Lupus

What it is: Lupus (also called SLE or systemic lupuserythematosus) is an autoimmune disease. It can affect many organs in your body.

Lupus, also known as systemic lupus erythematosus, is a chronic autoimmune disease which can affect many body parts, including the joints, skin, kidneys, heart, lungs, blood vessels, or brain. When lupus occurs, the immune system of the body malfunctions, meaning, though it is responsible for fighting off viruses, bacteria, and germs and protecting the body, it suddenly starts to attack your body’s healthy tissues. In this disease, the immune system becomes overactive as opposed to the condition of HIV when it becomes underactive. This condition can range from mild to life-threatening.

How does lupus occur?

The immune system in our bodies is responsible for producing antibodies that fight against antigens (intruders that sneak into our bodies to cause harm) and protect the body against any infections. Lupus occurs when the immune system of the body malfunctions and is unable to differentiate between antigens and healthy tissue. In this condition, the immune system in fact directs antibodies against the healthy tissue in our bodies, along with the antigens, causing swelling, pain, and tissue damage.

There are various types of lupus such as:

• Lupus nephritis: is inflammation of the kidney that is caused by systemic lupus erythematosus (SLE).
• Neonatal lupus: which affects newborn babies.
• Subacute cutaneous lupus erythematosus: which causes skin sores on areas of the body exposed to the sun.
• Discoid lupus erythematosus: which causes a skin rash that doesn’t easily disappear.
• Drug-induced lupus: which can be caused by certain medicines.

Who is prone to lupus?

The chances of developing lupus are higher in people who:

• are women
• are of black ancestry
• are between the ages of 15 and 45
• have a family history of lupus
• take medicines that are associated with drug-induced systemic lupus

What are the causes of lupus?

The cause of lupus in most cases, is as yet unknown. A few potential triggers include:

• Genetics: A family history of lupus may make you more susceptible to this disease.
• Infections: Contracting an infection can initiate lupus or cause a relapse.
• Sunlight:  Exposure to sunlight can trigger a response in susceptible people. Skin lesions may appear.
• Hormones: Both men and women produce estrogen, however, its production is much greater in females. Many women experience symptoms of lupus before menstrual periods and/or during pregnancy when estrogen production is high. This may indicate that estrogen somehow regulates the severity of lupus, however, researchers have not yet found any connection between estrogen, or any other hormone, and lupus.
• Medications:  Certain medicines such as anti-seizure medications and antibiotics, can cause lupus can be triggered by certain types of blood pressure medications. These patients usually get better after they stop taking the medicines.

What are the complications of lupus?

Some major complications of lupus include:

• anemia
• risk of bleeding or blood clotting
• inflammation of blood vessels
• kidney damage or kidney failure
• inflammation of chest cavity lining (pleurisy)
• headaches
• dizziness
• behaviour changes
• hallucinations
• strokes or seizures.
• inflammation of the heart muscle
• increased risk of cardiovascular diseases and heart attacks

What are the symptoms of lupus? How is lupus diagnosed?

The most common symptoms of lupus include:

• fatigue and fever
• joint pain, stiffness and swelling
• butterfly-shaped rash on the face that covers the cheeks and bridge of the nose
• skin lesions that occur due to exposure to the sun
• fingers and toes that turn white or blue when exposed to cold or during stressful periods
• shortness of breath
• chest pain
• dry eyes
• headaches
• confusion
• memory loss

Diagnosis

Lupus can produce different and often confusing symptoms in the body, so it may take some time for a physician to diagnose it. In fact, this disease is known as ‘the great imitator’ as its symptoms mimic many other illnesses.Usually, a general physician can diagnose lupus. Depending on the severity of your condition he may refer you to other specialists such as a dermatologist, cardiologist, nephrologist, neurologist, gastroenterologist, pulmonologist, or a perinatologist.

For diagnosing lupus your doctor will look for your current symptoms such as pain, heat, redness, swelling, and loss of function at a particular place in the body. He will also enquire about your complete medical history, and if you have a family history of lupus.

