Hyperthyroidism Awareness

It is important to remember that hyperthyroidism can occur at any age. While most may present with a rather typical constellation of symptoms, many may present with exacerbation of pre-existing conditions which may make the diagnosis initially elusive. Worsening anxiety, insomnia, fatigue, panic attacks, palpitations, hypertension or diarrhea may not initially signal that the thyroid is involved. Clinicians must have a low threshold to check thyroid function early to rule out a component of hyperthyroidism.

Once a suppressed thyrotropin (TSH) has been detected, further investigation with serum triiodothyronine (T3) and free thyroxine (free T4) can help delineate overt from subclinical disease. A thorough history of past thyroid disease, as well as current medications and supplements, can help detect any pre-existing diagnoses or exogenous sources of thyroid hormone or over supplementation with iodine. More commonly, hyperthyroidism is due to either Graves diseasetoxic multinodular goiter or toxic adenoma. Distinction between these can usually be made with the assistance of a thyroid uptake scan, TSH receptor antibody measurement, and thyroid ultrasound. An additional physical exam finding of exophthalmos can further support the diagnosis of Graves’ disease. Understanding the etiology can help guide patient expectations. A small percentage of patients with Graves’ Disease may undergo spontaneous remission after 1 to 2 years, which may prompt patients to wait before considering a definitive treatment option.

With confirmation of the diagnosis of hyperthyroidism, focus is on hormonal control with an antithyroid medication (ATM, most commonly Methimazole in the United States). This may be augmented with beta-blockade, steroids, cholestyramine or SSKI for those who are difficult to control.

Many patients may need further consideration for definitive management with either radioactive iodine ablation (RAI) or thyroidectomy. Your local resources may also influence these options, but it is critical to understand that all three treatments (ATM, RAI and thyroidectomy) are possible options. Certain patient factors and priorities may alter the preferred definitive treatment. Smaller gland size, easy to control hormones, and lack of eye symptoms are factors that may favor continued ATM management. A large goiter with compressive symptoms, difficult to control hormones requiring high dose medications/ multiple modalities, pregnancy, severe eye disease, multiple nodules within the thyroid with or without thyroid cancer, or desire for rapid and reliable hormone control may favor thyroidectomy. RAI is a good option for patients with a smaller gland size, and a desire to pursue definitive management but avoid surgery.

There are also relative contraindications for treatment options. ATMs may have serious side effects, like agranulocytosis or liver failure, which prevent further use, or may cause skin eruptions making long term use intolerable. Additionally, high dose requirements or fluctuating doses may make long term use of ATMs not reliable. Women who are pregnant, wanting to become pregnant in the next 6 months to 1 year, breast feeding or have small children in the home will want to avoid RAI. Patients with severe eye involvement, have a large goiter with compressive symptoms, or are smokers should also avoid RAI. Thyroidectomy will be a poor option for patients with multiple previous neck operations on or around the thyroid due to internal scarring, or who are high risk for general anesthesia. Additionally, if they have a history of previous gastric bypass surgery, they are higher risk for major complications from hypocalcemia/hypoparathyroidism after thyroidectomy.

To help the patient navigate these decisions, it is important to allow them the opportunity to discuss each treatment option with respective physician experts – medical management with endocrinology, RAI with endocrinology and potentially nuclear medicine as well, and thyroidectomy with the thyroid surgeon.

In summary, patients with hyperthyroidism require medical control, as well as a clear understanding of the etiology of their hyperthyroidism. Patients with Graves disease, toxic multinodular goiter and toxic adenoma have more than one treatment option, and it is important for patients to be educated and engaged in treatment decisions.

For Further Reference:
American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and other causes of Thyrotoxicosis| by the American Thyroid Association

What Kind of Introvert Are You?

Are you an introvert? It depends on which book you read. Here’s a sampling of the various conceptualizations of introversion in pop culture [1]: Preference for quiet, minimally stimulating environments: Quiet by Susan Cain Preference for concentration and solitude: The Introvert’s Way by Sophia Dembling Rechargeable battery: The Introvert Advantage by Marti Olsen Laney Thoughtful-introspective

Are you an introvert? It depends on which book you read.

