A Simple Guide to Hyperthyroid Disease

A Simple Guide to Hyperthyroid Disease
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What is Hyperthyroid Disease?
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Hyperthyroid disease is a condition when the thyroid gland produces too much thyroid hormones resulting in all the symptoms of excessive metabolism.


What is the cause of Hyperthyroid Disease ?
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Hyperthyroid disease is caused by conditions that increases the output of thyroid hormones:
too much thyroid hormone.

1.Graves' disease - diffuse goiter(enlarged thyroid) caused by autoimmune antibodies stimulation of the thyroid gland to produce more thyroid hormones.
Graves' disease is more common in young women.

2.Plummer's Disease (Toxic nodular thyroid)
Hyperactive thyroid nodules produce excess thyroid hormones especially in older women.

3.Hashimoto's Disease (Thyroiditis) inflammation of the thyroid gland causes production of excess thyroid hormones.

4.Idiopathic Hyperthyroid Disease is caused by ingestion of too much thyroid hormones.


What are the Symptoms of Hyperthyroid Disease?
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Symptoms:

1.anxiety, shaking, feeling nervous or irritated

2.fast heartbeat or palpitations

3.feeling hot all the time

4.Excess sweating

5.increased appetite

6.loss of weight

7.fatigue, exhaustion

8.increased frequency of bowel movements

9.changes in menstrual periods

10.eye irritation

11.bulging of the eyes

12.double vision

13.blurred vision

Signs:

1. Enlarged thyroid gland -diffuse or nodular

2. Bruit or blood flow sounds may be heard over the thyroid

3. Skin warm and sweaty

4. fine brittle nails

5. fine hair

6. Tachycardia -heart beat may be above 100/min , wide difference between systolic and diastolic pressure

7. Fine tremors of hands

8. Eye : bulging, peri-orbital edema, lid lag


How is diagnosis of Hyperthyroidism made?
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1. blood test is done for presence of high thyroid hormones(T3 and T4) and low TSH (thyroid stimulating hormone) levels.

2. Blood for thyroid antibodies(thyroiditis)

3. Ultrasound of the thyroid gland

What is the Treatment of Hyperthyroidism?
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1.Anti-thyroid drugs
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reduce the production of excess thyroid hormones

The drugs of choice are carbimazole and propylthiouracil initially on high doses then reducing down to a maintenance dose which has to be taken for 1-2 years depending on the severity of the condition.
Symptoms usually improve after 2 months but blood tests are needed to monitor the effect of the drugs.
Side effects include lowering of white cell count and concomitant infection of the throat.
Relapse after 1-2 years treatment are quite common.

2.Radioactive iodine therapy
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is more suitable for older patients and those who do not respond to anti-thyroid drugs and women who do not intend to have pregnancy.

The side effect of radioactive iodine is often radiation side effects which may lead to cancer of the bones 20 years down the road.
The other danger is the destruction of the thyroid producing cells which lead to hypothyroid disease later on.
The patient will then be required to take thyroxine for the rest of her life.

3.Surgery
may be required if the hyperthyroid condition did not improve with anti-thyroid
drugs or if there is frequent recurrences.
It is also done for women who do not wish to go for radioactive iodine therapy and who wishes to have a child later on.

A subtotal thyroidectomy is done.
Usually three quarters of the glands are removed.
Dangers of surgery and anesthesia are as usual rare however there may be removal of too much thyroid gland resulting in hypothyroidism or removal of parathyroid glands resulting in low calcium.
Patient will then need to take thyroxine and calcium replacement tablets for life.

4. Supportive treatment:
a.Propanolol and other beta blockers can slow down the fast heart beats caused by the excess thyroid hormones

b.tranquillizers such as ativan, xanax can help soothe the anxiety or stress in a person with hyperthyroid disease.
Most hyperthyroid disease patients have their excessive thyroid hormones production triggered off by stress and anxiety.

c.rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthyroid disease.


What is the prognosis of Hyperthyroid Disease?
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Most cases of patients treated with surgery and radioactive iodine recovered quite well although many can developed hypothyroidism later on in life when the thyroid hormones production is reduced.

Many cases on anti-thyroid medication usually have recurrence especially if the basic cause of stress and anxiety remains in their work or home life.

What are the prevention measures for hyperthyroid Disease?
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Rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthyroid disease.

Avoid stress and anxiety.

