THYROID (Hyper/Hypothyroidism, Goiter, Galaganda, Ghegha)

THYROID  

(Hyper/Hypothyroidism, Goiter, Galaganda, Ghegha)

Human beings are becoming less and less active as the technology grows. With such a low level of activity, keeping the balance of body systems is difficult, as a  result, Thyroid diseases.

Hyperthyroidism affects one in 500 pregnancies. About six percent of women have post-partum thyroiditis. Awareness about the disease and its diagnosis remains shockingly low.

It is estimated that 42 million people in India suffer from Thyroid diseases.

One in ten Indian suffers from thyroid disorders. It is estimated that 200 million people in the world have some form of thyroid disease. Thyroid disorders are prevalent and their manifestations are determined by the dietary iodine availability. While one in ten adults in India suffers from hypothyroidism. Women are ten times more likely than men to develop hyper or hypothyroidism. People older than age 60 have a higher incidence of thyroid disorders. Hyperthyroidism affects one in 500 pregnancies. About six percent of women have post-partum thyroiditis. Awareness about the disease and its diagnosis remains shockingly low.

Thyroid disease assumes various forms, the most frequent being hypothyroidism also known as myxedema, and hyperthyroidism, also known as thyrotoxicosis or exophthalmic goiter. Hypothyroidism results from the withering or atrophy of the thyroid gland. Hyperthyroidism is a serious condition where toxic symptoms develop.

Women are more prone to thyroid disease. They are especially likely to develop a sluggish thyroid after middle age. The disease is more common in women who are overworked and who do not get sufficient rest and relaxation. The period in older women' s life, when she is likely to be affected by this disease is at the menopause and thereafter, or when there is any extra physical strain on the body.

                                 

                                 

Introduction

The thyroid gland is often described as ‘butterfly’ shaped, it is located in the central lower portion of the neck in front, almost exactly where a bow tie would be located just below Adam's apple. It is an endocrine gland. It secretes a hormone that affects growth, metabolism and mental development. The thyroid hormones triiodothyronine (T3) and thyroxine (T4) are created from iodine and tyrosine. The thyroid also produces the hormone calcitonin, which plays a role in calcium absorption.

Iodine : This is a constituent of the secretion of the thyroid gland. Lack of iodine impairs the function of the thyroid gland resulting in goitre. Sources: This is present in green vegetables and sea foods.

Women are more prone to thyroid diseases. Ratio- F/M is 6:1. They develop a sluggish thyroid after middle age. The disease is more common in women who are overworked and who do not get sufficient rest and relaxation. It is likely to affect at the time of extra physical strain on the body or during menopause. 

The thyroid gland plays an important role in destroying toxic matter generated in the intestines, as a result of the putrefaction of animal protein like meat, fish eggs, cheese and milk. The thyroid glands will be overworked when excessive quantities of these foods are consumed, resulting in the clogging of the intestinal tract with toxic matter. The overworking of the thyroid gland is further complicated by wrong living habits and excessive emotionalism both of which weakens the system.

There are different types of thyroid malfunctions:

A.   Hyperthyroidism (or Thyrotoxicosis) / Overactive thyroid.

Hyperthyroidism is a serious condition of the body, which results from over activity of the thyroid gland. It is a clinical condition resulting from increased levels of free Thyroxine (T4) and triiodothyronine (T3). Abnormal hormone production is usually due to an abnormal thyroid.

Primary abnormalities of thyroid stimulating hormone (TSH) and thyrotropin releasing hormone (TRH), are very rare.

The overproduction of a hormone by the butterfly-shaped gland in the neck (thyroid).

Hyperthyroidism is the production of too much thyroxine hormone. It can increase metabolism. Overview. Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat

Symptoms include unexpected weight loss, rapid or irregular heartbeat, sweating and irritability, although the elderly often experience no symptoms.

Treatments include radioactive iodine, medication and sometimes surgery.

