Category: General

Hypoglycaemia, also known as low blood sugar, can unexpectedly affect anyone, not just individuals with diabetes. Have you ever wondered what could trigger such a sudden drop in your blood glucose levels? Here are some causes worth noting:

• Certain medications : Specific antibiotics, heart medications, or anti-malarial drugs can lower your blood sugar levels unexpectedly.

• Excessive alcohol consumption: Drinking alcohol without eating can result in a stealthy decline in blood sugar levels.

• Severe illnesses : Conditions affecting vital organs such as the liver, kidneys, or heart can also lead to low blood sugar.

• Infections: Serious infections, including cerebral malaria, can cause significantly low glucose levels.

• Long-term starvation or eating disorders : Disorders like anorexia nervosa can severely disrupt glucose balance.

• Pancreatic tumours (insulinomas) : These tumours produce excess insulin, leading to low blood sugar levels.

• Hormone deficiencies : Issues related to adrenal or pituitary glands can contribute to hypoglycaemia.

• Post-stomach surgery occurrences : Procedures like gastric bypass may result in unexpected drops in blood sugar levels.

If you experience symptoms that indicate hypoglycaemia and find relief by elevating your blood glucose, it is crucial to seek medical evaluation!                   

Dr. Tittu Oommen, MD, DM 

Thyroxine is most effective when taken on an empty stomach, typically in the morning. This allows for optimal absorption in the small intestine, as food can reduce its bioavailability, potentially leading to less effective treatment. It is recommended to wait at least 30 to 60 minutes before eating or drinking anything after taking the medication. Alternatively, thyroxine can be taken at night, provided it is at least 4 hours after the last meal.

Certain foods and beverages can affect thyroxine absorption, including high-fiber meals, soy products, and foods high in calcium and iron. Additionally, coffee, tea, and dairy products should not be consumed close to the time of taking thyroxine. Supplements such as calcium, iron, and antacids may also impact absorption and should be taken at least 4 hours apart from thyroxine.

Here are some guidelines to optimize the effectiveness of thyroxine:

• Take thyroxine at the same time every day to maintain consistent hormone levels.

• Swallow the pill with a full glass of water.

• Avoid taking calcium, iron, or fiber supplements within four hours of the dose, as they can interfere with absorption.

• If consuming coffee or tea, have them after eating, not with the medication.

• Regular blood tests are important to monitor thyroid levels and adjust the dosage if necessary.    

Mrs. Bini S John , D Pharm

Thyroid disorders and polycystic ovary syndrome (PCOS) are two of the most common endocrine disorders in the general population. Although the etiopathogenesis of hypothyroidism and PCOS is completely different, these two entities have many features in common. An increase in ovarian volume and cystic changes in ovaries have been reported in primary hypothyroidism. It is increasingly realized that thyroid disorders are more common in women with PCOS as compared to the normal population.

Hypothyroidism can lead to polycystic morphology of the ovaries. While this morphology can vary with severity and duration of hypothyroidism, there is no evidence to suggest that primary hypothyroidism can lead to PCOS. Research suggests that those with PCOS may have a higher risk of developing hypothyroidism. this could be due to common factors like insulin   resistance, autoimmunity, and genetic predisposition.

Managing both these hormonal conditions require drugs to maintain the thyroid hormone levels, strict life style measures including diet and regular exercises and in some cases drugs to manage menstrual irregularities. Hence those have features of hypothyroidism screen for PCOS and vice versa. Follow the advice of the endocrinologist and dietician and manage these problems effectively to avoid related problems.

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

Hypothyroidism is a common thyroid disorder in India, with a prevalence of around 11%. This means that approximately one in ten adults in India may be affected by hypothyroidism. The prevalence is higher in women and older adults, A significant portion of the population may also have subclinical hypothyroidism, where thyroid hormone levels are not severely low, but still affect thyroid function. These persons are kept under follow up only and don’t need hormone replacement.

Common Symptoms of Hypothyroidism:

1. Fatigue or feeling tired and lacking energy is a very common symptom.

2. Unexplained weight gain despite diet and exercise can occur

3. Feeling colder than usual or having difficulty tolerating cold temperatures.

4. Dry, brittle skin and hair , including hair loss or thinning.

5. Changes in bowel habits, including constipation  

6. Menstrual Changes include heavy or irregular periods in women.

7. Pain , stiffness , and swelling in muscles and joints.

 8. Cognitive issues- Problems with concentration,   memory, and thinking.

9. Symptoms of depression , including sadness, loss of interest, and fatigue.

10. Hoarse Voice : Changes in voice quality, including hoarseness.

11. Slowed Heart Rate : A slower than normal pulse

Hypothyroidism characterised by low thyroid hormone levels can lead to slower metabolic rate leading onto weight gain even if the calorie load is the same. On the other hand, obesity itself is associated with increased risk of subclinical hypothyroidism. In fact both the problems share common risk factors like sedentary life style, poor diet control and genetic predisposition. Hence addressing obesity through strict life style measures which include balanced diet and regular exercises can improve thyroid function. Similarly treating hypothyroidism with appropriate medication can help in managing weight gain. So a comprehensive approach is required if you have thyroid problem and obesity.

 Dr.Deepa G, MHSc (Diab), Dip (Diab)

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