Benign Lymphocytic Thyroiditis/Hashimotos Thyroiditis? *Chief Complaints* A 45 yr old female attended Mopd with Neck swelling since 16 yrs. No associated SOB,Dysphagia, Wt gain,Hair loss,Constipation,Pedal edema etc. No H/O HTN,DM,Thyroid disorder or Substance Abuse. Thyroid mass is non tender, irregular consistency, Soft,Mobile with deglutition, non mobile with Tongue protrusion, No Adjacent lymph node swelling etc. Rest Systemic and General Examination normal. Routine Ix along with USG Neck,Thyroid profile was advised. Pt attended with Reports for follow up showing- USG Neck - 5.2X3.1 CM Heterogeneous hyperechoic lesion with spongiform area,Macrocalcifications of rt Thyroid lobe with internal Peripheral vascularity. Another simple colloidal Cyst noted. Left lobe normal.TIRADS 4 lesion. Low Hb 9.1 Low Sr Ferritin 4.71 Normal Thyroid profile Stool for Occult blood neg PBS Microcytic Hypochromic Anemia Low MCV 73.2 Low MCH 22.8 Low MCHC 31 Suggestive of Iron Deficiency anemia. Then FNAC of Thyroid mass was planned and done. Reports arrived showing Benign mass with hyperplastic nodule with lymphocytic Thyroiditis and hurthle cells seen. Now Subtotal Thyroidectomy is being planned. Surgery and ENT opinion has been taken.

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.

A 42 years old lady c/o fatigue, constipation and gaining of weight for two years. Right and left lobe of thyroid gland enlarged. Falling of hair. White discoloration of the inner side of the lower lip pain in knees. Agg : motion. Blood reports attached. Please suggest treatment.

Homeopathy For Hypothyroidism ___________________________ Hypothyroidism is a condition in which the thyroid gland is under active and does not produce sufficient amounts of thyroid hormones required in the body. The most cause of hypothyroidism is Hashimoto’s thyroiditis. Hashimoto’s thyroiditis is an auto immune disorder in which the antibodies are produced by the immune system against its own tissue, which in turn attacks the thyroid gland resulting in hypothyroidism.Severe Iodine defficiency can also lead to hypothyroidism . Natural Homeopathic remedies for hypothyroidism are highly effective and especially useful for people who want to avoid the side effects of prescription drugs. Top Homeopathic Remedies for Hypothyroidism ______________________________________ #Calcarea carb , Sepia ,Lycopodium, Graphites and Nux Vomica are the leading homeopathic remedies for hypothyroidism . Calcarea Carbonica: Homeopathic medicine Calcarea Carbonica assumes the top most position in homeopathy for treating hypothyroid cases. It is one of the best homeopathic remedy for hypothyroidism. Its use is highly recommended in obese people who are always chilly and cannot tolerate cold air. The patient requiring this medicine is fair complexioned, fatty and flabby. Excessive sweating on head is a leading feature for its use in hypothyroid patients. Certain peculiarities in eating habits like craving for boiled eggs, desire for indigestible things like chalk, pencils, lime, and aversion to take fats also guide towards its use in patients of hypothyroidism. This homeopathic medicine for hypothyroidism can also help in relieving constipation in hypothyroid patients; the peculiar feature is that the first part of stool is hard and is followed by soft stool. This medicine proves to be very efficacious in women with hypothyroidism who suffer from very profuse menses that continue for long durations and occur earlier than the expected date. Coldness of feet is always present during the menstrual period. #Sepia Officinalis: Sepia Officinalis is also a significant homeopathic medicine for treating the hypothyroid patients. The patients requiring this medicine are very weak, have a pale yellow face and faint very easily especially on exposure to excessive cold temperature. Such patients lack vital heat of body and feel excessively chilly even in a warm room. This medicine can help in treating the menstrual complaints in patients of hypothyroidism where the menses appear too early and are copious in nature. The menstrual complaints are always accompanied by bearing down sensations in pelvis where the patient feels as if the pelvic organs will come out through the vulva and always sit with cross legs to prevent the escape. Sepia Officinalis is also prescribed for controlling the excessive hair fall due to hypothyroidism, especially in women of menopausal