Here’s a sampling of the various conceptualizations of introversion in pop culture [1]:

Historically, there has been just as much confusion in the psychological literature. Carl Jung originally defined introversion as a focus on one’s “inwardly directed psychic energy”. However, in the 30s, the psychologist J.P. Guilford showed that various attempts to measure Jung’s conceptualization of introversion resulted in multiple, distinct factors. In other words, there didn’t appear to be a single dimension of personality that captured all of introversion.

In the 60s Patricia Carrigan echoed this point, arguing that introversion was not effectively captured by a single scale. She cautioned that if the phrase introversion is to continue to be used, “care must be taken to specify its conceptual and operational referent. What appear to be minor distinctions between the various conceptions may in fact be crucial ones.” In the 70s, the heated debate continued, with a much older Guilford arguing with H.J. Eysenck over whether introversion can possibly, or even should, be captured by a single scale.

All seemed to be settled in the 90s with the emergence of the “Big Five” framework of personality. The five main factors of personality– extraversion, neuroticism, agreeableness, conscientiousness, and intellect/imagination– were empirically derived based on what patterns of behavior tend to go together within individuals. Under this framework, introversion is merely defined as the opposite of extraversion.

In the Big Five framework, extraversion comprises two main aspectsenthusiasm (reflecting sociability, positive emotions, and warmth) and assertiveness (reflecting the tendency to take charge, become a leader, and captivate attention). The common factor seems to be high sensitivity to rewards in the environment— which due to the highly social nature of humans throughout the course of human evolution, most prominently consists of rewards associated with social attention.

Therefore, under the dominant personality framework in modern psychology, if you score low in enthusiasm and assertiveness, you’re an introvert

Here’s the problem: the Big Five framework forces a definition of introversion onto people, many of whom do not conceptualize introversion in the same way. For instance, one study did a comparison of common-sense/everyday notions of introversion and ‘scientific’ conceptions of introversion. They found that the most prototypical characteristic of introversion, as identified by the general public, was the following item:

Clearly, many people equate introversion with introspection. In the Big Five framework, however, this item is classified as part of the intellect/imagination domain of personality, not the introversion domain. So there’s a serious mismatch between folk definitions of introversion and scientific definitions. People who view themselves as introverted because they are highly introspective are being told by scientists: “You aren’t really introverted based on patterns of covariation among the general population.” To which everyday people rightfully respond: “WTF?” [3]

As noted personality psychologist Jonathan Cheek told me, “by invalidating the ordinary language meaning of introversion by defining it solely as the opposite of Big Five Extraversion, the Big Five researchers are guilty of Psychological Imperialism [4].” Influenced by the seminal work of Jung, Guilford, and Carrigan, Cheek and his colleagues have decided to take a different approach, by focusing on the phenomenon of introversion on its own, free from having to be force-fit into one scheme or another.

As Carl Jung said, each individual is ultimately a unique crystal, but type theories can be helpful for navigating social life. Embracing this Jungian philosophy, Cheek and his colleagues argue that when people use the term “introversion”, they should never just use it by itself. Instead, they argue that researchers should put a specific modifier in front of the term. What modifiers could be used?

In her masters thesis (written under the advisement of Cheek), Jennifer Odessa Grimes defined four meanings of introversion: social, thinking, anxious, and restrained (which happens to form the positive acronym STAR). It’s possible to score high or low on either of these flavors of introversion. For instance, you could be low in social introversion by preference but not be particularly anxious in the presence of people. Or you could suffer from crippling social anxiety, but still have the desire to be highly social. Or any other combination of these four meanings of introversion.

By this point you’re probably wondering what kind of introvert you are. Well, you’re in luck. There’s a new test for that.

