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Common thyroid disorders and their symptoms

The thyroid is a small gland that helps regulate a person’s metabolism by producing hormones.

Problems can occur if the thyroid overproduces hormones, when it is known as hyperthyroidism, or under produced hormones, which is called hypothyroidism. These issues may also result in the growth of the thyroid, which is called a goiter.

Hyperthyroidism

In hyperthyroidism, the thyroid gland is overactive. It produces too much of its hormone. Hyperthyroidism affects about 1 percent of women. It’s less common in men.

Excessive thyroid hormone production leads to symptoms such as:

  • restlessness
  • nervousness
  • racing heart
  • irritability
  • increased sweating
  • shaking
  • anxiety
  • trouble sleeping
  • thin skin
  • brittle hair and nails
  • muscle weakness
  • weight loss
  • bulging eyes (in Graves’ disease)

Hypothyroidism                           

Hypothyroidism is the opposite of hyperthyroidism. The thyroid gland is underactive, and it can’t produce enough of its hormones.

Hypothyroidism is often caused by Hashimoto’s disease, surgery to remove the thyroid gland, or damage from radiation treatment.

Too little thyroid hormone production leads to symptoms such as:

  • fatigue
  • dry skin
  • increased sensitivity to cold
  • memory problems
  • constipation
  • depression
  • weight gain
  • weakness
  • slow heart rate
  • coma

Thyroid nodules

Thyroid nodules are lumps on a person’s thyroid. They can appear alone or in groups and are very common.

It is not clear why people develop thyroid nodules. Thyroid nodules do not typically cause symptoms, although there is a chance they may cause hyperthyroidism by becoming overactive.

A doctor will be able to feel thyroid nodules on a person’s neck, during an examination. If they discover nodules, they may check for hyperthyroidism or hypothyroidism.

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What Causes Painful Menstrual Periods?

Painful menstruation is also called dysmenorrhea. Menstrual cramps are pains in a woman’s lower abdomen that occur when her menstrual period begins (or just before) and may continue for two to three days. They may be throbbing or aching and can be dull or sharp. Symptoms can range in severity from a mild annoyance to severe pain that interferes with normal activities.

What are the causes?

It’s not always possible to identify the cause of painful menstrual periods. Some people are just at a higher risk of having painful periods.

These risks include:

  • being under age 20
  • having a family history of painful periods
  • smoking
  • having heavy bleeding with periods
  • having irregular periods
  • never having had a baby
  • reaching puberty before age 11

A hormone called prostaglandin triggers muscle contractions in your uterus that expel the lining. These contractions can cause pain and inflammation. The level of prostaglandin rises right before menstruation begins.

When to call a doctor

If menstrual pain is interfering with your ability to perform basic tasks each month, it may be time to talk to a gynecologist.

Talk to your doctor about your symptoms and if you experience any of the following:

  • continuing pain after IUD placement
  • at least three painful menstrual periods
  • passing blood clots
  • cramping accompanied by diarrhea and nausea
  • pelvic pain when not menstruating

Sudden cramping or pelvic pain could be signs of infection. An untreated infection can cause scar tissue that damages the pelvic organs and may lead to infertility.

If you have symptoms of an infection, seek prompt medical attention:

  • fever
  • severe pelvic pain
  • sudden pain, especially if you may be pregnant
  • foul-smelling vaginal discharge
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Breastfeeding – Myths and Facts

Every new mother finds themselves the recipient of a world of advice – some sound and others, unintentionally, not so – from family and well-wishers. The trouble one faces, when separating the truth from the chaff, is that many myths are steeped in partly truthful knowledge.

Here are some of the myths to watch out for!

Myth: Breastfeeding involves several food restrictions. Mother must eat only bland foods while breastfeeding.

Fact: It’s important for women who breastfeed to eat healthy, balanced meals. However, it’s false to think that they must reduce or increase their consumption of certain foods. It’s possible for babies to be affected by food their mother eats, but this is unusual. Also, it shouldn’t be assumed that breastfeeding requires mothers to drink more water of milk. Mothers who breastfeed don’t need to drink more milk to produce it. In terms of water, it’s true that drinking it promotes better health. However, there’s no specified number of glasses of water to drink if you are breastfeeding—simply drink until you are satisfied.

Myth: You Have to Wash Your Nipples before You Breastfeed

Not at all! Breastfeeding is different than bottle feeding for many reasons, so this myth comes from the use of bottles. You must wash bottle nipples before you use them because they can harbor bacteria which can contaminate infant formula or pumped breast milk. But, it isn’t the same for breastfeeding. Putting the baby to the breast actually helps to prevent infection. Aside from the fact that washing your nipples before every feeding adds about 12 extra steps to your day, it also takes away important oils from the Montgomery glands that lubricate and protect from the nipple.

