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

5 Ways to protect your skin this summer

Staying out in the sun too long can cause you to suffer from a host of skin problems such as age spots, wrinkles and even increase your risk of developing skin cancer. During the summer months, you need to take extra care of yourself as the sun is at its peak at that time. Here's what you can do in this summer to ensure that your skin remains protected:

1. Avoid the rays of the sun between 10 am and 2 pm

The strength of the UV rays depends on a number of factors such as reflective surfaces, height, and time of day. The sun's UV rays are at their strongest between 10 am and 2 pm. If you're outdoors, seek a cool area to protect yourself from the damaging rays of the sun. You could stand under a tree or use an umbrella to shield yourself from its ultraviolet rays.

2. Don't use tanning beds

Several studies reveal that tanning beds can cause skin cancer. According to these studies, individuals under 30 who use tanning beds increase their risk of melanoma (the most deadly of all skin cancers) by about 75%.

3. Increase your fluid intake

One of the ways in which you can beat the sun and protect your skin is by increasing your fluid intake during this time. On an average, one should have about 3 liters of fluids every day, which is about 1.5-2 liters of water and 1 liter of fluid from solid foods. From summer foods like watermelon and berries to beverages like fruit juice, milk, etc and liquid-based meals - all these avenues should be considered.

4. Have a proper cleansing regimen

To help your skin look fresh even during the summer months, you should exfoliate regularly. When you do this, all the dead skin cells are removed, giving your face a youthful and fresh appeal.

5. Use a sunscreen all the time

To protect yourself from the damaging ultraviolet rays of the sun, you should never forget to apply sunscreen when going out. Ideally, a sunscreen that has an SPF of 30 should be applied thoroughly to your skin 30 minutes before leaving your house. More importantly, it should be applied again every 2 hours.



5 Ways to protect your skin this summer

Silk pillowcase slows down skin aging

Using silk pillowcase is known to slow down skin aging by giving you a wrinkle-free skin. This is due to many good qualities of silk fibers.

Silk is a natural fiber obtained from animals and contains amino acids which are compatible and friendly to the human skin. It also contains temperature regulators which adjust your skin to the changing temperatures. Hypoallergenic silk fibers resist many skin allergens like fungus, spores etc making it ideal for sensitive skin.

The tightly woven fiber which remains most in contact with your face retains moisture to your skin and keeps your skin well hydrated. Unlike dry and flaky skin, moistened skin cells are most likely to show fewer wrinkles and hence slow down skin aging process.

Did You Know a Silk Pillowcase Can Slow Down Your Skin's Aging?

Vitiligo is a disease which results in the loss of skin colouring pigment and ultimately the person loose his or her skin colour in blotches. The rate and to what extent the colour loss will happen is always unpredictable. When the Melanocytes cells lose their ability or get destroyed completely, the human skin starts losing it's skin colour produced by these Melanocyte cells. Vitiligo can generally affect skin present of any body part. Vitiligo is a common disease and it affects almost one million people every year all over the world. The disease can affect a person of any age.

Causes of Vitiligo

There are different causes due to which Vitiligo is caused. Let us have a look :

Vitiligo can happen due to an autoimmune disorder, when the immune system becomes overactive and results in the destruction of the colour pigment-producing cells i.e. the Melanocytes.
Vitiligo is also believed to affect people because of genetic factors. The immune system can get affected by the genes and results in a loss of skin colouring melanocytes. It can be hereditary and gets passed on. However, it is not at all contagious and cannot be passed on to someone else.
Harmful exposure to UV rays can cause the body to loose melanocyte cells. Heavy sunburn is also a common cause of the disease.
A stressful life schedule or oxidative stress imbalance can easily make the melanocyte cells to go weak and eventually wither away.
A foreign virus or bacteria which may enter into the immune system and if not destroyed affects the melanocytes in different parts of the body.
Treatment for Vitiligo-

Vitiligo Treatment or White Patches Treatment is based on improving your skin s appearance by restoring its colour. Re-pigmentation treatment is most successful on face and trunk; hands, feet and areas with white hair respond poorly. Compared to long-standing patches, new ones are more likely to respond to medical therapy.

The treatment can be classified into

Medical

Medicines applied to the skin, such as:
Corticosteroid creams or ointments
Immunomodulator creams or ointments, such as Elidel & Protopic
Topical drugs such as methoxsalen (Oxsoralen)
Oral Medical treatment includes the use of immune-modulating drugs such as systemic corticosteroids, levamisole, cyclophosphamide, azathioprine, vitamin supplements (especially vitamin B12 and folic acid).
Phototherapy NBUVB full body   A medical procedure in which your skin is exposed to ultraviolet A (UVA) or ultraviolet B (UVB) light from a special lamp in full body chambers.
Excimer (Targeted Phototherapy)   Targeted phototherapy, also called concentrated phototherapy, focused phototherapy and microphototherapy, involves delivery of ultraviolet radiation directly focused on, or targeted at, the skin lesion through special delivery mechanisms.
Surgical Procedures

