Hypothyroidism

Hypothyroidism is an underactive thyroid gland. Hypothyroidism means that the thyroid gland can’t make enough thyroid hormone to keep the body running normally. People are hypothyroid if they have too little thyroid hormone in the blood.

What is thyroid gland?

The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

What are the causes hypothyroidism?

There can be many reasons why the cells in the thyroid gland can’t make enough thyroid hormone. Here are the major causes, from the most to the least common.
• Autoimmune disease. In some people’s bodies, the immune system that protects the body from invading infections can mistake thyroid gland cells and their enzymes for invaders and can attack them. The most common forms are Hashimoto’s thyroiditis and atrophic thyroiditis.
• Surgical removal of part or all of the thyroid gland. Some people with thyroid nodules, thyroid cancer, or Graves’ disease need to have part or all of their thyroid removed. If the whole thyroid is removed, people will definitely become hypothyroid.
• Radiation treatment. .
• Congenital hypothyroidism (hypothyroidism that a baby is born with)
• Thyroiditis.
• Medicines. Medicines such as amiodarone, lithium, interferon alpha, and interleukin-2 can prevent the thyroid gland from being able to make hormone normally.
• Too much or too little iodine.
• Damage to the pituitary gland.
• Rare disorders that infiltrate the thyroid. In a few people, diseases deposit abnormal substances in the thyroid and impair its ability to function. For example, amyloidosis can deposit amyloid protein, sarcoidosis can deposit granulomas, and hemochromatosis can deposit iron.

HOW IS HYPOTHYROIDISM DIAGNOSED?

The correct diagnosis of hypothyroidism depends on the following:
• Symptoms.
• fatigue.
• weight gain.
• trouble tolerating cold.
• joint and muscle pain.
• dry skin or dry, thinning hair.
• heavy or irregular menstrual periods or fertility problems.
• slowed heart rate.
• depression.
• Medical and family history. You should tell your doctor:
  • about changes in your health that suggest that your body is slowing down;
  • if you’ve ever had thyroid surgery;
  • if you’ve ever had radiation to your neck to treat cancer;
  • if you’re taking any of the medicines that can cause hypothyroidism— amiodarone, lithium, interferon alpha, interleukin-2, and maybe thalidomide;
  • whether any of your family members have thyroid disease.
• Physical exam. The doctor will check your thyroid gland and look for changes such as dry skin, swelling, slower reflexes, and a slower heart rate.
• Blood tests. There are two blood tests that are used in the diagnosis of hypothyroidism.
• TSH (thyroid-stimulating hormone) test. This is the most important and sensitive test for hypothyroidism. It measures how much of the thyroid hormone thyroxine (T4) the thyroid gland is being asked to make. An abnormally high TSH means hypothyroidism: the thyroid gland is being asked to make more T4 because there isn’t enough T4 in the blood.
• T4 tests. Most of the T4 in the blood is attached to a protein called thyroxine-binding globulin. The “bound” T4 can’t get into body cells. Only about 1%–2% of T4 in the blood is unattached (“free”) and can get into cells. The free T4 and the free T4 index are both simple blood tests that measure how much unattached T4 is in the blood and available to get into cells.

HOW IS HYPOTHYROIDISM TREATED?

THYROXINE (T4) REPLACEMENT. Hypothyroidism can’t be cured. But in almost every patient, hypothyroidism can be completely controlled. It is treated by replacing the amount of hormone that your own thyroid can no longer make, to bring your T4 and TSH levels back to normal levels. So even if your thyroid gland can’t work right, T4 replacement can restore your body’s thyroid hormone levels and your body’s function. Synthetic thyroxine pills contain hormone exactly like the T4 that the thyroid gland itself makes. All hypothyroid patients except those with severe myxedema (life-threatening hypothyroidism) can be treated as outpatients, not having to be admitted to the hospital. For the few patients who do not feel completely normal taking a synthetic preparation of T4 alone, the addition of T3 (Cytomel®) may be of benefit.

Diabetes

Diabetes is a chronic condition that impairs the body’s ability to process blood glucose, or blood sugar. Diabetes can lead to glucose buildup in the blood, which can increase the risk of dangerous complications, including stroke and heart disease.The most common types of diabetes include type 1, type 2, and gestational diabetes.

