heart disease, infections, inflammation or swelling in the pancreas, and injuries caused to the bile duct during surgery.

You might also need this type of surgery if you have the following:
1. Biliary dyskinesia, which occurs when the gallbladder doesn't fill or empty correctly due to a defect
2. Choledocholithiasis, which occurs when gallstones move to the bile duct and potentially cause a blockage that prevents the gallbladder from draining
3. Cholecystitis, which is an inflammation of the gallbladder
4. Pancreatitis, which is an inflammation of the pancreas

Laparoscopic surgery is preferred over open cholecystectomy surgery because the smaller incisions that are made reduce your risk of infection, bleeding, and recovery time.

Preparation
To prepare for your gallbladder removal surgery, the doctor may ask you to have a prescription fluid so that your bowels are flushed clean. You may also be asked to fast for at least six hours before the surgery so that there is no hindrance to the same. Also, the use of an antibacterial soap to bathe is usually prescribed so that the risk of contracting infections decreases.

While this surgery can be a simple one, you will have to take due care after the surgery to ensure that the recovery is fast and virtually pain free.

All About Gallbladder Surgery

Sometimes, when it comes to problems in the abdominal area, an ultrasound is not clear enough for a diagnosis. In such cases, an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed. This procedure gives the doctor a clear view of the duodenum, bile duct, pancreatic ducts, gallbladder and papilla of Vater.

This procedure is usually performed under intravenous sedation without general anesthesia. This procedure involves the use of a duodenoscope, which can be described as a thin, long, flexible tube with a camera at one end. It also has a fiber optic bundle that transmits lights to the camera and a chip to transmit video images to a TV screen.

This is inserted through the patient s mouth and sent down the throat through the food pipe to the stomach and duodenum while the patient is lying on his or her back. The air pipe is left undisturbed so as to not interfere with the patient s breathing. Since the patient is not under general anesthesia, he or she can move and turn according to the doctor s needs. The papilla of Vater is a small nipple like structure with an opening to the bile duct and pancreatic duct. Once this has been identified, a small plastic catheter is passed through the duodenoscope into the bile duct or pancreatic duct through the papilla. Dye is then injected into the area and X-rays are taken of the bile ducts and pancreatic duct. In cases where a biopsy is needed, other instruments can also be passed through the endoscope. Plastic or metal stents can also be passed through this to relieve obstructions in the bile ducts and pancreatic ducts.

ERCP can be used to diagnose and treat a number of conditions in the liver, bile ducts, gall bladder, pancreas and papilla of Vater. These include:

  Blockage of the bile duct by gallstones, cancer, scars, tumors or compression from adjacent organs.

  Jaundice due to an obstructed bile duct. This can also cause light stools and dark urine.

  Persistent upper abdominal pain

  Unexplained weight loss and loss of appetite

  Diagnosing a Dysfunctioning Sphincter of Oddi within the Papilla of Vater

ERCP can also be used to confirm pancreatic cancer and cancer of the bile duct. Once the diagnosis is confirmed, the doctors can customize treatment according to the patient s needs.

Endoscopic Retrograde Cholangiopancreatography - Procedure and Results

Don't wait any longer, manage your Podiatrist online with a Lybrate doctor today

Consult for Podiatrist - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES