Category: General

This is one of the most commonly asked questions by people with thyroid diseases. The answer is “ YES ”, cabbage and cruciferous vegetables like cauliflower, Brussels sprouts, and kale can be consumed, but in moderation.

Cruciferous (brassica) vegetables contain many healthy nutrients, including phytochemicals, with anti-carcinogenic, anti-oxidative, and anti-inflammatory activity. They also contain goitrogens, which can interfere with the thyroid gland’s ability to absorb iodine, which is essential for producing thyroid hormones. Multiple studies suggest that cooking these vegetables significantly reduces goitrogens and is not harmful for most people, even those with thyroid diseases. Cooking cruciferous vegetables (steaming, boiling, sautéing) reduces goitrogenic activity by leaching of glucosinolates into water and inactivation of the enzyme myrosinase.
 
Recommendations:

• Eat in Moderation : Enjoy cabbage and other cruciferous vegetables as part of a varied diet, rather than consuming large quantities regularly.

• Cook Them : Opt for cooked versions of these vegetables more often than raw.

• Ensure Adequate Iodine Intake : If you have thyroid disease, ensure you are getting enough iodine through your diet (e.g., iodized salt, seafood, dairy) unless your doctor advises otherwise.

• Listen to Your Body : Pay attention to any symptoms that might arise after consuming these vegetables and discuss them with your doctor or a registered dietitian.

• Consult Your Doctor : If you have a thyroid condition, it’s always best to discuss your diet with a qualified registered dietitian. They can provide personalized advice based on your specific condition and needs.

Mrs. Sreekutty.S, MSc

The common thyroid disorders in pregnancy are hypothyroidism and hyperthyroidism. Rarely, nodules and thyroid cancer can also be detected in pregnancy. Women with thyroid diseases are recommended to get optimal control of their thyroid disease before planning for pregnancy. Appropriate control of thyroid diseases in pregnancy reduces the risk of complications.

However, sometimes women are detected to have abnormal thyroid function tests or diseases during pregnancy. It then becomes a concern whether to terminate the pregnancy or continue it. Uncontrolled hypothyroidism in pregnancy is associated with miscarriage, preterm birth, and intrauterine growth restriction. Minor changes in IQ and attention deficits in children have been associated with severe hypothyroidism in the first trimester.

Hyperthyroidism is associated with miscarriages and premature delivery, and antithyroid drugs in pregnancy have been associated with congenital abnormalities.

However, there is no recommendation for medical termination of pregnancy if someone is detected to have thyroid disease in pregnancy. It is advised to

1. Discuss with the endocrinologist to understand the risks associated with your medical condition.

2. Understand what you can do to reduce the risks, such as adjusting medicines or monitoring the fetus.

3. Discuss what can be done before pregnancy for optimal disease control.

Dr. Deepa G MHSc (Diab), Dip (Diab)

Hypothyroidism and fatty liver are 2 medical conditions that are very common in the community. No wonder we see both diseases in the same person. However, it is still not clear if either of these diseases can cause the other.

Some studies have shown that people with fatty liver may have higher TSH levels than normal people. This could be because people with fatty liver tend to be obese and have insulin resistance. People with uncontrolled hypothyroidism can have abnormal cholesterol and triglyceride metabolism, leading to fatty liver. However, most of the fatty liver disease in the community is not related to thyroid disease. It is related to unhealthy eating habits, less physical activity, consumption of ultra processed foods, genetic predisposition, and alcohol use.

Thyroid hormones have an important role in fat metabolism in the liver. A drug that acts on the thyroid hormone receptor called Resmiterom is now approved as a treatment for fatty liver disease. To check if your fatty liver disease and thyroid are connected, please discuss with your endocrinologist.

Dr.Mathew John MD,DM

Iodine is a trace mineral that your body needs to produce thyroid hormones: thyroxine (T4) and triiodothyronine (T3). The thyroid gland is vital in regulating metabolism, energy levels, and overall hormonal balance.

