Hyperthyroidism

What is hyperthyroidism?

Hyperthyroidism, or overactive thyroid, happens when your thyroid gland makes more thyroid hormones than your body needs.

Your thyroid is a small, butterfly-shaped gland in the front of your neck. It makes hormones that control the way the body uses energy. These hormones affect nearly every organ in your body and control many of your body's most important functions. For example, they affect your breathing, heart rate, weight, digestion, and moods. If not treated, hyperthyroidism can cause serious problems with your heart, bones, muscles, menstrual cycle, and fertility. But there are treatments that can help.

Hyperthyroidism has several causes. They include:

• Graves' disease, an autoimmune disorder in which your immune system attacks your thyroid and causes it to make too much hormone. This is the most common cause.
• Thyroid nodules, which are growths on your thyroid. They are usually benign (not cancer). But they may become overactive and make too much thyroid hormone. Thyroid nodules are more common in older adults.
• Thyroiditis, inflammation of the thyroid. It causes stored thyroid hormone to leak out of your thyroid gland.
• Too much iodine. Iodine is found in some medicines, cough syrups, seaweed and seaweed-based supplements. Taking too much of them can cause your thyroid to make too much thyroid hormone.
• Too much thyroid medicine. This can happen if people who take thyroid hormone medicine for hypothyroidism (underactive thyroid) take too much of it.

You are at higher risk for hyperthyroidism if you:

• Are a woman
• Are older than age 60
• Have been pregnant or had a baby within the past 6 months
• Have had thyroid surgery or a thyroid problem, such as goiter
• Have a family history of thyroid disease
• Have pernicious anemia, in which the body cannot make enough healthy red blood cells because it does not have enough vitamin B12
• Have type 1 diabetes or primary adrenal insufficiency, a hormonal disorder
• Get too much iodine, from eating large amounts of foods containing iodine or using iodine-containing medicines or supplements

The symptoms of hyperthyroidism can vary from person to person and may include:

• Nervousness or irritability
• Fatigue
• Muscle weakness
• Trouble tolerating heat
• Trouble sleeping
• Tremor, usually in your hands
• Rapid and irregular heartbeat
• Frequent bowel movements or diarrhea
• Weight loss
• Mood swings
• Goiter, an enlarged thyroid that may cause your neck to look swollen. Sometimes it can cause trouble with breathing or swallowing.

Adults over age 60 may have different symptoms than younger adults. For example, they may lose their appetite or withdraw from other people. Sometimes this can be mistaken for depression or dementia.

If hyperthyroidism isn't treated, it can cause some serious health problems, including:

• An irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart problems
• An eye disease called Graves' ophthalmopathy. It can cause double vision, light sensitivity, and eye pain. In rare cases, it can lead to vision loss.
• Thinning bones and osteoporosis
• Fertility problems in women
• Complications in pregnancy, such as premature birth, low birth weight, high blood pressure in pregnancy, and miscarriage

Your health care provider may use many tools to make a diagnosis:

• A medical history, including asking about symptoms
• A physical exam
• Thyroid tests, such as
  • TSH, T3, T4, and thyroid antibody blood tests
  • Imaging tests, such as a thyroid scan, ultrasound, or radioactive iodine uptake test. A radioactive iodine uptake test measures how much radioactive iodine your thyroid takes up from your blood after you swallow a small amount of it.

The treatments for hyperthyroidism include medicines, radioiodine therapy, and thyroid surgery:

• Medicines for hyperthyroidism include
  • Antithyroid medicines, which cause your thyroid to make less thyroid hormone. You probably need to take the medicines for 1 to 2 years. In some cases, you might need to take the medicines for several years. This is the simplest treatment, but it is often not a permanent cure.
  • Beta blocker medicines, which can reduce symptoms such as tremors, rapid heartbeat, and nervousness. They work quickly and can help you feel better until other treatments take effect.
• Radioiodine therapy is a common and effective treatment for hyperthyroidism. It involves taking radioactive iodine by mouth as a capsule or liquid. This slowly destroys the cells of the thyroid gland that produce thyroid hormone. It does not affect other body tissues. Almost everyone who has radioactive iodine treatment later develops hypothyroidism. This is because the thyroid hormone-producing cells have been destroyed. But hypothyroidism is easier to treat and causes fewer long-term health problems than hyperthyroidism.
• Surgery to remove part or most of the thyroid gland is done in rare cases. It might be an option for people with large goiters or pregnant women who cannot take antithyroid medicines. If you have all of your thyroid removed, you will need to take thyroid medicines for the rest of your life. Some people who have part of their thyroid removed also need to take medicines.

