Wockhardt Hospitals Blog

Doctor Archana Juneja,M.D (Med.),DM (Endo), DNB (Endo),Consultant Endocrinologist at Wockhardt Hospitals, Mumbai shares her thoughts with us on "Thyroid Disorders"

The thyroid is an endocrine gland located in the front of the neck, overlying the wind pipe (trachea) and food pipe (oesophagus). It produces the hormones triiodothyronine (T3) and thyroxin (T4) which circulate in the blood. These hormones control the metabolism and function of our body cells. Thyroid Stimulating Hormone (TSH), a hormone produced by the pituitary gland in our brain, regulates the production of T3 and T4. T3 and T4, in turn, exert a negative feedback effect on the TSH production.

Iodine is the main constituent of the thyroid hormones.

Thyroid disorders arise either because of abnormal production of thyroid hormones (excess or under), abnormal structure or congenital developmental disorders.

Goiter: Goiter refers to an enlargement of the thyroid gland. Common causes for goiter are iodine deficiency and auto immune thyroid disease wherein antibodies, which slowly destroy the thyroid, are produced in the body. The symptoms of thyroid dysfunction are very subtle and can be easily overlooked. Hence a high index of suspicion is required to diagnose these disorders.

Hypothyroidism :Hypothyroidism refers to reduced activity of the thyroid gland leading to underproduction and low levels of T3 and T4 hormones in the blood. The TSH levels rise due to the negative feedback effect of the low hormone. This can occur because of primary damage to the thyroid gland by antibodies or because of drugs like lithium, amiodarone or iodine containing solutions. Very rarely, some pituitary tumors cause low TSH levels and thereby reduce the production of T3 and T4. This is called secondary hypothyroidism.

Hypothyroidism is more common in females. The usual symptoms of hypothyroidism (uncontrolled) include slowing of metabolism with tiredness, lethargy, cold intolerance., weight gain, mood changes, dry coarse skin, hoarse voice, heavy menses, infertility, anemia, high cholesterol etc. In children hypothyroidism leads to short stature and low IQ.

This is diagnosed by checking blood hormone levels which show low normal T3 and T4 with elevated TSH in primary hypothyroidism and a normal TSH with low T3 and T4 in secondary hypothyroidism. Tests like anti-microsomal or anti-thyroglobulin antibodies establish the cause of the problem.

Treatement

Treatment is replacing the deficient hormones by thyroxine tablets (T4 tablets eg: Eltroxin, Thronorm, Thyrox). The dose required is 1.6-1.8 mcg/kg to be taken every day in the morning on an empty stomach. Drugs like iron, calcium and antacids interfere with thyroxine and need to be spaced out. Treatment is usually lifelong except in rare circumstances. Yearly monitoring of TSH is required to decide the appropriate dose for each patient.

It can affect both sexes but is more common in males. The usual symptoms of uncontrolled hyperthyroidism include weight loss, palpitations, increased sweating, tremulousness, prominence of eyes, heat intolerance etc. In addition to these, silent diseases like irregular heart rate, heart failure, osteoporosis and worsening of diabetes can occur. Cigarette smoking can worsen this state.

Diagnosis is by detecting high normal T3 and T4 with low TSH levels in blood. Further investigations like technetium or radio-iodine scans may be useful to distinguish between thyroiditis (temporary hyperthyroidism, no treatment required) or Graves' disease (definitive therapy required).

There are various options like drugs, surgery and radioactive iodine depending on various factors like age, goiter size, eye complications, recurrent disease etc. In addition, beta-blockers for controlling symptoms and calcium and Vit. D supplements should be given to prevent osteoporosis.

Refers to benign growth of thyroid in patches leading to formation of nodules (single/multiple). The thyroid enlarges slowly and most common symptoms are of compression of the trachea or the esophagus. Thyroid hormone levels are usually normal. An ultrasound, a technetium scan or fine needle aspiration cytology (FNAC) of the nodule may be required.

Treatment options are watchful observation, surgery or radioactive iodine ablation depending on the clinical condition.

Thyroid malignancies are rare and usually seen with single nodules. Risk factors are extremes of age, large size and a rapid increase in size. The prognosis is good if detected early. Surgery followed by radioactive iodine therapy and thyroxin supplementation lifelong is the usual protocol of treatment.

