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

Acne is a condition that affects many people including teenagers and women during their menstruation period. It is characterized by red eruptions that are usually filled with oil, secreted by overactive oil glands in the hair follicles. So what else should you know about acne? 

Here are six things you probably did not know about this condition:

1. Clogged Pores - Acne signifies clogged or blocked pores that are filled with oil and dead skin cells that have not been cleaned out completely. This mixture of oil and dead skin cells blocks the pores, and ends up creating an eruption of red sores called acne and pimples. There is a chance that bacteria may have joined these two substances as well.

2. Over Treating the Skin - The worst thing that you can do is to touch, pick or even apply too many harsh chemicals to your skin during an acne breakout. These things can actually make the problem worse, and even create scars in the long run. The constant use of cleansers and moisturizers can also have a harsh effect on the skin, due to perfume and chemicals present in such products. 

3. Exfoliation - Using a salicylic acid wash or cleanser first thing in the morning will help in exfoliation, which is a good way to clear those dead skin cells from your skin. This will speed up the process of acne treatment as well, by clearing the pores. Also at night, the use of a medicated cream that contains benzoyl peroxide will help in killing the bacteria, so that there is no infection.

4. Two Weeks Notice - Trying new products to treat acne is a great idea. But give every new product at least two weeks before you write it off. Usually, any good product will take at least that much time to affect the acne, and clear the pores in an effective way. So before you start changing cleansers and creams every other day, remember to use the two week thumb rule.

5. Menstrual Cycle - Acne, more often than not, happens about five days before and a few days after the monthly menstrual cycle. So watch out for hormonal imbalances, which can cause acne and pimples. Avoid stress around this time too.

6. Dermatologist - Visit a dermatologist if regular cleaning and over the counter creams are not working. Persistent acne may turn into infection. Remember to ask your dermatologist for an oil reducing formula too. 

Acne is a skin problem that should be treated the right way.

All About Acne

If you see continual and long-term white patches of depigmentation on your skin, it could be vitiligo. Vitiligo is a condition that appears when melanocytes in your skin are no more alive. This bunch of cells is responsible for producing the melanin pigment that endows the skin with its colour as well as protects it from the harmful UV rays. The area which may be affected by this dermatological disease varies from person to person, and it can also affect the hair, mouth and eyes as well. In most cases, the vitiligo affected area stays discoloured for the rest of the patient s life.

Various types of vitiligo and their symptoms
Scientists have classified vitiligo into two types: segmental and non-segmental. The non-segmental vitiligo is the most common variant and 90 percent of vitiligo affected patients suffer from this kind of disorder. In this disease, the patches take place with little symmetry on both sides of the body. It can be further broken down into 5 sub-divisions.

Generalised vitiligo: It can occur at any part of the body without any rules, and this is by far the most common type.
Acrofacial vitiligo: It is mostly seen on the toes and fingers.
Mucosal vitiligo: In this condition, the discolouration normally takes place around the lips and mucous membranes.
Universal vitiligo: This is the rarest type of vitiligo where the whole body is covered in white patches.
Focal vitiligo: This is most commonly found in children. The children have white and scattered patches across the body.
Possible treatments for vitiligo

Though there are no treatments possible that will re-pigment your skin to its original colour, there are several remedies that aid in decreasing the visibility of white patches on the affected areas of the skin. Some of them include:

Phototherapy with UVB radiation: This is a common form of treatment where the affected area is exposed to UVB radiation and can be performed at home too. If you have large white spots across the body, it is important to have the treatment performed by an expert at any healthcare centre.
Phototherapy with UVA radiation: In this treatment, a drug is first administered for increasing skin s sensitivity to this radiation. Then the affected area of the skin is exposed to high doses of UVA radiation.
Skin camouflage: In mild cases of vitiligo, cosmetic creams and make-up can be used to camouflage the affected area. It can last for about 12- 18 hours when applied in proper techniques.
In case you are suffering from vitiligo, it is crucial to speak with an expert and opt for the best means to curb down the impact of vitiligo.

Vitiligo - Signs You Are Suffering From It!

Do you know that enlarged breasts, which are observed in many men are caused because of a health condition? This is known as gynecomastia and involves enlargement of the breast tissues in men. The condition is commonly called man boobs. It is usually not something serious and is not always permanent.

Causes
During the puberty stage, gynecomastia is quite common and normal. It occurs because of natural changes in oestrogen and testosterone, the sex hormones. The condition is also likely in men of old and middle age because of ageing and hormonal shift. Certain medicines such as antibiotics, heart medicines, AIDS medicines, drugs for heartburn and anti-anxiety medicines may also be responsible for this condition. Drinking alcohol in excess and taking marijuana, and other recreational drugs also increase the chances of gynecomastia. Breast size may also get enhanced by the use of herbal products containing lavender oil and tea tree oil.

Symptoms
Men affected by gynecomastia are featured by having a rubbery mass underneath their nipple region. It is less in amount and is usually tender. Fluid discharge is also an indication in some cases.

