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

Psoriasis is a chronic dermatosis characterised by an unpredictable course of remissionn & relapse. It is an non-infectious skin disaease chracterised by scaly, silvery patches mainly on the scalp and extensior surface of the body. Its exact cause is unkown. In ayurveda, it is closely resembles with ekakushta. The features of ekakushta explains in ayurveda classics resembles with the symptoms of psoriasis. Psoriasis is the challenge for modern science. There is no definite treatment for psoriasis in modern science till today. The drug available in the market use to treat psoriasis are not very effective and have local and systemic effects.

In ayurveda, vata pitta and kapha dosha is the main contributory factor for the disease. Due to vitiation of three dosha, the disease manifest and main line of treatment for psoriasis is panchkarma and internal medicine. It is considering the best approach for skin disorder in ayurveda. A case report of 42-year old male, presented with well demarcated red scaly, silvery patches mainly on both legs, hands, scalp, chest and back with itching, and also nail and joint involvement has been presented in this article.

Etiology of Psoriasis: 

Unknown but many factors have been associated-

Genetic: may be autosomal dominant

Triggers: physical trauma ,infection and drugs.

Biochemical change: like increase level of arachidonic acid and Cgmp.

Immunological factors: helper T cells PLAY A KEY ROLE.

Epidemiology: 

Roughly, 1% of population is affected. Can occur at any age and affected both sex. Most patients as worse in winters.around 7 million people are affected in developed country.

Histopathogenesis:

Increased epidermal cell proliferation.

Retention of nuclei in stratum corneum.

Proliferation of fibroblast.

Dilated and tortous capillary loops.

Shortened epidermal turnover time from normal of 60 to 10 days.

Clinical features: Usually chronic indolent lesions which persist for month. Lesions are mildly papule or plaque.erthematous plaque lesions with characteristic slivery, large, loose scales. The patients of psoriasis may also suffer from depression and low self-esteem.

In a patients with psoriasis always check for nail and joint involvement.

Nail: 10 to 15% of the patients have nail involvement. Pitting, nail plate thickening, subungual debris, discolouration of nail plate and oil spot seen in the nails.

Joints: 10% patients have joint involvement.

Sites: Scalp, pressor points & extensor. Sometimes generalised.

Chronic recurrent psoriasis is difficult to treat. Modern science treat with PUVA and corticosteroids but these drugs having local and systemic side effects like liver and kidney failure etc. So, it is the time to find out the effective and safe treatment for Psoriasis. Medicines which are used in ayurveda are safe and practised since many years. A huge numbers of drugs are prescribed in ayurveda for the treatment of kushta.

Case details: A 42-year old male patient, hindu brahman by religion, presented on 10 april 2016 with well demarcated raised red scaly, silvery patches on chest, back and both legs and hands. He complained of itching all over the body and on scraping, white powder like substances fall down and leaves a bleedy surface. On history, patients had complaints since 20 years and diagnosis of psoriasis by allopathic physician. Since 20 years he has been taking allopathy and homoepathy patients from various practioners of U.P and delhi. He is brahman and lives in well known temple of delhi and visit homes of peoples for religious ceremony. He is afraid that if the disease is spreading continously, then he is unable to work as priest because people neglect him due to disease. The disease is spreading all over his body and also involves nail and joint. Destruction of nail plates of hand and legs was also developed. For this, patients took allopathic treatment for such a long time but do not get relief.

The patients visit our clinic for the first time. He told use that his problem not solves since 20 years and spreading continuously. So, he is unable to trust us. So, we first give him counselling because reassurance and emotional support are invaluable. Physical and mental rest enhance the effects of the treatment. It is also important to tell him that the disease is not contagious and is benign.

SYMPTOMS OF THE PATIENTS :

Itching all over body

Silvery patches, especially, on legs ,chest ,back but now spreading in his hand and scalp.

Destruction on nail plates

Swelling and pain in left middle fingers and flexor deformity in proximal interphalangeal joint

Swelling in right middle metatarso phangeal joint and pain

Some blood test of the patients were done like CBC, LFT, KFT, SR, URIC ACID to assess outcome.

His general health was good and both physical and all blood test were within the normal limts.we advise patients for panchkarma and oral medication but patients refuse for panchkarma so we start his oral or internal medication. 

Investigation Done :

CBC(Complete Blood Count)

LFT(Liver Function Test)

KFT(Kidney function Test)

Sr. Uric Acid

Investigation was done to rule out any other pathology. Investigation were within normal limit.