Thyroid disorders can lead to infertility and miscarriages in women. Thyroid hormones are essential for normal brain development in the fetus. The developing fetus does not have a functioning thyroid gland till, at least 6months of pregnancy. It is totally dependent on the mother’s thyroid hormone, which should be maintained in the normal range. Both low and excess thyroid hormones in the mother can adversely affect the fetus. Low thyroid hormone levels in the fetus causes mental retardation. Hence, a hypothyroid mother should continue her thyroxin tablets in pregnancy and if necessary, may need to increase her dose. Similarly hyperthyroidism can cause low birth weight and heart failure in the fetus. A hyperthyroid mother should take tablets to control he hormone levels and should have blood tests done at regular intervals.

All babies born to mothers with thyroid problems should have thyroid hormone levels done on the 7th day of life.

Dr. Archana Juneja brings with her to Wockhardt Hospitals dedicated training and clinical expertise in Endocrinology from K.E.M. Hospital, Mumbai. She has also worked as a Consultant Endocrinologist at Chennai and has managed a comprehensive spectrum of endocrine cases including the extremely rare Carney’s complex and intersex disorders.

has extensive research experience on Polycystic Ovarian Syndrome, Cushing’s syndrome, thyroid disorders in pregnancy, and insulinomas and has also worked in collaboration with Interventional Radiologists on projects like Inferior Petrosal Sinus Sampling (IPSS) for ACTH and Arterial Stimulation and Venous Sampling (ASVS) for insulin, which is being done at very few centers in India.

To schedule an online Appointments with Dr Archana Juneja Please write into enquiries@wockhardthospitals.net or click here

Doctor Ashish Anand, consultant, sports medicine and orthopedic surgeon, Wockhardt Hospitals, Talks to us about "Rotator Cuff Injuries" causes , treatments and preventing them

Dr Ashis Anand is a highly qualified Orthopedic Surgeon who has worked in India and US. His areas of interest include Arthroscopy and Joint Replacement (Hip, Knee and Shoulder). With more than 450 replacements (Primary and Revision). He has also excelled in Unicompartmental Knee Replacement which is done by very few centers in India.

Cardio workouts on the treadmill, elliptical trainers and stairclimbers or weight training with bench press, leg extensions, leg curls and hip adductor and abductor - they could all make you fit, but could also injure you if done improperly.

The increasing number of gym-related injuries is certified by many of the city’s orthopedics and sports medicine specialists. They say that gym-related injuries now constitute anywhere between 40 to 90 per cent of their cases.

Rotator cuff is made up of the muscles and tendons which connect your upper arm bone with your shoulder blade. They along with the Deltoid also help hold the ball of r upper arm bone firmly in your shoulder socket. The combination results in the greatest range of motion of any joint in your body.

A rotator cuff injury includes any type of irritation or damage to your rotator cuff muscles or tendons. Causes of a rotator cuff injury may include falling, lifting and repetitive arm activities — especially those done overhead, such as throwing a cricketball or placing items on overhead shelves.

Most of the time, a rotator cuff injury heal on its own with self-care measures or exercise therapy.

Four major muscles (subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons constitute the Rotator Cuff and connect the upper arm bone (humerus) with the shoulder blade (scapula). A rotator cuff injury, which is fairly common, involves any type of irritation or damage to your rotator cuff muscles or tendons, including:

Tendinitis: Tendons in your rotator cuff can become inflamed and irritated due to overuse or overload, especially in athletes involved in overhead activities, such as in tennis or racquetball.

Bursitis:The fluid-filled sac (bursa) between your shoulder joint and rotator cuff tendons can become irritated and inflamed.

Strain or tear: Left untreated, tendinitis can weaken a tendon and lead to chronic tendon degeneration or to a tendon tear. Stress from overuse also can cause a shoulder tendon or muscle to tear.

Common causes of rotator cuff injuries include:

1. Normal wear and tear:This is commonly seen in people who are less than 40 years and most often occurs due to repetitive damage to the tendons.Age related wear and tear on your rotator cuff can cause a breakdown of fibrous protein (collagen) in the cuff's tendons and muscles. This makes them more prone to degeneration and injury. With age, one may also develop calcium deposits within the cuff or arthritic bone spurs that can pinch or irritate your rotator cuff.

2. Lifting or pulling: Lifting an object that's too heavy or doing so improperly — especially overhead — can strain or tear your tendons or muscles.