Diagnosis
For the diagnosis of gynecomastia, you should visit a plastic surgeon, who deals with cases of hormone imbalances. Blood or hormone tests may be required if your physical examination shows that your breasts are larger than usual, the lymph nodes are swollen, or when the lump is sore.

Treatment
Commonly, gynecomastia can not be cured with medicines. Surgery is compulsory. In the case of teenagers, the breasts become of normal shape within two to three years. Surgery is the only option for restoring your chest shape and improving your self-image. In the surgery for treating gynecomastia, a small cut is made on your breasts and extra breast tissues are removed. This makes your breasts smaller and flatter. The nipple may also need to be repositioned. Liposuction is another procedure which is carried out for this purpose, in which extra fat is sucked out from under your skin. Among the different modes of treatment for gynecomastia, surgery is meant for long term results. However, you need to undertake a healthy lifestyle in order to maintain your new chest shape. Gaining weight and taking drugs may cause gynecomastia to reoccur.

Gynecomastia - What You Need To Know About It!

Breasts are integral to womanhood. They define a woman s beauty. Well grown, firmer breasts are what every woman dreams of. However, not many women are lucky enough to have the perfect shape and size of breasts. A common belief among people is that bigger the size of the breasts, the better they are. This is a big misconception. The ideal breast size is the one that is in proportion to the rest of the body. Bigger breasts do not look good on women with smaller structure and are also prone to sagging. Apart from a disproportionate figure, many women with larger breasts complain of backache, neck and shoulder pain due to the physical burden born by the upper body. Hence, the need for a medical intervention. Such women can consider breast reduction as a permanent solution to their problem.

Breast reduction or reduction mammoplasty is a procedure that reduces the size of the breasts through surgical removal of tissues, fat and skin, thereby making it ideal as per the body structure. The procedure is performed under the guidance of a trained aesthetic plastic surgeon and takes about three to five hours.

Hospital admission is usually required and a general anesthesia is given to the patient. Healing of wounds may take a few days. Breast reduction surgery also deals with issues of sagging breasts and helps them give an uplifted and firmer appearance. Another advantage of this surgery is that it can reduce the size of areola making the breasts appear younger and better.

Like any other surgery, reduction mammaplasty is not free of side effects. There are risks associated and one has to carefully weigh the risks and benefits before taking this decision. It can cause complications like excessive bleeding and adverse anesthesia reactions. Apart from this, some of the common side effects of this surgery are loss of sensation in the nipples and areola, inability to breastfeed and scarring. Sometimes, the procedure may need to be repeated in case there is a visible asymmetry in the size of both the breasts.

In general, women considering this option are overweight, have no plans to bear children in future and are suffering from heaviness and pain in upper part of the body due to larger breasts. However, many women desire to improve their appearance. Cosmetic market delivers many new gels and creams for breast reduction, claiming them to be simpler and safer than surgery, but their effectiveness is doubtful. Women looking for a more permanent solution may consider a surgical procedure. However, following the surgeon s instructions is important pre as well as post-surgery. If you are worried about the size of your breasts, do visit a plastic surgeon and discuss your options.

Should You Get Breast Reduction Surgery? 

If sunburn is taking the mickey out of your fun time in the sun or your summer vacation, then you may want to read this article or pin it up where you can see it every day. Sunburn is something that does not show up immediately. It can happen when you have been in the sun for too long a time, and without the protection of proper clothing, hats, glares and sunscreen lotions. So what can you do when you feel that first sting of sunburn? here's our list!

Swift action: you will need to act fast towards cooling down the onset of a sunburn. Taking a quick dip in a pool or a lake if you are near one can help in soothing the area so that the sunburn is not too bad. Also, you can then cover yourself up and step indoors immediately, where you will be properly shaded from the sun. You can continue with the cool treatment by using a cold or ice compress to press around the area that is burning or has been most affected. Remember to stay away from the exact spot as it may lead to inflammation.

Avoid drying: do not let the area become too dry. Take frequent showers but stay away from harsh soaps as they may make the area dry which leads to chapping and pain.

Breathe: allow the skin to breathe. Do not obstruct the area with too many items of clothing and wear cotton fabric or other light weight clothing that will protect the area and let the skin breathe. Stay away from tight clothes as this may lead to chafing of the skin and the sunburns.

Moisturise: one good way of getting rid of sunburns quickly is to moisturise as soon as you have had a bath or a shower. This will help in locking in moisture which is not really possible when you moisturise the surface later. Use a gentle lotion or cream based moisturiser and stay away from products that contain petroleum gel as this may irritate the skin further and clog the area instead of getting absorbed into the skin.

Inflammation: tackle inflammation by taking corticosteroids or other anti inflammatory drugs. These should be prescribed by a doctor. Aloe vera can also be used to soothe the inflammation.

Hydrate: drink plenty of fluids for fast regeneration of the skin cells and so that the burns do not draw the fluid from the surface if the skin.

Take all the necessary precautions before you step out for some fun in the sun with proper sunscreen and protective clothing as well!

Feeling the Sting of Sunburn? These Tips Can Help!

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