However, once diagnosed with a thyroid disorder, such as hypothyroidism or hyperthyroidism, an individual’s iodine needs and the type of salt they consume may need to change. Understanding the relationship between iodine intake and thyroid function is essential for managing thyroid health effectively.

For individuals with hypothyroidism, particularly when caused by Hashimoto’s thyroiditis, salt intake should be moderate and carefully considered in relation to iodine. While iodine is essential for thyroid hormone production, excessive iodine can actually worsen autoimmune thyroid conditions like Hashimoto’s.

In hyperthyroidism, especially when caused by autoimmune conditions like Graves’ disease, salt intake should focus on limiting iodine, as excessive iodine can worsen thyroid hormone overproduction. In this case, it is generally recommended to avoid iodized salt and choose non-iodized options like natural sea salt or Himalayan salt that do not contain added iodine.

• Never start or stop iodine intake without medical advice. Both too much and too little iodine can cause or worsen thyroid problems.

• Processed foods often use non-iodized salt, so they contribute to sodium intake but not iodine. Balance this with whole foods.

• Get your iodine levels tested if your doctor suspects an imbalance.

• Ask your doctor whether you need iodized or non-iodized salt.
Use salt in moderation, regardless of type, to avoid excess sodium intake.

Mrs. Revathy V K, MSc

Carbimazole (Neomercazole) and Methimazole are common medicines used to treat hyperthyroidism. They reduce hormone production in the thyroid gland for people with hyperthyroidism; this will control the symptoms. However, some people taking these medicines may develop itching, rashes, arthralgia, liver toxicity, or low white blood cell counts (agranulocytosis). Although rare, these complications can sometimes be fatal.

People with Graves’ disease (an autoimmune form of hyperthyroidism) usually take Carbimazole for 18-24 months, following which it is stopped. People who continue to have hyperthyroidism are usually offered radioactive iodine ablation or thyroid surgery. However, there is scientific evidence that we can continue these drugs for a longer duration. However, people who decide to consume these medicines should check their thyroid functions as recommended by the doctor and also visit the doctor to check for any complications.

People with a condition called toxic nodular goitre (multinodular or single nodule) are also given Carbimazole for treatment. However, since these medicines don’t offer a cure, a decision for permanent treatment like radioactive iodine ablation or thyroid surgery is advised early. However, people at high risk for surgery or those who wish to be on medicines can continue to use it under supervision. So, extended periods of antithyroid drugs can be used under medical supervision for patients with hyperthyroidism. This treatment option can be discussed with your endocrinologist.

Dr.Mathew John,MD,DM

Steroid inhalers are used in the treatment of bronchial asthma and COPD. They deliver the steroid drug directly into the respiratory tract, and only a tiny fraction of the same crosses into the blood circulation. Steroid inhalers are excellent medicines, dramatically improving the symptoms and quality of life of people with respiratory diseases.

Other than minor irritations like sore throat, rare voice hoarseness and mild tongue coating, steroid inhalers are mostly safe. Some concerns with the use of steroid inhalers are

1. Effect on the natural steroid secretion by the adrenal glands
2. Adverse effects on bone health
3. Adverse effects of growth in children
4. Increased risk of lung infections
5. Increased risk of cataracts and glaucoma (increased eye pressure)

The adverse effects are more when there are larger doses, more potent steroids and more frequent use of steroids. Some people may be more vulnerable, like growing children and elderly. If you have concerns about the adverse effects of steroids, please talk to an endocrinologist.

Dr.Mathew John ,MD,DM

Steroid creams treat conditions like eczema, psoriasis, and allergic reactions. While effective, misuse or prolonged use can cause side effects.

Local side effects include skin thinning, bruising, stretch marks, worsening acne, steroid-induced rosacea, perioral dermatitis, pigmentation changes, impaired wound healing, and potential fungal, bacterial, or viral infections. Allergic reactions causing contact dermatitis may also occur.

Systemic side effects are rare but can result from extensive use, especially on thin or broken skin. These can include Cushing’s syndrome, adrenal fatigue, high blood sugar, hypertension, and growth retardation in children.