age. The next sphere in which this medicine proves very efficacious is the treatment of constipation in hypothyroid patients. The patients requiring this medicine complain of very hard and difficult stool that is passed in small balls with excessive pain during the passing the stool process that continues for long time after the stool. The mental symptoms that are to be considered for its use in hypothyroid patients is extreme irritability and indifferent behaviour towards family members who were earlier very much loved. An unusual excessive craving for acidic things and pickles can also be present. #Lycopodium Clavatum:This is an excellent homeopathic thyroid Remedy . This homeopathic medicine is mainly prescribed to those patients of hypothyroidism who suffer from gastric troubles. There is excessive flatulence in the abdomen with acidity that is mainly worse after taking farinaceous food. The complaints are mainly worse from 4:00pm-8:00pm. There is constipation with difficult, hard, incomplete stool. The person craves hot drinks and hot food; craving for sweets may also be found. The person is very weak with yellowish face and blue circles around eyes. The excessive hair falling in a hypothyroid person can be wonderfully tackled with this medicine’s use. The patients requiring this medicine are of very irritable nature and cannot bear little contradiction. #Graphites: Graphites is mainly used for those patients of hypothyroidism who are very obese and take on cold very easily. The long standing constipation where the stool is hard and passes with great difficulty in lumps can be treated with this medicine. Such patients also complain of fullness in abdomen due to obstruction of flatus and desire to loosen the clothing to get relief. Mentally the patient is very depressed, sad and weeps easily on listening to music. Timidity and inability to take decisions may also be present. #Nux Vomica: Nux Vomica is a wonderful homeopathic remedy mainly prescribed in those patients of hypothyroidism who are extremely temperamental in nature and get offended very easily; such people are very sensitive to all external impressions. This medicine works wonderfully in treating the obstinate constipation in hypothyroid patients. The stool is scanty and unsatisfactory where the patient feels constant urge to pass stool but with little evacuation. Bloated feeling in the stomach after eating is also present. There is an excessive desire for stimulants like alcoholic drinks and coffee; fatty food and spicy food. Patient is very chilly. This medicine can also help those women of hypothyroidism who complain of prolonged menses where the menstrual blood is blackish and accompanied by fainting spells. #Homeopathic medicines for Hypothyroidism – When Weight Gain is the Main Symptom Homeopathic medicine Calcarea Carbonica works well in controlling the excessive weight gain in patients due to hypothyroidism. The patient requiring this medicine is fatty, fair complexioned and flabby. Extreme sensitiveness to cold air is always present in the patient. Excessive sweating on the head usually at night time is also a very prominent symptom guiding towards using this medicine in weight gain. Another homeopathic medicine Graphites works well in controlling the weight gain in those persons who are very obese, chilly and suffer from obstinate constipation. Lycopodium Clavatum is also a natural homeopathic medicine for treating weight gain in hypothyroidism where the thighs and buttock region is obese. The patients requiring Lycopodium usually show excessive craving for hot drinks and sweets. #Homeopathic medicines for treating menstrual problems in a women suffering from Hypothyroidism: Sepia Officinalis is an excellent medicine to deal with menstrual problems due to hypothyroidism where the menses are very profuse and appear very early. Presence of bearing down sensations in pelvic organs along with excessive menstrual flow is a hallmark in using this medicine to correct menstrual problem. The patient requiring this medicine is very chilly and even faints in an extreme cold environment. Homeopathic medicine Calcarea Carbonica can help where the women complain of heavy bleeding during menses along with extremely cold feet during the flow. Excessive perspiration on the head during sleep can accompany this problem, and the patients requiring this medicine are usually obese. Next homeopathic medicine Ferrum Mettalicum