Thyroid threat to mother and baby’s health
Dr Meenal Kumar

The thyroid gland situated in the neck, just on the surface of the voice box, plays an important role in the growth and development of a baby and metabolism of the mother. Problems arise for the baby and the mother both when its functions become less than normal, or it works excessively.

Hypothyroidism (reduced function) is a common problem and can cause a variety of changes in a woman’s menstrual periods: irregularity, heavy periods, or loss of periods. When hypothyroidism is severe, it can reduce a woman’s chances of becoming pregnant.

Thyroid disease, when it occurs during pregnancy, can cause a number of health complications to the mother and her baby. During the first trimester, the foetus depends on the mother’s supply of thyroid hormone, which it gets through the placenta. Later on, the baby gets its supply of iodine, which the thyroid gland uses to make thyroid hormone through the mother’s diet. However, if the iodine supply is inadequate the baby will have developmental and intellectual problems.

Studies have shown that women with untreated hypothyroidism are four times more likely to give birth to a child with a low IQ. Even overt-hypothyroidism needs to be treated during pregnancy to prevent an adverse outcome for both the mother and the baby. Pregnant women being treated with thyroid hormone replacement often require a 30-50 per cent increase in their thyroid hormone dose. Routine TSH screening is recommended for all women as a standard part of their first visit to her gynaecologist.

Women contemplating pregnancy should make sure that they start taking a prenatal vitamin that includes not only folic acid, but iodine as well before becoming pregnant, and continue it throughout pregnancy. In India, a large percentage of pregnant women may not get enough iodine in their diet or through prenatal vitamins. Choosing iodized salt-salt supplemented with iodine-over plain salt is one way to ensure an adequate intake.

Who must get thyroid function tests done?

l Those women with a history of hyperthyroid or hypothyroid disease

l Women who have a family history of thyroid disease.

l Women with a goiter.

l Women who have tested positive for thyroid antibodies.

l Women who have symptoms or clinical signs — including anaemia or elevated cholesterol — that suggest possible hypothyroidism or hyperthyroidism.

l Women with type I (autoimmune) diabetes and other autoimmune disorders.

l Women who have had radiation to the head or the neck as part of some other medical treatment.

ll Women with a history of miscarriage or pre-term delivery.

The disturbed thyroid function

Uncontrolled hypothyroidism (as well as hyperthyroidism) during pregnancy can lead to the following problems:

l Congestive heart failure

l Preeclampsia

l Anaemia — a disorder in which blood does not carry enough oxygen to the body’s tissues

l Miscarriage

l Low birth-weight

l Stillbirth

Since thyroid hormones are crucial to foetal brain and nervous system development, hypothyroidism — especially during the first trimester — can lead to cognitive and developmental disabilities in the baby. Symptoms of hypothyroidism in pregnancy include extreme fatigue, cold intolerance, muscle cramps, constipation and problems with memory or concentration. High levels of TSH and low levels of free T4 generally indicate hypothyroidism. Thyroid function should be checked every six or eight weeks during pregnancy. Synthetic thyroxine is safe for the foetus and necessary for its well-being if the mother has hypothyroidism. Iron supplements and calcium supplements taken during pregnancy often interfere with thyroxine absorption.

Hyperthyroidism

Hyperthyroidism (excessive function) is much less common than its predecessor, and is diagnosed through a careful review of symptoms as well as blood tests —TSH, T4 and T3 levels. However, when present, it can affect the newborn with rapid heart rate that can lead to heart failure, poor weight gain, irritability, etc. Contrary to its predecessor, mild hyperthyroidism, in which TSH is low but free T4 is normal, does not require treatment. More severe hyperthyroidism is treated with drugs that interfere with thyroid hormone production. The lowest possible dose should be used to avoid hypothyroidism in the baby.

The writer is a Chandigarh-based senior gynaecologist. Email drkumar232@hotmail.com

How to prevent injuries in racquet sports
Dr Ravinder Chadha

Racquet sports like tennis, badminton and squash make players vulnerable to injuries of the wrist, elbow and shoulder joint. The usual culprits are weak muscles, incorrect technique, overuse, etc. The misconception that commonly prevails among players is that a regular exercise regime is not important as they are playing the game regularly. But the fact is that regular exercise improves fitness and this in turn entails speed, stamina, flexibility and strength.

Racquet sports facilitates the enhancement of aerobic fitness — speed and stamina. Flexibility can be improved by doing stretching exercises/yoga. The important aspect — strength — is neglected by most of the players which leads to injuries of the upper limb.

Racquet sports leads to the overuse of certain muscles which support the joints. Weak muscles, when these exceed the limit of muscle strength, put undue load on the tendons attached to the bones and also the ligaments supporting the joint. Different groups of muscles of the upper limb are involved during service and front and back hand strokes. In case, the muscles supporting the elbow joint are weak, the entire load is transferred to either the shoulder/wrist joint. This muscle imbalance is responsible for sustaining injuries.

The following injuries are common in the racquet sports:

Tennis elbow occurs due to the overuse of the wrist extensor muscles at the lateral side of the elbow. The usual symptom is pain felt at the lateral elbow while lifting weight, turning a door-knob. Usually it happens in late, mechanically poor, back hand stroke which places excess force on the extensor tendon. The other responsible factors are the grip size and loose string tension putting excessive load on the weak muscles of the elbow. Grip size, when correct, goes a long way in reducing the effort required to hold the racquet increasing the efficiency of the forearm and hand muscles, preventing the potential for overuse injuries.

