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

Plastic Surgery is a speciality that deals with reconstruction, alteration and restoration of certain parts in the human body. It improves a person's appearance and may also help in improving the functionality of various body parts. It can be classified as either re-constructive or cosmetic Surgery:

    Re-constructive Surgery: These type of surgeries are used to correct various defects in the body such as injuries as a result of trauma, physical birth defects, deformities in the ear and cleft lips.
    Cosmetic Surgery: Cosmetic Surgery is used to modify a part of the body for cosmetic reasons. The most common cosmetic surgery procedures are reconstructing the nose, removing fat from certain parts of the body and reshaping the breasts.

Outlined below are 5 facts about plastic surgery:

    Liposuction is popular among males: The most common plastic surgery among men is liposuction. So far, out of the 1 million plastic surgeries that men have undergone, most have been liposuction. The other popular cosmetic surgeries for men are face lifts and Rhinoplasty.
    35-50 year old undergo the maximum number of plastic surgeries. In 2014, over 4 million procedures were performed on people whose ages were in the range of 35-50 years. The most common concerns were sagging skin and fine lines. Liposuction was the most popular surgery in this age group.
    Most women opt for breast augmentation: Breast augmentation often requires correcting various issues such as post-op sagging and various other tweaks like modifying the size of the implants. The number of revisions in breast surgeries has actually gone up compared to the initial breast surgeries.
    Asian double eyelid surgery: A surgery where the eyelids are altered to make your eyes look bigger and attractive. It is a popular surgery among Asian women.

5 Facts You Never Knew About Plastic Surgery

Do you have a permanent tattoo which you want to remove because of certain circumstances? According to studies, almost 50% of people with tattoos in the US want to have their tattoos removed via the laser tattoo removal technique.

This tattoo removal technique eliminates your tattoo without having much side effects. In the procedure, lasers are used to remove your tattoo by breaking up the pigment colours of the tattoo, using a high-intensity beam of light. Black tattoo pigment absorbs all the laser wavelengths and is easiest to remove, while other colours can be removed by using certain selected lasers.

Laser Tattoo Removal Procedure-

The number of treatments or sessions you require depends on the colour and size of your tattoo. It may take about two to four sessions in the case of normal tattoos, while for those having large tattoos; it may take more than 10 sessions to get the tattoo removed. A consultation session with a trained professional is required to help you in evaluating your situation and whether you should go ahead with the procedure.

The laser treatment varies from person to person and depends on factors such as age, size and type of the tattoo. The patient s skin colour and depth to which the tattoo pigment extends also affects the removal process.

Here are the steps involved in a laser tattoo removal process:

Protected eye shields are placed on you.

Your skin s reaction to the laser is tested for determining the amount of energy to be used.

A handpiece is placed again on your skin surface, which activates the laser light. This process is extremely painful to undergo.

Small tattoos require less pulses while large tattoos require much more. After every session, your tattoo tends to get lighter, progressively.

Right after a treatment session, an ice pack is applied to your skin to soothe the areas treated. You will have to apply a topical antibiotic ointment and a bandage is used to protect the treated skin region. You must cover the area using a sunblock whenever you go out in between the treatment sessions.

In some cases, local anesthesia is used during the treatment procedure.

Because of modern-day technology, laser tattoo removal is now a common thing undertaken by many who want to get rid of their unwanted tattoos. The procedure is safer than the traditional tattoo removal methods like excision, salabrasion and dermabrasion.

Tattoo Removal: How To Get It Done?

It is a chronic autoimmune skin disease, in which the skin cells form a mass of scales. Usually, these patches of skin, which are dry, red and itchy, occur on the skin of the back, scalp, palms, knees, elbows and around the fingernails and toenails. But some people have the patches all over the body. The patches may also crack, flake and bleed. While there is no definite cure, the symptoms can be managed and treated.