Myth: You need to nurse every 2 hours around the clock to make sure your baby gets enough.

Fact: Just like adults, babies too have their own individual eating patterns. Most babies fall into the routine of feeding once every 2 hours. “Watch the baby and not the clock”. Feed your baby on demand. One way to look whether your baby is feeding enough is to observe their output ie; 6 wet diapers and 2 – 3 stools per day is an indicator of healthy baby.

Also better your child is latched on to your nipple, longer and adequately he or she will feed. Breast milk is also ideal for preterm babies.

Myth: Most women don’t produce enough milk

Fact: In fact, it’s quite the opposite. The majority of women produce enough milk to nourish more than one baby. Milk production is based on the law of supply and demand—the more baby demands, the more the mother will produce. However, it’s important to ensure that the baby latches on to the breast properly. In some circumstances, milk production may be insufficient—it may have been low from the start or have diminished suddenly for various reasons (i.e. due to medication that diminishes lactation or due to health problems). If this happens, talk to a health professional specialized in breastfeeding.

Myth: Babies must learn to drink from the bottle. You must always introduce the bottle before the baby refuses to take it.

Fact: Although several parents decide to introduce the bottle for various reasons, it isn’t necessary that a baby learn to drink from it. It’s more important to concentrate on starting to breastfeed. After that, it’ll be possible to occasionally introduce the bottle if you wish to. Giving the bottle when breastfeeding isn’t going well isn’t always a good idea. This may even complicate things. It’s preferable to consult a health professional who is specialized in breastfeeding to get help and to make an informed decision about it.

Myth: If I’m ill, it’s imperative that I stop breastfeeding.

Fact: In the majority of cases of common infections, there’s no reason to stop breastfeeding. If ever you must take medication, it’s important to mention to your doctor and your pharmacist that you are breastfeeding. Many medications are safe to take while you’re breastfeeding—however, it’s important to find out what they are. The same goes for over-the-counter medication and natural health products you can get at the pharmacy. Talk to your pharmacist before taking them. What happens if you must have an operation? Most times, you can start breastfeeding again as soon as you feel well enough to do so. It’s important to talk to the medical team about it, but it’s totally doable.

Myth: Don’t wake a sleeping baby to breastfeed.

Fact: Unless your baby is older than three months and a well-established breast feeder, this statement is not true. In the first couple of days after birth, your baby will sleep a lot. In order to create a regular breastfeeding routine and provide your baby with the necessary energy, you need to wake up your sleeping baby. Allowing a baby to continue to sleep and have longer periods of time between feedings could actually make them sleepier, and this can become a problem. In the days following birth, mothers need to wake their baby, provide them with nutrition and establish a feeding routine.

Myth– Breastfeeding is a reliable form of birth control.

Fact: Even if you exclusively breastfeed, ovulation and chance of becoming pregnant start after 3 months of delivery. So consult before that for contraception.

Mothers who breastfeed burn around 300 to 500 extra calories per day as compared to those who give formula feed and researches have shown that they do tend to slim down faster.

The experience of breastfeeding is different for every mother.

I hope the above facts help you with your breastfeeding experience and answer any questions you have.

Myth: If you give your baby bottles of pumped milk, she will refuse the breast.

Fact: Most babies switch between breast and bottle with no problem. “As long as you wait until your baby has mastered breastfeeding (usually at about six weeks) before you offer her a bottle, she should be willing to switch back and forth. However, those women who limit their babies to one bottle per day tend to have less of a struggle.

 

Article by:

Dr. Geethanjali,

Consultant Obstetrics & Gynecology,

Mehta Multispecialty Hospitals

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Breast Diseases

Most women experience breast changes at some time. Your age, hormone levels, and medicines you take may cause lumps, bumps, and discharges (fluids that are not breast milk).

If you have a breast lump, pain, discharge or skin irritation, see your health care provider. Minor and serious breast problems have similar symptoms. Although many women fear cancer, most breast problems are not cancer.

Breast pain

The most common type of breast pain is associated with swelling of the breast tissue during the menstrual cycle. It’s almost always hormonal. Some young women begin to have pain around the time of ovulation that continues until the beginning of their menstrual cycle. The pain may be felt in only one breast or may be felt as a radiating sensation in the under-arm region.