TYPE 1 DIABETES

Also known as juvenile diabetes, type 1 diabetes occurs when the body does not produce insulin. Insulin is a hormone responsible for breaking down the sugar in the blood for use throughout the body. A person living with type 1 diabetes may be diagnosis during childhood or teenage or early adulthood.
People living with type 1 diabetes need to administer insulin. Individuals may do this with injections or an insulin pump.
There is no cure for type 1 diabetes. Once a person receives their diagnosis, they need to regularly monitor their blood sugar levels, administer insulin, and follow some lifestyle strategies to help manage the condition.
Successfully managing blood sugar levels can help people living with type 1 diabetes avoid serious complications.

Type 2 diabetes

With type 2 diabetes, the body does not make or use insulin effectively. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) , type 2 diabetes is the most common type. It has a strong link with obesity.
A person living with type 2 diabetes may or may not need insulin. In many cases, medication, along with exercise and diet strategies, can help manage the condition. Anyone, including children and adults, can develop type 2 diabetes.
The CDC adds that around 50% of people with gestational diabetes will later develop type 2 diabetes.

GESTATIONAL DIABETES

Gestational diabetes occurs during pregnancy when a person becomes less sensitive to insulin. According to the  Centers for Disease Control and Prevention (CDC) , 2–10% of pregnancies each year result in gestational diabetes. Individuals with overweight or obesity going into pregnancy have an elevated risk of developing the condition.

During pregnancy, people can take steps to manage gestational diabetes. These include:
• staying active
• monitoring the growth and development of the fetus
• adjusting their diet
• monitoring blood sugar levels

Gestational diabetes can increase a person’s risk of developing high blood pressure during pregnancy. It can also cause:
• premature birth
• increased birth weight
• blood sugar issues with the newborn, which typically clear up within a few days
• increased risk of the baby developing type 2 diabetes later in life

OTHER TYPES OF DIABETES

In addition to type 1, type 2, and gestational diabetes, there are less common forms of the condition. Some examples:
• Monogenic diabetes: In this form, a single gene change causes the condition to develop. There are two main types of monogenic diabetes: neonatal diabetes mellitus and maturity onset diabetes of the young.
• Type 3c diabetes: This type of diabetes, which people may also call pancreatogenic diabetes, can result from damage to the pancreas following surgery to remove the organ, injury, or illnesses, like pancreatitis.
• Cystic fibrosis-related diabetes: People living with cystic fibrosis may develop this type of diabetes as a complication of the condition.
• Diabetes resulting from specific health conditions and diseases Some people may develop ‘other’ diabetes because of a different health condition or disease. This type of ‘other’ diabetes includes:
• diseases affecting the pancreas, for example, cystic fibrosis, cancer, pancreatitis, pancreatectomy
• endocrine diseases, for example, Cushing’s syndrome, acromegaly
• genetic syndromes, for example, Down syndrome, Friedreich ataxia and Turner syndrome
• viral infections, for example, congenital rubella and cytomegalovirus.
• Diabetes resulting from medications ‘Other’ diabetes can also be triggered from medications that people may need to manage or treat certain health conditions. This type of ‘other’ diabetes may be a temporary condition, but it can also be permanent. Examples of medications that can trigger this type of ‘other’ diabetes are:
• glucocorticoids, for example, cortisone (prednisone)
• medication prescribed for a cancer or to stop an organ-transplant rejection
• medication used to treat high blood pressure (thiazides)

DIAGNOSIS OF DIABETES:

• A1C test. This blood test, which doesn't require not eating for a period of time (fasting), shows your average blood sugar level for the past 2 to 3 months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. It's also called a glycated hemoglobin test.
  The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5% or higher on two separate tests means that you have diabetes. An A1C between 5.7% and 6.4% means that you have prediabetes. Below 5.7% is considered normal.
• Random blood sugar test. A blood sample will be taken at a random time. No matter when you last ate, a blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes.
• Fasting blood sugar test. A blood sample will be taken after you haven't eaten anything the night before (fast). A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
• Glucose tolerance test. For this test, you fast overnight. Then, the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested regularly for the next two hours.
  A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours means you have diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) means you have prediabetes.

TREATMENT

Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral drugs may be part of your treatment. Eating a healthy diet, staying at a healthy weight and getting regular physical activity also are important parts of managing diabetes.

