Category: General

Thyroid hormones

Thyroid blood tests measure the thyroid hormone levels in the blood. The commonly measures tests are TSH (Thyroid stimulating hormone), Free T4 ( Free thyroxine) and T3. T3 and Free T4 are secreted by the thyroid. When a patient has hypothyroidism (low thyroid hormone production from the thyroid gland), the T3 and Free T4 reduces viagra pour jeune homme. This will make the pituitary produce more TSH (TSH increases) . Just the opposite happens in hyperthyroidism ( Thyroid producing more hormones).

Sometimes the reduction in T3 and Free T4 is not noticable but the TSH gets elevated a bit and this is called “ SUBCLINICAL HYPOTHYROIDISM” .

Thyroid Autoantibodies

The innate nature to develop a immune response against ones own organs is called AUTOIMMUNITY. Thyroid autoimmunity is measure by two antibodies called Anti TPO antibody ( TPO : thyroid peroxidase) and anti Tg antibody ( Tg: thyroglobulin). People with thyroid autoimmunity are at high chance of develpoing thyroid disease.

Thyroid ultrasound

It is a scanning technique to see the thyroid gland structure. Doctors gain valuable information about the size of the thyroid nodule and its structure. There are certain features that make doctors suspect fluid in the nodule or a cancer.

Thyroid Radionuclide scan

This can be done with radioactive iodine or technitium. This is done to know the fuction of the thyroid nodule. Hot nodules take up the radioactive isotope and shine brightly. Cold nodules don’t take up the isotope and look like voids in an otherwise bright thyroid gland.

FNAC ( Fine needle aspiration cytology)

FNAC , just as the word signifies invloves putting a needle and aspirating the thyroid nodule. Reports may show colloid ( fluid), thyroid cells and blood. From the features of thyroid cells, pathologists can diagnose thyroid cancers like papillary cancers.

Thyroid diseases are not uncommon in men. It is often unrecognised and undertreated since it is common to associate thyroid thyroid testsdisease only with women. The symptoms of hypothyroidism and hyperthyroidism are different in men.

In hyperthyroidism, the symptoms are:

• Muscle Weakness: you feel difficulty in getting up from squatting position
• Breathlessness and palpitations
• Anxiety and insomnia
• Osteoporosis: in long standing and severe cases, especially in older men
• Trembling Hands
• Weight Loss
• Fatigue and exercise intolerance
• Heat Intolerance
• Increased Bowel Movements

In hypothyroidism (underactive thyroid), the symptoms are:

• Weight gain
• Constipation
• Dry skin
• Reduced libido
• Generalised tiredness and fatigue
• Hair loss
• Depression : especially in older people with hypothyroidism
• Memory loss
• High cholesterol

The more the symptoms you have, the more likely to have a thyroid disease. However, you can have thyroid disease even without any symptoms mentioned above. If you have a family history of thyroid disease, you are at higher risk of getting the same.

Not all patients with diabetes can fast. It is important to seek advice from your doctor before planning to fast. The following group of patients are considered as high risk for fasting:

1. Those with severe and recurrent episodes of hypoglycaemia and unawareness (not aware of early symptoms of hypoglycaemia despite low sugars)
2. Those with poor glycaemic control ( Blood sugars > 300 or HbA1c > 9 %)
3. Those with ketoacidosis in the three months before Ramadan
4. Those who experience hyperosmolar hyperglycaemic coma within the three months before Ramadan
5. Those with acute illness
6. Those who perform intense physical labour
7. Pregnant women
8. Those with comorbidities such as advanced macrovascular complications(heart disease) , renal disease, on dialysis, cognitive dysfunction, uncontrolled epilepsy (particularly precipitated by hypoglycaemia)

Low sugar or hypoglycemia can occur if there is a mismatch between the calories that you consume and utilization of the same. In subjects with diabetes, fasting for 12 hours without any consumption of calories makes you prone to developing low sugars. This is more common if the subject is on medicines like sulphonylurea(Glimiperide, Glibenclamide, Gliclazide, Glipizide) or on insulin.

If you are on any such medicines, you need to meet the doctor and adjust the doses so that there is no increased risk of hypoglycemia. Despite adjustments of medication doses, we suggest regular monitoring of blood sugars during the Ramadan fast.

Sometimes patients stop medications for diabetes due to fear of hypoglycemia or unscientifically reduce the dose. This can lead to high blood sugars during the day which can lead to excessive tiredness, hunger, thirst, excessive urination, electrolyte imbalance and weight loss. These patients can sometimes slip into serious consequences like diabetes ketoacidosis and hyperosmolar coma.

You should always seek medical advice during medication dose adjustment and monitor blood sugars during the fast.

Self monitoring of blood sugars helps you to know about the status of the blood sugar. You may be prone for high blood sugars and low blood sugars during the fast depending on your medications. We suggest you check the blood sugars at least 2-3 times daily during the fast. Blood sugar levels should be tested frequently, especially during the first hour of fasting, before Al – Zuhr (midday) and Al Asr (afternoon) prayers and before Iftar at Maghrib (sunset), so as to ensure that they stay under control.

Test readings should be discussed with the healthcare team who will adjust the frequency and timing of medication doses accordingly. It is suggested that you discontinue the fast if blood sugars are more than 300 mg/dl or less than 70 mg/dl. The best way to self monitor is by using a glucometer and not urine sugars. Be in touch with your diabetes care nurse or physician if you notice high or low blood sugars. Just monitoring blood sugars does not break a fast.

Subjects with diabetes can continue to exercise during Ramadan. 30 minutes is the preferred duration of exercise. The best time to exercise during Ramadan is the time before breaking fast in the evening. The exercise should be of moderate intensity and not too rigorous. The diet should have enough protein and subject should ensure enough hydration.

(http://www.health24.com/Fitness/Exercise/Exercising-during-Ramadan)

Before and after fasting include high fibre foods such as wholegrain cereals, granary, bread, brown rice, beans and pulses, fruit, vegetables, and salads. These should be slowly absorbable carbohydrates with a low glycemic index.