B.   Hypothyroidism (or Myxedema)

Clinical condition resulting from decreasing in circulating levels of T4 and T3 by the thyroid gland irrespective of the cause. There is deposition of mucinous material causing swelling of skin and of subcutaneous tissues. It is a condition when the Thyroid gland stops releasing thyroid hormone in the bloodstream. It results from the withering or atrophy of the thyroid gland.

This can be due to various reasons. To some extent this can be supplemented by additional intake of iodine with food. Iodized salt can help in prevention of this condition. Generally this can be overcome by giving thyroid stimulating hormone after evaluating the patient.

Cretinism

Cretinism is a condition of severely stunted physical and mental growth owing to untreated congenital deficiency of thyroid hormone (congenital hypothyroidism) usually owing to maternal hypothyroidism, in which growth of a child is stunted and the milestones are delayed.

C.    Thyroid Cancer

The incidence of thyroid malignancies is increasing rapidly but most thyroid cancers are curable.

D.   Thyroiditis

Infection of thyroid gland due to viral.

●     Basic Physiology

The Hypothalamus secrete TRH (thyrotropin releasing hormone), a tripeptide, which stimulate the production of TSH (thyroid stimulating hormone), a polypeptide from the anterior pituitary. TSH increases the production and release of thyroxin (T4) and triiodothyronine (T3) from the thyroid. T3 and T4 reduce production of TSH which is the basis of the TRH test. Thyroid produces mainly T4, some of which is converted into T3 in the blood. In the body 85% of T3 is produced this way; 15% is secreted from the thyroid. T3 is five times as active as T4. Most T3 and T4 in plasma is protein bound mainly to thyroxine binding globulin (TBG). It is the unbound portion which is active. T3 & T4 which is responsible for cell metabolism. They are vital to normal growth and mental development. They also increases the effect of catecholamines.

“Stamina is controlled by Thyroid”

Risk factor

●     Cause

Hypothyroidism

●     

• Hashimoto’s Disease: It is an autoimmune disorder of hereditary nature where your body produces antibodies that could attack and destroy your thyroid. It may also be caused by viral infection.

• Radiation therapy in the neck region: Radiation therapy for cancer, especially in the neck region might cause damage to your thyroid cells making it difficult to produce hormones.

• Radioactive iodine treatment: This destroy the cells in the thyroid making it less functional.

• Medication: Use of certain medicines may hinder your thyroid’s ability to produce hormones.

• Iodine in the diet: Thyroid needs iodine for hormone production and lack of it would lead to hypothyroidism.

• Pregnancy: Postpartum thyroiditis where there is a severe increase in thyroid hormone production followed by a sharp drop in the same.

• Congenital Hypothyroidism: It is a condition in which some babies may be born with a thyroid that is not well developed or not functioning properly.

• Pituitary & Hypothalamus Gland: Any damage or disorder to your pituitary and hypothalamus would lead to hypothyroidism.

SpPrimary Atropic hypothyroidism

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●     Iodine deficiency: Dietary deficiency due to stay in Goitrous region, sub Himalayan belt, Rajasthan.

●     Age usually after 35

●     Drug induced- anti thyroid drugs, lithium, Imodium, (e.g. In expectorants), para- aminosalicylic acid,   amiodarone.

●     After thyroidectomy or radioiodine treatment

    Hashimoto’s thyroiditis: Autoimmune disease in which there is lymphocyte and plasma cell infiltration. Usually in women at the age of 60-70 years. Autoantibody titres high.

●     Pituitary deficiency

●     Wrong feeding habits, faulty lifestyle

●     Graves' disease: (Diffuse iodine goitre) Common over 90%, especially in women aged 30-50 years. Majority in young adult. Immunology Hyperthyroidism in Grave’s disease results from presence in serum of IgG antibodies directed against the TSH receptors of thyroid follicular cell. These stimulate thyroid hormone production and stimulate TSH.