Cysts

A cyst is a fluid-filled sac that develops in the breast tissue. They typically occur in older women, but are sometimes found in teens. Cysts often enlarge and become tender and painful just before the menstrual period and may seem to appear overnight.

Cysts can feel either soft or hard. When close to the surface of the breast, cysts can feel like a large blister, smooth on the outside, but fluid-filled on the inside. However, when they are deeply embedded in breast tissue, a cyst will feel like a hard lump because it is covered with tissue.

Fibroadenomas

Fibroadenomas are solid, smooth, firm, benign lumps. They are most commonly found in women in their late teens and early twenties, but can occur in women of any age. Fibroadenomas are painless lumps that feel rubbery and move around freely. They vary in size and can grow anywhere in the breast tissue.

Fat necrosis

Fat necrosis is a condition in which painless, round, firm lumps caused by damaged and disintegrating fatty tissues form in the breast tissue. The condition most often occurs in women with very large breasts or after a bruise or blow to the breast.

These lumps are not malignant and they do not increase your risk of cancer. However, this condition may occur after a lumpectomy and radiation from a previous cancerous lump. In some cases, your doctor will watch the lump through several menstrual cycles, and may perform a mammogram before deciding whether to remove it.

Sclerosing adenosis

Sclerosing adenosis is a breast condition that involves excessive growth of tissues in the breast, often resulting in breast pain.

While these changes in the breast tissue are microscopic, they may show up on mammograms as calcifications and can produce lumps.

Generalized breast lumpiness

Breast lumpiness is known by many different names, such as “fibrocystic disease” and “fibroid breasts.”

Many doctors now believe that lumpiness is caused by normal breast changes that many women undergo throughout their lives. However, lumpiness in the breasts may make actual lumps harder to find. So, if you have lumpy breasts, it’s important to perform regular breast self-examinations and have regular check-ups.

Breast tenderness

Mild breast tenderness often occurs before your period. It can also be an early sign of pregnancy. Most adolescents don’t have severe breast tenderness, so if you do, contact your doctor.

Uneven breast size

Having breasts of different sizes (asymmetry) is common, especially in the early stages of breast development. However, if your breasts are different sizes, have your doctor perform a careful examination to rule out a breast mass, cyst or abscess.

Hard lump

Breast cancer is very rare in adolescents. However, if you find a lump with any of the following qualities, see your doctor for an exam:

  • hard
  • not movable
  • feels like it’s attached to the chest wall
  • combined with dimpling or puckering of the breast

How are breast disorders diagnosed?

The first step in diagnosing any type of breast disorder is a physical exam. Depending on the findings, your doctor may order other tests to help make a diagnosis. These tests may include:

  • ultrasound
  • mammogram
  • fine-needle aspiration
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Breast Cyst Vs Breast Cancer

Breast Cyst

Breast cysts are fluid-filled sacs inside the breast, which are usually not cancerous (benign). You can have one or many breast cysts and they can happen in one or both breasts. They’re often described as round or oval lumps with distinct edges. A breast cyst usually feels like a grape or a water-filled balloon, but sometimes a breast cyst feels firm.

Breast cysts don’t require treatment unless a cyst is large and painful or uncomfortable. In that case, draining the fluid from a breast cyst can ease symptoms.

Breast cysts are common in women before menopause, between ages 35 and 50. But they can be found in women of any age. They can also occur in postmenopausal women taking hormone therapy.

Symptoms

Breast cysts may be found in one or both breasts. Signs and symptoms of a breast cyst include:

  • A smooth, easily movable round or oval lump with distinct edges (which typically, though not always, indicates it’s benign)
  • Nipple discharge that may be clear, yellow, straw colored or dark brown
  • Breast pain or tenderness in the area of the breast lump
  • Increase in breast lump size and breast tenderness just before your period
  • Decrease in breast lump size and resolution of other symptoms after your period

Having breast cysts doesn’t increase your risk of breast cancer. But having cysts may make it more difficult to find new breast lumps or other changes that might need evaluation by your doctor. Be familiar with how your breasts normally feel so that you’ll know when something changes.

Breast Cancer

Breast cancer is cancer that develops in breast cells. Typically, the cancer forms in either the lobules or the ducts of the breast. Lobules are the glands that produce milk, and ducts are the pathways that bring the milk from the glands to the nipple. Cancer can also occur in the fatty tissue or the fibrous connective tissue within your breast.