The Case for a New Avenger

S.H.I.E.L.D. might have missed assembling team members from India, but it is never too late to correct an oversight. Imagine our larger-than-life superhero, Rajinikanth, partnering with other Avengers in a combined mission to save the planet from dangerous predators with bad intentions. Some aliens, some familiar ones! Yes, India is far from America, and the distance seems to have increased during the pandemic, but Rajinikanth could give some worthy company to Iron Man and perhaps teach him a trick or two, too, through holographic interfaces and augmented reality. Who knows, he could also kill all the mutants of Coronaviruses in this quest!

I wish to present some facts now to give you a background of my strategic human resource and leadership plan for S.H.I.E.L.D. India has one of the largest numbers of gig workers in the world. As per a March 2021 report by consulting firm Boston Consulting Group (BCG) and Michael & Susan Dell Foundation, the gig economy in India is expected to soar to 90 million in approximately a decade from now. Choose any vocation here and you will be spoilt for choices. Almost everyone is an expert on politics, economics, socio-cultural issues, fashion, sports, career, marriage, children, nature, animals, traffic, the dos, and don’ts … the list is endless. People can even advice others on how they should lead their lives. It’s affection, silly!

War for talent? Clearly, recruiters have not been able to explore the depth of this vast pool. To reiterate, India is a land bubbling with high potentials. Now let us go back to the topic of superpowers. There is plan B too. Rajinikanth could have a serious competition in a plain-looking community here. S.H.I.E.L.D. could consider appointing some members from this fraternity too.

You are rolling your eyes? Why? Hear me out. Presenting to you the case of beholders of the mighty pen (over a sword or a gun), and the upholders of fine speech. Their words hit no less than the missiles unleashed by Israel over the Gaza strip. Let me walk you through the innate gifts of a less publicized community with an immensely amoeba-like (plasma membrane) flexibility.

The teachers.

The extremely sturdy ones can stand the whole day, operate (teach) without a table and a chair, or, the basic infrastructure, and sometimes work even at low or no salaries for months. The strengths, struggles and coping mechanism of the privileged ones out of this lot are embedded in different realms. More on that, later! You will be astonished to learn how many hats teachers can don at the same time. They juggle between being a mentor, coach, counsellor, Devil’s advocate, friend, philosopher, or guide. Interestingly, even their DNA personifies versatility. Over the years, the mutations in their genetic material have helped them learn how to make milestones of the stones thrown at them by students unhappy with their marks, and parents unhappy with the teachers for giving those marks! Talk about heightened senses, their eyes can easily observe and sense the intention behind each greeting, smile and calls to the office. They are like Sharma ji ka beta/beti’, always expected to excel at everything and set an ideal example for the others to emulate.

Here, I would take a detour and ask you to recall the violinists who continued to play music for as long as they were alive, just to calm the passengers on the sinking Titanic ship. On similar lines, teachers continued to teach while the pandemic unleashed havoc around the world. The unlearning of years of classroom teaching was replaced by the immediate need to adopt new technological tools and re-learn the art of virtual teaching. The new and changed landscape was no less than the one post Thanos snapping his finger.

Aren’t convinced yet? Go to the polling booths and follow the polio immunization drives, you will know what I mean.

Now the final hook. Except for some teachers working with elite institutions, the rest won’t even charge much for their services. You can simply smile, appreciate their work, show some respect, and boy, see how they melt! Just watch how it lights up their faces. They are so motivated, especially on September 5 every year in India, that even Abraham Maslow bows to them from time to time from his grave. Had told you about their genetic sequencing earlier, remember? I do hope I have presented their (our) case well, S.H.I.E.L.D. Hopefully, you will have a relook at your current team now.

On a sidenote, can I be a contender too? Just saying. I can take it up as a gig assignment during the semester breaks. Imagine the newest Avenger on the block and that too a female from India! It will further boost the diversity and inclusion factors for you. If you can give equitable salary and perks, you could even find yourself on the pages of Harvard cases.

