ENDOCRINE
DISORDERS
Thyroid Disorders
(Hypothyroidism, Hyperthyroidism, Goitre, Autoimmune Thyroditis)
Hypothyroidism
The term myxoedema indicates severe hypothyroidism in which there is accumulation of hydrophilic mucopolysaccharides in the ground substance of the dermis and other tissues, leading to thickening of the facial features and doughy induration of the skin.
Classification
Primary hypothyroidism - due to a cause within the thyroid gland itself.
Secondary hypothyroidism - due to failure of TSH production following pituitary or hypothalamic disease.
Hyperthyroidism
Hyperthyroidism is a condition in which your thyroid creates and releases more hormones than you need. This is also called overactive thyroid. The main hormones your thyroid makes include triiodothyronine (T3) and thyroxine (T4).
Hyperthyroidism can affect your entire body and is a condition that needs to be treated by a healthcare provider.
Goitre
When iodine deficiency manifests as diffuse goitre in a particular geographic region, where more than 5% of the population is affected, it is called endemic goitre.
These endemic belts are characterised by:
A daily iodine intake of less than 50 µg (normal recommendation is 100 µg/day).
Very low iodine content in drinking water.
Deficient dietary sources of iodine like sea-fish, milk and eggs.
Autoimmune Thyroditis
Hashimoto's disease is an autoimmune condition that can cause hypothyroidism (underactive thyroid). Its a lifelong (chronic) condition.
Your thyroid is a small, butterfly-shaped gland located at the front of your neck under your skin. Its a part of your endocrine system and releases thyroid hormones.
Your thyroid's main job is to control the speed of your metabolism. This is the process of how your body transforms the food you consume into energy. It's common to mainly think of metabolism in terms of weight gain or weight loss. But this process affects every organ in your body, including your heart and brain.
In most cases of Hashimoto's disease, your thyroid can't produce enough thyroid hormone for your body. This slows down your metabolism and causes a range of symptoms.
Causes
Hypothyroidism
Spontaneous atrophic hypothyroidism (Hasimoto's thyroditis)
Iodine deficiency
Thyroidectomy
Dyshormonogenesis
Drugs (PAS, lithium, amiodarone, interferon)
Radiation
Hyperthyroidism
Grave's disease
Multinodular goitre
Solitary thyroid nodule (toxic adenoma)
Excess pituitary secretion of TSH
Drugs (excess of iodine; amiodarone)
Hydatidiform mole
Choriocarcinoma
Struma ovarii
Carcinoma of thyroid
Subacute thyroiditis
Goitre
Occasionally, goitre may be due to ingestion of goitrogens (e.g. cassaa roots, cabbage, cauliflower).
In India, it is estimated that more than 6.1 crore people are suffering from endemic goitre and 88 lakh people are mental/motor handicaps due to it.
Goitre is one of the several disorders that occur due to iodine deficiency. All the disorders are categorised under a term "iodine deficiency disorders" (IDD).
Autoimmune Thyroditis
Hashimoto's disease is an autoimmune disease, which means your body's immune system attacks your cells and organs.
Normally, your immune system protects your body against harmful outside invaders, like bacteria and viruses. But in Hashimoto's disease, the following happens:
Your immune system makes antibodies that attack your thyroid tissue for unknown reasons.
Large numbers of white blood cells (specifically, lymphocytes), build up in your thyroid.
This buildup causes inflammation (thyroiditis) and damages your thyroid.
Over time, the damage can prevent your thyroid from making enough thyroid hormone that your body needs. This leads to hypothyroidism. However, not everyone with Hashimoto's disease develops hypothyroidism.
Symptoms
Hypothyroidism
Thyroid : Enlargement of the gland
Gastrointestinal : Decreased appetite, constipation, ileus, ascites
Cardirespiratory : Angina, bradycardia, hypertension, cardiac failure, pericardial effusion, pleural effusion
Neuromuscular : Aches and pains, muscle stiffness, delayed relaxation of tendon reflexes (Woltman's sign), carpal tunnel syndrome, deafness, depression, psychosis, cerebellar ataxia, myotonia
Dermatological : Myxoedema (non-pitting oedema of the skin of hands, feet and eyelids), dry flaky skin and hair, aopecia, vitiligo, purplish lips and malar flush, carotenaemia, erythem ab igne, xanthelasmas
Reproductive : Menorrhagia, infertility, galactorrhoea, impotence
Haematological : Macrocytosis, anaemia
Miscellaneous : Tiredness, somnolence, cold intolerance, hoarseness of voice, low-pitched voice, slurred speech, weight gain
Other causes of delayed relaxation of tendon reflexes include anorexia nervosa, advance age, peripheral oedema, hypothermia, peripheral arterial disease and pregnancy.
