This is a case of subclinical Hypothyroidism probably Autoimmune thyroiditis or Hashimotos thyroiditis or Graves disease with PCOS. Absolutely she requires treatment with low dose of Thyroxine . As serum TSH is elevated ,and Anti Tpo antibodies titres are raised, start with low dose of thyroxine 25 mcg on empty stomach and regularly monitor serum TSH levels after 6 to 8 weeks and adjust the dose of thyroxine. When Anti Tpo antibodies are raised eventhough T3,T4 and TSH are with in normal limits,low dose of thyroxine should be started. A course of 8 tablets of vitamin D weekly once should be given. Start with low dose of Metformin or Pioglitazone to treat PCOD. Advice her regular exercise and to take Plenty of fruits.
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Hashimoto's thyroiditis in hypothyroid state Needs low dosage of levothyroxine , 12. 5 / 25 mcg daily. These people are brittle thyroid patients and may swing from hypo to hyper state with thyroxine . Needs once in 3 months monitoring of TSH Need to rule out Vitamin D3 deficiency
She is to be treated as she has PCOD, overweight, SCT
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A hypothyroid female on eltroxin 62.5 her report is enclosed.Should There be any changes in eltroxin doseDr. Medical Student0 Like10 Answers
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THYROID DISORDERS -EVERYTHING YOU SHOULD KNOW - by Dr Sunil kumar Dear friends and Curofians here's an brief information about thyroid disorders. Thyroid gland is a butterfly shaped gland in the front of the neck. 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. Thyroid disorders are conditions that affect the thyroid glands. It plays an important role in regulating numerous metabolic processes throughout the body. The Thyroid gland is located below the adam’s apple wrapped around the trachea. Thyroid disease is a common problem that can cause symptoms because of over- or under-function of the thyroid gland. The thyroid gland is an essential organ for producing thyroid hormones, which maintain our body metabolism. The thyroid gland is located in the front of the neck below the Adam's apple. Thyroid disease can also sometimes lead to enlargement of the thyroid gland in the neck, which can cause symptoms that are directly related to the increase in the size of the organ (such as difficulty swallowing and discomfort in front of the neck). Thyroxine T4 is the primary hormone developed by the Thyroid gland. A small portion of the T4 released from the gland is converted to Triiodothyronine (T3) which is the most active hormone. Hyperthyroidism: Too much thyroid hormone results in a condition known as hyperthyroidism. Affects about 1 percent of women. It's less common in men. Grave’s disease is the most common cause of hyperthyroidism. Symptoms: RestlessnessNervousnessIrritabilityracing heartIncreased sweatingShakingRestlessnessTrouble sleepingThin skinBrittle hairNailsWeight lossMuscle weakness Causes: Toxic adenomas: Nodules develop in the thyroid glands and begin to secrete thyroid hormones upsetting the body's chemical balance.Subacute thyroiditis: Inflammation of the thyroid that causes the gland to leak excess hormones, resulting in temporary hyperthyroidism that lasts a few weeks but may persist for months.Pituitary gland: Malfunctions or cancerous growths in the thyroid gland. Although rare, hyperthyroidism can also develop from these causes. Treatments for hyperthyroidism: destroy the thyroid gland or block it from producing its hormones. Antithyroid drugs: such as methimazole (Tapazole) prevent the thyroid from producing its hormones.Radioactive iodine: a large dose of it damages the thyroid gland. A pill is given by mouth. As thyroid gland takes in iodine, it also pulls in the radioactive iodine, which damages the gland.Surgery: Surgery can be performed to remove your thyroid gland. 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. Since the body needs some amount of thyroid for energy production and drop in hormone production leads to lower energy levels. Symptoms: FatigueDry skinIncreased sensitivity to coldMemory problemsConstipationDepressionWeight gainSlow heart rateComa 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. 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 disorderPeople with Chromosomal abnormalities like Down syndrome, Turners syndrome also have a high risk of suffering from hypothyroidism. 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 hypothyroidismAnti-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 retentionobesityinfertilityjoint painsdepressionA 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. If you wish to discuss about any specific problem, you can consult an Endocrinologist. Regards Dr Sunil kumarDr. Sunil Kumar16 Likes26 Answers
