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

Atopic dermatitis or as it is commonly known as, eczema, is one of the most common and recurring form of skin disease. Some of the common symptoms of eczema are redness, swelling of skin, temporary discoloration and dryness among others. It not only causes a significant amount of irritation, but is extremely persistent in its occurrence. Combating atopic dermatitis is a rather cumbersome task, often leading to anxiety and depression. It is indeed one of the most problematic skin hindrances. Dermatitis usually occurs due to the inflammation of the epidermis. 

Some of the more obvious causes are exposure to ultraviolet rays, familial predisposition, prolonged exposure to the offending allergen, latent infection, indigestion, hormonal imbalance among others. Occurrence of eczema considerably lowers the skin resistance and makes you vulnerable to various other skin troubles. Atopic dermatitis is especially congenital in nature. It has reported greater frequency in individuals whose family has some record of eczema or the other. Past incidents of asthma, hay fever may also act as triggers. Signs of eczema are usually manifested in itchy patches in the neck, scalp and palms. 

Given the commonness of the disease, there are numerous remedies for it as well. However, many vouch for the efficacy of homeopathy in curing such skin ailments. Homeopathy not only offers natural solutions to eczema but also detoxifies the system from within to curtail the frequency of such outbursts. Homeopathy also averts any kind of side effects. After closely scrutinizing the symptoms and their possible effects, homeopathy recommends a wide range of medicines to cure eczema. 

1. Sulphur: Sulphur is endowed with medicinal qualities. Used either as an ointment or in form of tablets, sulphur is used as arguably the best remedy for eczema.

2. Graphites: Graphites are extremely helpful in abating sticky oozes as well as eyelids. Graphites help in curing gelatinous discharges. 

3. Rhus Tox: Rhus Tox is an ideal therapy for dermatitis with itching and redness. It curtails the flare-ups and breakouts on skin. 

4. Mezereum: It is extremely helpful for weeping eruptions. It soothes intolerable itching and skin irritation.

5. Natrum Mur: Natrum Mur is extremely effective in curing hairline eczema.

Homeopathy and Atopic Dermatitis

Gallstones are bits of solid material that may be formed in the gallbladder. The gallbladder is a little organ located under the liver. You won't not know you have them until they've block your bile duct, causing pain that will need immediate medical intervention, and even hospitalisation in some cases.They may comprise of cholesterol, salt, or bilirubin, which consists of red platelets. Gallstones vary in size. They can be as little as a grain of sand or as even the size of an apricot in many cases.

Women are more likely to develop gallstones than men. Read on to know more:

Causes: There are a number of causes for this condition, especially in women. These causes are as follows:



Intake of anti-conception medication pills, hormone trade treatment for menopause side effects, or pregnancy
Fasting
Malfunctioning of the gall bladder
High cholesterol levels
Gallstones may be created when there is excessive amount of cholesterol in the bile discharged by the liver. This bile normally separates the cholesterol and helps in the normal functioning of the liver and other digestive organs of the body.
Bilirubin: Bilirubin is a substance created when your liver wrecks old red platelets. A few conditions, like cirrhosis of the liver and certain blood issues causes the liver to create more bilirubin than it ought to. This can lead to complicated conditions like gallstones.
Bile: Your gallbladder needs to exhaust bile to be sound. In the event that it discharges its bile content, the bile turns out to be excessively thick which causes stones to shape.
Weight: Being overweight or underweight can also cause a malfunction which can lead to the appearance of such stones. The diet also has a bearing in such cases.
Symptoms:

Fever
A yellowish tint in your skin or eyes, which can demonstrate jaundice
Sickness or retching
Clay coloured stools
Pain in the right upper quadrant of your stomach area
Nausea
Vomiting
Other digestive issues
Treatment:

Numerous individuals with gallstones may be asked to go through surgery to remove the gallbladder. These include the following:

Laparoscopic cholecystectomy: The specialist passes instruments, a light, and a camera through a few little cuts in the midsection.
Open cholecystectomy: The specialist makes bigger cuts in the belly to expel the gallbladder. You may have to spend a couple days in the hospital after the operation.
Without getting operated: If you have a mild condition and your specialist feels you shouldn't have an operation, he may recommend medicines like chenodiol, ursodiol, or both. These medications work by dissolving cholesterol stones. One may experience mild loose motions as a side effect.

Symptoms, Causes and Treatment of Gallstones in Women

Gallstones are solid deposits/stones of digestive fluids that form in the gall bladder. The size of these stones varies from person to person. While some people may develop only one stone in the bladder, others may develop multiple gallstones simultaneously.

Signs you must watch out for-

Abdominal pain
Pain in the back or between the shoulder blades
Vomiting and nausea
Heartburn
Bloating and indigestion
Change in bowel movement
Dark urine
Fever and chills
Rapid heartbeat
Yellowish skin and pale eyes (Jaundice)
These are the most common symptoms that a person with gallstones encounters. One should consult the doctor right away upon experiencing these symptoms. If ignored for long, these signs can aggravate and lead to further complications.