You might want to provide supplements of Vitamin T(eacher) to your team if Rajinikanth’s diary of appointments is full. Professor Hulk would not mind some more erudite company. In return, I vow to start quoting your example in my classes as a great employer brand with an excellent employee value proposition. Who knows, I might even write a research article. Told you, pen and words are the weapons here. Think about it. What say? Are you game?

P.S. I have recently bought a telescope to keep an eye on the stars and planets too. Taking my possible future role tad too seriously, eh?

The irrational things about trust

The obvious and rational equation is that being trustworthy plus being transparent will lead you to be trusted. Verification of trustworthiness should lead to trust.

This makes sense. Being trustworthy (acting in a way that’s worthy of trust) plus being transparent so that people can see your trustworthiness—this should be sufficient.

How then, do we explain that brands like Coke and Google are trusted? The recipe is secret, the algorithm is secret, and competitors like DuckDuckGo certainly act in a more trustworthy way.

In fact, trust often comes from something very different. It’s mostly about symbols, expectations and mystery.

Consider the relationship you might enter into if you need surgery. You trust this woman to cut you open, you’re putting your life in her hands… without the transparency of seeing all of her surgical statistics, interviewing all previous patients, evaluating her board scores.

Instead, we leap into surgery on the basis of the recommendation from one doctor, on how the office feels, on a few minutes of bedside manner. We walk away from surgery because of a surly receptionist, or a cold demeanor. 

The same is true for just about all the food we eat. Not only don’t we visit the slaughterhouse or the restaurant kitchen, we make an effort to avoid imagining that they even exist.

In most commercial and organizational engagements, trust is something we want and something we seek out, but we use the most basic semiotics and personal interactions to choose where to place our trust. And once the trust is broken, there’s almost no amount of transparency that will help us change our mind.

This is trust from ten thousand years ago, a hangover from a far less complex age when statistical data hadn’t been conceived of, when unearthing history was unheard of. But that’s now hard-wired into how we judge and are judged.

Quick test: Consider how much you trust Trump, or Clinton, Cruz or Sanders, Scalia or RBG. Is that trust based on transparency? On a rational analysis of public statements and private acts? Or is it more hunch-filled than that? What are the signals and tropes you rely on? Tone of voice? Posture? Appearance? Would more transparency change your mind about someone you trust? What about someone you don’t? (Here’s a fascinating story on that topic, reconstructed and revealed).

It turns out that we grab trust when we need it, and that rebuilding trust after it’s been torn is really quite difficult. Because our expectations (which weren’t based on actual data) were shown to be false.

Real trust (even in our modern culture) doesn’t always come from divulging, from providing more transparency, but from the actions that people take (or that we think they take) before our eyes. It comes from people who show up before they have to, who help us when they think no one is watching. It comes from people and organizations that play a role that we need them to play.

How to Make Money Blogging

. Online Courses and Workshops

Here at Smart Blogger, we make most of our income from online courses and workshops — over $1 million per year — but we are far from the only successful blog doing this. Most of the people making a lot of money from their blogs are doing it online

Books and Ebooks

Quite a few writers have parlayed their blogging success into a major publishing deal. Mark Manson, for instance, published a in 2015. Millions of readers later, he got a book deal with Harper Collins and went on to sell over 3,000,000 copies in the US alone.

Affiliate Marketing

If you’d like to create some passive income streams from your blog, one of the best choices is affiliate marketing — recommending the services, digital products, and physical products of other companies in exchange for a commission.

Advertising

Normally, we’re not big fans of selling ads on your site. You need roughly a million visitors per year for the large ad networks to take you seriously, and affiliate marketing is almost always more profitable and just as passive.

That being said, some niches like recipes, fashion, and news are hard to monetize through many of the other methods mentioned here, and they get LOTS of page views. In that case, putting a few ads on your site can make sense as a supplementary income source.

Speaking

There are many reasons to start a blog for personal use and only a handful of strong ones for business blogging. Blogging for business, projects, or anything else that might bring you money has a very straightforward purpose – to rank your website higher in Google SERPs, a.k.a. increase your visibility.