Internal Medication :

Medication are given into two phase. In First Phase, we are given panchsakara churna - one spoon two times daily for anulomana and pachan, Panchnimba churna- one spoon two times daily with luke water, panchtikta ghrita gugulu - two tab two times daily, and one oil for local application containing jyotishmati,bakuchi, and chakramad for five days. We told patient to apply the oil firstly only on legs for 5 days. Patient taking the same for 5 days and come on 5th day, we see the fabulous result, the rashes which are developed within 4 to 5 months just disappear and other rashes are also subsiding.

After 5 days, in second phase, we continue the same treatment and also added haridra khand - one spoon two times daily, gugulu tiktam kashaya - three spoon two times daily (one hour before food for 15 days). The patient came back on 20th day, with great result, the rashes were almost 60 % subsiding and pain and swelling in finger and ankle also reduce to great extent. Now, patient is not taking any pain killer for pain. Patient also get improvement in nails of legs.

We prescribe the same medicine for one month that time and ask him to do some physiotherapy additional for finger deformity. After that patient came with 70 to 75 % relief in symptoms and patients also tell that during the treatment, he will not develop any additional rashes.

During the treatment, we also told the patients to follow some dietary changes and live according to the rules of Ayurveda.

Result: Psoriasis is a disease with unkown etiology and triggered by many factors. In modern science, treatment of psoriasis is a challenge. They do not have any safe and proper medicine for psoriasis. But, ayurveda treatment gives satisfactory results as well as the quality life to the patients. Ayurveda removes toxin out of the body and corrects the formation of aama. Ayurveda gives the prevention as well as the treatment. So, by following the dietary and lifestyle change we prevent the reoccurrence of the disease.

Ayurveda For Psoriasis 

Cancer can be very devastating, it can tear families apart. The cancer virus generally kills all the healthy cells in your body and starts to destroy your organs one by one. When a person is affected by breast cancer, their breasts have to be removed so that the cancer virus doesn t affect the rest of the body. In the society which we live in we are fed with the notion that breasts are an integral part of a woman s body and only voluptuous breasts make a woman look more attractive. Survivors who have won the fight against breast cancer have had to surgically remove their breasts for survival. 

They are left with an empty spot in their body as well as their lives. So, in such cases breast reconstructive surgery becomes extremely important. Breast reconstruction surgery implants a mound in place of the actual breast. So that it looks like an actual breast with the nipples and the areola.

How to get ready for a breast reconstruction surgery?
1. You should quit smoking if you are a regular smoker.
2. Avoid certain vitamins or supplements as prescribed by your doctor before the surgery.
3. Take someone with you to stay back during and after the procedure for moral support and to assist you with your stay in a hospital.

Possible complications:
1. Infection can occur after the surgery.
2. Hematoma or pooling of blood.
3. The implants can also break through the skin.
4. The implants can rupture and the silicon or saline can leak from the breast tissues.
5. Hard scar tissues can form around the implant.
6. It might not be enough for a woman who has had larger breasts.
7. Implants don t last life-long. It needs to be replaced after a point of time.
8. Radiation therapy might damage the implants.
9. It can leave a scar from the region where the extra tissue was taken for constructing the breast.

Methods of breast reconstruction surgery:
1. Tissue expander
2. Flap reconstruction
3. Abdominal flaps
4. Mold-assisted reconstruction
5. Direct to implant procedure

Breast Reconstruction - How You Can Prepare Yourself?

Breast lift surgery or Mastopexy is a form of plastic surgery used for lifting or raising sagging breasts in women. The size, contour and elevation of the breasts are modified or corrected using this procedure.
The position and shape of the breasts in women change after pregnancy, breastfeeding, suffering weight loss or with age. A breast lift surgery is effective in treating sagging breasts.

During a breast lift surgery, extra skin is removed from the breasts, and the surrounding tissues are tightened for reshaping of the breasts. The nipples and areola are also reshaped to a better location. A breast lift surgery may involve the procedures of liposuction and abdominoplasty for an even better rejuvenation.

Breast lift surgery is undertaken by many women for different reasons. Some women do not like their breast shape or volume after pregnancy and have this surgery done.

A breast lift surgery offers various benefits. They are:

A breast lift surgery improves the body image of a woman and also boosts her self-esteem. Women feel their breasts have been affected negatively after pregnancy and undergoing this surgery enables them to have satisfactory breasts again. A breast lift surgery does not cause the breasts to increase in size. They appear bigger because they are higher in position and firmer than before.
Having a breast lift surgery can push you to make better and healthier choices about your lifestyle. For undergoing any form of surgery, it is recommended that you stay as healthy as possible. This includes proper diet and eating habits along with regular exercise.
A breast lift surgery improves the quality of life in women. Body image is improved, and the woman feels good about her breasts and body as a whole. According to studies, 92% of women having a breast lift surgery had improved self-esteem and a better, healthier life than before. Women become less conscious about their breasts after the surgery, as the breasts become satisfactory.
As a result of this surgery, some clothes may fit better, and a woman can experiment with trendier outfits, and may also not wear a bra at times.
A breast lift surgery gives women a better proportion between their breasts and buttocks. The contrast is better and makes a woman more attractive. More cleavage is created, and the breasts get more projected.
A breast lift surgery is an efficient procedure to improve the breasts of women. Sagging breasts are corrected by a surgery which gives certain benefits to women.