Myxoedema facies is a peculiar facial appearance due to periorbital puffiness resulting from myxoedema, scanty eyebrows, facial pallor due to vasoconstriction and anaemia, a lemon-yellow tint to the skin due to carotenaemia (caused by reduced conversion of carotene to Vitamin A), purplish lips and malar flush.
Subclinical hypothyroidism is a milder degree of throid failure characterised by mild to moderate increase in serum TSH but with T₄ values still within normal range. "Antithyroid antibodies can be detected in 80% of these patients. Progression from subclinical to overt hypothroidism occurs in 5-18% of persons with subclinical hypothyroidism per year. Levothyroxine therapy should be started if TSH>10.0 mIU/L while therapy needs to be individualised if TSH<10.0 mIU/L.
Hyperthydroidism
Thyroid : Diffuse or nodular enlargement
Gastrointestinal : Weight loss, increased appetite, vomiting, increased stool frequency, diarrhoea, steatorrhoea
Cardiorespiratory : Exertional dyspnoea, exacerbation of asthma, palpitations, angina, sinus tachycardia, atrial fibrillation, wide pulse pressure, cardiac failure, cardiomyopathy
Neuromuscular : Nervousness, irritability, emotional lability, psychosis, fine tremors, hyper-reflexia, ill-sustained clonus, muscle weakness, proximal myopathy, bulbar myopathy
Dermatological : Increased sweating, puritus, palmar erythema, spider naevi, oncholysis, alopecia, pigmentation
Reproductive : Menstrual disturbances (amenorrhoea or oligomenorrhoea), infertility, repeated abortions, loss of libido, impotence
Miscellaneous : Heat intolerance, fatigue, apathy, gynaecomastia, thirst
Elderly patients with hyperthyroidism present with anorexia, apathy and dominant cardiovascular and myopathic features.
Younger patients with hyperthyroidism presnt with dominant neurological manifestations.
Goitre
Endemic goitre manifests clinically as a diffuse enlargement of the thyroid with a patient in euthyroid state in the initial stage. This is known as simple goitre. Later, hypothyroidism develops.
In children and adults endemic goitre may be associated with features of hypothyroidism and mental retardation.
Cretinism : Iodine deficiency causes severe hormone-induced psychological damage to foetus and newborn resulting in cretinism (stunning, deaf-mutism, malformed limbs, spastic motor disorders, goitre, as well as mental impairment).
Autoimmune Thyroditis
Some people with Hashimoto's disease may not have any symptoms at first.
As the condition slowly progresses, your thyroid gland will sometimes become enlarged (a condition called goiter). Goiter Is a common first sign of Hashimoto's disease. It's shouldn't hurt, but it can create a feeling of fullness in your lower neck. It can make the front of your neck look swollen.
If Hashimoto's disease leads to hypothyroidism, it can cause the following symptoms over time:
Tiredness (fatigue), lethargy and excessive sleeping.
Mild weight gain.
Dryskin.
Feeling cold.
Slower-than-normal heart rate (bradycardia).
Joint stiffness and muscle pain.
Dry, brittle hair; slow hair growth; or hairloss.
Low or depressed mood.
Puffy eyes and face.
Memory problems or difficulty concentrating.
Heavy or irregular periods.
Decreased libido (sex drive).
Female infertility or male infertility.
Treatments
Hypothyroidism
Homoeopathic medications help in curing the disease from its origin and cures the hormonal disturbance that is caused. Gradually the symptom s of this disease also disappear. The hormonal imbalance is re regulated in such a way that it does not get into disease state later after few years again.
Few homoeopathic remedies that help are Silicea, sepia, Kali iodum etc.
Certain diet management and exercise is also needed along with medications to heal and keep your body healthy.
Hyperthyroidism
Homeopathy has huge scope in thyroid problems. These medications work on the entire body this helping the body to again balance its hormones. The aim to cure the cause and ultimately the disease signs and symptoms.
Homeopathy can treat this disease without any other intervention.
Few remedies which help in such cases are abrotanum, iodum, thuja etc.
Goitre
There is treatment for goitre in homeopathy. Homeopathy heals the thyroid gland and complete hormonal system and cures the symptoms. Further progress of disease is stopped and patient is also given immunity to have any hormonal disturbances in later age.
Few medications which help in such patients are iodum, Kali iodum, lycopus etc.
Autoimmune Thyroditis
Such autoimmune diseases can be mainly treated with medications like Homoeopathy. Homoeopathy acts on the cells which are working against the body’s own immune system and causing autoimmune conditions. This helps in curing this problem from within. It also helps in preventing further progress of disease and again beginning of autoimmune disorders in future. Gradually patients recover by homoeopathic medications.
Few homeopathic medications which help in such cases are sepia, calcarea iodum, graphitis etc.
