Category: General

It is common to find a thyroid disease when a lady gets investigated for menstrual abnormalities. It is prudent for doctors to check thyroid function while investigating anyone with menstrual problems. Menstrual problems can occur in both hypothyroidism and hyperthyroidism.

Women with significant hypothyroidism can have increased menstrual bleeds (menorrhagia) and irregular dates. If the thyroid disease is severe, some women may cease to have periods for a while. Some women with hypothyroidism may have a polycystic appearance of the ovaries. This should not be confused with polycystic ovary disease. Most of these changes can be reversed with proper dose titration of thyroxine.

Women with hyperthyroidism can have irregular periods and hypomenorrhea (less bleeding during periods). Some women with severe hyperthyroidism can have significant weight loss and this can lead to irregular periods. Rarely women with thyroid diseases may have premature ovarian failure. Both these diseases are autoimmune and hence can occur together. Physicians treating people with thyroid disease and menstrual problems should consider this possibility.

Obesity is a complex medical condition influenced by various factors, including genetics, environment, and lifestyle. Various aspects of food consumption, appetite and satiety are linked to abnormalities in brain circuits and hormones. These include hormones like Ghrelin which stimulate hunger, and others like GLP-1, Cholecystokinin, Leptin and Amylin, which leads to satiety. So despite our efforts to control the intake of high-calorie food and exercise, it is essential to address the various abnormal physiological changes that drive obesity. While making healthy choices is vital, it is not as simple as “trying harder” or having more willpower.

• It is essential to understand that just like diabetes and hypertension, obesity is also a disease that requires proper treatment. While overeating and lack of physical activity can contribute to obesity, many other factors can also play a role. These include genetics, certain medical conditions, and medication side effects.

• People with obesity have abnormalities in the circuitry related to various areas of the brain like hypothalamus and amydala. There are changes in the neurons like POMC/CART and AgRP/NPY that regulate the weight. In addition, there are hormones like Ghrelin which stimulate hunger and others like GLP-1, Cholecystokinin, Leptin and Amylin which leads to satiety. These hormones are produced by the gut, adipose tissue, or pancreas.

• External factors like diet and physical activity are part of the obesogenic environment that facilitate obesity. And these are potentially modifiable too. But these alone do not lead to obesity.

Reality: Obesity is a serious medical condition that can lead to a variety of health problems. It can include metabolic problems like diabetes, hypertension, high cholesterol levels and high uric acid. Obesity is a risk factor for various cancers like breast cancer, endometrial cancer, prostate, and colonic cancer. It can lead to fatty liver disease which could progress to cirrhosis. Sleep apnoea and gastroesophageal reflux is also related to obesity. Certain mechanical problems like osteoarthritis of knee and ankle and plantar fasciitis. People with obesity have higher risk of coronary artery disease, stroke, and heart failure. In addition, obesity can be associated with depression, mood disorders and eating disorders.

So, obesity is much more beyond a mere cosmetic issue.

Just like diabetes and hypertension, obesity is also a disease. Obesity results in various other diseases that may eventually become fatal. Just like not all diabetes can be controlled with diet, not all people with obesity can get their weight down with diet and exercise.

People with obesity and multiple other diseases like sleep apnea, uncontrolled diabetes, fatty liver and hypertension have a poor quality of life and reduced lifespan due to these diseases. So, anyone with obesity and other associated disorders would benefit from using anti-obesity drugs like Semaglutide, Liraglutide or Tirzepatide. People with higher degrees of weight gain and related diseases also will benefit from bariatric surgery. Bariatric surgery has been shown to prolong the lifespan and reduce the risk of diseases like diabetes, hypertension, sleep apnea, fatty liver and heart disease.

Body mass index ( weight ( in kg)/height(meters) 2) is a straightforward measure of obesity. It is easily measured without any complicated instruments and tests. In the western world, a normal BMI is defined as below 25 and above 30 is classified as obese.

We are using a measure like BMI to understand if the person is at risk of developing complications associated with high-fat mass. However, BMI may not be an accurate measure of body fat for many people. For example, the BMI may be high for someone with a high muscle mass, but the fat mass may be low. Similarly, the relation between BMI and disease risk is different in ethnic populations like Asian Indians. Here we define obesity as BMI > 25 and normal as less than 23. Such assessments like body composition analysis( hyperlink to Inbody page) may be helpful in deciding the degree of body fat. So, although useful, BMI cannot be considered the best measure of obesity.

Although more significant weight loss may result in more benefits to the body, even losing > 2.5 % of weight can improve blood glucose and triglycerides. More considerable reductions ( say >10 %) would lead to improvements in sleep apnea and fatty liver. Significant weight loss ( > 15 kg loss ) can lead to remission of diabetes in many people with shorter disease duration. People who have undergone bariatric surgery and lost significant weight have seen improvements in heart disease and risk of death.

So, if you are a person with obesity and starting a weight loss program, congratulate yourself for every kilogram lost!

Childhood obesity is a major problem that can increase the risk of metabolic diseases like dyslipidemia, diabetes, hypertension and sleep apnea. Although various genetic causes can appear as obesity in childhood, most obesity in childhood is related to calorie excess on a background of genetic influences.

Although there are limited studies to address this issue, studies have shown that childhood obesity tracks into adulthood. For example, in a model that tracked obesity from 2 years to 35 years, the relative risk of obesity as an adult( at 35 years) was 1.3 times if you were obese at two years and 2 times if you were obese at 19 years. However, the converse is not true; not all people obese at 35 years were obese as children.

Hence it is essential to plan healthy diets and lifestyle changes in children.

Turner syndrome( TS) is a genetic ( not inherited ) condition. It is caused by a full or partial loss of the second female sex chromosome. Therefore, only females can have Turner syndrome. Girls with Turner syndrome are usually identified when they present with short stature or when their menstrual periods do not start on time. Most girls with Turner syndrome will have normal intelligence but may have social immaturity, attention-deficit disorder, and specific learning disabilities. Other distinctive physical features of Turner Syndrome include low-set ears, webbed neck (excess skin on the neck), scoliosis, and fingernails and toenails that turn upward. People with TS can also have problems with the heart, kidneys, thyroid and ears. However, they could look like any short, ordinary girl.

If you feel your child is not growing well, please seek care from an endocrinologist.

Because the signs of Turner syndrome are usually obvious, most girls with the condition are diagnosed shortly after birth or in early childhood. However, some women with Turner Syndrome look normal except that they are short in height. In addition, girls with more severe forms of Turner Syndrome may be diagnosed early, whereas others may not be diagnosed until adolescence when they don’t start their menstrual periods.

The test used to determine Turner syndrome is called a karyotype. A karyotype is a blood test that produces an image of your chromosomes. That way, your doctor can identify whether one of your sex chromosomes is missing or partially missing.

It is common to find that the condition is unidentified for many years before parents bring the kids to an endocrinologist.