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27 year male epigastric / chest discomfort weakness anxiety tachycardia Lean & thin built can't tolerate cold wt. loss please guideDr. Rajendra Bagadia4 Likes8 Answers
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Autoimmune Diseases: Types, Symptoms, Causes and More........Check it Out...! ---------------------------------------------------------------------- ---------------------------------------------------------------------- What is an autoimmune disease? An autoimmune disease is a condition in which your immune system mistakenly attacks your body. The immune system normally guards against germs like bacteria and viruses. When it senses these foreign invaders, it sends out an army of fighter cells to attack them. Normally, the immune system can tell the difference between foreign cells and your own cells. In an autoimmune disease, the immune system mistakes part of your body — like your joints or skin — as foreign. It releases proteins called autoantibodies that attack healthy cells. Some autoimmune diseases target only one organ. Type 1 diabetes damages the pancreas. Other diseases, like lupus, affect the whole body. CAUSES Why does the immune system attack the body? Doctors don’t know what causes the immune system misfire. Yet some people are more likely to get an autoimmune disease than others. Women get autoimmune diseases at a rate of about 2 to 1 compared to men — 6.4 percent of women vs. 2.7 percent of men . Often the disease starts during a woman’s childbearing years (ages 14 to 44). Some autoimmune diseases are more common in certain ethnic groups. For example, lupus affects more African-American and Hispanic people than Caucasians. Certain autoimmune diseases, like multiple sclerosis and lupus, run in families. Not every family member will necessarily have the same disease, but they inherit a susceptibility to an autoimmune condition. Because the incidence of autoimmune diseases is rising, researchers suspect environmental factors like infections and exposures to chemicals or solvents might also be involved . A “Western” diet is another suspected trigger. Eating high-fat, high-sugar, and highly processed foods is linked to inflammation, which might set off an immune response. However, this hasn’t been proven . Another theory is called the hygiene hypothesis. Because of vaccines and antiseptics, children today aren’t exposed to as many germs as they were in the past. The lack of exposure could make their immune system overreact to harmless substances . BOTTOM LINE: Researchers don’t know exactly what causes autoimmune diseases. Diet, infections, and exposure to chemicals might be involved. COMMON AUTOIMMUNE DISEASES 14 common autoimmune diseases There are more than 80 different autoimmune diseases . Here are 14 of the most common ones. 1. Type 1 diabetes The pancreas produces the hormone insulin, which helps regulate blood sugar levels. In type 1 diabetes, the immune system attacks and destroys insulin-producing cells in the pancreas. High blood sugar can damage blood vessels, as well as organs like the heart, kidneys, eyes, and nerves. 2. Rheumatoid arthritis (RA) In rheumatoid arthritis (RA), the immune system attacks the joints. This attack causes redness, warmth, soreness, and stiffness in the joints. Unlike osteoarthritis, which affects people as they get older, RA can start as early as your 30s . 3. Psoriasis/psoriatic arthritis Skin cells normally grow and then shed when they’re no longer needed. Psoriasis causes skin cells to multiply too quickly. The extra cells build up and form red, scaly patches called scales or plaques on the skin. About 30 percent of people with psoriasis also develop swelling, stiffness, and pain in their joints . This form of the disease is called psoriatic arthritis. 4. Multiple sclerosis Multiple sclerosis (MS) damages the myelin sheath — the protective coating that surrounds nerve cells. Damage to the myelin sheath affects the transmission of messages between your brain and body. This damage can lead to symptoms like numbness, weakness, balance issues, and trouble walking. The disease comes in several forms, which progress at different rates. About 50 percent of people with MS need help walking within 15 years after getting the disease. 