●     Excessive TSH Secretion- Pituitary tumour, Trophoblastic tumours (choriocarcinoma, hydatidiform mole)

●     Exogenous iodide- Radiographic contrast media, iodisation programmes, drugs (e.g. amiodarone).

●     Neonatal hyperthyroidism due to trans placental passage of TSH- in children of mothers with Grave’s disease.

●     Environmental and psychogenic factors- Emotional stresses causing over stimulation

●     Toxic adenoma i.e. nodule producing T3 & T4. On scanning it is ‘ ‘Hot nodule’

●     Subacute  thyroiditis: Usually post-Partum. Goiter (usually painful)

Sign & Symptoms

Hypothyroidism

●     Onset- Insidious with physical mental and metabolic processes below normal.

●     General- Tiredness, sleepiness, weight  gain, cold intolerance, Goitre

●     Skin and subcutaneous tissue- Coarse  dry skin

●     Puffiness of face, with malar flush. Baggy eyelids

●     Myxedema- Swollen edematous appearance of supraclavicular region, neck, backs of hands and feet, minimal sweating.

●     Alopecia, Vitiligo, Carotenemia

●     Cardiovascular Angina, bradycardia, cardiac failure, pericardial effusion, pleural effusion

●     Psychiatric feature- Depression, Myxedema, madness

●     Neuromuscular- Carpal tunnel syndrome, polyneuritis, muscle cramps and stiffness, slurred speech, myopathy, hoarseness, deafness, delayed relaxation of ankle reflexes

●     Gastrointestinal - Constipation, ascites

●     Reproductive -Infertility, menorrhagia, impotence

●     Insidious onset, weight gain, Constipation, dislike of cold

●     Menorrhagia. Depression, dementia

●     Hoarse voice, lack of energy

●     Toad like face, bradycardia, dry skin and hair, goitre

●     Slowly relaxing reflexes, heart  failure

●     Non pitting edema (e.g. eyelid, hands, feet)

●  Impaired memory, obesity, irregular menstruation. More prevalent in women of menopausal age, Menorrhagia

●     BMR- Basal metabolism rate decreases below normal with the results the patient tends to be slow in his movement.

●     He is susceptible to cold, suffers from constipation and puts on weight

●     Dry, scaly and thickened hair, puffiness in the face

●     Pulse is slow and the patient often complains of vague pains in the back and stiffness in the joints.

• Weight gain – as your metabolic rate would be low.

• Swelling of the thyroid – goiter.

• Your heart rate will be slower than usual.

• Less active and depressed.

• Dry hair and hair loss.

• Greater sensitivity to cold, as thyroid disorders will hinder the body’s ability to regulate temperature.

• Constipation

• Dry and brittle nails

• Irregular menstrual cycle

• Carpal Tunnel Syndrome (CTS) caused by swelling of the median nerve near to the wrist bone.

"Although hyperthyroidism can be serious if you ignore it, most people respond well once hyperthyroidism is diagnosed and treated."                                     

●     Hyperthyroidism 

• Weight  loss : despite increased appetite
• Person is overactive,
• Sweats frequently, Dislike of hot weather, profuse sweating, weak sensitive to heat
• Fine Tremor — usually a fine trembling in your hands and finger
• Goiter : Diffuse with or without bruit  An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck
• Fatigue, muscle weakness
• Difficulty sleeping
• General- Fever, restlessness, apathy, sweating, heat intolerance
• Cardiovascular- Palpitation The heart is overactive and usually enlarged. The pulse rate is rapid and may be irregular. Tachycardia which persist during sleep. Large pulse pressure with raised systolic pressure. Flushing of face and neck in warm atmosphere due to unstable vasomotor system. Capillary pulsation may be seen. Cardiac arrhythmia Ectopic beats.
• Ocular- Exophthalmos diplopia, ophthalmoplegia, optic nerve compression, blurring of vision. Exposure keratitis, periorbital oedema, glaucoma, lid lag, lid retraction causing ‘stare’.
• Gastrointestinal Weight loss despite increased appetite, diarrhea, vomiting
• Behavioral & Emotional Nervousness, agitation, psychosis
• Reproductive- Menorrhagia, oligomenorrhoea (infrequent periods) ,infertility, changes in menstrual pattern.
• Dermatological- Skin thinning, Pruritus, palmar oedema, pretibial myxedema, thinking of hairs. Pretibial myxedema (oedematous swellings above lateral malleolus)
• Neuromuscular- ,  Anxiety, irritability, emotional liability,   Patient is usually nervous.
• Graves' ophthalmopathy : Sometimes an uncommon problem called Graves' ophthalmopathy may affect your eyes, especially if you smoke. This disorder makes your eyeballs protrude beyond their normal protective orbits when the tissues and muscles behind your eyes swell. Eye problems often improve without treatment

