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  (1) What Is Thyroid
(2) Hyperthyroidism (Thyrotoxicosis)
(3) Cure Of Thyrotoxicosis( Hyperthyroidism)
(4) Cure of Hypothyroidism
(
5)
Hypothyroidism
(
6) Goitre (Thyroid enlargement)
(7) Hypothyroidism in  infancy & childhood
(8
) Hyperthyroidism during Pregnancy
(9) Hypothyroidism during Pregnancy
(10
) Thyroiditis
:  Subacute Thyroiditis
                             Silent Thyroiditis
                            
Hashimoto Thyroiditis
                             Post Partum Thyroiditis
(11) Thyroid Carcinoma
 


Hypothyroidism
 

  What is Hypothyroidism
Symptoms
Causes (Permanent & Temporary)
Investigations & Diagnosis
Treatment of Hypothyroidism?
Cure of Hypothyroidism
Hypothyroidism during Infancy & Childhood
Hypothyroidism during Pregnancy
 

What is Hypothyroidism: Hypothyroidism means deficiency of thyroid hormone in the body. When thyroid gland works less than normal leading to decreased level of thyroid hormone in the body is called hypothyroidism. In this disorder thyroid hormone (T3, T4) production from thyroid gland is decreased so that T3, T4 level in blood decreases &
TSH increases.

Symptoms of Hypothyroidism: Symptoms of hypothyroidism are weight gain, dry skiin, decreased sweating,  hair loss, constipation, feeling of cold, anxiety, nervousness, irritability, depression, weakness (fatigue, Tiredness), body pain, swelling over face & body,  high blood pressure (hypertension) wrinkling of skiin, breathlessness, anemia, hair fall, hair become dry, brittle& fall easily, eyebrow hair may also fall specially on outer side, constipation, decreased appetite, excess snoring, day time sleepiness, less retaining of studied material (poor memory) & poor performance in studies difficulty in walking & muscular weakness, muscle of body may become enlarged & stiff but still they have less strength, & poor growth leading to short height in child. Anemia (low hemoglobin) may occur. In women it may lead to menstrual irregularity ( late period or early period associated usually with heavy bleeding but rarely bleeding may e even less).some times bleeding may totally stop i.e. amenorrhoea i.e. no period at all). It may also lead to difficulty in getting pregnancy or even if she conceives may lead to recurrent abortion.

In males it leads to less sperm & infertility & even nil sperms.

Hypothyroidism at birth called congenital hypothyroidism, hypothyroidism in new born infant & child leads to difficulty in standing, poor mental development (low I.Q.), poor memory, poor scholastic performance & dwarfism (short height). Children affected by hypothyroidism become mentally weak (called cretinism).

Thyroid hormone regulates body temperature, maintains normal heart rate and normal functioning of the digestive tract, including bowel regularity and stimulates normal appetite. Thus any deficiency of thyroid hormone level affects almost all body systems.

Subclinical Hypothyroidism is called when T3, T4 is normal but TSH is high it need to be properly investigated & treated for permanent cure.

Causes of Hypothyroidism

Causes of permanent Hypothyroidism:

The various causes for permanent thyroid hormone deficiency are as follows:

1)      Idiopathic Atrophy of thyroid: In this disease thyroid is destroyed by some thyrotoxic cells or due to antithyroid antibodies.

2)      Severe iodine deficiency

3)      Thyroid dysgenesis: The thyroid gland is either absent (aplasia), markedly under-developed (hypoplasia), on not in its proper location (ectopic)).

4)      Central Hypothyroidism:  there is defect in thyroid controlling hormone due to defect in pituitary or hypothalmic gland. In this thyroid gland is absolutely normal in structure still thyroid hormone formation is less.

5)      Thyroid hormone resistance: in this variety, patient has normal thyroid gland & normal thyroid hormone, still thyroid hormone is unable to work due to defect in thyroid hormone action. Thus patient has all the features of hypothyroidism even with normal thyroid hormone values.

 6)      Thyroid hormone forming capacity defect is also a important cause of hypothyroidism.

