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