If you have hyperthyroidism, it's important not to get too much iodine. Talk to your health care provider about which foods, supplements, and medicines you need to avoid.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Impaired Driving

Impaired driving is dangerous. It's the cause of more than half of all car crashes. It means operating a motor vehicle while you are affected by:

• Alcohol
• Legal or illegal drugs
• Sleepiness
• Distractions, such as using a cell phone or texting
• Having a medical condition which affects your driving

For your safety and the safety of others, do not drive while impaired. Have someone else drive you or take public transportation when you cannot drive. If you need to take a call or send a text message, pull over.

National Highway Traffic Safety Administration

Knee Replacement

What is knee replacement surgery?

Knee replacement surgery is a surgery to replace parts of your knee joint with new, artificial parts. You may need a knee replacement if you have knee damage that causes severe pain and difficulty doing daily activities, such as walking and climbing stairs. It is usually done when other treatments for knee pain haven't helped enough. The goal of a knee replacement is to relieve pain and help you move better.

People of all ages may have knee replacement surgery. But it is more common in older people. The decision whether to have surgery is based on your overall health and how much your knee bothers you.

Knee replacement surgery treats conditions that cause the cartilage of the knee joint to wear away. These include:

• Knee osteoarthritis. This is the most common reason for knee replacement surgery. It usually develops over time after an injury or with aging.
• Knee damage from other types of arthritis.
• Problems from knee joints that aren't formed correctly.

During the surgery, a surgeon removes damaged cartilage and some bone from the surfaces of your knee joint. Cartilage is tissue that covers your bones where they meet. Healthy cartilage is smooth and helps the bones glide over each other when you move. When cartilage becomes rough and wears away, the bones rub against each other, causing pain.

After removing the damaged knee cartilage and bone, the surgeon attaches the artificial parts to your bones. The artificial parts are made of metal and plastic. They will give your knee new, smooth surfaces.

Knee replacement surgery may replace all the damaged parts of your knee (total knee replacement) or just part of your knee (partial knee replacement). In a total knee replacement, the surgeon replaces 3 surfaces:

• The end of the shinbone
• The end of the thighbone
• The back of the kneecap

Some people go home the same day they have surgery. Other people will stay in the hospital a few days. To help prevent blood clots, you'll most likely take blood thinners and wear special socks or coverings on your legs for a short time after surgery.

The success of your surgery depends a lot on what you do at home to help yourself recover. A physical therapist will teach you exercises to make your knee stronger and help it bend. It is important to do these exercises regularly. You may need to use a cane or walker for several weeks after the surgery. It will probably also be several weeks before you can drive. Your doctor will tell you when you can start driving again.

Most people who follow their recovery instructions can get back to nearly all of their normal daily activities within 3 to 6 weeks after surgery.

After recovering from surgery, most people can move better with less pain than before surgery. But having an artificial knee is not the same as having a normal, healthy knee.

You need to protect your new knee by:

• Staying at a healthy weight.
• Getting regular physical activity.
• Not doing any high-impact activities, such as jogging, running, and jumping. Instead, you can try low-impact activities that are good for your knee, such as walking, biking, and swimming

The chance of having problems after knee replacement surgery is low. But there are risks after any surgery. Possible problems after knee replacement surgery include:

• Infection
• Blood clots
• Heart attack
• Stroke
• Nerve damage
• Scarring that limits how far you can bend your knee

Your age, general health, and how active you are can all affect your risk of having a problem after knee replacement surgery.

A knee replacement doesn't last forever. After 15 to 20 years, the artificial knee parts may become loose or worn. If that happens, you may need another surgery on the same knee.

If you're thinking about having knee replacement surgery, talk to your doctor about the risks and benefits. Together you can decide if a knee replacement is right for you.

LDL: The "Bad" Cholesterol

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.

LDL and HDL are two types of lipoproteins. They are a combination of fat (lipid) and protein. The lipids need to be attached to the proteins so they can move through the blood. LDL and HDL have different purposes:

• LDL stands for low-density lipoproteins. It is sometimes called the "bad" cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.
• HDL stands for high-density lipoproteins. It is sometimes called the "good" cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.

If you have a high LDL level, this means that you have too much LDL cholesterol in your blood. This extra LDL, along with other substances, forms plaque. The plaque builds up in your arteries; this is a condition called atherosclerosis.

Coronary artery disease happens when the plaque buildup is in the arteries of your heart. It causes the arteries to become hardened and narrowed, which slows down or blocks the blood flow to your heart. Because your blood carries oxygen to your heart, this means that your heart may not be able to get enough oxygen. This can cause angina (chest pain), or if the blood flow is completely blocked, a heart attack.

