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

Is Hair Transplant Surgery a Lasting Option?

Hair transplant surgery is the technique wherein hair is taken out from other parts of your body and grafted on the scalp to treat baldness. Basically, these are such hair follicles that are genetically resistant to balding; therefore, they serve as a permanent treatment for hair loss. Experts believe that in most cases, hair transplant surgery is a lasting option.

How long does the transplant last?

If you are worried about the length of time for which your hair transplant will last, you can be assured that it may even last a lifetime. Only a few among the transplanted hair are lost with time but this loss is not very noticeable.

Reason why hair transplant surgery can be considered as a lasting option

Hair transplant surgery is naturally a lasting and safe treatment for hair loss, as the chances for your body to reject the intervention in the form of implanted hair is minimal. This is because the technique that is used involves taking your own hair out from the follicle roots, (mostly from areas like the neck or the back and sides of your head) where they are not needed so much and place them in specially designed holes in the bald areas. Since no external factors are involved, the body does not tend to reject the transplant.

Supplementary Treatment

Hair transplant surgery is anyway a lasting option but just as everything else, it may require a little care over time. Hair may still be lost from those parts of your head that have not been subject to the implantation, so those areas do require little efforts in order for you to maintain the overall results. Occasional touch-up sessions along with easy, non-surgical treatments such as laser therapy, rogaine, and Propecia would ensure a permanent and lasting solution to all your problems related to hair loss and baldness. Such supplementary treatment solidifies the hair follicles that have been transplanted and also decreases the chances of hair loss from hair follicles that were not treated during transplantation.



Is Hair Transplant Surgery a Lasting Option?

Vitiligo is a type of skin disorder. It is an autoimmune disease in which the melanin cell stops functioning or starts dying, and forms blotches on the skin. It can affect any part of the skin. It may also affect the inside of the mouth and hair.

There are many treatments available to restore the pigmentation of the skin. However, one of the most trusted and reliable treatments is described in Ayurveda. According to Ayurveda, there are tons of ways available in the house. By using these remedies, one can easily and adequately treat Vitiligo without any side effects. In Ayurveda, Mustard oil is one of the most significant remedies. Mustard oil is very beneficial to heal this type of skin disease.

Know More About Mustard Oil:

Mustard oil is extracted from the mustard seed by the process of steam distillation. The connotations of this oil may vary depending upon the part of the world the mustard seed is coming from. In some countries, mustard oil is only used for massage purposes. However, in many countries, it is considered edible. In both cases, mustard oil has millions of medicinal values and health benefits.  

Nutritional Value of Mustard Oil:

Mustard oil is packed with all the nutrients of the mustard seed. In 1 litre of mustard oil, there are 844 calories. Mustard oil has a total fat content of 100 grams which includes 21 grams of polyunsaturated fat, 12 grams of saturated fat, and 59 grams monounsaturated fat. It has zero content of sodium, carbohydrates, and protein. It also contains some important fatty acids such as  linoleic, oleic, and erucic acid along with some important substance called Allyl isothiocyanate, that has several health benefits.

Benefits of Mustard Oil:

There are many health and medicinal benefits of mustard oil. Some of them are:

Mustard essential oil improves blood circulation.

Mustard oil helps in digestion by keeping the digestive system intact.

Mustard oil boosts appetite and makes a person feel full.

Mustard essential oils fight bacterial infections.

Mustard essential oils prevent fungal infections.

Mustard oil repels insects.

Mustard oil is good for hair.

It is also beneficial for many orthopaedic problems like arthritis, lumbar pain, cervical pain, vertigo, etc.

Mustard is also used for the treatment of Vitiligo.

How Is Mustard Oil Used To Treat Vitiligo?

Mustard oil is one of the most popular home remedies used to heal Vitiligo. It helps in producing intense melanoid pigments and one can observe pigment initiation within 10 days. Regular use of mustard oil in food, massaging, or in the form paste will help to treat this skin disorder.

According to a recent study, mustard or mustard oil has enormous therapeutic potential for treating Vitiligo. Paste of mustard oil and turmeric will help intensify the pigments of the skin.  

Take Away:

There are many home remedies available used to cure Vitiligo and mustard oil is one such ingredient. It is the most popular and scientifically proven method for the treatment of Vitiligo. However, it is best to consult a dermatologist or physician before opting for any of these remedies. Everyone s skin and internal function is different and hence it is better to always go for the options which are prescribed for better and safe result.

How Is Mustard Oil Beneficial In Vitiligo Treatment?

Lymphedema is a condition that typically affects the arms and legs. The most common cause of this condition is damage to the lymph nodes or their removal as part of a cancer treatment program. There is no known cure for this condition. However, surgeries such as Vascularized lymph node transfer surgery may help deal with it better.

Vascularized lymph node transfer surgery involves replacing the affected lymph nodes with healthy lymph nodes from other parts of the body. This allows blood to flow more easily and restores or augments the lymphatic drainage system. In most cases, the healthy lymph nodes are harvested from the patient s groin. This procedure is relatively new, and its limits are still being explored by doctors. In cases of breast cancer that causes lymphedema in the upper limbs, this procedure may be performed along with breast reconstruction.

To be a viable candidate for this procedure the patient must have maximized control over lymphedema through other forms of lymphedema therapy. This therapy will need to be restarted after the surgery to ensure good results. The lymphedema diagnosis should also be less than 5 years old such that the patient s lymphedema is in its early stages.