                                                       

    
                                                                

• Ocular- Exophthalmos diplopia, ophthalmoplegia, optic nerve compression, blurring of vision. Exposure keratitis, periorbital oedema, glaucoma, lid lag, lid retraction causing ‘stare’.
• Dry eyes
• Red or swollen eyes
• Excessive tearing or discomfort in one or both eyes
• Light sensitivity, blurry or double vision, inflammation, or reduced eye movement
• Protruding eyeballs

                                                 

“ Endocrinologist should be consulted”.

Diagnosis

Thyroid Function Test : Normal values-

Blood test:

Serum Thyroxine                  T4.     4.5 - 12 ug/ dl

Serum Triiodothyronine     T3.     80 - 180 ng / dl

Serum thyrotropin                TSH    0.5 - 6 uU / ml

Hyperthyroidism: most sensitive test is

●     Plasma T3 ,T4 (which is raised) and TRH test

●  Thyroid Scanning is indicated if there is an area of thyroid enlargement: to find the extend of retrosternal goiter, to detect ectopic thyroid tissue, to detect thyroid metastasis (using whole body scan)

●     Ophthalmoscopy test visual fields, acuity and eye movement

Hypothyroidism

●     Diagnosed by low T4 (and T3), TSH (high in thyroid failure, low in pituitary failure

●     ECG

●     Tendon reflex duration It is prolonged

●     Chest X- Ray

●     Serum cholesterol- Fasting cholesterol and triglycerides which may be raised

●     The blood may show a normochromic, macrocytic anemia

●     Thyroid antibodies

●     most sensitive test are

●     Plasma T4 (lowered)

●     And TSH  Thyroid stimulating hormone (raised). Normal TSH is < 5.7mU/l

●     FNAB Fine needle aspiration biopsy

●  Immunoradiometric TSH This is a sensitive assay of TSH such that if levels are undetectable, hyperthyroidism is diagnosed.

●     Ultrasound distinguishes cystic (usually benign) from solid (possibly malignant) ‘cold nodule’

●     Thyroid autoantibodies Serum thyroglobulin is useful in monitoring the treatment of carcinoma.

Diagnosis of hypothyroidism

Many of its symptoms are similar to other diseases and so, it has to be diagnosed with the help of the following tests.

• TSH test: Generally, normal TSH level is a sign of hypothyroidism. A slight elevation in the TSH level without symptoms is termed Mild or Subclinical Hypothyroidism. This condition is often seen as an early stage in hypothyroidism.

• T4 test: In hypothyroidism, the T4 level may be lower than normal.

• If your thyroid test results are abnormal, your doctor may prescribe a thyroid ultrasound or a scan to check the presence of thyroid nodules or inflammations.

Treatment of hypothyroidism

• Daily dose of Synthetic Thyroxine pills.

• The patient’s age, weight, the severity of hypothyroidism etc. need to be monitored.

• TSH levels are monitored 6 to 8 weeks after the pill is administered and the dose is adjusted accordingly.