Using steroid creams near eyes may lead to glaucoma or cataracts. To minimize risks, follow your doctor’s prescription, avoid extended use unless directed, apply only to affected areas, monitor for unusual reactions, and consult your doctor if adverse effects arise.

Dr. Tittu Oommen MD, DM

Dehydroepiandrosterone (DHEA) is a hormone produced in the adrenal gland and helps to produce sex hormones, including testosterone and estrogen. Natural DHEA levels peak in early adulthood and slowly fall as you age.

A synthetic version of DHEA is available in tablet, capsule, powder, topical cream, and gel forms. These are considered health supplements and not therapeutic medicines. People use DHEA as an anti-aging therapy, for infertility, to improve physical performance, and to treat depression and menopausal issues.

As an anti-aging medicine and for enhancing performance, no significant data supports its use. The National Collegiate Athletic Association has banned DHEA use among athletes.

In women with primary adrenal insufficiency, less DHEA is produced by the adrenal. So, it is recommended as a replacement to improve libido. There is limited long-term scientific information that supports its use. DHEA is extensively used in infertility treatment to improve the quality of eggs and to help implantation. However, there is no substantial evidence to support its regular use.

DHEA can increase the levels of androgens and has steroidal effects. Hence, DHEA might increase the risk of cancers like prostate, breast, and ovaries. Further, DHEA can cause acne, oily skin, and increased hair loss. Avoid using DHEA if you’re pregnant or breastfeeding and when you are on multiple other medicines, as there can be drug interactions.

There is little evidence for using DHEA, and reputable organizations like the Mayo Clinic advise against DHEA supplements. They have limited evidence for benefit and have the potential to cause unwanted side effects. Talk to your healthcare provider if you are thinking of taking these supplements.

Dr. Deepa G, MHSc (Diab), Dip (Diab)

Cortisol, referred to as the “stress hormone,” is essential in managing stress, regulating blood sugar, and maintaining blood pressure. The body releases cortisol during various types of stress, such as short-term, long-term, or traumatic stress. Persistently high cortisol levels may indicate health concerns.

Hypercortisolism, or elevated cortisol levels, can result from chronic stress, adrenal gland disorders like Cushing’s syndrome, prolonged use of corticosteroids, or other endocrine issues such as pituitary tumours. Symptoms linked to hypercortisolism include weight gain around the abdomen and face, high blood pressure, fatigue, muscle weakness, mood changes, sleep disturbances, and decreased immune function.

To diagnose hypercortisolism, tests are conducted on blood, urine, or saliva for cortisol levels, ACTH levels are checked, and other relevant examinations are performed. Treatment varies according to the cause and may involve lifestyle modifications, medication adjustments, or surgery for tumours. If high cortisol levels are suspected, it is advisable to consult a healthcare professional for comprehensive evaluation and guidance.

Dr. Tittu Oommen MD,DM

Nuts are calorie-dense and a good source of healthy nutrients. Nuts do not increase cholesterol; instead, they can help lower bad cholesterol (LDL) and increase good cholesterol (HDL) when consumed in moderation. Nuts are rich in unsaturated fats, fiber, and plant sterols, which help reduce LDL cholesterol and improve heart health. Regular consumption of nuts has been linked to lower cholesterol levels and reduced risk of heart disease.

How Nuts Affect Cholesterol:

• Increase Good Cholesterol (HDL): Helps remove excess cholesterol from the bloodstream.

• Reduce Bad Cholesterol (LDL): Nuts contain healthy unsaturated fats, which help lower LDL cholesterol.

• Contain Healthy Fats: Monounsaturated and polyunsaturated fats support heart health.

• Rich in Fiber & Plant Sterols: Block cholesterol absorption in the intestines.

Best Nuts for Managing Cholesterol:

Almonds, walnuts, pistachios, pecans, and hazelnuts are high in healthy fats and antioxidants.

Avoid salted or sugar-coated nuts – Added salt and sugar may increase health risks.

Tips: Moderation is key. Consume a small handful (about 28g) of unsalted nuts daily as part of a balanced diet for heart health.

Ms.Sreekutty.S, Msc