can prove to be very efficacious in those women who complain of excessive bleeding during menses where the blood is pale and watery leading to anemia and weakness. Cinchona Officinalis is yet another useful natural homeopathic medicine for treating menstrual trouble in women suffering from hypothyroidism. The symptom guiding towards its use is profuse menstrual flow containing dark clots. #Homeopathic medicines for dealing with cold intolerance in hypothyroid patients: Homeopathic medicines Psorinum, Silicea, Calcarea Carbonica are wonderful medicines to deal with sensitiveness to cold in hypothyroid patients. All these are equally good for decreasing the sensitivity towards cold but the selection of the medicine solely depends upon the constitutional symptoms given by the patient. Psorinum may be given to those patients who always feel chilly and even in hot weather desire extra coverings to combat the extreme chilliness. Patients requiring Psorinum may also give a history of some sort of skin complaint during their life time. Next medicine Silicea mainly suits obstinate kind of people who are extremely sensitive to cold and who have offensive perspiration on feet. For using Calcarea Carbonica, the symptoms of excessive perspiration on scalp, obesity and craving for boiled eggs along with chilliness are given utmost importance. #Homeopathic medicines Alumina, Nux Vomica and Bryonia Alba for treating the constipation in a person suffering from Hypothyroidism: The first homeopathic medicine Alumina gives excellent results in treating the trouble of constipation in a hypothyroid patient. Patient requiring this medicine passes many days without going for stool, he feels no desire for stool until a large accumulation has occurred in intestines. The stool is mainly soft and clay like but it requires great straining to expel the stool due to sluggish action of rectum. Next medicine Nux Vomica works well in relieving those cases of constipation where the patient feels constant desire to pass stool but only scanty stool is passed. The stool is insufficient and does not give satisfaction to the patient. Pain in abdomen usually precedes the expulsion of stool. Intake of spices and coffee makes the patient worse. The last medicine Bryonia Alba can help in relieving those patients who complain of excessively hard and dry stool. An unusual thirst for large quantities of water may be present in patients requiring Bryonia Alba.

*Hypothyroidism* *☝ all about☝* – also called underactive thyroid – is the most common thyroid disorder. It happens when your thyroid gland doesn’t produce enough thyroid hormone, which is essential because thyroid hormone helps regulate important body processes, such as your metabolism. But with low thyroid function, these body processes slow down. Pathophysiology The hormones produced by the thyroid gland are T3 and T4. These hormones have an action on almost all parts of the body. The secretion of these hormones is regulated by TSH or thyroid stimulating hormone that is secreted by the pituitary gland. The secretion of thyroid hormone occurs only from this particular gland. The presence of iodine and amino acid tyrosine are a must for the production of thyroid hormones. Hypothyroidism and low levels of the thyroid hormones can occur if there is a deficiency of iodine for thyroid or thyroid stimulating hormone (TSH). The hypothalamus of the brain secretes TRH thyroid releasing hormone which acts on the pituitary gland and initiates the release of TSH or thyroid stimulating hormone. TSH then acts directly on the thyroid gland to release thyroid hormones T3 and T4. The normal functioning of the thyroid (healthy thyroid) is regulated by negative feedback mechanism where the levels of thyroid hormones increase or decrease under the influence of TSH. Causes Hashimoto’s thyroiditis: This autoimmune disease is the most common cause of hypothyroidism. Medications: Certain medications, such as lithium, can cause hypothyroidism. Pregnancy: Hypothyroidism can develop during or after pregnancy. Treatment for hyperthyroidism: People who have hyperthyroidism (overactive thyroid) are treated with radioactive iodine therapy, which impairs thyroid function and can cause hypothyroidism. Thyroid surgery: If your thyroid gland is removed, you can’t make thyroid hormone, so you’ll need to take thyroid hormone replacement. Radiation therapy: Radiation used for the treatment of cancer in