As a business, you rely on consumers to keep buying your products and services. As a new business, you rely on blogging to help you get to potential consumers and grab their attention. Without blogging, your website would remain invisible, whereas running a blog makes you searchable and competitive.

There are many reasons to start a blog for personal use and only a handful of strong ones for business blogging. Blogging for business, projects, or anything else that might bring you money has a very straightforward purpose – to rank your website higher in Google SERPs, a.k.a. increase your visibility.

As a business, you rely on consumers to keep buying your products and services. As a new business, you rely on blogging to help you get to potential consumers and grab their attention. Without blogging, your website would remain invisible, whereas running a blog makes you searchable and competitive.

Blogs and websites

Many people still wonder if there is any difference between a blog and a website. What is a blog and what is a website? It’s even more challenging to differentiate between the two today. Many companies are integrating blogs into their websites as well, which further confuses the two.

Depression

The hope to open anxiety & depression is a collection of heartfelt honestly by a people

In past few year articles anxiety depression and a host of other mental health condition have taken the internet by storm things that’s decades age many people were afraid to talk about they fear doing so might make them appear weak or flawed or troubled but not a wave of openess and honestly has led to more and more people to talk about there mental health and the issues they might be facing

You might be woundering but what exactly is mental health you have heard of things like anxiety and depression and you are some what familiar with negative effects stress can have on the body but you don’t know about the nuances of these things and why caring for our mental health such a crucial part of living happy healthy and well rounded life.

A Poem in Appreciation of Solitude.

Did you know solitude is different from loneliness? Though many think the words mean the same, it is not the case. Loneliness refers to a state of feeling lonely. It is possible to feel lonely even when you are with people. But solitude refers to being alone. It means being by yourself and spending time with yourself. Many philosophers have appreciated solitude. In fact, the Chinese philosopher, Lao Tzu, once said, ‘Ordinary men hate solitude. But the Master makes use of it, embracing his aloneness, realising he is one with the whole universe.’ 

The English poet, Alexander Pope, sings in praise of solitude in his poem ‘Ode on Solitude’, just as the title says. Though a man lives secluded, he can be happy if he has a small land to take care of. He wouldn’t have big ambitions and would feel content just by breathing the fresh air of his native. He surrenders to nature and enjoys being by himself. He does so because he feels tranquility.

Happy the man, whose wish and care

   A few paternal acres bound,

Content to breathe his native air,

                         In his own ground.

He feels happy even when he is all by himself because he has enough of everything for him. His cattle provide him milk, his fields food, his congregation clothes, and his trees give him shade during summer and firewood during winter. He doesn’t need to worry about making ends and spends time for himself. 

Blessed is he who doesn’t need to worry about running out of time. He enjoys the drifting time and passing days because he can take care of himself. He is healthy and peaceful, so he is calm doing his routine in daytime and sleeps well at night.

Blest, who can unconcernedly find

   Hours, days, and years slide soft away,

In health of body, peace of mind,

                         Quiet by day,

When he has enough time for himself, he learns many things and does everything with ease. When this happens, he reflects on his deeds, his memories, and on himself. He recalls his past and re-lives those happy moments. He understands about himself and can reveal his true self without fearing to be judged. 

Sound sleep by night; study and ease,

   Together mixed; sweet recreation;

And innocence, which most does please,

                         With meditation.

The last stanza ends with the poet asking to be granted such a life where he can live   unnoticed by people and unknown to them. He doesn’t want people to mourn his death for he wants to leave this earth without regrets. When he dies, he doesn’t want to take anything from the world, not even a stone which marks his grave and let people know where he lays dead.

Thus let me live, unseen, unknown;

   Thus unlamented let me die;

Steal from the world, and not a stone

                         Tell where I lie.

This poem shows us how self satisfying solitude can be. We keep running and running without ever knowing what we are after. So, by being alone and spending time with ourselves, we can know what we need and what we want to do. Thus, when you enjoy loneliness, it becomes solitude.