“Get your Thyroid tested” (T3, T4, TSH)

Inmas Hospital Institute of Nuclear Medicine And Allied Sciences Lucknow Road, Timarpur, Delhi”

Lifestyle

• ●     Wake up early in the morning before sunrise
• ●     Morning walk to keep fit
• ●     Drink sufficient water to flush out toxins
• ●     Dinner should be taken between 7 - 8 PM
• ●     No sleeping in the day
• ●     Do not sleep more than 6-7 hours in night
• ●     Ensure proper evacuation of bowel
• ●     Practice pranayama and yoga asanas in your daily routine
• ●     Exercise should be a part of daily routine
• ●     Eat lots of salads, vegetables and fruits
• ●     Use iodised salt
• ●     Have buttermilk with lunch
• ●     To plan pregnancy only, when the patient is euthyroid
• ●     Take one tsp of Triphala at night before sleeping with warm water
• ●     Massage with oil once or twice a week
• ●     Include light food and avoid fried food
• ●     Great care must be taken never to allow the body to become exhausted
• ●     And any irritation is likely to cause emotional upset should be avoided 

•        Jeevan  Bindis for iodine deficient women.

“Your car runs on gasoline and your thyroid runs on iodine”

Yoga

Bhujangasana (cobra pose)

●     Lie down on your abdomen by keeping legs apart

●     Keep the palm beside the chest.

●     Breathing in, lift the upper part of your body, up to naval region

●     Hold it for 10 seconds by feeling the stretch on your abdomen
Gomukh Asana

●     Sit erect on the ground with your legs stretched out in front of you

●     Now gently bend your left leg, and place it under your right buttock

●     Fold your right leg and place it over your left thigh

●     Place both your knees close together as they are stacked one on top of the other

●     Gently fold your left arm and place it behind your back

●     Take your right arm over your right shoulder, and stretch it as much as you can until it reaches your left hand. With practice, you will be able to not just reach, but also catch your left hand.

●     Keep the trunk erect, expand your chest, and lean slightly back.

Sarvangasana (Shoulder Stand pose)

●     Lie down fixed on your back in the Shavasana– The Corpse Pose

●     Breathe in by your nostrils slowly and put your palms facing in downward direction flat on the floor. Holding the hips fixed on the floor slowly curve your knees and get them upward towards the abdomen though breathing out.

●     Breathe in by the nostrils, pressing your hand in downward direction try to rise your body from the waistline upwardly away the floor, curving the backbone backwards and unbending the arms , your hips should be on the floor.

●     Breathe in, and then whilst breathing out, raise your legs directly upward perpendicular to the floor. You can support your hips with your hands
Making sure that your legs should be united, knees straight and toes pointed straight up.

●     Keep your head straight ,don’t turn it to any side.
The chin should be compressed against the chest.
Holding the posture for a while breathe softly through the nostrils .

●     Invert the steps to come back to the Shavasana– The Corpse Pose

Pranayama

     Ujjayi Pranayama

●     Sit in any meditative pose. Contract the muscles of the throat  as much as possible. Bend the neck so that chin touches the sternum . Inhale air through both nostrils. On doing so the air should touch muscles of the contracted throat.

●     While inhaling a sound of snoring is produced. 

      Kapal  Bhatti

●     Kapal-  means forehead. Bhati- means light. So with this pranayama one becomes luminous and lustrous. In this  normal inspiration and forceful expiration is done. In doing so, the abdominal area gets inward and outward movements.

      Bhastrika

●     Sit in comfortable  Asana. Breath in through both nostrils forcefully, till the lungs are full and till the diaphragm is stretched.

●     Then breath out forcefully

      Bhramari

●     Breath in till the lungs are full of air. Close the ears with the thumbs and eyes with the middle fingers. Press forehead with both the index fingers lightly close the eyes. Then press the eyes and nose bridge with remaining fingers.

●     Concentrate on Ajna Chakra. Close the mouth. Begin slowly exhaling making humming sound like a bee while reciting OM mentally.

Exercisey for 

●     Regular exercise daily half an hour at least five days a week is a must.