Symptoms of Psoriasis

The symptoms of psoriasis may vary from patient to patient. However, if more than two of the following signs are seen, it is likely that psoriasis is the causative condition:

1. A sharp and localized pain in the joints accompanied by stiffness
2. Soreness in the throat
3. Tiny depressions in the nails or large brown patches under the nails
4. The diseased patches of skin can crack, peel and bleed
5. Swelling and tenderness of the limbs
6. Dental plaque
7. Muscle pain due to the swollen bands of connective tissue
8. A whitish and silvery mass of scales surrounded by red patches of stinging, itchy skin
9. The appearance of blisters or rashes on the dry scaly skin and also along the nails
10. Bumps on the folded skin like back of the knees, armpits etc.

Causes of Psoriasis

HIV
Human Immuno-deficiency Virus adversely affects the immune system and increases susceptibility of all kinds of infections and diseases. HIV-positive individuals have been found to have an increased risk of psoriasis than HIV-negative people.

Medication
Anti-malarial, anti-inflammatory and blood pressure medicines can cause psoriasis as a side effect. The disease is also an effect of withdrawal from topical steroid creams and other steroid-based medication.

Genetics
More than 32% of the cases of psoriasis have been linked to genes. In case of identical twins, if one twin has the disease,the other has a 70% chance of getting it too. There are several genes associated with the disease- most of these genes are related to the immune system. T cells (lymphocytes which affect cell specific immunity) can also cause psoriasis.

Other diseases
Diseases like strep throat, chronic infections, skin infections and stress may be responsible for the condition. Other factors like obesity, alcoholism, skin dryness and smoking can also lead to psoriasis.

Psoriasis: Symptoms and Causes

Aloe Vera Stops Hair Fall And Helps in Hair Growth

Water and air pollution are the biggest causes of hair fall. And, Aloe vera is the biggest cure for hair fall!  Not just hair fall control it also promotes hair growth. Alkalizing properties of aloe vera improves the pH levels of hair which help in hair growth. Its application also reduces dandruff and itching. 

Take an aloe vera leaf, extract the gel and apply this gel to the hair. Leave it for hours and wash the hair with warm water. Follow this procedure for 3   4 times a week for better results. You can also use aloe gel easily available in markets.

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


Hair Fall Due To Pollution? Here s the only home remedy that will stop it.

A mole, sometimes known as a birthmark, is a non-cancerous disorder of pigmented skin cells. They can vary in color and shade and by and large, can be medium to dark brown, sometimes they can be skin-colored or black too. Most of them are regular in shape, flat to moderately even as well. Sometimes, they appear to be slightly raised above the skin, are delicate to touch and lighter in shade. Also, they may or may not cause any kind of pain.

You need to get your moles checked at least once in every three months, because of the following reasons:

In case you have noticed the growth of new moles or have a family history with medical background marked by melanoma.

You need to watch out for moles that do not look like your other moles specifically. Dysplastic moles are the ones that look different from the normal ones and may lead to melanoma. In case you have different dysplastic moles, you are in serious danger of getting melanoma.

In case you have any moles that are bigger than the others and are smudgy or have unpredictable edges, which are uneven in shading or have some pinkness, you need to see a specialist and get them checked. Also, if you notice a change in the color or shade or it gets itchy, agonizingly painful or begins to bleed, it can be a sign of something serious. Thus you must visit a specialist immediately. 

Although, most of them are non-cancerous and not that dangerous. However, there are some types that can convert into lumps and can be cancerous in nature. Although the chance of something like that happening is very rare, still it is a possibility.

In case you notice a liquid discharge or pus formation in the mole, you must consult a doctor immediately. 

Being proactive about your well-being is the best way to avoid serious health conditions and you must look out for moles that can be risky as they are connected to skin cancer. Self-diagnose and examine your skin in front of a mirror. Give careful consideration to the zones of your skin that are frequently exposed to the sun, for example, the hands, arms, abdomen, face and head. Along with limiting your exposure to sunlight and utilizing sunscreens, inspecting yourself for moles can help with early detection of melanoma (the deadliest kind of skin tumor) and hence, get treated for the same. In case you have a concern or query you can always consult an expert & get answers to your questions!

Important Reasons Why Should You Get Your Moles Checked!

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