There is no single diagnostic test for systemic lupus, however, the test usually suggested by doctors for lupus is called the antinuclear antibody (ANA) test. This is not a test specifically for lupus, but this test along with many other laboratory tests can build up a picture providing more information to your doctor and finally confirm if it is lupus.Other tests include:

• blood test (for complete blood count)
• kidney and liver assessment
• urinalysis
• chest X-Ray
• echocardiogram
• skin biopsy

What is the treatment of lupus?

Medical Treatment for Lupus

Depending on the severity of your condition, your doctor may prescribe medicines to suppress the immune system, reduce inflammation, and treat pain, swelling and fever associated with lupus.

Exercise

Research shows that lupus patients who exercise build stronger muscles, prevent joint stiffness, control fatigue, and avoid weight gain.Before deciding on an exercise regimen, make sure to consult your doctor to find out what type of exercises suit you the best since some movements can be harmful if you have swollen joints or muscle pain.

Some exercises that you can consider are yoga, pilates, Tai Chi, dancing, swimming, and bicycling.

Hemorrhoids are enlarged, bulging blood vessels in and about the anus and lower rectum. Straining, exertion, pregnancy, and other activities can lead to bleeding, pain, itching and swelling of hemorrhoids.  Sometimes hemorrhoids make it difficult to get clean after a bowel movement and can lead to rashes and irritation around the anal area.  More severe hemorrhoids cause obstruction and stricture of the anal area making the process of having a bowel movement even harder and more discomforting.  Once hemorrhoids have become enlarged producing symptoms the patient often will need an intervention to “shrink” or remove the hemorrhoids before they can obtain relief.

Hemorrhoid treatment options

There are three major methods of treating hemorrhoids in the office; Infrared coagulation (Laser), Rubber band ligation, and Sclerotherapy.  All methods are essentially “painless” when performed by an appropriate physician.  Office treatments require no down time, can be performed during a normal office visit, require no special preparation, no anesthesia, and no medication.  These procedures can be done and you can go right back to work.  A surgeon trained in rectal surgery can determine which treatment method will produce the best results for your condition.

1. Infrared coagulation (Laser)- Using a small probe, a burst of infrared energy is applied to the hemorrhoid’s surface in an area where there is typically no sensation.  This removes a couple millimeters of tissue and requires repeat applications to produce results.  This can be effective for hemorrhoids that do not prolapse (bulge with bowel movements out of the anal canal).
2. Rubber band ligation - One of the most permanent in office procedures for the removal of symptomatic hemorrhoids. A small band is placed around the base of the hemorrhoid, above the area where there is sensation.  The band effectively will remove a large portion of the hemorrhoid, essentially leaving a smaller hemorrhoidal cushion.  This typically can begin to produce relief after the first application.  One band is placed per visit to decrease the chances of having any discomfort and bleeding.  Having multiple bandings performed can be as effective as a full, inpatient surgery for removal of a patient’s hemorrhoids.  This treatment when done right will not produce pain and will produce immediate results.
3. Sclerotherapy- An effective treatment for reducing bleeding internal hemorrhoids.  While in the office a small injection is made into the hemorrhoidal vessels which are above the area of normal sensation.  Over a period of time the hemorrhoid “hardens” and shrinks due to minor interruption of the blood supply.  Can be very effective for patients on blood thinning medication who bleed with bowel movements.
4. Hemorrhoidectomy – For the most severe of cases, your surgeon may recommend a hemorrhoidectomy which is a surgery performed in the hospital under general sedation.  Typically this has been regarded as a painful surgery, but recently has been improved through the use of a tool called the harmonic scalpel.  A harmonic scalpel hemorrhoidectomy uses ultrasound generated energy to gently remove the hemorrhoid, minimizing damage to underlying, sensitive tissue.  This both decreases bleeding after the surgery as well as any “collateral” damage through traditional surgery with electrocautery and sutures.  For most cases a surgery performed in this manner can be done on an “outpatient” basis without the need for an overnight hospital stay.

What is body odor?