Shoulder-rotator cuff injuries

During a serve, our shoulder is an integral part of a kinetic chain. More than 50 per cent of energy is derived from the leg hip-trunk movement. The shoulder acts as a force regulator and the arm elbow-wrist act as a force delivery mechanism. When the muscles of the leg and trunks are weak they exert excessive load on the shoulder, the elbow and the wrist, exaggerating their vulnerability to injury.

The rotator cuff is a group of four muscles that help to lift the shoulder over the head and to rotate it towards and away from the body. Rotator cuff injury can occur due to a fall, as a result of repetitive movement, high velocity overhead motion, etc.

Wrist pain occurs in cases of acute injury or develops gradually as a result of overuse. Acute injuries happen as a result of a fall on the outstretched hand, a mistimed shot or a violent twist to the wrist while swinging a racquet. Commonly encountered injuries are fracture, dislocation of the bones, inflammation of the tendons and injury to the nerves. A common training error that leads to injury is to repeatedly practice a single shot day in and day out. The body is thus loaded heavily and repetitively in an unfamiliar fashion.

The type of grip the player uses is particularly important. For example, the double-handed back hand can often inflict injuries on the non-dominant wrist, depending on the precise placing of the grip. Generalised hyper mobility is a common underlying cause and, therefore, the incidence of wrist injuries is higher among females.

Treatment involves avoiding the activities that aggravate injury. In case one feels pain or discomfort that persists for one hour after stopping the game, it is advisable to either modify or discontinue that activity.

Exercises to prevent injuries

Wrist curls: Grasp a band/dumb-bell in your hand with the palms facing upwards. Begin by curling the band upwards at the wrist and then slowly return back. Repeat 10 to15 times.

Reverse wrist curls: Grasp a band/dumb-bell in your hand with the palms facing downwards. Begin by curling the band/dumb-bell upwards at the wrist and then slowly return back. Repeat 10 to 15 times.

Forearm pronation / supination: Grasp the racquet/hammer in one of the hands, perpendicular to floor with forearm supported. Rotate the hand to a palm-down position, return to a start position, rotate to a palm-up position. Repeat this 8-10 times.

Wrist rolls: Attach the one end of a string to a cut-broomstick and the other end to a weight. In standing, extend the arms with elbows straight out in front. Roll the weight up from the ground to work extensors. Repeat holding the stick with the palms up to work flexors. Five to eight rolls, each way up, will do.

Rowing — In a sitting position, loop the band around your foot and hold the ends with the hands. Pull the band backwards. Repeat 10 to 15 times.

Rotator cuff exercise: Tie one end of the band in a door knob. Hold the other end with the elbow at the side. Move the band externally 10 times. Change the side and do full internal rotation 10 times.

The writer is a former doctor/physiotherapist, Indian cricket team.E-mail—chadha_r2003@yahoo.co.in

Problems associated with wisdom teeth
Dr Anu Aggarwal

Most of us have grown up with some myths which are passed down from our parents or grandparents and are accepted by us in a way that they are difficult to be removed from our lives. One of such myths is that the wisdom molar (the third molar), commonly called “Aqal Dar”, is related to wisdom or intelligence. So, its removal may lead to the loss of wisdom or intelligence in the person concerned.

The reality, however, is that wisdom tooth usually erupts when a person is between 17 and 21 years of age, thought to be an age when he or she is getting ‘wiser’. Otherwise, it has no relation with intelligence or wisdom of a person.

The wisdom molars are the ones that can cause maximum problems while they are erupting in the oral cavity. Most common of these problems are as follows:

Impacted teeth: Due to the process of evolution and change in diet from raw uncooked food to soft and cooked food habits, the jaws are progressively becoming short in length and wisdom teeth erupt. As they are the last ones to erupt in the oral cavity, sometimes they do not get enough space in the jaw for their eruption. Therefore, they may not erupt and get locked against the adjacent teeth. These are then called impacted teeth.

Pericoronitis: If the wisdom molar has not erupted completely, part of the gum overlying the wisdom molar acts as a pocket. Then whatever the patient eats gets stuck inside the pocket or around the tooth. Due to the lack of proper cleaning in that area, gum infection takes place, swelling the gums surrounding the crown of the tooth (pericoronal flap). There is severe pain and sometimes the patient is not even able to open one’s mouth completely. Such pain may be radiated towards the ear or the head on that side and may appear as headache. This condition is called pericoronitis.

Pain can also occur because of the gum which is covering wisdom molar (which is not erupted completely) and gets sandwiched or lacerated between the upper and lower third molars leading to pain on biting.

The wisdom molar may be placed at an angle with the tooth anterior to it which results in an improper contact. In this position, food lodgement occurs easily between the second molar and the wisdom molar, which can also lead to the decay of the wisdom molar as well as the second molar which is placed just anterior to it.

The upper wisdom molar, if buccally erupted, may cause ulceration in the cheeks. In rare cases, this may lead to cancer.

Cysts may develop around the wisdom molar.

Treatment

Treatment varies with the position of the wisdom molar in the oral cavity, whether it is erupted or not.

The problems caused by the wisdom molar, which can erupts fully later in the oral cavity in proper position, can be treated by deeply cleaning the pocket formed (or the gum margin around the tooth) and with medication or by the removal of the gum covering the tooth by surgery, if required.

The wisdom molar, which has no chance of eruption in proper position and can cause trouble to the patient, must be removed as early as possible. That is the best thing we can do about the wisdom molars.

The writer is a dental consultant at Fortis City Centre, Chandigarh.