Meditation

      Omkar Jap

●     Meditation on  the sacred Mantra OM. The body and the universal cosmic body are filled with this mantra. Om is a divine energy. It is more beneficial to start asanas and Pranayama practices with OM Japa. Breath in and out very slowly with Omkar Japa in mind. The breath is to be so slow that inhalation and exhalation is to be limited to one minute. The breath should be felt deep inside. This state lead to concentration. Gayatri Mantra also can be chanted in the  same way.

Bandha

      Jalandhara Bandha

●    Jal means net, and Dhara means flow. Jalandhara Bandha is the lock which controls the network of Nadis (channels) in the neck. The physical manifestation of these Nadis are the blood vessels and nerves of neck. Where the thyroid gland is situated.

●     Sit in any comfortable meditative Asana Padmasana, Sukhasana or Vajrasana. The head is bent forwards so that chin is pressing the neck. The awareness is concentrated on vishudha chakra. Which is located at the region of thyroid gland.

Mudra

      Surya Mudra

●     Formation- The tip of the ring fingers is to be placed at the base of the thumb and thumb is to be placed gently on the back of ring finger.
Surya means the sun, Surya Mudra generates heat in the body like the sun.
It is also beneficial for the patient of High cholesterol in the blood.

SuSurya mudra is good for Hypothyroidism and slow metabolism.   

     Shankha Mudra

●     In Sanskrit Shankha means Conch

●     Place a thumb of the left hand at the base of the right thumb

●     This is the point of Thyroid gland in the palm

●     Fold the fingers of the right hand covering the left thumb

●     Join the index finger of the left hand with the thumb tip of the right hand. The other three fingers of the left hand are to be placed on the back of the right palm.

Surabhi Mudra

Kamadhenu is the divine cow who dwells in heaven and grants all our wishes. Surabhi is the daughter of the divine  cow Kamadhenu. Like the mother she also grants aou prayers and she secretes nectar from her udders. This mudra represents  the four udders of Surabhi.

Formation :

Form Namaste and keep the thumbs apart. Join the tips of index fingers and middle fingers which are opposite to each other then join little finger with the ring finger tips which are opposite to each other. The mudra formed looks like the udders of the cow. This is surabhi mudra.

Effect :

Thumbs kept apart help reduce the fire. The joining of tips of middle and index fingers and joining of the tips of  ring fingers and little fingers remove the problems of bile and gout. and rheumatism. As the eight fingers come together  they activate a number of nerve centers and glands especially Adrenaline, Pituitary and Pineal. 

Benefits :

• All glands Adrenaline, Pituitary,, Pineal and thyroid functions better.
• The three doshas, Vata, Pitta and Kapha get balanced.

Kriya

·      Kunjal (Stomach cleansing process)

It is meant for purification of upper digestive tract. Drink around 3-5 glasses of lukewarm water. Next step is to vomit out the entire water. Bend over a wash basin or sink to vomit out the  entire water. To aid in the vomiting insert two fingers into your throat, tickle the root of your tongue with your fingers. This will cause a vomiting reflex and the water is thrown out.

·      Basti (Enema)

Therapeutic cleansing of the large intestine by medicated enema, Basti is used to flush out the loosened Doshas through the intestinal tract.

Marma 

●     Marma of Neck For Thyroid stimulate Marma of neck region i.e 8 Matrika and 4 Nila Manya.

●     Take deep breath and take your tongue out

●   Take deep breath with open mouth, hold back in chest and blow cheeks and exhale  through nose.

●     Clenching of teeth

Reflexology

●     Base of thumb should be massaged by another hand round and round.

Chakra

●     Vishudha Chakra. Concentrate on vishudha chakra. It is located in the region of throat.

Acupressure point

●     Pressing below the thumb over thinner eminence is the thyroid point.