When a body gives off a scent others may find unpleasant, it is known as body odor.

Body odor usually becomes evident if measures are not taken when a human reaches puberty. People who are obese, those who regularly eat spicy foods, as well as individuals with certain medical conditions, such as diabetes, are more susceptible to having body odor.

People who sweat too much, such as those with hyperhidrosis, may also be susceptible to body odor. However, often the salt level of their sweat is too high for the bacteria to break down. It depends on where the excess sweating is occurring and which type of sweat glands are involved.

Sweat itself is virtually odorless to humans. It is the rapid multiplication of bacteria in the presence of sweat and their breaking down of sweat into acids that eventually causes the unpleasant smell.

Body odor is most likely to occur in the following places:

• feet
• groin
• armpits
• genitals
• pubic hair and other hair
• belly button
• anus
• behind the ears
• the rest of the skin, to a lesser extent

Body odor can have a pleasant and specific smell to the individual and can be used to identify people, especially by dogs and other animals. Each person’s unique body odor can be influenced by diet, gender, health, and medication.

Causes

Body odor is caused by bacteria breaking down sweat and is largely linked to the apocrine glands. Most body odor comes from these.

These glands are found in the breasts, genital area, eyelids, armpits, and ear. In the breasts, they secrete fat droplets into breast milk. In the ear, they help form earwax. Apocrine glands in the skin and the eyelids are sweat glands.

Most of the apocrine glands in the skin are located in the groin, armpits, and around the nipples. In the skin, they usually have an odor. They are scent glands.

The apocrine glands are mainly responsible for body odor because the sweat they produce is high in protein, which bacteria can break down easily.

What causes foot odor?

Most of us wear shoes and socks, making it much more difficult for the sweat to evaporate, giving the bacteria more sweat to break down into smelly substances. Moist feet also raise the risk of fungi developing, which can also give off unpleasant smells.

Prevention

A large concentration of apocrine glands is present in the armpits, making that area susceptible to the rapid development of body odor.

The following steps may help control armpit odor:

1) Keep the armpits clean: Wash them regularly using anti-bacterial soap, and the number of bacteria will be kept low, resulting in less body odor.

2) Hair: When armpits have hair, it slows down the evaporation of sweat, giving the bacteria more time to break it down into smelly substances. Shaving the armpits regularly has been found to help body odor control in that area. Reusable razors are available to purchase online.

3) Deodorant or antiperspirant: Deodorants make the skin more acidic, making it more difficult for bacteria to thrive. An antiperspirant blocks the sweating action of the glands, resulting in less sweating. Some studies, however, have indicated that antiperspirants may be linked to breast cancer or prostate cancer risk.

This study suggests that current research is inconclusive on the risks of antiperspirant sprays.

Deodorants and antiperspirants with natural ingredients are available to purchase online.

Tips on preventing foot odor

Smelly feet are less of a problem socially than underarm B.O. because the unpleasant odor is usually contained by shoes and socks.

However, the smell may become obvious if the person with smelly feet visits a home where shoes are taken off before entering, as is the custom in various countries and homes.

The following steps may help control foot odor:

1) Wash your feet at least once a day: Warm water is better at killing bacteria than cold water. Make sure you dry your feet thoroughly afterward, including in between your toes.

2) Socks: They must allow the sweat to evaporate. The best socks are those made of a combination of man-made fibers and wool. Wear a clean pair of socks each day.

3) Shoes: If you wear trainers or shoes with plastic linings make sure it is not for long. A leather lining is better for sweat evaporation. If you have a problem with sweaty feet, do not wear the same pair of shoes two days in a row. Shoes do not completely dry overnight.

4) Pumice stone: Bacteria thrive on dead skin. If the soles of your feet have patches of dead skin remove them with a pumice stone. These are available to buy online.

5) Deodorants and antiperspirants: Ask your pharmacist for special foot deodorants and antiperspirants. If you have athlete’s foot, you should not use deodorants or antiperspirants. Treat the fungal infection with appropriate medication.