A Simple Guide to Pterygium

A Simple Guide to Pterygium
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What is Pterygium?
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Pterygium is a fleshy tissue that grows in on the inner corner of the eye
towards the pupil.

It may also appear on the outer corner.

It is usually triangular in shape.


Who is affected by Pterygium?
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Pterygium is more common in people who spend time outdoors than indoor

What is the Cause of Pterygium?
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The exact cause of Pterygium is not known.

1. Long-term exposure to sunlight, especially ultraviolet (UV) rays

2. chronic eye irritation

3. dusty conditions

4. dry eye may contribute to pterygium as well.



What are the Symptoms and signs of Pterygium?
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Symptoms varies from mild to severe:

1.discomfort in the eye

2.Conjunctival congestion

3.Tearing -excess tears from irritation

Signs:

1.fleshy growth on the conjunctiva on inner side of eye growing towards pupils

2.increased dilated blood vessels in the fleshy growth


How do you make the Diagnosis of Pterygium?
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The presence of fleshy growth with blood vessels on the conjunctiva on inner side of eye growing towards pupils


What are the complications of Pterygium?
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1.Partial blindness if the pterygium covers the cornea

2.Recurrent irritation and conjunctivitis of eyes.

3.Severe infection of the eye - rare

What is the treatment of Pterygium?
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Treatment depends on the severity:

1.Mild:

Eye drops with anti congestion and anti-inflammatory properties may shrink the blood vessels which provide nourishment for the growth of the pterygium.

2.Severe:

Once the pterygium reaches the cornea and may cover the cornea, surgical resection of the pterygium may be necessary otherwise the eye sight may be compromised.

Surgical resection may also be done if the pterygium is unsightly.

What is the prognosis of Pterygium?
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The prognosis is usually good.

Recurrence is rare but do occur due to regrowth of the blood vessel supplying the pterygium.

This occurs more in younger people.

How is pterygium prevented?
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Wearing UV protective sunglasses

Avoid dry and dusty conditions

Use of artificial tear eye drops

A Simple Guide to Entropion

A Simple Guide to Entropion
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What is Entropion?
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Entropion is an inversion(rolling inwards) of the eyelid

Who is affected by Entropion?
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Entropion is more common in women than in men.


What is the Cause of Entropion?
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The causes of Entropion can divided into 2 type:

Spasm of Orbicularis muscle:

1. Degeneration of the peripheral connective tissue of the eye

2. Occurs in old age

3. Occurs also after removal of eyeball

4. Primarily affects the lower eyelid.

Cicatricial:

1. Scarring of the eyelid muscle to connective tissue as a result of injury, trauma, burns

2.retraction of the connective tissue of eyelid from infections such as trachoma, chronic infections

3.Congenital disease

4. May affect either upper or lower eyelid

What are the Symptoms and signs of Entropion?
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Symptoms varies from mild to severe due to rubbing of eyelashes against the cornea or conjunctiva:

1.Irritation of the conjunctiva

2.Conjunctival congestion - increased blood flow through irritated eye shows up the blood vessels

3.Tearing -excess tears from irritation

Signs:

1.Erosions, opacities and vasculisation of the cornea

2.increased dilated blood vessels of conjunctiva present due to irritation

3.The presence of inward turning eyelids and eyelashes


How do you make the Diagnosis of Entropion?
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The presence of inward direction of the eyelashes and eyelid can be seen using a slit lamp microscope.

What are the complications of Entropion?
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1.Recurrent corneal ulcers

2.Recurrent irritation and conjunctivitis of eyes.

3.Severe infection of the eye - rare

What is the treatment of Entropion?
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Treatment depends on the type of Entropion:

Spastic:

1.Eversion of eyelid especially lower eyelid with adhesive plaster or tape for temporary relief together with lubricating eye
drops

2.Surgery - by removal of inturning eyelashes using laser
- eversion of eyelid by surgery as below

Cicatricial:

Surgery to tighten the eyelid muscle is usually required:

1.Quickert procedure: 2 to 3 strategically placed stitches are used under local anesthesia to evert the eyelid.

Recurrence is common.

This is useful for patients who are not suitable for surgery and can be followed the full repair surgery later on when the patient is better.

2.Repair of inverted eyelid is done by incision above and below the eyelids and removal of connective tissue or scarred tissue and tightening of the eyelid muscle.

This is usually done on an outpatient basis and under local anesthesia.

Post-operatively the wounds are protected by antibiotic creams and dressings.