the head or neck, lymphoma, or leukemia, may slow or halt the production of thyroid hormone. This will almost always lead to hypothyroidism. Risk factors There are two main factors to consider – age and sex. The chances of being hypothyroid increase with age, and they are greater if an individual is a woman. You have a family history of thyroid disease or any autoimmune disease You have type 1 diabetes or rheumatoid arthritis, or other autoimmune disorders As mentioned in the causes section medications and thyroid surgery also a major risk factors Signs and Symptoms in adults Women who are over age 60, as well as men who are aging, should look out for these potential symptoms of hypothyroidism: Weight gain Fatigue Sensitivity to cold temperatures Depression Dry skin Thinning hair Heavy menstrual periods (in women) Trouble sleeping Difficulty concentrating Pain or swelling of the joints Constipation High cholesterol levels Muscle weakness Signs and symptoms in Children and teen Symptoms of hypothyroidism in children and teens are similar to symptoms in adults and can include: Poor growth or short stature Delayed puberty Slow reaction time Weight gain Coarse, dry hair or skin Muscle cramps Delayed mental development Increased menstrual flow for girls Signs and Symptoms in Infants Symptoms of hypothyroidism in infants may include: Jaundice (yellowing of the skin and whites of the eyes) Frequent choking Puffy face Constipation Complications Heart disease and stroke Hypothyroidism can lead to insulin resistance The myxedema coma Goiter Mental health issues Peripheral neuropathy Low levels of thyroid hormone can interfere with ovulation, which impairs fertility Birth defects Diagnosis and test Medical evaluation Your doctor will complete a thorough physical exam and medical history. They’ll check for physical signs of hypothyroidism, including: Dry skin Slowed reflexes Swelling A slower heart rate In addition, your doctor will ask you to report any symptoms you’ve been experiencing, such as fatigue, depression, constipation, or feeling constantly cold. Blood test There are several types of blood tests – the most definitive one is called the TSH test (thyroid-stimulating hormone). However, in some cases, physicians may refer to the free thyroxine or T4, free T4 index, or total T4 to aid in the diagnosis. TSH Test A thyroid-stimulating hormone or TSH is a blood test that measures the amount of T4 (thyroxine) that the thyroid is being signaled to make. If you have an abnormally high level of TSH, it could mean you have hypothyroidism. 0.4 mU/L to 4.0 mU/L is considered the reference range (there may be a slight variation depending on the laboratory), TSH >4.0/mU/L with a low T4 level indicates hypothyroidism. T4 (thyroxine) Test The thyroid gland produces T4 (thyroxine). The free T4 and the free T4 index are blood tests that, in combination with a TSH test, can let your physician know how your thyroid is functioning. Anti-thyroid Microsomal Antibodies Testing A third hypothyroid test is for anti-thyroid microsomal antibodies—anti-thyroid peroxidase (anti-TPO). These antibodies, which are produced by the immune system, may attack thyroid cells. If a blood test determines their presence, it shows that there has been thyroid damage which could potentially lead to hypothyroidism. Differentiation of Hypothyroidism Primary hypothyroidism Primary hypothyroidism is due to disease in the thyroid; thyroid-stimulating hormone (TSH) is increased. The most common cause is autoimmune. It usually results from Hashimoto thyroiditis and is often associated with a firm goiter or, later in the disease process, with a shrunken fibrotic thyroid with little or no function. The 2nd most common cause is post-therapeutic hypothyroidism, especially after radioactive iodine therapy or surgery for hyperthyroidism or goiter. Secondary hypothyroidism Secondary hypothyroidism occurs when the hypothalamus produces an insufficient thyrotropin-releasing hormone (TRH) or the pituitary produces insufficient TSH. Sometimes, deficient TSH secretion due to deficient TRH secretion is termed tertiary hypothyroidism. Subclinical hypothyroidism Subclinical hypothyroidism is elevated serum TSH in patients with absent or minimal symptoms of hypothyroidism and normal serum levels of free T4. Subclinical thyroid dysfunction is relatively common; it occurs in more than 15% of elderly women and 10% of elderly men, particularly in