“Keep your thyroid humming and your metabolism soaring by eating these healthy foods”

Diet

                              

                                              

●     Apples, sea weeds

●     Yogurt, green tea

●     Shellfish like lobster and shrimps (Prawns) are good source of iodine

●     One large egg contains 16% of iodine

●     Oyster, chicken, salmon

●     Olive oil, whole grain

●     Garlic, chocolate, lentils

●     Avocado, broccoli, peppers

●     Strawberries

Avoid

●     Foods to avoid for hyperthyroidism

●     Alcohol, coffee

●     Excess fiber, processed food

●     Sugary food, fatty foods, gluten

●     Cruciferous vegetables i.e. broccoli, cabbage, cauliflower, turnip

●     Soy

●     White flour products, white sugar, flesh foods, fried and greasy foods

●     Preserves, condiments, tea, coffee and alcohol

Prevention

Simple solution for thyroid is activity. Keep on moving

“Just imitate a grasshopper”.

Treatment

●     Hypothyroidism

Treatment of hypothyroidism

• Daily dose of Synthetic Thyroxine pills.

• The patient’s age, weight, the severity of hypothyroidism etc. need to be monitored.

• TSH levels are monitored 6 to 8 weeks after the pill is administered and the dose is adjusted accordingly.

●     Replacement Therapy

●     Tab Thyroxine (Eltroxin, Thyronorm) is the treatment of choice 100 mgs.

●     Thyroxine should be taken on empty stomach. No food or tea or coffee for at least 30 mins.

     Myxedema coma : Management-

●     Tracheal intubation and mechanical ventilation if indicated

●     IV fluids and glucose

●     Additional cover for passive warming

●     Thyroxine supplementation

●     Injection T4, Injection T3

“ Lifelong therapy is needed for hypothyroidism”.

     Hyperthyroidism

●     Rest Both physical and mental.

●     Sedatives Diazepam

●     Vitamins In adequate doses.

●     Psychotherapy For anxiety necrosis.

●  For exophthalmos Dark glasses, eye drops, for swelling of eyelids elevation of head of bed and diuretics.

●     Tab Carbimazole (Neomercazole) 30 mg/ day as single dose or in three divided doses.

●     Propylthiouracil  (PTU) 200 mg three times a da

●     Elderly patient require calcium supplements e.g. Calcium carbonate (Shelcal) 1 g/ day

●     Surgery Subtotal thyroidectomy. Note: (patient must be euthyroid prior to surgery)

●     Radioactive iodine (RAI)

●     Steroid if Ophthalmoplegia or gross oedema

●     Elderly patient does not want surgery

●     Multiple relapses after medical therapy

●     Failure of surgery

●     Note: Antithyroid drugs should  be discontinued 5 days before and 5 days after RAI therapy.

●     Hyperthyroid crisis Steroids are given

● Treatment of hyperthermia: Sponging with cold water. Fluid replacement: 5% dextrose with electrolytes and vitamin supplements.

●     If heart failure: Digoxin

●     Toxic multinodular goitre and toxic solitary nodule:

●     Achieve euthyroid state with antithyroid drugs. Surgery/RAI

●     The cure of thyroid disease is not a speedy one and there is often a recurrence of symptoms but these should gradually become less pronounced.

●     Strict adherence to diet is essential for one year for complete cure

●     Half the daily intake of food should consist of fresh fruits and vegetables, and starch element should be confined to whole wheat product and potatoes.

●     The protein food should be confined to cheese, peas, beans, lentils and nuts.

●     The only real treatment of the thyroid disease whether hypothyroidism or hyperthyroidism or any other condition of thyroid gland.is cleaning of the system and adoption of a rational dietary Thereafter, combined with adequate rest and relaxation .

●     To begin with, patient should take juices of fresh fruits such as orange, apple, pineapple and grapes .

●     Well balanced diet consisting of seeds, nuts and grains, vegetable and fruits.

“With correct lifestyle and balanced diet say goodbye to thyroid problems”

Link: THYROID (Hyper/Hypothyroidism, Goiter, Galaganda, Ghegha)

* Medicine as suggested above should only be taken under the consultation and supervision of registered medical practitioner.

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