Treatments for all types of diabetes

• An important part of managing diabetes — as well as your overall health — is keeping a healthy weight through a healthy diet and exercise plan:
  • Healthy eating. Your diabetes diet is simply a healthy-eating plan that will help you control your blood sugar. You'll need to focus your diet on more fruits, vegetables, lean proteins and whole grains. These are foods that are high in nutrition and fiber and low in fat and calories. You'll also cut down on saturated fats, refined carbohydrates and sweets. In fact, it's the best eating plan for the entire family. Sugary foods are OK once in a while. They must be counted as part of your meal plan.
  • Physical activity. Everyone needs regular aerobic activity. This includes people who have diabetes. Physical activity lowers your blood sugar level by moving sugar into your cells, where it's used for energy. Physical activity also makes your body more sensitive to insulin. That means your body needs less insulin to transport sugar to your cells.
    Aim for at least 30 minutes or more of moderate physical activity most days of the week, or at least 150 minutes of moderate physical activity a week. Bouts of activity can be a few minutes during the day. If you haven't been active for a while, start slowly and build up slowly. Also avoid sitting for too long. Try to get up and move if you've been sitting for more than 30 minutes.
• Treatments for type 1 and type 2 diabetes
  • Treatment for type 1 diabetes involves insulin injections or the use of an insulin pump, frequent blood sugar checks, and carbohydrate counting. For some people with type 1 diabetes, pancreas transplant or islet cell transplant may be an option.
  • Treatment of type 2 diabetes mostly involves lifestyle changes, monitoring of your blood sugar, along with oral diabetes drugs, insulin or both.
• Injectable insulin comes in five types:
  • Rapid-acting (taking effect within a few minutes and lasting 2-4 hours)
  • Regular or short-acting (taking effect within 30 minutes and lasting 3-6 hours)
  • Intermediate-acting (taking effect in 1-2 hours and lasting up to 18 hours)
  • Long-acting (taking effect in 1-2 hours and lasting beyond 24 hours)
  • Ultra-long-acting (taking effect in 1-2 hours and lasting 42 hours)

A rapid-acting inhaled insulin ( Afrezza ) is also FDA-approved for use before meals. It must be used in combination with long-acting insulin in patients with type 1 diabetes and should not be used by those who smoke or have chronic lung disease. It comes as a single dose cartridge. Premixed insulin is also available for people who need to use more than one type of insulin.
Insulin degludec  is a once-daily, long-acting insulin, providing a basal dose of insulin lasting beyond 42 hours. (It's the only basal insulin approved for both type 1 and type 2 diabetes in patients as young as 1 year old.) It is also available in combination with rapid-acting insulin (Ryzodeg 70/30).
Each treatment plan is tailored for the person and can be adjusted based on what you eat and how much you exercise, as well as for times of stress and illness.

• Drugs that increase insulin production by the pancreas, including  chlorpropamide , glimepiride, glipizide , glyburide , nateglinide , and repaglinide
• Drugs that decrease sugar absorption by the intestines, such as acarbose  and miglitol.
• Drugs that improve how the body uses insulin, such as pioglitazone  and rosiglitazone.
• Drugs that decrease sugar production by the liver and improve insulin resistance, like metformin . Metformin causes weight loss and this is one of the ways it helps bring blood sugars back to normal.
• Drugs that increase insulin production by the pancreas or its blood levels and/or reduce sugar production from the liver, including   exenatide , linagliptin , liraglutide ,saxagliptin , semaglutide , sitagliptin .
• Drugs that block the reabsorption of glucose by the kidney and increase glucose excretions in urine, called sodium-glucose co-transporter 2 (SGLT2) inhibitors. They also trigger weight loss which helps bring blood sugars back to normal. They are dapagliflozin , empagliflozin . These drugs can also help reduce the risk of hospitalization for heart failure and cardiovascular death in patients with heart failure.
• Pramlinitide is an injectable synthetic hormone. It helps lower blood sugar after meals in people with diabetes who use insulin.
Some pills contain more than one type of diabetes medication. They include the recently approved empagliflozin/linagliptin . It combines a SGLT2 inhibitor that blocks reabsorption of glucose into the kidneys with a DPP-4 inhibitor which increases hormones to help the pancreas produce more insulin and the liver produce less glucose.

Hypertension

Hypertension (high blood pressure) is when the pressure in your blood vessels is too high (140/90 mmHg or higher). It is common but can be serious if not treated.
People with high blood pressure may not feel symptoms. The only way to know is to get your blood pressure checked.