5. Systemic lupus erythematosus (lupus) Although doctors in the 1800s first described lupus as a skin disease because of the rash it produces, it actually affects many organs, including the joints, kidneys, brain, and heart . Joint pain, fatigue, and rashes are among the most common symptoms. 6. Inflammatory bowel disease Inflammatory bowel disease (IBD) is a term used to describe conditions that cause inflammation in the lining of the intestines. Each type of IBD affects a different part of the GI tract. Crohn’s disease can inflame any part of the GI tract, from the mouth to the anus. Ulcerative colitis affects only the lining of the large intestine (colon) and rectum. 7. Addison’s disease Addison’s disease affects the adrenal glands, which produce the hormones cortisol and aldosterone. Having too little of these hormones can affect the way the body uses and stores carbohydrates and sugar. Symptoms include weakness, fatigue, weight loss, and low blood sugar. 8. Graves’ disease Graves’ disease attacks the thyroid gland in the neck, causing it to produce too much of its hormones. Thyroid hormones control the body’s energy usage, or metabolism. Having too much of these hormones revs up your body’s activities, causing symptoms like nervousness, a fast heartbeat, heat intolerance, and weight loss. One common symptom of this disease is bulging eyes, called exophthalmos. It affects up to 50 percent of people with Graves’ disease . 9. Sjögren’s syndrome This condition attacks the joints, as well as glands that provide lubrication to the eyes and mouth. The hallmark symptoms of Sjögren’s syndrome are joint pain, dry eyes, and dry mouth. 10. Hashimoto’s thyroiditis In Hashimoto’s thyroiditis, thyroid hormone production slows. Symptoms include weight gain, sensitivity to cold, fatigue, hair loss, and swelling of the thyroid (goiter). 11. Myasthenia gravis Myasthenia gravis affects nerves that help the brain control the muscles. When these nerves are impaired, signals can’t direct the muscles to move. The most common symptom is muscle weakness that gets worse with activity and improves with rest. Often muscles that control swallowing and facial movements are involved. 12. Vasculitis Vasculitis happens when the immune system attacks blood vessels. The inflammation that results narrows the arteries and veins, allowing less blood to flow through them. 13. Pernicious anemia This condition affects a protein called intrinsic factor that helps the intestines absorb vitamin B-12 from food. Without this vitamin, the body can’t make enough red blood cells. Pernicious anemia is more common in older adults. It affects 0.1 percent of people in general, but nearly 2 percent of people over age 60 . 14. Celiac disease People with celiac disease can’t eat foods containing gluten — a protein found in wheat, rye, and other grain products. When gluten is in the intestine, the immune system attacks it and causes inflammation. Celiac disease affects about 1 percent of people in the United States . A larger number of people have gluten sensitivity, which isn’t an autoimmune disease, but can have similar symptoms like diarrhea and abdominal pain. SYMPTOMS Autoimmune disease symptoms The early symptoms of many autoimmune diseases are very similar, such as: fatigue achy muscles swelling and redness low-grade fever trouble concentrating numbness and tingling in the hands and feet hair loss skin rashes Individual diseases can also have their own unique symptoms. For example, type 1 diabetes causes extreme thirst, weight loss, and fatigue. IBD causes belly pain, bloating, and diarrhea. With autoimmune diseases like psoriasis or RA, symptoms come and go. Periods of symptoms are called flare-ups. Periods when the symptoms go away are called remissions. BOTTOM LINE: Symptoms like fatigue, muscle aches, swelling, and redness could be signs of an autoimmune disease. Often symptoms come and go over time. SEE A DOCTOR When to see a doctor See a doctor if you have symptoms of an autoimmune disease. You might need to visit a specialist, depending on the type of disease you have. Rheumatologists treat joint diseases like rheumatoid arthritis and Sjögren’s syndrome. Gastroenterologists treat diseases of the GI tract, such as celiac and Crohn’s disease. Endocrinologists treat