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

Best Lifestyle Blogs to Follow in 2021

Lifestyle Blog niche is one of the most competitive blogging niches around. Lifestyle bloggers are competing against digital lifestyle magazines, in a niche that is already quite saturated. So lifestyle blogs that gain a large readership are of a high standard in both design and content.

Online mags often have huge budgets, a print edition as well as digital, and content that is varied and expertly written, with professional photos. But lifestyle blogs have an edge in that they can supply new content every day if they so wish. Lifestyle blogs are free to access whereas digital magazine editions can only be accessed through paid subscriptions.

For a lifestyle blog to thrive, the authors need to provide excellent, accurate content and photos that create interest and capture the readers’ imaginations. Lifestyle bloggers have raised their standards to compete with the best of both online mags and other lifestyle blogs.

But what exactly constitutes a lifestyle blog?

Let’s find out!

Defining Lifestyle Blogs

A lifestyle blog is defined as digital content representing the author’s everyday life and interests. The word “lifestyle” according to the dictionary means “habits, attitudes, moral standards, which together constitute the way of life of a given person or group”. (source: dictionary.com)

As a result, lifestyle blogs can fall into many micro-niches. This allows bloggers to provide content for a specific target audience. Lifestyle bloggers often promote products, brands, and services to monetize their blogs. So it’s almost essential that the person behind the blog is well-versed in whatever the specific topics are.

Here’s a shortlist of typical Lifestyle Blogging niches:

  • Luxury Lifestyle Blogs
  • Foodie Lifestyle Blogs
  • Home & Garden Lifestyle Blogs
  • Fashion Blogs & Beauty Lifestyle Blogs
  • Travel Blogs & Photography Lifestyle Blogs
  • Health & Fitness Lifestyle Blogs
  • Men’s Lifestyle Blogs
  • Natural Living Lifestyle Blogs
  • Outdoor Lifestyle Blogs
  • And Lifestyle Blogs for people with children (also called mom blogs or parenting blogs.)

Sometimes even these categories get split into various combinations, depending on the blogger. So you could end up with a Fashion and Travel Blog, A Natural Living Mom Blog, or even a Foodie and Photography Lifestyle blog.

Lifestyle blog vs. personal blog

Lifestyle blogs are not personal blogs because they focus more on users (readers). The content is created here for the reader and his expectations. What’s more, lifestyle blogs focus on the author’s benefits, not just on telling stories.

In personal blogs, the most important are the author’s emotions and thoughts, who expresses his opinions, writes about his experiences, feelings, reflections. In the personal blog, the author himself is the most important, not the reader.

I can’t write about lifestyle blogs without mentioning a few from each niche. I’ve tried to give you a selection of the most captivating from each subgenre (or micro-niche). These Lifestyle blogs check all the boxes. They are fun, relevant, trendy, polished, and loaded with content that appeals to a specific target audience.

A Quick Note To Would-Be Lifestyle Bloggers

Before I launch into “Our Best Of” list, a word of caution to would-be lifestyle bloggers; even if you have many areas of interest yourself, try to whittle your content down to cover only one or two main topics. This helps when you are trying to grow a steady, loyal readership.

Male readers don’t want to read about fishing, fashion, and raising a brood of ankle snappers! A young professional will not be interested in “Ten Tips To Wean Your Child off Breast Milk”, and your Luxury Lifestyle blog will not impress our Tree Hugging friends who will recoil in horror at the decadence of luxury lifestyles! Readers who enjoy luxury will also not be impressed with Frugal Living!

On the other hand, the lifestyle blogging niche allows the most freedom for bloggers who genuinely do have a vast array of topics that pair well together. If you can create the content and maintain the variety, then you will create space for a wider readership.

Top blogs in lifestyle category

This collection of blogs showcases the variety and range of lifestyle blogs that get it right!

1. Goop.com

Goop was one of the first lifestyle blogs to hit the circuit, way back in 2008. The brainchild of actress and mother, Gwyneth Paltrow, Goop covers everything for the modern woman. She focuses on wellness and how to create a balance between parenting and work. Something all working moms know about! She has a strong team behind her and Goop is a mini-empire in its own right.

Goop covers:

  • Beauty
  • Food & Home
  • Style
  • Travel
  • Wellness

Target Audience: Women of all ages and enlightened men.

