Our hypothyroidism symptoms checklist below will help you with knowing the signs of having this condition. Hypothyroidism is a condition where the thyroid gland does not make enough thyroid hormone to meet your body’s needs. When this occurs, a lot of the body’s functions will slow down1. The thyroid is a small butterfly-shaped gland located in the front of the neck. It sends out hormones that can help control how your body uses energy. Since every part of the body uses energy, thyroid hormone plays an important role in the function of almost every organ, including the heart, brain, liver, kidneys, and skin1,2.  There are many causes of hypothyroidism. Among them are: Hashimoto’s Thyroiditis. The most common form of hypothyroidism is Hashimoto’s thyroiditis. It is an autoimmune disorder where the thyroid is attacked by your own immune cells and over time, your gland may produce less thyroid hormone2. Radiation Treatment. When patients with other medical conditions are treated with radiation in their head or neck, thyroid gland damage can cause it to produce less hormones3. Congenital Hypothyroidism. Sometimes, babies can have hypothyroidism if they are born with an absent or partially formed thyroid, or if their thyroid cells do not work correctly3. Pituitary gland damage. The pituitary gland in the brain sends out a hormone (TSH) which tells the thyroid gland how much thyroid hormone (T4 & T3) to make. If the pituitary is damaged by a tumor, radiation, or surgery, it may no longer produce TSH (thyroid stimulating hormone), resulting in the thyroid producing less T4 and T31. Too much or too little iodine. The thyroid gland needs iodine to make thyroid hormone. Having too little or too much iodine in the diet can cause or worsen hypothyroidism3. As outlined above, there are many different causes of hypothyroidism, so be sure to check with your physician to determine the cause.  *These symptoms are a generalized group that have been noted in individuals with hypothyroidism in the past, but they overlap with many other diseases. If you have any combination of these symptoms, it does not always mean you have hypothyroidism. Rather, they are an indicator that it might be good to check thyroid function. General/Metabolism-related factors 1,3●         Fatigue●        Drowsiness●        Depression●        Weight gain●        Fluid retention●        Decreased sweating●         Increased sensitivity to cold  Skin, Hair, and Nails 4●        Dry skin●        Coarse hair with increased hair loss●        Brittle nails GI●        Constipation Cardiovascular 5,6●        Decreased heart rate●        Anemia●        Elevated cholesterol levels  Since the symptoms of hypothyroidism can potentially overlap with hyperthyroidism, other endocrine diseases, or even non-endocrine causes, the best way to know if you have hypothyroidism is to visit your primary care physician or an endocrinologist. By reviewing your blood work and listening to your history, they can accurately diagnose and recommend a plan of care or follow-up.   TSH (thyroid stimulating hormone)TSH is a stimulating hormone released by the pituitary gland. It binds to your thyroid cells and stimulates it to release thyroid hormone. If TSH levels are high, it could indicate hypothyroidism since low thyroid hormone levels will cause the pituitary to release more TSH. T4 & T3T4 and T3 are your thyroid hormones. T4 is the one that is primarily checked, and if its levels are abnormally low*, it indicates hypothyroidism.*Important note- since the “normal” levels of T3 and T4 fall in a very wide range, individuals can have varying definitions of what a “normal” or “abnormal” level is for them. Thyroid antibodiesIf there are thyroid antibodies present in the bloodstream, it can indicate likelihood of an autoimmune disease being the cause of the hypothyroidism.  Hypothyroidism is treated by replacing the hormone that your own thyroid is struggling to make, in order to raise the levels of thyroid hormone to what they should be for you. Levothyroxine is a medication that is identical to the hormone that the thyroid normally makes. It comes in the form of a daily pill. The dosage of the medication will vary significantly from person-to-person, since it depends on your body’s specific thyroid levels.Your primary care physician or endocrinologist will require repeat blood work every 3 to 6 months initially in order to keep track of your thyroid hormone levels and adjust the dosage of medication as needed.  Authors: Dr. Anjanette Tan, MD, FACE; Yasasvhinie Santharam