Each type of breast cancer can cause a variety of symptoms. Many of these symptoms are similar, but some can be different. Symptoms for the most common breast cancers include:

  • a breast lump or tissue thickening that feels different than surrounding tissue and has developed recently
  • breast pain
  • red, pitted skin over your entire breast
  • swelling in all or part of your breast
  • a nipple discharge other than breast milk
  • bloody discharge from your nipple
  • peeling, scaling, or flaking of skin on your nipple or breast
  • a sudden, unexplained change in the shape or size of your breast
  • inverted nipple
  • changes to the appearance of the skin on your breasts
  • a lump or swelling under your arm

If you have any of these symptoms, it doesn’t necessarily mean you have breast cancer. For instance, pain in your breast or a breast lump can be caused by a benign cyst. Still, if you find a lump in your breast or have other symptoms, you should see your doctor for further examination and testing. Learn more about possible symptoms of breast cancer.

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Precautions for surgery during covid-19 crisis

During the covid-19 pandemic, Dr.Mehta’s hospitals has continued to performed essential surgeries for patients in whom a delay could cause harm. Our medical and surgical teams have taken measures to help ensure the safety of all patients in our hospital.

Our infection prevention practices and protocols are aimed at protecting our patients and visitors. Everyone entering our hospital will be screened for symptoms and known high risk exposures. Everyone will be offered a mask to wear to prevent spread of infection to others.

We perform surgery or other procedure in the safest possible circumstances. Our teams working around the clock to stay on top of the evolving covid-19 crisis, to ensure both excellent patient care, family and visitor safety. At the current time, patients are allowed to have single attender during the hospital stay. Attender must be screened for symptoms of covid-19.

In the operation theatre (OT), laminar air flow is closed after operation. The operation theatre is fumigated. The OT is cleaned and disinfected. The OT is closed for at least 2 h, and the next operation will be performed.

We discharge the patients postoperatively as early as possible to reduce the risk of exposure to covid-19.

Having a surgery in our hospital doesn’t increase the chances of developing covid-19. Because covid-19 positive patients are kept in special isolation wards to protect other patients.

With any surgery, we must weigh the risk of delay with the benefit that can be achieved by moving forward with surgery. In some

situations, it may not be safe to delay further. Our surgeon and their team are working hard to assess whether surgery can be safely postponed.

Our surgical team will take measures to help ensure the safety of all patients at Dr.Mehta’s hospitals, and we have not had any in-hospital transmission of covid-19.

 

Dr.S.Balamurali, MS, FMAS, FIAGES, Fellow in endoscopy

Consultant General and Laparoscopic surgeon

Dr.Mehta’s hospitals, global campus

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Laparoscopic surgery in covid-19 crisis

Among surgeons, a concern with the use of laparoscopy has been raised due to a proposed risk of viral transmission of the corona virus disease with the creation of pneumoperitoneum. Despite the concern regarding aerosolization, there is currently no evidence of viral transmission during laparoscopy.

Laparoscopy carries the advantage of a decreased length of stay and consequent increased hospital bed availability. For the patient, laparoscopy may result in a decrease risk of complications and a faster recovery. Laparoscopy allows a self-contained operative field with less risk of fluid spillage.

There is no scientific evidence to support the use of laparoscopy over open surgery to reduce viral transmission of covid-19. There may be a theoretical risk of transmission from the abdomen of an infected individual. So, the following recommendations during laparoscopic procedure to reduce the possible risks of covid-19 transmission.

  • Routine use of covid-19 testing
  • Routine use of full PPE
  • Laparoscopic surgery should be performed by trained laparoscopic surgeons, in order to minimise operating time and potential for aerosolization.
  • Routine use of closed-circuit smoke evacuation
  • Appropriate port size selection
  • Minimising instrument exchanges
  • Use of disposable ports that may reduce gas loss
  • Use of the lower abdominal insufflation pressure (12mmHg or less)
  • Minimal use of energy devices during procedures, to reduce smoke plume and particle aerosolization
  • Closed evacuation of all gas at the end of procedure

These recommendations may be of low or debatable benefit; however, may be considered in all laparoscopic cases in this covid-19 crisis.

Dr.S.Balamurali, MS, FMAS, FIAGES, Fellow in endoscopy
Consultant General & laparoscopic surgeon
Dr.Mehta’s Hospitals, global campus

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SCREENING IS MY BIRTH RIGHT!

Congenital hypothyroidism is an important cause of poor growth and delayed mentation in neonates and infants.

Congenital hypothyroidism (CH) is inadequate thyroid hormone production in newborn infants. It can occur because of an anatomic defect in the gland, an inborn error of thyroid metabolism, or iodine deficiency. CH is the most common neonatal endocrine disorder, and historically, thyroid dysgenesis was thought to account for approximately 80% of cases.