Surgical treatment   Normal skin is used as donor tissue and then grafts are surgically transplanted on areas of Vitiligo treatment. The new skin grafts start producing pigment. Patients who are candidates for this procedure must have stable Vitiligo, or Vitiligo that has not changed for at least one year. The criteria of stability is taken as (a) no new White patches, (b) no extension of existing White patches and (c) no loss of pigmentation of previously repigmened patches for at least 1 year. This procedure can be used for patients with limited areas of Vitiligo and also in those with more extensive disease.
Melanocyte cell transplantation   In this procedure, a skin graft is taken from the patients own thigh, this skin is then treated with an enzyme known as trypsin which separates all the layers of the skin and thus Melanocytes and Keratinocytes are concentrated. The Vitiligo (Skin White Spot) skin is then removed with the use of diamond burs or Lasers and the cells are transplanted. The advantage of this procedure is that cell culture is not needed and that skin harvesting from the donor area, preparation of cell separation and application of Melanocytes can all be undertaken in a single 3-h procedure.
Blister Grafting   In this procedure, blisters are created on your pigmented skin primarily by using suction. The tops of the blisters are then cut out and transplanted to a depigmented skin area where a blister of equal size has been created and removed.
Punch grafting  Punch grafting is the simplest and the least expensive of all the grafting procedures in Vitiligo. The procedure involves the transfer of circular pieces or punches of skin tissue from the donor area into similar shaped pits that are made on the recipient skin. The size of these punches can range from 1 mm to 2 mm and they are spaced 5-10 mm apart on the recipient skin.
De-pigmentation  Depigmentation involves fading the rest of the skin on your body to match the already-white areas. If you have vitiligo on more than 50 percent of your body, depigmentation may be the best treatment option. In this procedure, the drug monobenzone (Benoquin) is applied twice a day to the pigmented areas of your skin until they match the already-depigmented areas. Some patients who are resistant to depigmentation with drug monobenzone (Benoquin) will need Q Switch NDYAG Laser to destroy the pigment cells. Depigmentation in most patients is a permanent technique in which the whole body is gradually turned white.
Color (Camouflage)   Camouflage used to treat vitiligo can be classified into two- temporary and permanent. 
Temporary colouring is the method which intends to blend the white patches with the rest of the body s colour. The method is done using coloured creams to the affected skin. Those creams will have the same shade as that of the natural skin. Applying the creams make the patches less noticeable.
Tattooing (permanent coloring)   Tattooing is injecting artificial pigment into the depigmented area. After selecting the pigment shade which matches the surrounding skin color, the pigment granules are implanted into the depigmented patch either with a manual or electrically driven needles. Though the patch resembles the surrounding normal skin, it may permanently fade or acquire a bluish hue after 1   2 years which is distinctly noticeable and may become unacceptable. Hence, tattooing is usually not advised unless the patch is in an inoperable site.

Best Vitiligo Treatment  - Medical & Surgical Methods

Vitiligo is a medical condition, which causes the loss of skin color due to loss of pigmentation. This usually occurs in blotches and looks very unsightly. Vitiligo is very unpredictable and can affect any part of your body. In some cases it also affects the inside of the mouth, eyes, and hair. Vitiligo is more noticeable on people with darker skin tone.

Symptoms of Vitiligo:

Premature graying or whitening of the hair in your eyebrows, eyelashes, scalp, and beard. This usually occurs before the age of 35.
Skin discoloration can also occur from other parts of the body such as hands, feet, abdomen, neck and other areas.
Change or loss of the color of the retina (inner layer on the eyeball).
Discolored patches on and around the navel, rectum and genitals.
What causes vitiligo?

A medical disorder where your immune system destroys and attacks the melanin forming pigments in your skin. This is known as an autoimmune disorder and by far is the most common cause behind vitiligo. An event such as sudden or prolonged stress, sunburn, or being exposed to industrial chemicals. A history of family members or relatives having vitiligo in the past.

Ayurvedic Treatments for Vitiligo:

Mustard and Turmeric Oil: A paste made with mustard and turmeric oil can be applied on the affected area. This is also good for the skin and reduces vitiligo. Do this at least 2 times a day to reduce the patches considerably.
Duckweed: This is a type of water plant and is very rich in a mineral called lignin. It is considered a natural treatment for skin disorders and vitiligo. It will also help to restore your natural skin color.
Sun screen: If you already have vitiligo, exposure in the sun can make it worse, so applying a sunscreen with SPF 30 or above (or an appropriate level of sunscreen protection) can protect your skin from further damage.
Papaya: This fruit is great for restoring and reviving melanin (responsible for skin pigmentation). Drinking papaya juice or rubbing papaya on the affected area can reduce vitiligo to some extent.

Vitiligo - 4 Ayurvedic Preparations for Treating 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? 

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