Dr. Neelam Pandey Kukreti

The thyroid gland, in the lower front of the neck, releases hormones in the bloodstream that affect almost every part of your body, from your brain and heart, to your skin and muscles. It also controls metabolism which is the process of changing the food you eat into energy. When the thyroid gland does not produce enough thyroid hormone, it is called hypothyroidism.

Symptoms of hypothyroidism include:

1. Constipation
2. Hair loss and dry hair
3. Dry skin
4. Fatigue
5. Sensitivity to cold
6. Decreased heart rate
7. Goitre (swollen thyroid glands)
8. Weight gain and difficulty in losing that weight
9. Persistent jaundice

Hypothyroidism is not curable, but it can be controlled with the right medication.

Along with taking your medicines, you can also adopt the following lifestyle changes:

1. Eat right: While there is no specific diet for hypothyroidism, you should consume vegetables, fruits, whole grains, healthy fats and lean proteins. Since gaining weight is a common symptom of hypothyroidism, eating the right things can help you maintain your weight.
2. Regular exercise: Exercising can reduce stress, improve energy and help you maintain your optimum weight. Aerobics (for example, cardio), flexibility and strengthening workouts can help with hypothyroidism. Other than that, light weightlifting, yoga and walking, are also beneficial. Do not forget to consult your doctor before you start on any of these exercises.
3. Reduce stress: Hypothyroidism is chronic, and the one thing that worsens chronic diseases is stress. Stress has serious repercussions on your overall health. So it is important to reduce your stress as much as you can. Meditate daily, at least for five minutes, and schedule a weekly massage to deal with your stress.
4. Get enough sleep: Fatigue is a symptom of hypothyroidism; you feel tired and sluggish throughout the day. The best way to counter this is to establish a schedule for sleeping. Try to sleep and wake up every day at the same time in the night and in the morning. Generally, sleeping for seven to eight hours is recommended.

Testosterone is often the subject of jokes but an insufficiency of this hormone is no laughing matter. Along with affecting your sex drive, low levels of testosterone can also affect your ability to concentrate on tasks, lead to high blood pressure and cholesterol. Additionally, it can increase your risk of obesity and type 2 diabetes.

Here are a few signs that could indicate low levels of testosterone-

1. Decreased Libido: With age, you may experience a lowered libido but a sudden decline in your sex drive could be caused by a lack of testosterone.

2. Erectile Dysfunction: Lowered levels of testosterone in the body can affect the release of nitric oxide necessary for an erection. Men suffering from lowered testosterone levels often find themselves either not able to have an erection or have erections that are not firm enough for intercourse.

3. Fatigue: Feeling tired at the end of a day is normal but men who have lowered testosterone levels may find themselves feeling extremely tired by lunchtime. You may also notice a loss of drive and enthusiasm.

4. Moodiness: Men with low levels of testosterone often become depressed and dejected. They feel less optimistic than normal and become more irritable.

5. Reduced Muscles: Testosterone is linked to muscle building and hence a lowered level of testosterone can be indicated by a reduction in the arm, chest or leg muscles. Men with low testosterone also find it difficult to build muscle mass.

6. Lowered Attention Span: Testosterone is responsible for focus and attention. Hence, trouble concentrating on work and memory problems can be seen as signs of lowered testosterone levels.

7. Development of Breasts: The lack of testosterone can cause an imbalance of oestrogen to testosterone ratio in the body. As the oestrogen levels get higher, men may find themselves growing breast tissue. This condition is also known as gynecomastia.

8. Bone Problems: A lack of testosterone can affect bone density. This may lead to osteoporosis like conditions and joint pains. Men with low testosterone levels are also more prone to injuries.

9. Lowered Semen Production: Testosterone is directly linked to semen production. The lower a man’s testosterone levels, the lesser the amount of semen produced.

10. Hair Loss: Many men experiencing lowered testosterone levels suffer from hair loss on their head and other parts of the body as well.

The good news is that this disorder can be treated. Hence, if you find yourself experiencing any of these symptoms, consult a doctor at the earliest.  

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:

1. 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.
2. 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.
3. Surgery: Surgery to remove thyroid gland (for e.g. thyroid cancer treatment, overactive thyroid etc.)
4. Radiation to the neck (to treat cancer in the neck area): The thyroid gland cells are damaged due to the radiation.
5. 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.
6. Certain medicines: Certain medicines used to treat heart conditions, cancer, psychiatric conditions etc. – for e.g. amiodarone, lithium, interleukin-2, interferon-alpha.
7. Pregnancy: Pregnancy (the reason is unclear but it has been noticed that the thyroid may get inflamed after delivery – this is called Postpartum thyroiditis.
8. 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.
9. 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.
10. 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:

1. Primary hypothyroidism: The problem is in the thyroid gland itself and thus there is reduced production /secretion of thyroid hormones.
2. 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:

1. Overt hypothyroidism: Here the patient is having the symptoms. Further the T3/T4 are low and TSH is high
2. 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?