 7)      Hypothyroidism due to goitrogens

 8)      Hypothyroidism due to drug induced as lithium, amiadarone etc.

       9) Hashimoto Thyroiditis: In this condition there occurs infiltration in the thyroid by thyroid damaging immune cells leading to progressive damage to thyroid. This results in gradual decline of thyroid functions. It may also be associated with thyroid enlargement swelling due to deposition of inflammatory cells in the thyroid. Symptoms are thyroid enlargement & symptoms of hypothyroidism. It may occur any time from childhood to old age.

10)  Thyroid damage due to Subacute Thyroiditis

11)  Thyroid damage due to silent Thyroiditis

12)  Thyroid damage due to post partum Thyroiditis
 

Causes of Temporary Hypothyroidism: Many cases of hypothyroidism can be cured permanently if correct diagnosis is made. The various etiologies which cause temporary hypothyroidism are as follows:

1)      Hypothyroidism due to iodine deficiency

2)       Hypothyroidism due to Subacute thyroiditis

3)      Hypothyroidism due to silent thyroiditis

4)      Hypothyroidism due to goitrogens

5)      Hypothyroidism due to drug induced as lithium, amiadarone etc.

6)      Hypothyroidism due to goitrogens

7)      Hypothyroidism due to radiation exposure.

8)      Hypothyroidism due to goitrogens

9)      Hypothyroidism due to sick euthyroid syndrome.

10)    Thyroid damage due to Subacute Thyroiditis

11)  Thyroid damage due to silent Thyroiditis

12)  Thyroid damage due to post partum Thyroiditis

Investigations & Diagnostic Tests:  Some of the following tests are required for correct diagnosis of severity of hypothyroidism, what its cause is & whether it is temporary or permanent. After below mentioned test we may decide what dose to be given & how long to continue it.

1) Free T3, Free T4 & TSH / or T3, T 4 & TSH ( In hypothyroidism there is low free T3 or T3 & free T4 & T4 & high TSH.

Other below mentioned tests required to know the cause of hypothyroidism & also in deciding whether this thyroid disorder is temporary i.e. permanent or temporary.

2) Thyroid microsomal antibody (also known as anti-peroxidase antibody or anti-                 microsomalantibody

3) Anti-thyroglobulin antibody

4) Thyroid scan

5) Urinary iodine

6) ESR

7) Fine needle aspiration cytology

8) Sonography Thyroid

9) Thyroglobulin

11) Other relevant tests.


Treatment: Before starting the treatment we decide the severity of illness, its cause & whether it is temporary or permanent. Normally in cases of temporary hypothyroidism we need to give small doses just for three to six months. Thus before staring the treatment asks your doctor whether your thyroid is temporary or permanent & whether it can be cured or not. In cases of permanent hypothyroidism full dose for that particular patient is decided. After diagnosis proper treatment in form of Thyroxine hormone (Eltroxin, Thyrox, and Thyronorm) is prescribed. It should be started in small doses initially then gradually increased to full doses otherwise it can lead to certain side effects. Thyroid medicine is safe during pregnancy.  It does not harm the fetus during pregnancy. During pregnancy we need to keep it well control. Initially Thyroid tests are done every six weekly and accordingly dose of thyroxine hormone adjusted. In thyroid patients inspite of control thyroid level patient may still get some symptoms due to certain other hormones may be abnormal. If you keep taking medicine regularly & get yourself checked by thyroid specialist you can live healthy life without any side effects. Remember if you forget to take medicine in the morning take it immediately the moment you remember & if forget whole day next day take double dose. In cardiac patients thyroid hormone replacement should be given very gradually otherwise it can lead to aggravation of heart problems. 