conditions of the glands, including Graves’ and Addison’s disease. Dermatologists treat skin conditions such as psoriasis. DIAGNOSIS Tests that diagnose autoimmune diseases No single test can diagnose most autoimmune diseases. Your doctor will use a combination of tests and an assessment of your symptoms to diagnose you. The antinuclear antibody test (ANA) is often the first test that doctors use when symptoms suggest an autoimmune disease. A positive test means you likely have one of these diseases, but it won’t confirm exactly which one you have. Other tests look for specific autoantibodies produced in certain autoimmune diseases. Your doctor might also do tests to check for the inflammation these diseases produce in the body. BOTTOM LINE: A positive ANA blood test can show that you have an autoimmune disease. Your doctor can use your symptoms and other tests to confirm the diagnosis. TREATMENT How are autoimmune diseases treated? Treatments can’t cure autoimmune diseases, but they can control the overactive immune response and bring down inflammation. Drugs used to treat these conditions include: nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn) immune-suppressing drugs Treatments are also available to relieve symptoms like pain, swelling, fatigue, and skin rashes. Eating a well-balanced diet and getting regular exercise can also help you feel better. BOTTOM LINE: The main treatment for autoimmune diseases is with medications that bring down inflammation and calm the overactive immune response. Treatments can also help relieve symptoms. BOTTOM LINE The bottom line More than 80 different autoimmune diseases exist. Often their symptoms overlap, making them hard to diagnose. Autoimmune diseases are more common in women, and they often run in families. Blood tests that look for autoantibodies can help doctors diagnose these conditions. Treatments include medicines to calm the overactive immune response and bring down inflammation in the body.Dr. V Srivastava6 Likes6 Answers
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MY RESEARCH ARTICLE PUBLISHED IN INTERNATIONAL JOURNAL OF MEDICAL SCIENCES.. HAIR-AN SYNDROME WITH PCOS AND HASHIMOTOS THYROIDITIS: (CITE FULL ARTICLE : Kulkarni A, Srivastav SK, Susarla S, Kulkarni U, Ashok Kumar C, Chikkala S, Tabassum SM. Hyperandrogenism-insulin resistance- acanthosis nigricans syndrome with PCOS and Hashimoto’s thyroiditis: case report. Int J Res Med Sci 2015;3:2514-23.) Female hyperandrogenism is a frequent motive of consultation. It is revealed by hirsutism, acne or seborrhea, and disorders in menstruation cycle combined or not with virilisation signs. Several etiologies are incriminated but the hyperandrogenism-insulin resistance-acanthosis nigricans syndrome is rare. A 21-year female, having had a three- year-old secondary amenorrhea, known case of hypothyroidism since 4 years on medication. The exam revealed a patient, hypertensive with blood pressure at 170/110 mmHg with a Body Mass Index (BMI) at 40.08 (Obese Class-3, as per WHO 2004) and a waist measurement of 106cm, a severe hirsutism assessed to be 27 according to Ferriman and Gallwey scale, acanthosis nigricans behind the neck and elbows. The assessment carried out revealed testosteronemia at 1.07 ng/mL, which is more than twice the upper normal of the laboratory. Imaging studies revealed enlarged right adrenal gland, hepatomegaly with fatty infiltration of grade-1 also bilateral polycystic ovaries. The retained diagnosis is HAIR-AN syndrome with polycystic ovaries, hypertension, type-II diabetes mellitus, hypothyroidism since last 4-years and dyslipidemia and was provided with metformin 500 mg thrice daily, spironolactone 25 mg twice daily, atorvastatin 20 mg once daily, telmisartan 20 mg once daily with continuation of eltroxin 50 Mcg for hypothyroidism. To our knowledge this is the first case report of HAIR-AN syndrome in 21 year old female associated with Hashimoto’s thyroiditis, dyslipidaemia, hypertension and type-2-diabetes and this case also highlights about early diagnosis and management of HAIR-AN Syndrome with PCOS and Hashimoto’s thyroiditis which could help prevent long-term sequalae such as cardiovascular disease and endometrial cancer and with the advent of knowledge and availability of health resources we can prevent long-term adverse effects (threefold) on health of women. This woman should be observed for these ailments in later life.Dr. Shashank Kumar Srivastav7 Likes13 Answers