Healing usually occurs within 1 week.

Antibiotics are also given for any infections of the conjunctiva and cornea.



What is the prognosis of Entropion?
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The prognosis is usually good.

Recurrence is rare but do occur especially due to weakening of eye muscles from age.

A Simple Guide to Corneal Ulcer

A Simple Guide to Corneal Ulcer
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What is Corneal ulcer?
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Corneal ulcer is a inflammatory disease of the surface of the cornea which causes local destruction of the superficial layer of the cornea resulting in ulcers.

Corneal ulcers can be infectious(due to infection) or non infectious(due to injury or autoimmune disease)


Who is affected by corneal ulcer?
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Corneal ulcers may be present more frequently in patients with :
Vitamin A deficiency

autoimmune disease

neurological disorders like facial palsy

What is the Cause of corneal ulcer?
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The causes of Corneal ulcers can divided into 2 type:
Infections:
1. Bacterial infection such as Streptococci, Staphhylococci, pneumococci, pseudomonas

2. Viral infections such as herpes simplex, herpes zoster,

3. Fungal infection

Non-infection:
1.Injury due to hard contact lens, abrasions from trauma, accidental scratch

2.autoimmune disease

3.Systemic disease

What are the Symptoms and signs of corneal ulcer?
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Symptoms varies from mild to severe:

1.Severe pain in the eye or around the eye and eyebrow especially with infectious causes. Non-infectious causes may not give rise to pain.

2.Red eye - increased blood flow through inflamed eye shows up the blood vessels

3.Tearing -excess tears from inflammation

4.Discharge -may be pus discharge from eyes especially in the morning

5.Light sensitivity - sensitive to bright lights

Signs:

1.White spot on the cornea, that depending on the severity of the ulcer, may not be visible with the naked eye

2.increased dilated blood vessels present due to inflammation


How do you make the Diagnosis of corneal ulcer?
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The presence of a corneal ulcer can be seen using a slit lamp microscope.
Sometimes a dye fluorescein may be dropped into the eye making it more visible and easier to detect.

What investigation are necessary in Corneal ulcer?
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If the patient is suspected to have infection(pus discharge from the eyes), a tissue culture of the corneal cells(gently scraped from the ulcer) may be necessary to determine the type of micro-organism infecting the eye.


What are the complications of corneal ulcer?
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The complication is always the risk of :

1.Severe infection of the eye especially with pseudomonas infection causing infection of the anterior chamber of the eye and then spreading to the rest of eye resulting in loss of an eye.

2.Scarring of the corneal ulcer resulting in partial loss of vision

What is the treatment of corneal ulcer?
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Treatment depends on the type of corneal ulcer:

Infection:
1.Bacterial infection requires more intense treatment with oral antibiotics and antibiotic eye drops (given every 15 minutes)

2.Viral infections are usually treated with acyclovir tablets orally and acyclovir eye cream

3.Fungal infections are less common but are usually treated with antifungal medicine and eye drops.

In all infection cases, corticosteroid medications are not given.
Painkillers such as paracetamol can be given for pain

Non-infection:
1.Corticosteroid eye drops are usually given to reduce the inflammation

2.Antibiotic are also given to prevent infections of the ulcer.

In all cases the eye should be covered with eye pad until the epithelium of the ulcer heals about 10-14 days.

What is the prognosis of corneal ulcer?
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The prognosis depends on the severity of the disease

Most cases can be healed if detected early.

There may be minimum scarring of the cornea with possible loss of some vision.

Rarely the eye may be lost if there is severe infection and no treatment.


What are preventive measures in corneal ulcer?
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1. A nutritious diet with vitamin supplements can strengthen the body resistance against illness.

2.Avoid the use of infected contact lens lotion

3.A soft lens are more prone to eye infection. Always wash the hands before using any contact lens.

4.Avoid rubbing the eyes with dirty hands or tissues

5.A healthy lifestyle with less stress and mild exercise is always good for the body.

A Simple Guide to Crohn's Disease

A Simple Guide to Crohn's Disease
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What is Crohn's Disease?
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Crohn's Disease(Regional Enteritis) is a chronic inflammatory disease of the gastrointestinal tract which affects the layers of the lining of the whole gastrointestinal tract from mouth to anus.

It was originally called regional ileitis because the ileum was typically affected but has been extended to regional enteritis because the whole layer of the lining of the gastrointestinal tract can be affected from the mouth to anus.