1. Women have a higher risk of suffering from hypothyroidism than men.
2. Older people are at increased risk.
3. People suffering from other autoimmune diseases like Coeliac disease, Type-1 Diabetes Mellitus, Vitiligo, Pernicious anemia, Multiple sclerosis, Rheumatoid arthritis, Addison’s disease etc.
4. People with psychiatric conditions such as bipolar disorder
5. 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:

1. Depression
2. Constipation
3. Hair loss
4. Dry hair
5. Dryness of the skin
6. Tiredness
7. Body pains
8. Fluid retention in the body
9. Irregular menstrual cycles
10. Increased sensitivity to cold
11. Reduced heart rate
12. Increase in size of the thyroid gland – called Goitre. This is due to constant stimulation of the thyroid gland by TSH.
13. Weight gain
14. Carpal tunnel syndrome
15. Hoarse voice
16. Infertility
17. Loss of libido/sex drive
18. 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:

1. 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.
2. T4: A low level of thyroxine indicates hypothyroidism.
3. T3: these levels are generally not needed to diagnose hypothyroidism
4. Anti-Thyroid peroxidase antibodies (anti-TPO antibodies) or Anti- thyroglobulin antibodies are present in 90-95% of patient with autoimmune thyroiditis.
5. Other blood tests include Creatinine Kinase, Serum Lipids, Complete blood picture etc.
6. 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.

Thyroid disorders are associated with the thyroid gland. A thyroid gland is a butterfly-shaped gland situated right at the base of one’s neck. The role of the thyroid gland is to carry out numerous metabolic processes within the body. The brain regulates the functioning of the thyroid gland through a feedback mechanism. There are a number of disorders, both severe and trivial, which could affect the thyroid gland.

Main symptoms of thyroid disorders:

1. Weight loss and weight gain

2. Changes in heart rate (arrhythmia)

3. Hair loss

4. Frequent mood swings

5. Swollen neck

6. Sudden bouts of moderate to high fever

Other symptoms include:

1. Numbness or a tingling sensation in the hands

2. Constipation

3. Abnormalities or irregularities in menstruation

4. Brittle nails and dry skin

5. Blurred vision

6. Weakened muscle tone and frequent tremors in the body

Treatment Options:

Intake of thyroid hormone pills may prove beneficial. Once you start with the treatment, you may notice significant improvement within the first two or three weeks. Generally, once affected by thyroid disorders, one might have to be on these medications his/her entire life. Over time, this treatment procedure should result in lowering of the cholesterol levels, increased energy; but in certain cases, might throw up side effects in the form of sudden and unexplained weight loss.

Anti-thyroid medications help reduce and regulate the secretion of the thyroid hormone, thus treating certain thyroid disorders (such as hyperthyroidism).

Beta blockers are drugs help in reducing high blood pressure, heart palpitations and controlling heart rate.

In severe cases, such as enlargement of the thyroid gland, surgery is advised by the doctor, in which the thyroid gland is removed. Tumors or thyroid nodules are also treated by this surgical process.

In cases of thyroid cancer, besides the surgical procedure, radioactive iodine therapy (radioiodine) is recommended. This therapy helps destroy the thyroid gland and other thyroid (malignant) cells which may be taking up iodine. However, the side effects of this technique are minimal. This procedure helps to destroy those tissues which may not have been removed by the surgery. If the thyroid cancer has spread to the lymph nodes or to other parts within the body, this particular mode of treatment can be very effective.

Types of Thyroid Disorders:

1. Hypothyroidism: This is a condition characterized by an underactive thyroid gland. In this case, sufficient thyroid hormone is not secreted in the body.

2. Hyperthyroidism: This is characterized by an overactive thyroid gland, that results in overproduction of the thyroid hormone.

3. Thyroid cancer: It is a type of cancer of the thyroid gland.

4. Goiter: This is a disorder wherein the thyroid gland gets abnormally enlarged.

5. Thyroid nodules: This is marked by swelling of the thyroid gland. If you wish to discuss about any specific problem, you can consult a endocrinologist and ask a free question.

Hypopituitarism is defined as a condition in which the pituitary gland is unable to produce enough hormones. Under-secretion of pituitary hormones affects reproduction, body growth and blood pressure. It also results in pre-mature aging.

The pituitary gland is a small bean-shaped gland situated at the base of your brain, behind your nose and between your ears. Despite its size, this gland secretes hormones that influence nearly every part of your body.

In hypopituitarism, you have a short supply of one or more of these pituitary hormones. This deficiency can affect any number of your body's routine functions, such as growth, blood pressure and reproduction.

