Hypothyroid

Thyroid diseases are, arguably, among the commonest endocrine disorders worldwide. India too, is no exception. According to a projection from various studies on thyroid disease, it has been estimated that about 42 million people in India suffer from thyroid diseases.

A bit about our thyroid gland

1. Thyroid gland, being a part of the endocrine system, is the only gland that absorbs iodine from food that we eat and uses it to make two hormones (T3 and T4).
2. The crucial function of  T3 (Triiodothyronine) and T4 (Thyroxine) is to break down calories, produce energy and boosts metabolism when released into the bloodstream.
3. And it is important, two of the above shouldn’t be either too low or either too high.Above all, two glands in our brain -the hypothalamus and pituitary works a major role in maintaining the balance of T3 and T4.
4. The hypothalamus produces TSH Releasing Hormone (TRH) that signals the pituitary to tell the thyroid gland to produce more or less of T3 and T4 by either increasing or decreasing the release of a hormone called thyroid stimulating hormone (TSH).

Hypothyroid symptoms start very gradually with weight gain and fatigue and then can produce a list of signs and symptoms as the condition worsens.

• Fatigue
• Increased sensitivity to cold
• Constipation
• Dry skin
• Weight gain
• Puffy face
• Hoarseness
• Muscle weakness
• Elevated blood cholesterol level
• Muscle aches, tenderness and stiffness
• Pain, stiffness or swelling in your joints
• Heavier than normal or irregular menstrual periods
• Thinning hair
• Slowed heart rate
• Depression
• Impaired memory

Congenital hypothyroidism - congenital hypothyroidism is insufficient production of thyroid hormone in the newborn infant.  It is probably the most important, as it is requires an early diagnosis, which is usually followed by appropriate therapy that can prevent the onset of brain damage. It can occur because of an anatomic defect in the gland, an inborn error of thyroid metabolism, or iodine deficiency.  Hence all infants are screened now to determine if they are hypothyroid or not.

In adults: One in ten adults in India suffer from Hypothyroidism.  A recent survey done by the thyroid society of India depicts that the awareness of the disease ranked ninth as compared to other common ailments like asthma, cholesterol, depression, diabetes, insomnia and heart problems.

Hypothyroidism is more prevalent among women who are three times more likely to get the disease than men especially in the age group of 46-54 years.  The prevalence seem to be increasing at an alarming rate.

Types of hypothyroidism

Hypothyroidism results when the thyroid gland fails to produce enough hormones. Hypothyroidism may be due to a number of factors, including:

• Hashimoto's thyroiditis have the most common cause of hypothyroidism. Here body’s own antibodies attack the thyroid gland, causing inflammation and the gland’s ability to produce hormones.  Cause can be genetic or any virus/bacterial infection.
• Thyroid surgery - removing a part or whole of the thyroid gland can diminish or stop the production of hormone resulting in hypothyroidism.
• While treating hyperthyroidism - medications or treatment with radioactive iodine to normalise the thyroid function can lead to permanent hypothyroidism
• Radiation therapy. Radiation used to treat cancers of the head and neck can affect your thyroid gland and may lead to hypothyroidism.
• Medications - Several medicines may lower thyroid hormone production. These include ones used to treat psychological conditions, as well as cancer and heart disease. This can lead to hypothyroidism.
• Pituitary disorder. A relatively rare cause of hypothyroidism is the failure of the pituitary gland to produce enough thyroid-stimulating hormone (TSH) — usually because of a benign tumour of the pituitary gland.
• Pregnancy. Some women develop hypothyroidism during or after pregnancy (postpartum hypothyroidism), often because they produce antibodies to their own thyroid gland. Left untreated, hypothyroidism increases the risk of miscarriage, premature delivery and preeclampsia (high blood pressure)

Risk Factors

Although anyone can develop hypothyroidism, you're at an increased risk if you:

• Are a woman older than age 60
• Have a family history of thyroid disease
• Have other autoimmune diseases, such as rheumatoid arthritis or lupus, a chronic inflammatory condition
• Have been treated with radioactive iodine or anti-thyroid medications
• Received radiation to your neck or upper chest
• Have had thyroid surgery (partial thyroidectomy)
• Have been pregnant or delivered a baby within the past six months

Based on the symptoms and on the blood tests.  Measuring the levels of t4 hormones and TSH (thyroid stimulating hormones) help in diagnosis.  If you have low levels of free T4 and high levels of TSH, you are hypothyroid.

Testing for autoimmune thyroid disease - Thyroid peroxidase (TPO) antibodies are a marker for the presence of autoimmune thyroid disease. Blood test results for TPO antibodies are positive in 95% of patients with Hashimoto's disease, and in 50% to 80% of patients with Graves' disease.

1. Thyroid medication generally advised if the TSH levels are too high and the thyroid gland is secreting insufficient thyroxine and to help relieve the symptoms.
2. Diet therapy - proper dietary habits goes a long way in managing hypothyroid. Proper dietary habits goes a long way in managing hypothyroid, helps in weight loss and also to alleviate the symptoms of hypothyroid.

Do’s and Don’ts of diet therapy

Do’s

• Include food rich in omega 3- fatty acids like flax seeds, chia seeds, walnuts, salmon and tuna that act as antioxidant and protect the gland, also help in lowering cholesterol.
• Include food rich in zinc and selenium like dry fruits, nuts, seafood, eggs, sunflower seeds and curd.  Zinc and Selenium are required for the thyroxine production plus hypothyroidism can lead to deficiency of zinc and selenium
• Iron rich food like dark green leafy vegetables, dates, figs to manage iron deficiency
• Iodine rich foods like fortified table salt, seaweed, salt water fish, dairy and eggs are good sources.
• Complex carbohydrates - whole grain cereals and pulses, whole fruits instead of juices, help in weight management

Don’ts

• Goitrogens are substances that suppress the functioning of the thyroid gland.  They act by interfering and blocking enzymes that allow thyroid to use iodine, leading to enlargement of the gland since it is under pressure to produce more hormones.  Restrict the consumption of goitrogens like cauliflower, cabbage, sweet potatoes, strawberry, groundnuts, soy and its products, broccoli, Brussels sprout, kale and so on.
• Include foods that are refined and highly processed.  Restrict on chips, bakery products, high sugar and fatty foods.

The treatment usually involves stimulating the thyroid gland and removing the toxins by use of various herbs and detoxification plans.

• Stimulates the gland naturally without any hormones
• Detoxification ( Panchakarma treatment)
• Focuses on physical & mental health and reduces symptoms.
• Numerous herbs like the gokshura, brahmi, jatamansi, ashwagandha and punarvana are used in ayurvedic treatment for hypothyroidism.