Our most prized possession (okay maybe I’m a bit biased), is our vision. Moms out there, I cannot imagine how challenging it may be at home to make sure everything is optimized to keep your children safe from potential accidental eye injury. In this post, I will explore both chemical eye injury and then overall eye injuries in the pediatric population. A topic that was special to me in my residency and that I developed into a poster presentation in 2019 at The Association for Research in Vision and Ophthalmology (ARVO) was chemical-related eye injuries in pediatric patients across the country. We analyzed seventeen years of data from one hundred pediatric emergency departments in the country. Let me start first with the trends we found and then we can explore ways through which you can prevent eye injuries for your children.  In terms of chemical-related eye injury, the most common culprit was laundry soap and laundry detergent pods! This most commonly occurred for children in the summer, at home, and usually in kids between ages one to four years old. Other culprits included swimming pool cleaners and household cleaners. What do I mean in terms of chemical-related eye injuries? Well, any substance or chemical depending on its composition can cause a spectrum of injuries to our eyes, ranging but not limited to infection and compromise to the cornea’s ability to maintain its layers. Every injury to the eye, whether it be traumatic or related to a chemical, should be treated seriously and should be evaluated by an Ophthalmologist in an emergency setting.  Now let’s shift gears into looking at more broad pediatric eye injuries.  Pediatric eye injuries are wide-ranging, but often include animal bites/scratches, chemicals, and trauma (for instance an object to the eye). This was the foundation of many of my consults during training. Thus, I have developed from my experience six pearls for parents - in either preventing or managing an eye injury for your child: 1)      Keep things out of reach! One of the most simple ways to prevent injury is to keep items such as detergents, cleaners, sharp objects, hot objects etc. out of reach! 2)      If your child has sustained a traumatic eye injury, try not to manipulate the eye before an Ophthalmologist conducts their exam.If your child has sustained aa trauma to the eye, do not manipulate/touch the eye in case there is serious injury. Ensure your child does not touch his or her eye and then bring him or her in to see an Ophthalmologist as soon as possible (same day)!3)      In the instance of a chemical injury to the eye, the best thing you can do is flush and irrigate your child’s eye(s) with water. If you have saline at home, you can use this also. Irrigate until you can’t irrigate anymore! This is the best initial treatment for this injury and can prevent progression of chemical injury to the cornea and ocular surface.4)      Do not assume a red eye is just a red eye.Often parents notice redness on a child’s eye and attribute it to irritation or nothing serious. Do not underestimate what a red eye could really mean. It is only with appropriate instrumentation and a thorough exam by an Ophthalmologist that severe eye injury can be ruled out. 5)      Do not buy over the counter topical therapy (drops, ointments) to use on your child’s eyes until an Ophthalmic exam has been performed.Often the general population does not realize that over the counter drops and ointments are not all benign and totally harmless. Certain ingredients and formulations can worsen a preexisting eye condition or injury, so it is always best to hold off on treatment until your child has been seen by an Ophthalmologist. 6)      If you have a pet at home, ensure that his or her vaccinations are maintained and updated, and that their claws (if applicable) are appropriately managed and trimmed. Even the kindest, sweetest pets sometimes do not know better, and children can sustain significant injuries near or within their eyes as a result. With these pearls, you will be better prepared in anticipation of any potential eye injury that your child may face. Through education, discussion, and anticipation you can really do a lot in minimizing the risk of a child undergoing an incidental eye injury. I encourage dynamic discussion between each caretaker of a child to ensure that these precautions are being implemented in all of the settings a child may be in on a given day.  As always, I welcome, encourage, and love answering questions.  I hope this blog post helps even one parent out there! Nitasha Khanna, MDCornea and External Disease FellowOphthalmologist Follow her on Instagram Reference: Khanna N, Yilmaz T, Simon M, Migliori M. Epidemiology of Pediatric Chemical-related Eye Injuries Treated in US Emergency Departments (2000-2017). Annual Meeting, The Association for Research in Vision and Ophthalmology, Vancouver, Canada, May 2019.