Few Causes:

1. Head injury

2. Tuberculosis

3. Radiation treatment

4. Stroke

5. Brain tumors

6. Brain surgery

7. Meningitis (brain infection)

8. Hypophysitis (autoimmune inflammatory disorder)

9. Sarcoidosis is an infiltrative (accumulation of cells and tissues in excess of the normal amount) disease which occurs in various organs.

10. Impaired hormone secretion by the pituitary gland is caused by genetic mutations.

11. Sheehan’s syndrome: It is a condition in which the pituitary gland gets damaged due to severe blood loss during childbirth.

12. Hypothalamus (a part of the brain which is located above the pituitary gland) diseases wherein the pituitary activities are directly affected by the hypothalamus.

Symptoms:

1. Fatigue

2. Reduced sex drive

3. Decreased appetite

4. Anemia

5. Irregular menstruation, pubic hair loss, hot flashes (feverish heat), and inability to breast-feed properly because of low breast milk production).

6. Dwarfism in children

7. Weight loss

8. Increased sensitivity to cold temperature

9. Infertility

10. Facial puffiness

11. Reduction in body hair or facial hair

Treatment Options:

1. Hormone replacement drugs include:

   • Corticosteroids: Adrenocorticotropic hormone deficiency leads to low production of adrenal hormones (different kinds of hormones such as cortisol and adrenalin, produced in the endocrine glands). These drugs act as a replacement of adrenal hormones.

   • Growth hormone: Growth hormone, also known as somatropin, is injected beneath the skin. This treatment method promotes growth, which balances the height in children. Growth hormone deficiency in adults is also cured by these medications to some extent.

2. Surgery: Surgical procedure is needed if the condition of hypopituitarism is the result of a tumor. The doctor will remove the tumor through surgery, thus resulting in normal growth.

3. Radiation: Radiation therapy helps in reducing the size of the tumor which causes stunted growth or pre-mature aging. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

Here are prevention and management of diabetes.

Here are types, symptoms and diagnosis of diabetes.

Hi viewers I am Dr. Neelum. I am consultant in endocrinology and diabetology. Today I will be briefing you regarding diabetes because it’s a major it’s a big public health problem and it is spreading like an epidemic Diabetes is basically a disorder in which our glucose is not able to get utilized by the body for lack of insulin either or when the insulin is not able to act the way it should act in the body tissues. And in that case we have two major types of diabetes. That is type-1 Diabetes and type-2 Diabetes. In type-1 diabetes there is absolute depletion of insulin and the patients are usually lean and they are requiring insulin for their diabetes control for entire life. And type-2 diabetes patients are usually obese and they have family history of diabetes, diabetes run in their family and they usually have insulin resistance.

They can be well controlled initially with diet, lifestyle modifications and medicines. And subsequently in the late stages or maybe, when it is not controlled with the medicines, they may require insulin. Now there is another variant of diabetes that is GDM; Gestational Diabetes Mellitus which is seen in pregnant females. And why it is important to know that? Because nowadays. Due to screening of diabetes and during pregnancy it is picked and sugar controls have to be in target range because there is fetal development and metabolic programming is done so it is important to have a healthy baby for which sugars should be adequately controlled via lifestyle modification, diet, if not then insulin is also given.

Then the other less type of diabetes are also known which are syndromic diabetes, which I am going to discuss here, because the important ones and the major ones are type-1 and type-2 And the cause of concern is that initially it was thought that type-2 diabetes is seen after 40, but it is not the picture. It was always there in kids, now it is increasing in alarming proportions. The kids are more glued to the screen and gadgets and they are having more type-2 diabetes because they have sedentary lifestyle, their food choices are little, they are more into binging, snacking and they are not that much physically active. And even younger kids in their teens and, adolescence and young adults, they are also having type-2 diabetes. So all this has to be picked because they develop complications first than adults. So how do we pick whether you have diabetes or not? So the symptoms are polyphagia, osmotic symptom typically these may not be in all the patients. You have to have a high index of suspicion.  If you have family members who are diabetic or obesity or hypothyroid or hypertension, their blood sugar should be checked.

Now how do we diagnose diabetes? Well blood tests which are done to detect diabetes are very simple. They are fasting blood sugar and 2 hours pp. we have sudden cutoff. And there is one more test which is called HPA1C. So HPA1C tells you monthly average blood glucose which comes in percentage. If it is above 6.5% and fasting blood glucose is above than 126mg/dl then you are labelled as diabetes. So in this part I’ll be speaking about the diagnosis which I have just spoken and in the next part I’ll be telling you once are diagnosed with diabetes, how can you have control over the diabetes and how can you follow up to have a good glycemic control?

If you want to have online consultation, you can contact me via lybrate website or you can see me in my clinic which is located in Sushant Lok, Gurgaon.