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How is your thyroid?

For some people it might be a little difficult to answer this question without looking it up on the internet, because not everyone even knows that they have this little gland, in the shape of a butterfly, just below the pharynx.   This lack of awareness of the thyroid happens precisely because it works silently, producing tri-iodothyronine hormones (T3) and thyroxin (T4), whose function is to regulate the metabolism, or rather, the way in which the body stores and uses energy, and this ensures balance in all the systems of the body.     This harmony, however, can be interrupted by the gland malfunctioning, either because it starts to produce fewer hormones, a situation known as hypothyroidism, or because it starts to work too much and makes more hormones than are needed, which is the case in hyperthyroidism.   In both cases, when extreme, the organism feels it in several ways. After all, the thyroid hormones act on vital organs and take part in various organic processes, such as fertility, menstrual cycles, growth – in the case of children and adolescents -, concentration, mood swings and memory, among, other things.     Low hormones in hypothyroidism  According to the Brazilian Society for Endocrinology and Metabolism, hypothyroidism is  the most common malfunction of the thyroid and mostly affects women over sixty-nine, especially those with a family history of the condition.   One of the main causes is Hashimoto disease, which is an autoimmune problem in which the organism produces autoantibodies that attack the gland, cause inflammation and sometimes increase the size and reduce its activity.   The problem can also be caused by prior treatment of any organ using radioactive iodine, which destroys the thyroid cells, and by a local operation – removal of a nodule, for example.   In this situation of not enough thyroid hormones, everything in the organism becomes slower, as if the fuel were running out.   Thus, symptoms can include - besides characteristic slowness - over tiredness, feeling cold, constipation, irregular menstruation, depression, insomnia, reduced memory, slower heartbeat and muscular and join ache, among other things.   What is more, there is usually slight weight gain, as well as increased levels of cholesterol in the blood. Hypothyroidism is treated by T4 replacement, which is done by taking the synthetic hormone, levothyroxine, daily at an appropriate dose for each person, and this varies a great deal from individual to individual.  Specialists warn that lack of treatment lowers physical and mental performance and increases the likelihood of heart disease.   In pregnant women, there should be double the attention given, as the mother’s problem may harm the development of the fetus. Therefore, proper functioning of the thyroid needs to be ensured during pregnancy.  It is worth remembering that at birth babies are also tested for congenital hypothyroidism by way of the heel prick test, which ensures early diagnosis and treatment of the condition, and this is an essential measure because thyroid hormone deficiency compromises the neurological development of the child.     Too many hormones in hyperthyroidism At the other end of the scale, hyperthyroidism produces too much hormone by an overactive thyroid and, therefore, is the opposite of hypothyroidism.   The heart beats too fast and irregularly, the intestine over functions, the person seems to be running on two charged batteries, talking and gesticulating a lot.   They will also complain of the heat, of increased sweating, of shaky hands, of eye irritation, irritability, anxiety , fatigue and weight loss. Infertility can also be caused by this condition.   However, people with slight increases in thyroid hormones, like the elderly, may not have any symptoms at all. The main cause of hyperthyroidism is also an autoimmune problem –Graves’ disease -, which is a chronic illness whereby autoantibodies attack the gland and cause it to increase in size and this leads to above-normal hormone production.   Less often, inflammation and nodules may give rise to the condition.   The treatment of this malfunction depends on the cause, on the patient’s state of health and age and, of course, on the degree of the symptoms.   The endocrinologist chooses the therapeutic strategy carefully, in a way that is tailor-made for the patient, among which there are antithyroid medicines that reduce the amount of hormones, betablocker drugs that control the palpitations and some more serious measures, like surgical removal of the thyroid or by applying radioactive iodine, both of which cause consequent hypothyroidism and a later need for daily replacement of T4 by taking levothyroxine.   Thyroid malfunctions are democratic.   They appear in any age bracket, in both sexes, without being able to count on primary preventive measures, as happens with cardiovascular diseases.   The fact is that, as symptoms of these disturbances are unspecific, regular visits to the doctor and having examinations done that measure thyroid activity (link to Getting to know how the thyroid functions) are recommended, and then it will be possible to make an early diagnosis before the condition detected can bring about more discomfort or a more serious health problem.      To get to know how the thyroid functions  The work of the thyroid is controlled by the hypophysis, a gland that is also part of the endocrine system and produces the hormone that stimulates the thyroid (TSH), which, as the name suggests, induces it to produce T4 and T3.  So, diagnoses of hyperthyroidism and of hypothyroidism only depend on the laboratory dosage of these hormones in the blood.  In clinical practice, however, it is enough to know the levels of TSH and T4 to reach a verdict.   A result of high TSH with low T4 means hypothyroidism – the thyroid is found to be stimulated, but, as it is ill, cannot produce the right amount of hormone.   Whereas, a result of low TSH with high T4 means hyperthyroidism – the gland is not stimulated but, even so, there is too much hormone on account of the pathological process.   In the same way, these examinations serve to accompany the treatment and to adjust the dose of levothyroxine accordingly. Of course, to look for the causes of each situation, some other tests are needed, including even some image ones, but the dose of TSH and T4 are the basis for detecting thyroid malfunction.     