Cure of hypothyroidism:
After detail history, examination & some of the above mentioned test one should decide that whether thyroid problem of that particular patient is temporary or permanent. Because many cases of thyroid are temporary still doctor keep giving lifelong medication wrongly. Thus before staring the treatment asks your doctor whether your thyroid is temporary or permanent & whether it can be cured or not. If proper diagnosis of etiology of thyroid disorder is diagnosed then many times it can be cured permanently. Thus ask your doctor or meet us at our diabetes & thyroid centre to find out correct diagnosis.  Because many of the causative agent once they are removed lead to cure of thyroid.. For knowing whether hypothyroidism can be cured or not you may contact us personally.  

                  
Hypothyroidism in Infancy & Childhood

When hypothyroidism occurs from birth is called congenital hypothyroidism & when it starts after the age of one year then it is called juvenile hypothyroidism. 

Congenital Hypothyroidism:
Congenital Hypothyroidism  is defined as thyroid hormone deficiency starting from the time of birth. When untreated Congenital Hypothyroidism leads to mental retardation is also referred to as cretinism.

Symptoms of congenital hypothyroidism in infancy and early childhood: Most often than not, babies effected by Congenital Hypothyroidism appear perfectly normal at birth. Symptoms are usually not noticed in newborns until the lack of effective thyroid hormone has already begun doing lasting damage. Even if present the symptoms are so nonspecific or subtle that they are invariably missed in initial few weeks of life.. In fact, Congenital Hypothyroidism babies are often described as “good babies” because they rarely cry and sleep most of the time. The skiin may be pale, cold, mottled, or jaundice, extremities may be short (.e. broad hands with short fingers) and voice resembling a hoarse sounding cry. A distended abdomen, umbilical hernia, anemia, delayed bone maturation and respiratory distress are some more indications of problem. The temperature, heart rate and blood count are usually below normal. Physical development may be slowed, with floppy muscles, sluggish reflexes, poor weight gain and slow mental development. 

Most prominent symptoms are poor brain development, low I. Q., dull child, inability to speak or walk at right time (i.e. delay in walking or speaking in infancy), Brain & Central nervous system maturation may be Decreased IQ, Deafness, Neurological dysfunction (Spasticity, incordination, tremor), squint, Attention Deficit Disorder, obesity, swelling over body, poor food intake i.e. less appetite. Lethargic child, such children cry less, child often keeps open mouth, flat nose, large tongue, puffy face, dry brittle hair, short thick neck, thyroid enlargement (goitre) in neck, Constipation, Feeding problems, Prolonged jaundice, Hypothermia (low body temperature), low pulse rate, Decreased sweating, pale skiin, Anemia, Dry, thickened skiin, Muscle may be prominent but weak, Decreased long bone growth resulting in short height, prominent head, Delayed tooth eruption.

If such children are not started treatment very soon after birth then their intelligence decreases in adult life. Their memory power as well as other fine motor performance decreases. But if the treatment started at very early age no brain damage occurs & child develops with full normal intelligence. If not adequately treated children develop mild to severe grade mental retardation, learning disabilities, autism or dyslexia.

There are three effects of thyroid hormone on development of child

Brain Development
during the first few years of life is dependent on thyroid hormone. It is crucial in regulating development of the brain and nervous system.
Growth:
Thyroid hormone is critical for promoting normal  height growth as it controls the development of the bones and muscles. Thyroid hormone also affects the growth of the teeth.
Metabolism:
Thyroid hormone regulates body temperature, maintains normal heart rate and normal functioning of the digestive tract, including bowel regularity and stimulates normal appetite.

Causes Of Congenital Hypothyroidism: The normally due to failure of the gland to develop correctly or due to other causes as iodine deficiency, defect in thyroid hormone forming capacity etc.. The thyroid gland may be absent or be present in an abnormal location or may fail to produce enough thyroid hormone or the thyroid gland may be absent. Some cases of hypothyroidism in infant is temporary where as others are permanent. Thus before starting the treatment we must make sure that whether aby is suffering with temporary or permanent hypothyroidism.

