Thyroid

The hormones secreted by the endocrine glands regulate many physiological and biochemical processes in the body. Over activity or under activity of the endocrine glands may lead to the development of several disorders. Thyroxin is such an important hormone, which has an effect on all most all organs of the body and is secreted by thyroid glands. This thyroid gland is a butterfly shaped gland, situated in front of the neck. When thyroid gland produces in excess or less quantity of thyroxin, it effects in the normal functions of the body. When thyroxin is produced in excess it causes hyperthyroidism and when it is less result in hypothyroidism.

HYPERTHYROIDISM

Hyperthyroidism is a disturbance of thyroid gland in which there is an excessive secretion of thyroxin with a consequent increase in the metabolic rate. Exophthalmic goitre or toxic goitre or thyrotoxicosis, graves disease and basedow's disease are all different manifestations of hyperthyroidism.

SYMPTOMS

1. Weight loss.
2. Palpitation, decreased effort tolerance, easy fatigability.
3. Restlessness, irritability, emotional disturbance, hyperactivity, lack of sleep.
4. Tremor.
5. Intolerance to heat, excessive sweating.
6. Muscular weakness.
7. Lack of menstruation or menstrual disturbance.
8. Puffiness around eye, protrusion of eye, double vision.
9. Swelling over the neck.
10. Diarrhea.
11. Fine skin
12. Increased body temperature.

TREATMENT

Hyperthyroidism is treated with radioactive iodine, anti thyroid drugs or surgery. A liberal diet providing adequate amount of calories, proteins, vitamins and minerals is indicated because patients have severe malnutrition since the basal metabolic rate is increased thus the calorie requirement are also increased. 4000 - 5000kcal will be allowed. Protein requirement is also increased to 50% more than the actual requirement, which is about 120 - 130 gm per day. This should come mainly from good quality protein milk and its products and cereal and pulse combination.

A diet rich in vitamin A, B complex and C should be increased to twice the daily requirements. Pulse and wheat sprout combination will enhance the B complex and C vitamins. Carotene rich foods like papaya, mango and fenugreek leaves will ensure the vitamin A supplement. Carotene will be converted to vitamin A in the body. Calcium and phosphorous excretion is greatly increased in the urine. So liberal calcium and phosphorus rich food like milk and milk products, dark green leafy vegetables, ragi, must be part of the diet every day. Ragi and milk preparation is an excellent source of calcium and phosphorus.

People with hyperthyroidism may benefit from eating foods such as raw cruciferous vegetables that contain a natural thyroid suppressor. Cabbage, radishes, peaches, rutabagas, mustard greens, turnips, horseradish, soybeans, spinach, peanuts, millet, and pine nuts are part of the food group that contains a suppressor substance. However people with hypothyroidism should not eat this food in excess.

A person suffering from hyperthyroidism, by limiting smoking, alcohol, caffeine found in tea, coffee, cola and chocolate may feel reduced symptoms as they all can raise the metabolic rate.

DIET IN HYPERTHYROIDISM

On waking up	1 glass orange juice with sugar
Breakfast	1 cup milk + cornflakes + 2 slices bread with butter and cheese cubes
Mid morning	1 glass chikoo milk shake and 2 cookies
Lunch	1 ½ cup Rice + 3 roti + 1 ½ cup dal + 1 cup aloo gobi + 1 cup curd + good helping of salad
Evening (4:00 pm)	1 cup tea / coffee (with sugar) + almond handful
Dinner	1 bowl green peas soup + roti 4no + sprouts 1 ½ + palak paneer 1 cup + sheera 1 helping + salad 1 helping
Bed time	1cup milk

HYPOTHYROIDISM

Hypothyroidism is the opposite of the hyperthyroidism. This condition is due to the decreased secretion of the thyroid hormone. This condition is known as myxoedema when there is generalized swelling and as cretinism when the deficiency exist since newborn period.

SYMPTOMS
1. Slow body function both physical and mental
2. Easy fatigability, lethargy, ache, muscle cramp and pain.
3. Facial puffiness, generalised oedema.
4. Weight gain.
5. Intolerance to cold.
6. Skin dry and thick, loss of hair, brittle nail.
7. Slow gruff speech.
8. Constipation.
9. Excessive sleep, forgetfulness, hearing loss, emotional instability, depression.
10. Anaemia.
11. Menstrual disturbance, infertility.
In cretinism - mental retardation and short stature are the characteristic features apart from above-mentioned symptoms

TREATMENT

Oral replacement of thyroxin is the main stay of management. Replacement therapy should be taken regularly and most of the time has to continue for life long. Diet comprising of low calorie, adequate protein, fat, minerals and vitamins should be given. In hypothyroidism the basal metabolic rate is low so the calories should be reduced to 30 - 40% of the normal requirements. The protein should be adequate to meet normal requirement. Fat should consist mainly from vegetable oil, which are rich in essential fatty acids. It should not exceed more than 30gm per day.
Vitamins and minerals should be just adequate to meet the daily needs.

Vitamin C plays a key role in boosting immune system - and thyroid gland - function. It's important in the treatment of both hyperthyroidism and hypothyroidism. Vitamin E works with zinc and vitamin A to produce thyroid hormone so it should be included in adequate quantity.

Iodine is imporant because it is a major component of thyroid hormone. Other B - complex vitamins like niacin, riboflavin, B6 is essential for normal manufacture of thyroid hormone.

But the sodium chloride as common salt should be kept at the minimum and avoid salted confectioneries, chips and pickles. In cases of endemic goiter iodine supplementation is required.

Thyroxin is an important hormone, which has an effect on most of the organs of the body, secreted by thyroid glands. When thyroid gland produces in excess or less quantity of thyroxin, it effects in the normal functions of the body. When thyroxin is produced in excess it causes hyperthyroidism and when it is less result in hypothyroidism. Diet in thyroid disorder has only a supplementary role and it cannot substitute medication.

DIET IN HYPOTHYROIDISM

Early Morning	1-cup tea with ½ tsp sugar
Breakfast	1 cup skim milk + 1 tomato open sandwich
Mid morning	Buttermilk 1 glass
Lunch	Rice 1 cup + moong dal 1 cup + Bottle gourd sabji 1 cup + curd 1 cup + salad a good helping
Mid Evening	1 cup tea with ½ tsp sugar + Pineapple 1 bowl
Dinner	Lentil soup 1 bowl + salad good helping + Oats upma with vegetables 1½ cup + Sprouts 1 cup