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Newborn heel prick test

More than just a diagnosis, it is an opportunity to live a full life Besides the Apgar test, whereby the new-born baby is evaluated regarding certain factors like heart rate, respiration, muscle tone, reflexes and skin color a few hours after being born, the baby goes through some other evaluations, some of which are compulsory and others that are recommended.  Among the compulsory ones is neonatal triage, better known as the heel prick test. The examination involves collecting, on filter paper, a few drops of blood from the baby’s heel when it is 3 to 5 days old, which is enough time for the little one’s organism to be working on its own. The aim of this is to search for important congenital diseases that harm the physical and mental health of the baby well before any symptoms can be seen, which enables doctors to intervene in plenty of time.    In the public health system, the test has been available free since 1992 and investigates six diseases that are most prevalent in new born babies: Congenital hypothyroidism, cystic fibrosis, sickle cell anaemia and other hemoglobinopathies, phenylketonuria, congenital adrenal hyperplasia and biotinidase deficiency.  The sample is sent to a reputable service for this type of analysis.   In Sao Paulo, it is sent to the Association of Parents and Friends of the Disabled (Apae), which is the entity that implemented the method in Brazil in 1976. If there are any alterations in the triage, the family is called in so that a specific examination for the suspected condition can be done on the baby, the purpose of which is to confirm it or not. Once the diagnosis has been made, the pediatrician is able to set up the correct conduct quickly, which, for the babies, can make the difference between normal development and some degree of physical or mental retardation.   In the case of phenylketonuria, for example, the remedy is to adopt a diet that is low in phenylalanine, which is an amino acid found in protein foods.    Children who are born with this disease accumulate this substance and, if the correct diet is not set up before they are three months old, they end up presenting some global retardation in neuro-psycho-motor development, intellectual deficiency, hyperactivity or autism, convulsions or skin problems. Although a person who has the condition must spend their life controlling what they eat and resorting to special formulae, having information like this as soon as one is born is inestimably beneficial and it totally justifies carrying out this screening on all newborns.    Wider triage: what is the difference?  It is as a result of this reasoning that the private sector has been offering, for a few decades, wider versions of the test, which screen for from 10 to 53 serious conditions that are quite common at birth, including metabolic, congenital and infectious conditions.  Recently the triages have begun to include screening for some innate defects in immunity, called primary immunodeficiencies, which generally present an extremely bad prognosis when identified too late. Even though these illnesses are – fortunately – not very frequent, early diagnosis and treatment of any one of them may change the destiny of the child, giving him or her the chance to live a healthy life with almost no limitations.    If you are planning to increase your family or are already about to have an heir, do not fail to talk to your doctor about the available options for neonatal triage.     Which diseases are screened for by the heel prick test? Sickle cell anaemia and other hemoglobinopathies:  Abnormal alterations of hemoglobin, a protein that transports oxygen in the blood, which make circulation and the subsequent oxygenation of the cells difficult. This can cause retarded growth and generalized infections.   It requires frequent accompaniment from a multidisciplinary team to adopt therapeutic measures that depend on each individual need, such as transfusions.      Biotinidase deficiency: a metabolic disease characterized by a biotinidase enzyme defect that is responsible for absorbing biotin from foods, which is a vitamin found in various foods in a normal diet.   When not corrected, it causes neurological disturbances and skin problems. However, the treatment is simple and is based on taking biotin daily.    Phenylketonuria: derives from a defect in producing the phenylalanine hydroxylase enzyme, and this causes the sufferer to accumulate phenylalanine amino acid.    Early diagnosis enables there to be early conduct, in a way that, as soon as the baby stops breastfeeding, it is fed formula containing low content of phenylalanine, and so does not run the risk of being neurologically compromised.     Cystic fibrosis:  a genetic illness that affects how the glands producing mucous, sweat and pancreatic enzymes function, which makes these secretions thicker, and there are important repercussions for the lungs, pancreas and digestive system. The treatment consists of taking medicines, especially those for reducing lung complications and ensuring that nutrients are absorbed.   Congenital hypothyroidism:  occurs when the baby’s thyroid gland does not produce enough thyroid hormones – T3 and T4 – which, if not treated by replacement with the synthetic hormone levothyroxine, results in permanent neurological damage.   Congenital adrenal hyperplasia: an alteration in the adrenal gland that is the result of defective enzymes and causes a lack of the cortisol and aldosterone hormones, which are fundamental for growth and mineral balance in the organism.   The most serious form results in an extreme loss of salt, and thus is an emergency in Pediatrics. The condition is treated with glycol-corticoids to rectify the lack of cortisol and with mineral-corticoids to balance the mineral salts.       