Symptoms

Signs of cretinism or congenital hypothyroidism in a newborn include:

  • lack of weight gain
  • stunted growth
  • fatigue, lethargy
  • poor feeding
  • thickened facial features
  • abnormal bone growth
  • mental retardation
  • very little crying
  • excessive sleep
  • constipation
  • yellowing of the skin and whites of the eyes (jaundice)
  • floppiness, low muscle tone
  • hoarse voice
  • unusually large tongue
  • swelling near the navel (umbilical hernia)
  • cool, dry skin
  • pale skin
  • swelling of the skin (myxedema)
  • swelling in the neck from an enlarged thyroid gland (goiter)

Congenital hypothyroidism can be identified by a small heel prick blood to see if your baby has an elevated TSH. Elevated TSH on heel prick could be a pointer to a defective function of thyroid gland. This has to be confirmed by a venous blood test. Subsequently, your baby may undergo scans to ascertain the cause and duration of therapy. If congenital hypothyroidism is recognised early, medication will be adviced for your baby.

 

Taking the medicine will ensure that your baby’s growth and mentation is preserved. Next time you visit your paediatrician for vaccination, do ask you doctor if your baby has been screened for congenital hypothyroidism – is it your baby’s birth right!

 

Articles by

Dr Hemchand K Prasad

Consultant, Pediatric Endocrinologist

Dr Mehta’s Hospitals, Chetpet

 

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IS MY DAUGHER MATURING EARLY

Parents frequently wonder whether their child’s maturing to puberty is occurring at too early an age. Often, girls in fourth grade seem to be maturing, and their parents are not ready for it.

For girls, puberty usually starts around age 11. But it can start as early as age 6 or 7. For boys, puberty begins around age 12. It can start as early as age 9. Puberty is a process. It occurs for several years. Most girls finish puberty by age 14.

All girls undergo a transformation into a woman during adolescence. Menarche is the culmination of this puberty process. The onset is usually noted as breast budding and hair appearance on the axilla and genital area. If you notice either breast budding or hair appearance earlier than 8 years in your daughter, be careful – this could be a sign of early puberty. Early puberty is worrying for doctors because of two factors. Firstly, early puberty may be a sign of hormonal disturbance. Hormonal disturbance is assessed by the doctor using an X-ray for skeletal maturity, ultrasound to assess size of the uterus and some hormone tests. If a hormone disturbance is found, your child may be initiated on some injections. Second reason why one should worry is compromised height. Early maturation will result in reduced years of growth and compromised final height. Thus, it is mandatory that all girls have their sexual maturity assessed in every visit to your paediatrician after 6 years. Next time you visit your paediatrician; don’t forget to get her sexual maturity assessed!!!

Articles by
Dr Hemchand K Prasad
Consultant, Pediatric Endocrinologist
Dr Mehta’s Hospitals, Chetpet

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IS MY CHILD GROWING WELL?

There are three broad stages of development: early childhood, middle childhood, and adolescence. The definitions of these stages are organized around the primary tasks of development in each stage, though the boundaries of these stages are malleable.

The term “gross motor” development refers to physical skills that use large body movements, normally involving the entire body. In the sense used here, gross means “large” rather than “disgusting.”

Fine motor skills are necessary to engage in smaller, more precise movements, normally using the hands and fingers. Fine motor skills are different than gross motor skills which require less precision to perform.

Growth is a barometer of well being in a given child. It is very important that children have their height and weight measured periodically and plotted on the growth chart. Growth chart is a tool that is used to assess the performance of growth of the child in the perspective of the general population. The Indian academy of paediatrics and World health organisation have given growth charts for Indian children. In every visit to your paediatrician, your child’s height and weight is measured and plotted on growth chart. If the height or weight is below the 3rd percentile (the lowest line on the growth curve), the child has to assessed carefully for presence of underlying disorder. If the weight alone is below the 3rd percentile, the child may be having nutritional deficiency or an underlying systemic disease. If the height is less than the 3rd percentile, the child may be having a hormone deficiency like growth hormone deficiency or thyroid hormone deficiency. It is very important that the parents maintain the growth chart properly and bring in to the paediatrician every year and have the growth assessed.

Next time you visit your paediatrician – don’t forget to ask for your child’s performance on the growth chart!!!

 

Articles by
Dr Hemchand K Prasad
Consultant, Pediatric Endocrinologist
Dr Mehta’s Hospitals, Chetpet

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