5 Benefits Of Breast Lift Surgery

Vitiligo is a disease that causes the loss of skin shading and colour in patches. The degree and rate of colour loss from vitiligo cannot be determined. It can influence any part of the skin on your body. It might also influence one s hair, inside of the mouth and even the eyes. 


Ordinarily, the shade of one s hair, skin and eyes is measured by melanin. Vitiligo happens when the cells that create melanin quit working or die. Vitiligo influences individuals of all skin types; however, it might be more common in individuals with a darker skin. The condition is not contagious or life threatening.


Numerous medicines may be used to restore the skin shading or level out the skin tone. A few medicines might have some serious side effects on some people. So your specialist may propose that you first try to improve your skin by applying self-tanning products or make-up. Here are some of the top ways to treat vitiligo:


Medicines 
Creams that control aggravation: A topical corticosteroid may cause the skin to return to its natural shade (repigment), especially if you begin utilising it right at the start of the disease. 
A type of vitamin D: Topical calcipotriene (Dovonex) is a cream that can be used with corticosteroids. Possible reactions include dry skin, rash and itching. 
Medicines that influence the immune system: Treatments containing tacrolimus or pimecrolimus (calcineurin inhibitors) might be compelling for individuals with little ranges of depigmentation, particularly on the face and neck.
Therapies
Light therapy: This uses a narrow band of UVB light. You may get treatment in a specialist s office up to three times each week. 
Laser treatment: This technique brings the shading back to the patches of light skin by treating them with an excimer laser, which utilises a particular wavelength of UVB light. 
Depigmentation: A solution with monobenzone is connected to the unaffected zones of the skin. This progressively lightens the skin so that it blends with the affected areas.
Surgery
Skin grafting: In this system, your specialist removes little segments of your ordinary, pigmented skin and joins them to regions that have lost colour. 
Rankle grafting: In this system, your specialist makes blisters on your pigmented skin with suction. He or she then removes the highest points of the blisters and transplants them to a range of stained skin. 
Micropigmentation: In this method, your specialist utilises an extraordinary surgical instrument to embed colour into your skin. 
Other treatments
Shield your skin from the sun and UV light. In case that you have vitiligo, especially in case you have light skin, use a wide range of waterproof sunscreen with an SPF of not less than 30. 
Abstain from tattoos that are not associated with treating your vitiligo. 
Make-up concealers may enhance the appearance of the skin and help you feel better about yourself, particularly if your vitiligo patches are on uncovered skin.


4 Top Ways You Get Vitiligo Treated

Green Tea is often referred to as the elixir of health. It is refreshingly light, has minimal calories and provides so many health benefits that you would love introducing this to your everyday fitness and health regimes. Check out some of the wonders of Green Tea-

1) Cuts Your Risk of Cancer - Major researchers from all over the world agree that drinking Green Tea regularly can reduce your risk of cancer. Several polyphenols found in Green Tea are potent antioxidants that can prevent the growth of cancer cells and reduce the opportunities for tumors to thrive!

2) Protects Skin - Consumed or applied Green Tea has several benefits as well. For instance, Green Tea, when applied directly on the skin can help block skin cancer and reduce tanning. That's the reason why growing number of companies now use green tea extracts in their moisturizers and sunscreens. At the same time, it soothes your skin from cuts and scrapes when applied directly.

3) Increases Metabolism - You have heard it before! But we will remind you of the same again. Green tea is often known for increasing metabolism, which in long run, with exercising and healthy dieting can help you lose more weight. Drink a cup about half an hour before exercising and you will feel more powerful.

4) Stay Young - Green Tea, when consumed at least two cups a day regularly can help you stay younger, by giving your skin a natural glow and ensuring that your arteries don?t clog fat and cholesterol.

5) Steadies your Blood Pressure - Sipping even a single cup of Green Tea every day can help in reducing your chances of getting hypertension and high blood pressure. This is because of polyphenols, which can keep vessels from contracting and raising blood pressure.

If you have any more questions, click on consult privately to ask me.

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Top 5 Reasons to Start Drinking Green

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