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Pay attention to the health of your eyes

It is estimated that 80% of human contact with the outside world is done through the sense of sight, according to the Brazilian project Olhar Brasil, of the Ministry of Education and the Ministry of Health. Despite that, we often only realize the importance of this sense when something hurts it. And this is not a rare case. According to data from the Brazilian Council of Ophthalmology and the International Agency for the Prevention of Blindness, 253 million people around the world are blind or have great difficulty seeing. Fortunately, according to the World Health Organization (WHO), most of these cases can be prevented by means of preventive treatments or strategies. Prevention of eye diseases requires some day-to-day care, most of which is easily accessible, but depends on regular visits to the ophthalmologist, given that the first signs of illness that result in loss of vision, if left untreated, can only be detected in such consultations. Likewise, this specialist is able to identify refractive errors, such as myopia and astigmatism, and provide the pathway to correct such problems - the prescription of eyeglasses or contact lenses or even surgery. In practice, it is recommended that children be taken annually to the ophthalmologist until the age of 8, especially due to refractive errors that they cannot verbalize and that, most frequently, may be behind a learning disability, for example, or a constant complaint of headache. From 8 to 40 years of age, the gap between consultations may be longer, every two years or according to medical recommendation, provided there are no symptoms or history of eye diseases in the family.  From the age of 40 onwards, however, annual eye tests should be resumed. In this phase, other complaints often arise, such as the difficulty of reading closely, which characterizes presbyopia, usually corrected with reading glasses. Even when there is nothing unusual with the eyes, from that age the ophthalmologist needs to measure the intraocular pressure, to detect and stop the progress of glaucoma, and to evaluate the state of the structures of the fundus of the eye, seeking to diagnose diseases such as cataract, macular degeneration and diabetic retinopathy, which together with glaucoma are among the main causes of blindness in adults and the elderly in Brazil. The fact is that regularity of ocular checkup can prevent and resolve, if not all, the majority of the causes of blindness and low visual acuity. Therefore, do not forget to prioritize this need in your health agenda and never get used to any visual complaints, however mundane they may seem.  Eye CareIf only the ophthalmologist can observe changes in the eyes that we are unable to perceive, in our daily routine there are several measures that we can adopt for the maintenance of our eye health:  - Protect your eyes from sun exposure, which worsens the effects of cataract and can cause irreversible damage to the retina cells. To do so, wear sunglasses with lenses that have a protective factor against ultraviolet rays, even on cloudy days. - Do not make use of eye drops without a prescription, and even when indicated, only apply the medication for the time recommended by the ophthalmologist. Especially those containing corticosteroids can raise intraocular pressure and give rise to secondary glaucoma. - Choose hypoallergenic make-up for the eye area and even so, always remove it before bed so it will not clog the hair follicles, which can cause painful styes. Avoid cosmetic products for cleansing. Neutral baby shampoo and water are enough. - Do not scratch your eyes. This will aggravate irritation and can lead to infectious agents that cause not only eye diseases, such as conjunctivitis, but also problems in the airways – colds and the flu, for example. - Do not try to remove any foreign body from your eyes with tweezers or other sharp instruments, even if it is a simple eyelash. Seek emergency ophthalmologic assistance. - If you work with activities that may release particles or droplets that could compromise the health of your eyes, wear eye protectors. - Avoid diabetes. Follow a healthy diet, do regular physical activity and keep the ideal weight for your height and gender. - Take breaks in the use of computer and mobile devices to rest your eyes from the brightness of the screens. Visual problems symptoms: when to look for an ophthalmologist?In addition to routine appointments, depending on your age group, always seek an ophthalmologist when the following occurs: - Lacrimation during or after visual effort;- Dry eye sensation;- Secretion;- Red eyes;- Crusty eyelashes;- Need to tighten or even open your eyes wide to see;- Need to get a lot closer to see and read;- Need to move an object or text away so that it can be viewed;- Need to tilt the head to see and read;- Blurry vision;- Sensitivity to light;- Headaches;- Double vision;- Ocular deviation.  

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