A blood test can measure your cholesterol levels, including LDL. When and how often you should get this test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger::

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are age 20 or older::

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

For people who are older than 65:

• They should have the test every year.

You may need to get your cholesterol checked more often if you have heart disease, diabetes, or a family history of high cholesterol.

Things that can affect your LDL level include:

• Diet. Saturated fat and cholesterol in the food you eat make your LDL level rise
• Weight. Being overweight tends to raise your LDL level, lower your HDL level, and increase your total cholesterol level
• Physical Activity. A lack of physical activity can lead to weight gain, which can raise your LDL level
• Smoking.Cigarette smoking lowers your HDL cholesterol. Since HDL helps to remove LDL from your arteries, if you have less HDL, that can contribute to you having a higher LDL level.
• Age and Sex. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women's LDL levels tend to rise.
• Genetics. Your genes partly determine how much cholesterol your body makes. High cholesterol can run in families. For example, familial hypercholesterolemia (FH) is an inherited form of high blood cholesterol.
• Medicines. Certain medicines, including steroids, some blood pressure medicines, and HIV medicines, can raise your LDL level.
• Other medical conditions. Diseases such as chronic kidney disease, diabetes, and HIV can cause a higher LDL level.
• Race or ethnicity. People from certain racial or ethnic groups may have an increased risk of high blood cholesterol. For example, African Americans typically have higher HDL and LDL cholesterol levels than White Americans. Asian Americans are more likely to have higher LDL levels than other groups.

With LDL cholesterol, lower numbers are better, because a high LDL level can raise your risk for coronary artery disease and related problems. The general ranges for healthy adults are:

If you have coronary artery disease or are at high risk for it, your health care provider may have different goals for your LDL level.

There are two main ways to lower your LDL cholesterol level:

• Heart-healthy lifestyle changes, which include:
• Heart-healthy eating. A heart-healthy eating plan limits the amount of saturated and trans fats that you eat. Examples of eating plans that can lower your LDL level include the Therapeutic Lifestyle Changes diet and the DASH eating plan.
• Weight management. If you are overweight, losing weight can help lower your LDL level.
• Physical Activity. Everyone should get regular physical activity.
• Drug Treatment. If lifestyle changes alone do not lower your LDL level enough, you may also need to take medicines. There are several types of cholesterol-lowering drugs available, including statins. The medicines work in different ways and can have different side effects. Talk to your provider about which one is right for you. While you are taking medicines to lower your LDL level, you still should continue with the lifestyle changes.

Some people with familial hypercholesterolemia (FH) may receive a treatment called lipoprotein apheresis. This treatment uses a filtering machine to remove LDL cholesterol from the blood. Then the machine returns the rest of the blood back to the person.

NIH: National Heart, Lung, and Blood Institute

Learning Disabilities

What is a learning disability?

Learning disabilities are conditions that affect the ability to learn. They can cause problems with:

• Understanding what people are saying
• Speaking
• Reading
• Writing
• Doing math
• Paying attention

Often, children have more than one kind of learning disability. They may also have another condition, such as attention deficit hyperactivity disorder (ADHD). This can make learning even more of a challenge. The sooner a learning disability is identified and addressed, the better a child is likely to perform in school.

Learning disabilities don't have anything to do with how smart your child is. They are caused by differences in the brain, and they affect the way the brain takes in and uses information. These differences are usually present at birth. But there are certain factors that can play a role in the development of a learning disability, including:

• Genetics
• Environmental exposures, such as lead
• Using substances while pregnant

The earlier you can find and treat a learning disability, the better. Unfortunately, learning disabilities are usually not found until a child is in school. If you notice that your child is struggling, talk to your child's teacher or health care provider about having your child evaluated for a learning disability. The evaluation may include:

• Doing a physical exam to check for a medical problem that might make learning more difficult.
• Asking about your family history.
• Test your child's intellectual and school performance.

The most common treatment for learning disabilities is special education. A teacher or other learning specialist can help your child learn skills by building on their strengths and finding ways to make up for their weaknesses. They may suggest ways you can help your child when they do homework. Instructors may try special teaching methods, make changes to the classroom, or use technologies that can assist your child's learning needs. Some children also get help from tutors or speech or language therapists.

A child with a learning disability may struggle with low self-esteem, frustration, and other problems. Mental health professionals can help your child understand these feelings, develop coping tools, and build healthy relationships.

If your child has another condition, such as ADHD, they will need treatment for that condition as well.

NIH: National Institute of Child Health and Human Development