2. The Pioneer Woman (thepioneerwoman.com)

This is a lifestyle blog that stands out for me. Unlike so many lifestyle blogs, Ree Drummond blogs about a lifestyle that all Americans know and love. Pure salt of the earth, rustic ranch life. The blog packs a punch! Ree has combined recipes, style, beauty, home & life, food & cooking, news, and entertainment. And great giveaways. She started as a lone ranger but now has a team of editors assisting her in keeping the blog relevant, trendy, and homegrown.

Target Audience: People keen on ranch-style living.

*3. Brightbazaarblog.com

Bright Bazaar blog was founded in 2009 by Will Taylor. This is the place where Will blogs about his love for colorful design, travel, and fashion. This blog is recommended by esteemed publishing houses Elle Decor, Martha Stewart Living, and many others.

If you need more home inspiration, look at other famous bloggers in the article: The Best Interior Design Blogs.

Target Audience: People who love design.

4. Cup of Jo (cupofjo.com)

Joanna Goddard is a perfect example of what can be achieved through blogging. Joanna launched Cup of Jo in 2007, as a hobby. At that time her career was quite a high-powered one. She has loads of editorial experience and her resume brags the likes of Cosmo, Bene, Glamour, and New York.

Today Cup of Jo has a team of writers and is Joanna’s full-time gig. She lives in Brooklynn with her husband and two kids. The blog covers relationships, design, food, style, travel, culture, and motherhood. This is a great blog for women.

Target Audience: Women and mothers of all ages

. Say Yes (sayyes.com)

. Say Yes (sayyes.com)

‘Travel by Train’ by J B Priestly.

“I can pass, at all times, for a quiet, neighborly fellow, yet I have sat more than once, in a railway carriage with black murder in my heart.”

This quote is for you if you had ever hoped for your train journey to end fast, if you had met with passengers who roused your inner devils and had your patience tested by them. We are not always gifted with best travel companions and J B Priestly gives an account of different types of fellow travelers we meet during our journey in his essay ‘Travel by  Train.’

The first type of a traveler is the one who often arouses hatred in others.

“She is a large, middle-aged woman, with a rasping voice and a face of brass.”

Carrying heavy packages in all shapes and varying sizes, she pushes her way into smoking compartments. She glares at everyone around her until a poor victim gives their seat to her. She comes along with a ‘whining cur’ which is only less offensive than the lady by one degree. She wedges herself into the seat and the mood of the whole compartment is completely spoiled by her entry. It will be not long before she gets into trouble for there are few who are bold enough to call her out. 

“From the moment has wedged herself in there will be no peace in the carriage, but simmering hatred, and everywhere dark looks and muttered threats.”

The most common among the travelers who annoy us to varying degrees are those as follows. Firstly, the person who comes with a myriad of luggage packing every old chattel and household utensil. They buy baskets of fruits and bunches of flowers adding weight and misery to themselves and others. Then there are those who forever eat and drink during the journey. As soon as they take their seats, they pass sandwiches and pastry to each other. They talk with their mouths full, scattering food crumbs on those around them. 

“Some children do not make good travelling companions, for they will do nothing but whimper and howl through a journey,…”

Some children either weep throughout the journey or keep smearing their faces with chocolate and try to climb out of the window. There are also these ‘cranks’, as the author calls them, who insist on opening the windows on a cold winter day and on closing the windows on a hot summer day.

There are also these ‘innocents’ who always board the wrong train. Halfway through the journey, they ask if the train is going to their destination. When proved contrary, they get off at the next station looking clueless.

“I have often wondered if these simple voyagers ever reach  their destinations, for it is not outside probability that they may be shot from station to station, line to line, until there is nothing mortal of them.”

The author envies the ‘mighty sleepers’ the most who fall asleep the moment they settle in their seats. While other passengers have to spend their journey in a boring way, they go on adventures and quests in their dreams. But no matter how deep asleep they are, they always wake up two minutes before their destination and get off at the right station.

The author remarks that the Seafaring men are the best companions for they have the best stories to tell. But they are hard to come across. As a contrast, we meet the ‘confidential stranger’ who compels us to listen to his ‘interminable story of his life’ and some boring hobbies. Lastly, there is this elderly gentleman who starts the conversation by telling that “the train is at least three minutes behind time.” On the cue of the slightest interest, he recites the whole railway time table and the essayist warns the readers of such an elderly gentleman.

“Beware of the elderly man who sits in the corner of the carriage and says that the train is two minutes behind the time, for he is the Ancient Mariner of railway travelers,…”

Have you come across any of these travelers? Or do you belong to one of these travelers? Which is your worst train travel? It’s time to think about it.