Things that increase the risk of having high blood pressure include:
• older age
• genetics
• being overweight or obese
• not being physically active
• high-salt diet
• drinking too much alcohol

Lifestyle changes like eating a healthier diet, quitting tobacco and being more active can help lower blood pressure. Some people may still need to take medicines.
Blood pressure is written as two numbers. The first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats.
Hypertension is diagnosed if, when it is measured on two different days, the systolic blood pressure readings on both days is ≥140 mmHg and/or the diastolic blood pressure readings on both days is ≥90 mmHg.

RISK FACTORS

Modifiable risk factors include unhealthy diets (excessive salt consumption, a diet high in saturated fat and trans fats, low intake of fruits and vegetables), physical inactivity, consumption of tobacco and alcohol, and being overweight or obese.
Non-modifiable risk factors include a family history of hypertension, age over 65 years and co-existing diseases such as diabetes or kidney disease.

SYMPTOMS

Most people with hypertension don’t feel any symptoms. Very high blood pressures can cause headaches, blurred vision, chest pain and other symptoms.
Checking your blood pressure is the best way to know if you have high blood pressure. If hypertension isn’t treated, it can cause other health conditions like kidney disease, heart disease and stroke.

People with very high blood pressure (usually 180/120 or higher) can experience symptoms including:
• severe headaches
• chest pain
• dizziness
• difficulty breathing
• nausea
• vomiting
• blurred vision or other vision changes
• anxiety
• confusion
• buzzing in the ears
• nosebleeds
• abnormal heart rhythm

If you are experiencing any of these symptoms and a high blood pressure, seek care immediately.
The only way to detect hypertension is to have a health professional measure blood pressure. Having blood pressure measured is quick and painless. Although individuals can measure their own blood pressure using automated devices, an evaluation by a health professional is important for assessment of risk and associated conditions.

TREATMENT

Lifestyle changes can help lower high blood pressure. These include:
• eating a healthy, low-salt diet
• losing weight
• being physically active
• quitting tobacco.

If you have high blood pressure, your doctor may recommend one or more medicines. Your recommended blood pressure goal may depend on what other health conditions you have.

Blood pressure goal is less than 130/80 if you have:
• cardiovascular disease (heart disease or stroke)
• diabetes (high blood sugar)
• chronic kidney disease
• high risk for cardiovascular disease.

For most people, the goal is to have a blood pressure less than 140/90.

There are several common blood pressure medicines:
• ACE inhibitors including enalapril and lisinopril relax blood vessels and prevent kidney damage.
• Angiotensin-2 receptor blockers (ARBs) including losartan and telmisartan relax blood vessels and prevent kidney damage.
• Calcium channel blockers including amlodipine and felodipine relax blood vessels.
• Diuretics including hydrochlorothiazide and chlorthalidone eliminate extra water from the body, lowering blood pressure.

PREVENTION

Lifestyle changes can help lower high blood pressure and can help anyone with hypertension. Many who make these changes will still need to take medicine.

These lifestyle changes can help prevent and lower high blood pressure.
• Do:
  • Eat more vegetables and fruits.
  • Sit less.
  • Be more physically active, which can include walking, running, swimming, dancing or activities that build strength, like lifting weights.
    • Get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity.
    • Do strength building exercises 2 or more days each week.
  • Lose weight if you’re overweight or obese.
  • Take medicines as prescribed by your health care professional.
  • Keep appointments with your health care professional.
• Don’t:
  • eat too much salty food (try to stay under 2 grams per day)
  • eat foods high in saturated or trans fats
  • smoke or use tobacco
  • drink too much alcohol (1 drink daily max for women, 2 for men)
  • miss or share medication.

Reducing hypertension prevents heart attack, stroke and kidney damage, as well as other health problems.

Reduce the risks of hypertension by
• reducing and managing stress
• regularly checking blood pressure
• treating high blood pressure
• managing other medical conditions.

COMPLICATIONS OF UNCONTROLLED HYPERTENSION

Among other complications, hypertension can cause serious damage to the heart. Excessive pressure can harden arteries, decreasing the flow of blood and oxygen to the heart. This elevated pressure and reduced blood flow can cause
• chest pain, also called angina;
• heart attack, which occurs when the blood supply to the heart is blocked and heart muscle cells die from lack of oxygen. The longer the blood flow is blocked, the greater the damage to the heart;
• heart failure, which occurs when the heart cannot pump enough blood and oxygen to other vital body organs; and
• irregular heart beat which can lead to a sudden death.

Hypertension can also burst or block arteries that supply blood and oxygen to the brain, causing a stroke.
In addition, hypertension can cause kidney damage, leading to kidney failure.