As with any other surgical procedure, there are certain risks associated with this procedure. These can include

Reaction to anesthesia
Bleeding
Infection
Scarring at the site and poor healing
Damage to adjacent blood vessels
Nerve damage that can cause a temporary loss of sensation
Muscle weakness
Numbness ta the sites from where healthy lymph nodes were harvested
Risk of Lymphedema in the area where the lymph nodes were harvested from
After the surgery, the patient will need to keep pressure off the site where the lymph nodes have been transferred. The surgery site may be bandaged but compression garments will not need to be worn. On being discharged the patient may resume normal activities such as driving and work. High-intensity exercises that involve the use of the operated limb should be avoided for at least a month after the surgery. Compression garments should not be used until recommended by the doctor or a minimum of 2 weeks post-surgery. They will also need to schedule review consultations with the doctor. The schedule followed usually involves check-ups after 2 weeks, 1 month, 3 months, 6 months, 9 months and 1 year. 

Lymphedema - Vascularized Lymph Node Transfer Surgery!

A common skin condition, which causes the discoloration of your skin in patches across the face, melasma is more of a social embarrassment and cause for distress rather than being a serious condition. Although it affects men as well, studies have shown that over 90 percent of patients are women. It is also known as the mask of pregnancy as many pregnant women develop this skin condition.

Causes of Melasma
Primary causes of melasma have been attributed to various hormonal changes within the body. Let's look at some of the factors that may cause this disorder:
1. Pregnancy: This is often attributed as the leading cause of melasma, the primary cause has often been attributed to hormonal changes that a woman may experience due to pregnancy.

2. Treatments that may change hormonal balance: Women on contraceptive pills or who have implants such as intrauterine devices may also develop this disorder. This is due to the balance of estrogen and progesterone being changed within the body.

3. Sun exposure: Continued sun exposure may also lead to melasma. This is due to the activation of melanocytes within the body which start producing more melanin.

4. Stress: Long periods of stress on the body can also trigger hormonal changes and cause melasma.

5. Thyroid problems: If someone suffers from Hypothyroidism or low levels of the thyroid hormone, it can trigger other hormonal changes and also cause this skin disorder. 
It has also been noticed that people with generally a darker skin tone tend to get melasma and it is less common in people with fairer skin.

Certain characteristics of Melasma
Melasma develops in certain patterns which can be easily diagnosed either as spots on the skin similar to freckles or brown patches of skin that grow bigger. Some of these patterns are:
a. Malar pattern: This grows on the nose and cheeks
b. Mandibular pattern: Starts growing around the jaw line
c. Brachial melasma: This grows on the upper arms and shoulders
d. Lateral cheek pattern: Grows on the cheek on both sides of the face
e. Centrofacial pattern: Nose, upper lips, forehead and cheeks

Treatment of Melasma
Most women who develop melasma during pregnancy report that it goes away after childbirth. However certain forms of melasma may appear in non-pregnant women due to hormonal changes. Treating the underlying hormonal changes usually resolves the problem. However certain other methods may be required to resolve the issues such as skin creams, chemical peels, dermabrasion and microdermabrasion.

All About Melasma

How to control hair loss through Ayurveda?

Hair loss has a direct impact on the way you feel about yourself, your self esteem and confidence. It is also true that it is a very common problem and can be controlled and stopped completely through proper treatment. Ayurvedic treatment for hair loss has long term effects and it brings out the best results since the issues get rectified from the inside which prevents them from coming back.

Ayurveda and Hair Loss
According to Ayurveda, hair fall is associated with body type that varies from person to person and also the stability of mind-body structure. Hair is considered as a byproduct of bone formation, as stated by Ayurveda. The tissues which are responsible for the development of bones are also responsible for hair growth. Diet, yoga, meditation and medicated herbal oil massage are the ayurvedic treatments generally recommended for hair loss.

Here are some ways through which Ayurveda addresses the problem of hair fall.
1. Dietary modifications
It is important to identify the lifestyle habits that cause hair fall problems. Consumption of excessive alcohol, meat, coffee, tea and smoking are some of these habits. Hair fall can also be aggravated by indulging in intake of too much greasy, spicy, oily, sour, fried and acidic foods.
Here are some ways suggested by Ayurveda to beat hair fall:
- Hair growth can be stimulated by drinking fresh juices of Pomegranate, carrot, spinach and Kokam.
- Sesame seeds promote hair growth as they are rich in magnesium and calcium.
- Cow's Ghee is a trusted remedy to resolve all scalp problems.
- Green vegetables and fruits are rich in fiber and hence help in preventing hair fall.
- To make the roots of hair strong foods rich in vitamin C, vitamin B-complex, sulphur and zinc must be consumed, which are found in whole grains, soybeans, buttermilk, nuts and milk.

2. Yoga and meditation
Inverted asanas help in stimulating the blood flow to the head. Additionally, practicing deep breathing exercises to control anxiety, stress and keep the mind balanced is also advisable.

3. Ayurvedic herbs and medicated oil
Bhringaraja, Brahmi, Amla, Neem, Ritha and Ashwagandha are some ayurvedic herbs rich in essential nutrients that help in reducing stress and promoting hair growth. Different types of oils including coconut oil, brahmi oil, amla oil or mustard oil are useful in hair fall.

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

How to control hair loss through Ayurveda?

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