Category: General

Thyroid diseases are common in the community. It is essential to understand that many of these do not have symptoms, and some may not have significant health consequences. The prevalence of thyroid diseases may differ according to the ethnicity of the people where this was studied, the iodine intake of this population and their age. Around 10 % of people have mild or subclinical hypothyroidism, and about 4% have overt or symptomatic hypothyroidism. Hyperthyroidism is less common. About 1.6% of people have subclinical or mild hyperthyroidism, and 1.3 % have overt hyperthyroidism. If you look at the presence of Anti TPO antibodies, around 17% of people may have these. Many of these people may not have any thyroid dysfunction.

Around one in 100,000 men and around 1.8 in 100,000 women are newly diagnosed with thyroid cancer annually. The risk of thyroid nodules increases with age and is more seen in women and those with iodine deficiency or after radiation exposure. Depending on how you try to detect the nodules, around 20 to 40 % have thyroid nodules on ultrasound and about 5 % percentage when you feel it clinically. If you take women in pregnancy, about 2.5% of women may have hypothyroidism and around one to 4 out of 1000 women may have hyperthyroidism. Hence, thyroid diseases are widespread in the community, but not everyone requires treatment. If you are detected to have thyroid disease, you should meet an endocrinologist to sort it out.

There are various thyroid antibodies, the commonest being anti-TPO antibodies. Anti-TPO stands for anti-Thyroid Peroxidase. TPO is an enzyme in the thyroid gland that is important for synthesizing thyroid hormones and is present in everyone. Due to various reasons, the body develops an immune response against this TPO. The antibody so generated is called anti-TPO antibody. The elevated level of this antibody shows that the body has an immune attack against the thyroid.

Anti-TPO antibody is very common, and around 17 % of people have them. People with anti-TPO antibodies have a high chance of developing thyroid disease if they don’t already have it. They also have a chance of progression of thyroid disease if they already have a mild thyroid disease. Although there are scientific data associating anti-TPO antibodies with various medical problems like recurrent abortions and heart disease, there is no convincing proof that antibodies are responsible for this. Therefore, there is no role in treating anti-TPO antibodies if thyroid functions are normal.

So, the anti-TPO antibody is only a marker of autoimmune thyroid disease and not a disease. So don’t panic over high levels, and don’t keep repeatedly doing it.

Being told that a person has lumps or nodules in the thyroid can worry the patient. But there is no need to be concerned regarding thyroid nodules. Thyroid nodules are widespread, affecting more than half of the population above 60 years. Most thyroid nodules don’t have symptoms and are found incidentally. However, in other cases, the nodules can get big enough to cause problems.

The vast majority — more than 90% — of thyroid nodules are benign (noncancerous). However, if a concern arises about cancer, the doctor may recommend monitoring the nodule over time to see if it grows. Ultrasound is the test to evaluate and monitor the thyroid nodule and determine the need for a biopsy. If needed, a thyroid fine needle aspiration biopsy is done, and samples of cells from the nodule are examined under a microscope, which can provide your doctor with more information about the behavior of the nodule.

If a thyroid nodule is causing voice or swallowing problems, your doctor may recommend treating it with surgery to remove all or part of the thyroid gland. Even if a nodule turns out to be thyroid cancer, it is treatable. Surgery to remove the gland addresses the problem, and recurrences or spread of the cancer cells are uncommon.

There is no need to be worried about being diagnosed with a thyroid nodule. Instead, choosing an experienced specialist(endocrinologist)will help you get proper treatment.

Patients with hypothyroidism (low thyroid hormone levels) will require oral consumption of thyroid hormone (levothyroxine) daily. Dietary habits can influence how the body absorbs levothyroxine. Take levothyroxine once a day in the morning, ideally at least 30 -60 minutes before having breakfast or a drink containing caffeine, like tea or coffee. Food and caffeinated drinks can stop your body from absorbing levothyroxine properly, so it does not work either.