those with underlying Hashimoto thyroiditis. Treatment and medication Medications Hypothyroidism is a lifelong condition. For many people, medication reduces or alleviates symptoms. Hypothyroidism is best treated by using levothyroxine (Levothroid, Levoxyl). This synthetic version of the T4 hormone copies the action of the thyroid hormone your body would normally produce. The medication is designed to return adequate levels of thyroid hormone to your blood. Once hormone levels are restored, symptoms of the condition are likely to disappear or at least become much more manageable. Animal extracts that contain thyroid hormone are available. These extracts come from the thyroid glands of pigs. They contain both T4 and triiodothyronine (T3). If you take levothyroxine, you’re only receiving T4. But that’s all you need because your body is capable of producing T3 from the synthetic T4. These alternative animal extracts are often unreliable in dosing and haven’t been shown in studies to be better than levothyroxine. For these reasons, they aren’t routinely recommended. Thyroid Hormone Replacement Therapy The main goal is to compensate for the lack of hormone secreted by the thyroid gland. In most cases, an affected individual will take a daily dose of T4 (or T3 and T4) in a pill taken orally. But it’s important to understand that every patient’s therapy may be different. There is no cookie-cutter dosage or treatment plan when it comes to thyroid hormone replacement therapy. How the body absorbs the hormones, along with the number of hormones needed to help the body function properly is very varied. Prevention Taking iodine supplements can prevent hypothyroidism. Exercises and alternative therapies may prove more than effective in minimizing symptoms of thyroid imbalance than traditional treatments. Get a screening test every five years if you are 50 years old or older. Get regular screenings if you: Have Type 1 diabetes Have infertility (females) Take certain medications Natural remedies Do not use non-stick cookware Eliminate Soy: Soy restrains functions of the thyroid, imbalances hormones & it has been appeared to cause goiters Balance Estrogen Levels: Excessive consumption of estrogen slows down the thyroid organ. This implies disposing of anti-conception medication, expanding the fiber in the eating routine & keeping away from all non- organic meats. Adhere to an Alkaline Diet: This is greatly useful when curing any severe issue. Exercise: Find a physical movement activity that is fun & does it regularly. Iodine: The thyroid requires iodine to work appropriately & loads of individuals now experience the ill effects of iodine lacks. To test yourself, put some iodine on your stomach. In case it vanishes in 12 hours, at that point you are lacking iodine. Continue including iodine in increased amounts, until it doesn’t vanish in a 12-14 hours’ time. This works because of the way that the body trans-dermally absorbs iodine at the rate at which it is required. Avoid all types of fluoride Move for natural diet: To enable the body to recuperate itself, take away the loads on its immune system. This implies every single processed food, synthetic flavors, hues, additives, white sugar, white flour, table salt, hydrogenated oils, aluminum and etc. ought to be removed from the diet chart. Organic food is perfect. Chlorophyll: Including chlorophyll gives fundamental copper, oxygenates the body, adds healthy RBC’s, and in general helps with skin health. Chlorophyll is a safe strategy for the oral supplement of copper. Pears and Apples: Pears help most when combined with or mixed with apple juice. Try this pear juice formula, and drink it routinely. Zinc and Selenium: Studies demonstrate that serious zinc or selenium insufficiencies would cause diminished thyroid levels. Never take zinc first thing in the stomach. Brazil nuts are high in both zinc and selenium. Coconut Oil: Buy natural, fresh squeezed, coconut oil from a health store. Take around 1 teaspoon every day. You can likewise use it in cooking, yet be cautioned that it smokes at low cooking temperatures, so it should just be utilized for low-warm cooking. Coconut oil speeds up the digestion improve thyroid hormone generation and cut down candida yeast. Avoid Canola Oil: Canola oil meddles with the generation of thyroid hormones, among its numerous risks. Treat canola oil like the evil, genetically engineered hereditarily designed poison.