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

Cultivating Self-Love

 

Owning our story and loving ourselves through that process is the bravest thing that we’ll ever do. Be proud of who you are, and not ashamed of how someone else sees you.

The process of loving yourself can be extremely difficult. Especially if you don’t know what steps to take. So, it is quintessential to discern what self love constitutes and what it doesn’t.

Self-love is having time for your own beautiful ideas, memories and dreams. It is honouring yourself enough to believe in those passions and see that you need them, that you need to pursue them to be the person you were born to develop into. Self love is allowing yourself to mature and change, to grow into new perspectives and be comfortable enough in your own skin to allow your creativity to have the chaos it needs to be strong and the focus it needs to move in a positive direction. It is a state of being that respects these rights in others, that takes to heart that only they can see their path as only we can see ours, and that this sort of respect is a fundamental key to being human and living together. That this is part of liberty, that order comes from divine chaos, and all that requires self respect. Thus, self-love is genuine and complete acceptance of oneself.

However, what self-love discards is the egoistical self-centred sense of being whereby you only “love” yourself when you’ve “won” versus others, or when you consider yourself “better” than others. This is unsustainable and not authentic love for self, as when you truly love and accept yourself you don’t need to compare yourself to others. True self-love is not selfish pleasure, but rather the origin of discipline and willpower.

When you are conscious of that, that’s fantastic, you have made the first step- pat yourself on the back as it takes a lot of strength to admit that to yourself. Self-love is the most efficient route to everything from true self-discipline to pursuing your dreams, living out your full potential, and living an authentic and fulfilling life. It’s not easy, I am still on this path but it’s gradual and when you see yourself progressing on it, it truly is amazing. So how do we do it?

When you make choices or decisions ask yourself- ‘What would I do if I truly loved and accepted myself?”. Even if you haven’t accepted yourself yet, it puts you in the right mind-set and your decisions will reinforce the love for self. Aim to free yourself of any attachment. You are not your things, you are not your job, you are not your partner, you are not your friends, you are not your money. You are you. We cling on to them because they help us define ourselves – all because we don’t love ourselves. Stay true to yourself and if that means some people won’t accept you because of it – that’s fine because you are accepting yourself. Doesn’t it feel amazing when you acted naturally and did what was true to you ?
Do more of things that bring you true joy and not just pleasure. For example, think about what activities make you most happy or brought you most joy when you were a kid or teenager. It could be drawing, reading a book, helping someone, playing an instrument, etc. It must be true joy and not just superficial pleasure from activities as they might not help you cultivate that real self love.

Then, try focusing more of your attention to the present. Don’t get stuck with an image of you in the past or future. You need to realise that there is only now and no other time is real. The past was gone and the future is yet to come. Now is the only real setting there is- so bring your attention to it and cherish it. Look around you, focus on what your senses are feeling and even act surprised as if you just found out you exist. I personally found meditation to be incredibly powerful in cultivating this as a daily mind-set.

Those were the five things that helped me, I hope you will find something useful in them. Remember – let your ego fall and let unconditional love rise – for yourself and for others. You cannot truly love others unless you’ve learned to love yourself first. You must put oxygen mask on yourself first before putting it on others.

Self-love is looking out for yourself, not in a selfish way, but in a healthy way. Once we develop this discipline, we can use it in all sorts of life areas, like going to bed early, keeping up with physical activities, saying no to junk food, dedicating time to read and learn, and so much more. Quell the spoiled toddler, become the correct parent of your own mind. All the best with your beautiful journey !

Self-love Culture: Is it Healthy?

Importance to the individual and the self is a phenomenon that came by as a product of modernity. With more emphasis on self-accomplishment and success becoming often defined as what you are able to make of yourself, talks about what is important to the self and how to understand our own personalities have increased. Nowadays we see a large number of people who propagate what is known as the ‘self-love’ culture. The self-love essentially prioritizes the well-being of the self and calls for the acceptance by each person of their own individuality.

woman in black shirt holding white flowers
Photo by Masha Raymers on Pexels.com

This movement which is increasingly seen in online spaces and urban settings have its benefits as well as adverse effects. We can say that it is extremely necessary, especially when we have a society that is constantly finding fault with us and setting standards that very few are able to stick to. Everyone who does not meet those standards, whether it be about success or beauty or relationships, are considered as failures. Many companies are designed in such a way that they prey on insecure individuals and make a profit by offering them products that supposedly will make them ‘enough’. However, this is a false hope. in this situation, it is absolutely crucial that we have counter-narratives that dispel these myths of success and encourage people to understand their own uniqueness. We should not buy into the ideas that are marketed for the sake of money nor give into traditions that place unwarranted emphasis on appearances and performances. This idea can even cause serious mental health issues when one is constantly seeking the approval of others to be worthy of love.

The problem with this self-love culture, however, is when it goes out of hand and becomes almost narcissistic. People tend to get obsessed with their own selves and will do anything they have to in order to secure what they think will bring them fulfillment. This is dangerous because such an individualistic outlook might lead them to take advantage of others and even cause them harm. It also makes them egoistical and unwilling to accept any criticism. They forget that loving oneself does not mean loving everything about one’s own self and being against all kinds of change or betterment. In fact, if one is loving, one should be willing to change or work towards bettering aspects of their personality which might be potentially hurting themselves or others. Anger issues is an example of an aspect like this.

Self-love is healthy as long as it doesn’t lapse into the other extreme of being obsessed and infatuated with everything about ourselves. Man being a social animal has to live in relationship with others and anything that hinders that will potentially hurt him as well. It is a tightrope walk of loving oneself and accepting our personalities, flaws and all, and being cocksure of our supremacy and infallibility as an individual. We should love ourselves enough to identify things that could potentially be hindering our growth as a person while also keeping in mind that it is not our performance in the world out there that defines our worth. If we are able to be secure in our identity thus, evolving and changing, and embracing it, then we will also be willing to take constructive criticism as well as discern between what should be taken seriously and what should not be.