The various causes are as follows:
 
Cause of Permanent hypothyroidism from birth:
The causes of permanent hypothyroidism from birth are

a)       Thyroid Dysgenesis: The thyroid gland is either absent (aplasia), markedly under-developed (hypoplasia), on not in its proper location (ectopic)), Hypoplasia, Aplasia,
 
b)
      Thyroid Dyshormonogenesis: Iodide transporter defect, Organification defect, Thyroglobulin abnormality

c)
      Central Hypothyroidism: TSH deficiency, TSH receptor mutation
In this  defect is due to abnormalities of the hypothalamus (in the brain) and/or pituitary (another gland in the brain). 

d)   Thyroid hormone resistance

e)   Endemic cretinism due to Iodine deficiency & goitrogens


Causes of Temporary Hypothyroidism at birth:

Maternal thyroid disease can have a substantial influence on foetal and neonatal thyroid function. Maternal auto-antibodies (seen in autoimmune thyroiditis) can cross the placenta and inhibit thyroid function. Much less commonly, transient hypothyroidism may occur in babies that are exposed to iodine-containing substances (e.g. X-ray dyes and certain skiin cleansers) either at or soon after birth Maternal iodide deficiency, Maternal antithyroid drug therapy,  Idiopathic, Intrauterine thyroid inflammatory disease  Autoimmune thyroiditis, transplacental passage of thyrocytotoxic factors, Maternal sensitized lymphocytes, Iatrogenic, Maternal iodide therapy, Impaired thyroid response to thyrotropin, ,  Maternal TSH receptor blocking antibody,  Drug induced
Hypothyroidism with prematurity, Iodine deficiency


Juvenile i.e. Hypothyroidism acquired after one year age:

A child, just like an adult, can become hypothyroid at any point of time; this is called acquired or juvenile hypothyroidism. Causes symptom diagnosis & treatment of juvenile & childhood hypothyroidism is same as for adult patients.


Hypothyroid during Pregnancy   

The various thyroid disorders during pregnancy are:  As in adult pregnant women may suffer with thyroid hormone deficiency (hypothyroidism), or thyroid hormone excess (thyrotoxicosis), or simply thyroid enlargement (goitre).

Hypothyroidism is called when thyroid hormone (T3, T4) production is decreased so that T3, T4 level in blood decreases & TSH increases (increased).

Consequences of Hypothyroidism:
during pregnancy is risk of abortion. But if properly treated no abortion occurs & healthy child is born. If thyroid is not well controlled it may lead to various complication to mother or fetus.

Complications to Foetus: If thyroid is not adequately treated then following complication may occur in fetus in uterus or after the birth.

Abortion
? Intellectual deficiency: some studies have shown that if thyroid is not properly treated it may lead to some point of intelligence loss in baby.
Low Birth weight         
Under-weight in utero or after birth      
Premature birth
Intrauterine growth retardation 
Rare congenital hypothyroidism


(Note: but if thyroid is treated by thyroid expert & thyroid level are kept in proper range no complication to fetus will occur.)

Maternal complications of hypothyroidism
           
Development of high blood pressure during pregnancy
Preterm delivery
Postpartum hemorrhage (excess bleeding during labour)

Treatment of hypothyroidism during pregnancy: First diagnosis of severity of thyroid hormone deficiency & diagnosis of its cause is assessed first.  Once the diagnosis is made the treatment is started in full dose. Remember full dose of thyroid hormone replacement started from beginning. We decide the full dose based on severity of hypothyroidism & weight of the mother & the duration of pregnancy. Full dose started from beginning so that with in a week time thyroid can be normalized. Once we start the right dose from beginning the no complication will occur to mother or baby. Thyroid hormone treatment given in the form of Thyroxine hormone (Eltroxin, Thyrox, and Thyronorm) is prescribed. Remember thyroid medicine can be safely given during pregnancy. It has no side effect. It does not harm the child. During pregnancy we need to keep thyroid level well control so that risk of abortions can be avoided. So get your thyroid test regularly every six weekly after that dose may need to be adjusted by thyroid experts.

After birth of fetus thyroid is tested & accordingly managed.

It has been advised by most authorities in medical science that thyroid problem during pregnancy should be managed by thyroid experts i.e. those doctors who are qualified ENDOCRINOLOGIST (DM).  


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