Who is affected by Crohn's Disease?
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Crohn's Disease is more common in Jews than non-Jews and in whites than non-whites

It occurs equally in men and women and can be found in families.

Crohn's Disease can be found in all ages but are more common in the 20-30 years age group.

What is the Cause of Crohn's Disease?
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The exact cause of Crohn's Disease is not known.

It has been suggested that an autoimmune disease is the main cause of Crohn's Disease.

A protein produced by the immune system, called anti-tumor necrosis factor (TNF) may be a possible cause of the body's reaction in the lining of the gastrointestinal tract resulting in inflammation.

Infectious causes has also been blamed.


What are the Symptoms and signs of Crohn's Disease?
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Symptoms varies from mild to severe:

1.severe abdominal pain, especially in the right iliac fossa

2.diarrhea

3.Rectal Bleeding

4.fever

5.weight loss

6.loss of appetite

7.joint pain

Signs:

1.Abdominal distension and tenderness
Abdominal mass may be felt in the right iliac fossa

2.Rectal examination may show blood in the stool

3.pallor due to anemia

4.skin lesions


How do you make the Diagnosis of Crohn's Disease?
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1.A history of abdominal pain , diarrhea and bloody stools

2.The physical exam consists of
a.palpation of the abdomen for tenderness and right iliac fossa mass

b.digital rectal exam to detect blood.

3.stool may be tested for blood

4.blood tests(Hb, WBC, ESR, blood culture) are done for evidence of infection.

5.X-rays of the abdomen, barium meal and barium enema may be done to show evidence of extent of inflammation and narrowing of segment of intestine

6.Colonoscopy is also done to confirm extent of colon involvement.
A biopsy of inflamed lining may be done for microscopic examination.

7.A small camera which can be swallowed and passed out in the stools can take photos of the entire gastrointestinal tract.


What are the complications of Crohn's Disease?
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Bowel complications:

1.Strictures of intestine leading to blockage

2.Fistula especially in the rectal region

3.Fissures in the anal region

4.hemorrhage

Non-bowel complications:

1.Bones: arthritis, sacroiliatis
osteoporosis

2.Eyes: uveitis, iritis

3.mouth ulcers

4.Skin: eczema

5.Nutrition: malabsorption and vitamin deficiency

What is the treatment of Ulcerative Colitis?
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Treatment is symptomatic to relieve discomfort, correct nutritional deficiencies, and control inflammation of the gastrointestinal tract.

Medications:

1.Anti-diarheal and bulk forming agents

2.Anti-spasmotic medication for spasm of the colon

3.Anti-inflammation drugs like Sulfasalazine (immunosuppressant) given indefintely.
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.

4.Oral corticosteroids in high doses at first, followed by reduction of dosage.
These are for short term use only because of the side effects.

5.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system

6.Infliximab (Remicade). This drug helps by blocking the body's inflammation response

7.Antibiotics like ampicillin, septrim, flagyl, cephalosporin, tetracycline helps to treat bacterial infections in strictures, fistulas.

8.Correction of anemia and nutritional deficiencies is important to enhance the immune system

9.Replacement of fluids and electrolytes are important in cases of dehydration especially in children.

10.Regular hemoglobin, blood counts and liver function tests

Surgery:

Surgery is required:

1.if medications cannot control the symptoms or progression of the disease
2.to treat complications such as blockage, perforation, abscess, or bleeding in the intestine.

Resection of the inflammed segment of the intestine is removed and may relieve symptoms but is not a cure.
There has been instances where recurrence occur in the the segment next to the resected intestine.

In more severe cases a total colectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done.

Emergency surgery may be done for perforation, peritonitis, or continued bleeding.


What is the prognosis of Crohn's Disease?
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The prognosis depends on the severity of the disease

Three quarters of patients with Crohn's Disease will require surgery sooner or later.

There will be temporary relief of symptoms but recurrences are common.

In many cases with proper treatment, patients are able to lead a normal life.

What are preventive measures in Crohn's Disease?
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A nutritious diet with vitamin supplements can strengthen the body resistance against illness.

Certain foods such as spicy food, milk products and alcohol which may spark off an attack of abdominal discomfort and diarrhea should be avoided.

Stress can also trigger off episodes of Crohn's disease.

A healthy lifestyle with meditation and mild exercise can always help to prevent triggering off an attack of Crohn's Disease.