The HEALTH | JULY , 2018

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NEARLY one in three people have thyroid disease , the majority of which are women . Yet more than half of those with a thyroid condition don ’ t know they have it . Women are five to eight times more likely to have thyroid disease .

The thyroid gland is a butterfly-shaped gland found inside your neck , right under your larynx or voice box . Your thyroid is responsible for producing the master metabolism hormones that control every function in your body . Hypothyroidism occurs when your thyroid produces too little thyroid hormone , a condition that is often linked to iodine deficiency .

Prince Court Medical Centre consultant Endocrinologist Dr Shamin Ramasamy explained that the thyroid ; one of the largest endocrine glands , greatly influences almost every cell in the body .

“ Aside from regulating your metabolism and weight by controlling the fat-burning process , thyroid hormones are also required for the growth and development in children and in nearly every physiological process in the body .”

“ When your thyroid levels are out of balance , so are you . Too much or too little hormone secretion in this gland can spell trouble for your overall health and well-being .”

“ It can be diagnosed with a simple blood test . When you ’ re a patient navigating a thyroid condition , it can feel like you ’ re all alone on the journey . After all , “ you look normal , so shouldn ’ t you feel normal ” is a common misconception many people have about thyroid disease ,” she added .

It can be hurtful statements like these that can keep women from getting the help they need . Which means they struggle with their fatigue , infertility , depression , hair loss and other symptoms for far too long .

Prince Court Medical Centre consultant Endocrinologist Dr Shamin Ramasamy explained that hypothyroidism is most often due to an autoimmune disease known as Hashimoto ’ s .

“ Autoimmune disease is when the body begins attacking itself which results in destruction of tissue . In the case of Hashimoto ’ s , your body destroys your thyroid gland , resulting in an inability to produce sufficient hormones . This is the most common way hypothyroidism occurs .”

Hormones that lead to weight gain

OLYCYSTIC Ovarian

Syndrome ( PCOS ) is one of the most common hormonal disorders in women with reproductive age . It affects approximately six to 20 per cent of women in this age group , which varies by type of criteria used ( see table ).

University of Malaya , Faculty of Medicine Department of Medicine senior lecturer and consultant Endocrinologist Dr Lee Ling Lim explained

Dr Lee Ling Lim .

that PCOS is a combination of androgen ( male hormones particularly testosterone ) excess and ovarian dysfunction in women .

“ The common symptoms include irregular or no menstruation , subfertility , acne and hirsutism ( excessive male-pattern terminal hair growth at the facial , upper arm , chest , below umbilicus and inner thigh areas ),” she said .

Practitioners can grade the severity of hirsutism according to the modified Ferriman-Gallwey score using available charts . A typical feature of insulin resistance is the presence of dark , thickened skin around the neck , groin and in the skinfolds of the armpits .

To date , there are three well-standardised diagnostic criteria for PCOS . Other causes of androgen excess need to be excluded before a PCOS diagnosis is made .

“ The clinical presentation of PCOS is heterogenous . Once a woman is diagnosed , she is classified into either subtype : Classic PCOS : presents with both androgen excess and irregular menstruation , irrespective of the presence of polycystic ovaries ( most severe type ) Ovulatory PCOS : presents with androgen excess and polycystic ovaries Non-hyperandrogenic PCOS : presents with irregular menstruation and polycystic ovaries ( least severe phenotype )

Cause

The exact cause of PCOS is largely unknown . However , accumulating evidence indicates that it is a complex disorder with influences from both genetic and environmental factors . The latter includes diet rich in carbohydrates or saturated fat , sedentary lifestyle , smoking , alcohol consumption and pollution .

Under normal circumstances , androgen is released from the ovaries and adrenal glands in healthy women . PCOS occurs when there is excess release of androgen from these organs , which results in insulin resistance and long-term health consequences .

“ PCOS is associated with a number of metabolic complications

“ Women menstruate , which means we have hormone cycles . And in a perfect world , those cycles make us feel great the entire month with maybe a little more needed rest during our moon .”

“ But in a not so perfect world , hormone imbalances occur driving estrogen dominance . And this makes sense — since stress drives progesterone down and allows for estrogen to move about the body unchallenged . You see , there is this delicate balance among all the hormones and without enough progesterone that estrogen is not blocked from affecting your tissues ,” she added .

Estrogen has the ability to enhance the inflammatory process of the immune system . This means estrogen could contribute to the

attack on the thyroid .

The interaction between our fluctuating hormones and the immune system may be the very thing that puts us at risk .

It is well documented that pregnancy puts stress on the thyroid gland , as the demand for thyroid hormone increases following conception . Hypothyroidism can occur anytime during the pregnancy and should be monitored for that reason .

But one common thyroid secret is that giving birth can be a trigger for autoimmune thyroid disease . In fact , studies have shown that as many as one in 12 women develop postpartum thyroiditis .

The shift in hormones and the immune system both during and after pregnancy put women at risk of developing a thyroid condition .

Australian female Singer Conchita with facial hair . One of the symptoms of PCOS .

such as type 2 diabetes , high blood pressure , high cholesterol and excessive weight gain particularly abdominal fat . These further increase the future risks of stroke , obstructive sleep apnea , heart and kidney diseases . In addition , PCOS is associated with mood disorders particularly depression and anxiety and endometrial cancer .”

Given that these women are of reproductive age , the presence of PCOS also puts them at risk of developing complications during pregnancy such as diabetes in pregnancy [ gestational diabetes ], preterm delivery , high blood pressure in pregnancy which can lead to poor maternal and fetal outcomes .

TREATMENT of PCOS is symptom-oriented and needs to adapt to personal needs . No drugs are currently approved specifically for PCOS .

Birth control pills containing an antiandrogenic or neutral progestins :

Can help to reduce the production and release of androgen from ovaries . They can also increase the sex-hormones binding globulin level , leading to a decrease in free androgen level in the blood . It is the first line management for hirsutism / acne and irregular menstruation of PCOS . Practitioners consider using birth control pills for six months , if fails , anti-androgen is added . Hirsutism : Cosmetic techniques such as plucking , shaving and waxing with topical and / or oral drugs depending on their severity . Drugs are only for women who are not attempting to conceive such as eflornithine , whereby discussion with a practitioner is required . Acne : Cosmetic techniques include laser / light therapy or cosmetic surgery for severe scarring . Drugs are only for women who are not attempting to conceive such as retinoids whereby discussion with a practitioner is required .

Anti-androgen ( such as cyproterone acetate , spironolactone , finasteride ) can treat hirsutism .

To be used if not attempting to conceive . However , appropriate contraception is needed .

Regular screening for complications include blood sugar test , cholesterol test , blood pressure monitoring , BMI and waist measurements , history of depression and anxiety and history of obstructive sleep apnea Insulin resistance : Weight loss : lifestyle modification . Consider anti-obesity drugs and metabolic surgery . Can help with menstruation too . Metformin can be used in women with PCOS and type 2 diabetes / prediabetes who failed lifestyle modification .

Desire to conceive :

• Weight loss

• Discuss about methods of ovulation induction with fertility specialists