3. Repetitive stress: Repetitive overhead movement of your arms can stress your rotator cuff muscles and tendons, causing inflammation and eventually tearing. This occurs often in athletes such as swimmers and tennis players. It's also common in painters and carpenters.

4. Faulty posture: When you slouch your neck and shoulders forward, the space where the rotator cuff muscles reside can become smaller. This can allow a muscle or tendon to become pinched under your shoulder bones (including your collarbone), especially during overhead activities, such as throwing.

The most common symptom is pain. You may experience it when you reach up to comb your hair, bend your arm back to put on a shirt or carry something heavy. Lying on the affected shoulder also can be painful. If you have a severe injury, such as a large tear, you may experience continuous pain and muscle weakness.

1. When did you first begin experiencing shoulder pain?
2. Have you experienced any symptoms in addition to shoulder pain?
3. How severe is your pain?
4. What movements and activities aggravate and relieve your shoulder pain?
5. Do you have any weakness or numbness in your arm?

Once you see the Shoulder Specialist and after a proper evaluation and investigations , you may be offered one or combination of treatments.

To know more about Sports Injuries Centre at Wockhardt Hospitals,Please write to enquiries@wockhardthospitals.net

Ankylosing Spondylitis Graphic Illustration

Ankylosing spondylitis (AS) was previously known as Bechterew's disease, Bechterew syndrome, Marie Strümpell disease

Ankylosing Spondylitis is approximately three times more common in men than women.It is generally seen in people in the age group of 20 to 40 years. However it is also known to affect children.

Ankylosing Spondylitis is believed to be genetically inherited. People with a particular gene called HLA-B27 are at a much higher risk of developing Ankylosing Spondylitis although not everyone with this gene will have the disease. There is no consensus in the medical community as to the other factors that causes the disease; some researchers put it down to a combination of factors i.e. genetics and environment.

The symptoms of Ankylosing Spondylitis are due to inflammation of the spine and joints . Hence pain in the lower / mid back, buttock and neck is usually the initial symptom. Pain is generally worse while resting and more prevalent in the early morning hours resulting in disturbed sleep. It reduces with physical activity and anti-inflammatory pain killers. The onset of pain is generally gradual, progressive with worsening over a period of time and in some cases the progression can be rapid and very disabling.

Patients with severe disease can develop complete fusion of the spine (known as Ankylosis), once fused the pain disappears but spinal mobility is lost resulting in severely compromised quality of life. The disease could affect hips and knees resulting in permanent damage.Some people with ankylosing spondylitis develop problems other than in the spine viz. eye inflammation (uveitis), skin rashes (psoriais) and chronic diarrhea (inflammatory bowel disease).

The diagnosis of Ankylosing Spondylitis is based on the patient's symptoms, a physical examination, x-ray findings and blood tests. The changes on X-ray are apparent only in the later stages of the disease. Magnetic resonance scan (MRI) is helpful to diagnose the disease in its early stages and also to delineate the severity.

Traditionally the treatment for Ankylosing Spondylitis involved the use of painkillers, physiotherapy and exercise. These only gave partial relief from pain but did not prevent the progression of the disease. Joint replacement surgery is recommended for those with severe hip or knee arthritis.

More recently, over the last few years, newer drugs (Biological therapy /anti-TNF therapy) have been discovered for this disease. The advent of biological therapy has revolutionized care for patients with this disabling disease. Infliximab (Remicade) and Etanercept (Enbrel) are the two drugs that are now available in India. They have been shown to cause dramatic reduction in pain, stiffness and resulting in greatly improved mobility of the spine. They are also believed to prevent the progression of the disease which had not been possible with the older treatments. This would hence reduce the intake of pain killers, reduce deformity and prevent the need for future joint replacement. In order to be more effective they should be used earlier in the disease rather than in the late stages.

It is important to diagnose and treat patients with Ankylosing Spondylitis early so as to enable the patient to lead a relatively normal life. The disease is chronic and hence long-term care is necessary.

More awareness needs to be created among the medical community and the general public to ensure early diagnosis and appropriate treatment.

To know more about Ankylosing Spondylitis and to schedule an appointment with Doctor Ramesh Jois,please write to enquiries@wockhardthospitals.net

picture courtesy : Albert Einstein Healthcare network