Urine should be yellow.  Each person has a different “normal” in the color range from very pale to darker shades of yellow.  You should recognize when your urine color is average for you.  When you drink the proper amount of water a day, urine is probably pretty light yellow.  The more dehydrated you are, the darker it will look.  If your urine is cloudy, a color other than yellow, or brown, consult your medical professional. Diet can also be a factor in the color of your urine.  Beets and berries can cause your urine to be pink or reddish.  Some processed foods also contain dyes that will affect the color.  The beta carotene that we are encouraged to consume in carrots and sweet potatoes converts to Vitamin A that can make your urine darker or even orange. If you have recently switched or added certain vitamins to your regimen, you should realize that the B vitamins like B-2 and B-12 can cause urine to fluoresce into almost a yellow-green color.  This includes those shakes that have a lot of riboflavin and cobalamin.  Vitamin C may show up darker or even orange.  Vitamin C is also high in foods like tomatoes, strawberries and broccoli. As mentioned, keeping hydrated is a good thing, especially if you exercise vigorously.  If you have worked out or have been dealing with summer heat, you probably should increase your water intake.  If your urine is darker than usual after exertion, have a glass of water.  If you are consistently dehydrated, you will notice your urine is brownish like a cola or tea.  Especially if you are also experiencing muscle pain, seek medical attention quickly.  This is serious.Medications can also affect the appearance of urine.  This includes over-the-counter as well as prescription versions.  Examples include phenazopyridine (Pyridium) and rifampin are known to produce an orange hue.  Laxatives and some chemotherapy treatments also change the color of urine. If you have ruled out dehydration, food sources, and medicines, but you still notice discoloration, cloudiness, or an unusual odor, you may have developed an infection or issues with your kidneys or bladder.  This can be a sign of a serious illness or condition.  Consult a physician as soon as possible to rule out anything critical.  Especially if the discoloration is accompanied by any other symptoms like fever, pain, or vomiting. Age and gender play important roles in the chances of developing some condition or illness.  Most women will, at some point, develop a uterine tract infection (UTI) and men can have problems with their prostate gland, either of which can cause bleeding expelled through the urinary tract.  For children, urinary tract bleeding is very serious and should be addressed quickly by medical personnel. When you visit the doctor and he or she orders a urinalysis, you should be prepared to answer a number of questions especially when the discoloration began, sleep patterns, smoking, unexplained weight loss, rashes, and any changes in your regular routine.  Through a physical examination and the results of your blood work, the physician should be able to direct you to a cause and treatment options. 

Dry shampoo is a product designed to freshen hair between showers or traditional shampooing - but Is dry shampoo safe for regular use? Dry Shampoo is an alcohol- or starch-based substance.For some people, dry shampoo is beneficial during camping trips or traveling where daily showers are not always available. For other it is just a convenience to avoid washing hair quite as often. This is good if you have hair that needs more moisture or after menopause when hair is less oily.  It can give a boost for an extra day or so between washes.Dry shampoo is safe to use on an occasional basis but if overused, it can damage hair and even cause problems with the scalp. That will result in hair breakage, clogged follicles and even hair loss. Physicians recommend that it be used for no more than two days in a row.Proper usage is also important. Holding the canister about 6 inches from the head, spray only the hair, not the scalp. Use it only on oily areas like the temples or crown, where the oil is more noticeable. Using a comb or your fingers make sure any accumulated spray is moved from the roots and distributed evenly over the oily areas.Dry shampoo is not a cleaning agent. It is just designed to absorb extra oil. It has no effect on dirt and really doesn’t even remove all of the oil.Some of these hair care products have alcohols that will dry out hair and when you comb or brush your hair, it will snag on the comb or on each other and then break off. If you leave the dry shampoo on too long, it will build up on the scalp which can cause the follicles to clog or even develop a bacterial or fungal infection.Dry shampoo does not seem to directly cause hair loss, but hair that grows from a follicle damaged by the fungal or bacterial infection is not very well anchored and is more likely to fall out. The scalp is covered with follicles that not only grow hair but produce a natural oil called sebum. Sebum softens the scalp, gives hair texture, and protects the skin.Cancer LinkSome of these dry shampoos are made from or contain talc. In its natural state, talc is composed of asbestos particles. Products produced in the US or imported for use are prohibited from the use of asbestos because of its carcinogenic qualities. You may have read about the possible link between talcum powder (non-asbestos) and ovarian cancer. There is no known link between that condition and the use of dry shampoos but the American Cancer Society recommends avoiding talc-related products pending additional research.AlternativesOf course, the best thing is to keep your hair clean and well conditioned.  There are shampoo and other products that are organically made.  There are also some home made versions that use cornstarch and rice starch.  Add a few drops of essential oils and you are ready.So the take-away is that if you want to use a dry shampoo, do it in moderation and avoid those products made with talc.