Complications that may arise from gallstones-
There are quite a few complications of gallstones, including the following-

Cholecystitis- when gallstones become stuck at the neck of the gallbladder, it causes inflammation.
Obstruction in the pancreatic duct- a gallstone blocking the pancreatic duct can cause pancreatitis followed by intense abdominal pain.
Blockage in the bile duct- if the gallstones create a blockage in your bile duct, the outcome may be an infection or jaundice.
Gallbladder cancer- people, who have a history of gallstones, are more likely to develop gallbladder cancer.
Treatment of Gallstones-
Gallstones can certainly be treated, if diagnosed early in time. To confirm the diagnosis, your doctor may perform a CT scan, X-ray, Ultrasound or an ERCP. Once the condition is diagnosed, your doctor will recommend a surgery to remove the stones in the gallbladder (known as Cholecystectomy). The preferred choice of surgery includes the following-

Laparoscopic removal- In most of the cases, the doctor adopts this minimally invasive approach to remove gallstones. First, he makes a small incision in the abdomen. He will then insert a tube-like instrument with an attached camera into the gallbladder to have a clear sight of the gallstones, and surgically remove them from the gallbladder.
Open surgery- This is performed under general anesthesia. During this procedure, a single, long incision of roughly 3-6 inches is made on the upper side of your right abdomen. The tissues and muscles are pulled back to divulge the gallbladder. The gallstones are then removed, and the incision stitched up. Open surgery is performed when laparoscopic surgery is not suitable for the patient.
Gallstones cannot be managed with just diet and medications. A surgery is usually needed to remove the stones and cure the patient. For Laparoscopic surgery, the rate of success is nearly over 95%. Identify the symptoms before it aggravates, and consult a doctor for treatment.

Gall Stones - Is Surgery The Only Treatment?

Eczema is a skin condition which is characterized by rough, cracked, red, itchy and inflamed skin. Sometimes it can also cause blisters. Eczema is also known as atopic dermatitis. It is a severe condition which starts during infancy and can go on throughout childhood. While some people may outgrow this condition, the rest might have it till adulthood.

Causes of Eczema:
1. Irritants- Certain irritants found in vegetables, meats, juices extracted from fresh fruits, disinfectants, shampoos, detergents and soaps can cause eczema.
2. Allergens- Dandruff, mold, pollens, pets and dust mites can also contribute to Eczema.
3. Microbes- Certain bacteria such as Staphylococcus Aureus, fungi and viruses can also cause eczema
4. Food products- Many people are allergic to food products such as wheat, soy products, seeds, nuts, eggs and dairy products. This might contribute to Eczema.
5. Stress- This doesn t cause eczema but can aggravate the symptoms of it.
6. Hormones- Women usually experience worsening of Eczema during certain stages of their menstrual cycle or during pregnancy.

Symptoms of eczema in infants and children:
1. Rashes appearing on the cheeks and scalp
2. Rashes which bubble up before fluid discharge
3. Rashes which cause itchiness and lead to disturbed sleeping; continuous scratching and rubbing can result in skin infections
4. Rashes which can appear behind the creases of the knees and the elbows; these rashes are also common on the legs, creases of the buttocks, ankles, wrists and neck.

Symptoms of Eczema in adults:
1. Rashes on the nape of the neck
2. Rashes on the eyes, face and neck
3. Rashes that can cause extremely dry skin
4. Extreme discomfort caused due to itching
5. Scaly skin caused due to rashes
6. Rashes which can result in skin infections
7. Lichenification, a condition wherein the rashes thicken and develop knots, is also a possibility.

How is Eczema treated?
1. Topical ointments and corticosteroid creams- These are anti-inflammatory medications which relieve symptoms of eczema such as itchiness and skin inflammation.
2. Antibiotics- These are usually prescribed if there is any underlying bacterial skin infection.
3. Antihistamines- These mainly reduce scratching at night. In some cases, it can also cause drowsiness.
4. Topical calcineurin inhibitors- This is a drug that suppresses activities of the immune system. It helps to prevent flare-ups and decrease inflammation.
5. Barrier repair moisturizers- These types of moisturizers repair the skin and reduce water loss from the skin.

Eczema - 5 Ways It Can Be Treated!

The gall bladder, which sits just below the rib cage to the right of the stomach, is very tender to touch. It is a little sac or storage compartment for bile, which is produced by the liver. The gallbladder emits bile into the small intestines via a duct referred to as the cystic duct. The entire process is meant to break down foods (namely fatty foods). 
Gallbladder attack symptoms may include one or more of the following:
1.Pain in the back right shoulder blade:
Sometimes, pain radiates through to the back shoulder blade on the right side or in the middle between the shoulder blades. This is pain from the gallbladder affecting the back of the shoulder. This back shoulder blade chest pain is one of the most common yet unknown symptoms of a gallbladder disorder. This can come and go or be constant. It may be sharp, excruciating or dull. It may also occur especially at night. A gallbladder attack will typically last for one to four hours.
2. Pain in the stomach: 
The most common symptom of a gallbladder problem is pain. This pain usually occurs in the mid to upper-right section of your abdomen. It can be mild and intermittent, or it can be quite severe and frequent. In some cases, the pain will begin to radiate to other areas of the body, including the back and chest.
3. Nausea or Vomiting: 
Nausea and vomiting are common symptoms among all types of gallbladder problems. But only a chronic gallbladder disease may cause digestive problems, such as acid reflux, gas, nausea, and vomiting.
4. Diarrhea:
Having more than four bowel movements a day for at least three months may be a sign of chronic gallbladder disease.
5. Fever or Chills:
An unexplained fever may signal that you have a bile duct infection. If you have an infection, you need treatment before it worsens and becomes dangerous. The infection can become life-threatening if it's allowed to spread to other parts of the body.
6. Unusual Stools or Urine: 
Lighter-colored stools and dark urine are possible signs of a common bile duct block.

Recognizing The Symptoms Of A Gall Bladder Attack

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