Certain medications and supplements decrease the absorption of thyroid hormone and should be taken 3-4 hours after taking thyroid hormone. These include

• Fiber supplements
• Calcium and iron supplements
• Proton pump inhibitors (omeprazole and pantoprazole)
• Multivitamins
• Soy products

Also, ensure that the medicine container is stored at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Saliva plays a vital role in protecting your mouth and reducing bacterial growth. The reduction of salivary flow while fasting is the main reason for bad breath. Reduced saliva production will cause bacteria to multiply in the mouth more quickly. As a result, bacteria can produce gases that give off an unpleasant odour, causing bad breath. Once the person starts eating, the salivary glands are soon stimulated, and saliva production becomes normal. People with diabetes have higher glucose content in saliva, favouring the growth of bacteria and periodontal infections. This places them at a higher risk of bad breath. In addition, since saliva production suffers during fasting, bad breath may likely be troublesome in people with diabetes.

Yes. For a person with diabetes, mild to moderate physical activity levels can be a part of their day-to-day life, even during fasting. Following precautions in the duration, timing, and intensity of exercise can help avoid common complications seen during fasting. Individuals can exercise at a low intensity but for a maximum of 35 minutes, focusing predominantly on aerobic and strength training. This is generally safe in people with diabetes and can help control blood glucose. People who are used to more intensive exercise can pursue the same with more glucose monitoring to avoid hypoglycemia. Health professionals can discuss moderate resistance training / low-intensity cardio workouts instead of intensive exercise regimes. Brisk walking, stair climbing, yoga, swimming, Tai- Chi, and cycling are low-intensity exercises that people with diabetes can perform during fasting. Individuals can perform these exercises five times per week or 150 minutes per week to optimize their health and control their blood glucose levels.

Ramadan is an ideal opportunity to fine-tune the strength and desire required to adhere to good dietary habits. Nutrition advice offered to an individual by an expert dietician helps to alter and achieve structured dietary change during Ramadan. If a person is already practising a diet for weight loss before Ramadan fasting, they can continue it after getting professional advice. Consideration should be given to prevent dehydration. Healthy weight loss results in better control of glucose. Gradual weight loss of 0.5-1kg per week is desirable. If you are into an exercise plan, you may be unable to follow the same during Ramadan fasting. Therefore, you should plan the time and the type of exercise. Even for diet modifications, you should plan to modify the diet during the non-fasting hours.

Most people with hypothyroidism consume their thyroxin tablets (Eltroxin, Thyronorm, Euthyrox etc.) on an empty stomach after waking up. This is followed by the next meal or drink after 30-60 minutes. However, during Ramadan fasting, people find it challenging to consume the medicine and then fast for the next 30-60 minutes. Therefore, they can consider taking the tablets 30 minutes before Suhoor meal or 1 hour after the night snack before to bed. Scientific studies have shown that bedtime intake of thyroxine results in good absorption of the tablets. It is less of a challenge for people with hyperthyroidism to consume Carbimazole or Methimazole. However, doctors should avoid radioactive iodine therapy in people with hyperthyroidism around the time of Ramadan fast. This is to prevent the potential risk of worsening hyperthyroidism that can happen following the ablation and avoid the risk of hypothyroidism and subsequent doctor visits during Ramadan fast.

It is better to avoid fasting following a severe infection within the last three months before fasting. Some people who had COVID 19 in the past may experience a prolonged and severe post-COVID syndrome. Some have a heightened risk of developing blood clots, blood pressure and heart rate variations, extreme exhaustion, and even lung fibrosis. People with prolonged illness secondary to COVID-19 can become severely dehydrated and risk sudden acute deterioration during fasting. Hence it is safe to abstain from fasting and let your body slowly recover. It is wise to undergo an assessment with your treating doctor to see if you can observe the fast. Please follow his advice closely on whether to fast or not.

According to scientific studies, there is a 3-fold increase in the risk of migraine during Ramadan fasting. Migraine can be triggered by stress, hunger, low glucose levels, dehydration, irregular sleeping habits, and acidity. When you observe fasting for more than 12 hours, these problems can arise, leading to another episode of migraine headache. However, if you plan to observe fasting, you must continue to take the prescribed medicine. Caffeine withdrawal can lead to increased migraines. If you regularly take caffeine, it is good to have a strong coffee at Suhoor. Increase the quantity of water during non-fasting hours to avoid dehydration. Make sure that you get enough sleep and reduce the use of smartphones. If the episodes of migraine worsen, consider abandoning the fast.