6) Walk around barefoot: Whenever you can, walk around barefoot, or at least slip out of your shoes regularly.

First, you’ll have what’s called a cardiac catheterization. Medication will be given to relax you, then the doctor will numb where the catheter will go with anesthesia.

Next, a thin plastic tube called a sheath is inserted into an artery — sometimes in your groin, sometimes in your arm. A long, narrow, hollow tube called a catheter is passed through the sheath and guided up a bloodvessel to the arteries surrounding the heart.

A small amount of contrast liquid is put into your blood vessel through the catheter. It’s photographed with an X-ray as it moves through your heart’s chambers, valves, and major vessels. From those pictures, doctors can tell if your coronary arteries are narrowed and, in some cases, whether the heart valves are working correctly.

If the doctor decides to perform angioplasty, he will move the catheter into the artery that’s blocked. He’ll then do one of the procedures described below.

The whole thing lasts from 1 to 3 hours, but the preparation and recovery can add much more time. You may stay in the hospital overnight for observation.

What Types of Procedures Are Used in Angioplasty?

There are several your doctor will choose from. They include:

Balloon: A catheter with a small balloon tip is guided to the narrowing in your artery. Once in place, the balloon is inflated to push the plaque and stretch the artery open to boost blood flow to the heart.

Stent: This is a small tube that acts as a scaffold to support the inside your coronary artery. A balloon catheter, placed over a guide wire, puts the stent into your narrowed coronary artery. Once in place, the balloon is inflated, and the stent expands to the size of the artery and holds it open. The balloon is then deflated and removed while the stent stays in place. Over several weeks, your artery heals around the stent.

These are often placed during angioplasty to help keep the coronary artery open. The stent is usually made of metal and is permanent. It can also be made of a material that the body absorbs over time.

Some stents contain medicine and are designed to reduce the risk of the artery getting blocked again (your doctor may call that restenosis). The doctor will decide if this is the right stent for your blockage.

Rotablation: A special catheter, with an acorn-shaped, diamond-coated tip, is guided to the point of the narrowing in your coronary artery. The tip spins at a high speed and grinds away the plaque on your artery walls. The microscopic particles are washed away in your bloodstream. This process is repeated as needed to improve blood flow.

This is rarely used because balloon angioplasty and stenting have much better results. They’re also easier for the cardiologist to perform.

Atherectomy: The catheter used here has a hollow cylinder on the tip with an open window on one side and a balloon on the other. When the catheter is put into the narrowed artery, the balloon is inflated, pushing the window against the plaque. A blade in the cylinder rotates and shaves off any plaque that protrudes into the window. The shavings are caught in the catheter chamber and removed. This process is repeated as needed to allow for better blood flow.

Like rotablation, this procedure isn’t used much.

Cutting balloon: This catheter has a special balloon tip with small blades. When the balloon is inflated, the blades are activated. The small blades score the plaque, then the balloon presses the plaque against the artery wall.

Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that can’t be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn’t improve with rest.

This condition is also known as systemic exertion intolerance disease (SEID) or myalgic encephalomyelitis (ME). Sometimes it’s abbreviated as ME/CFS.

The cause of chronic fatigue syndrome is unknown, although there are many theories — ranging from viral infections to psychological stress. Some experts believe chronic fatigue syndrome might be triggered by a combination of factors.

There’s no single test to confirm a diagnosis of chronic fatigue syndrome. You may need a variety of medical tests to rule out other health problems that have similar symptoms. Treatment for chronic fatigue syndrome focuses on symptom relief.

Symptoms

Signs and symptoms may include:

• Fatigue
• Loss of memory or concentration
• Sore throat
• Enlarged lymph nodes in your neck or armpits
• Unexplained muscle or joint pain
• Headaches
• Unrefreshing sleep
• Extreme exhaustion lasting more than 24 hours after physical or mental exercise

When to see a doctor

Fatigue can be a symptom of many illnesses, such as infections or psychological disorders. In general, see your doctor if you have persistent or excessive fatigue.

Causes:

People who have chronic fatigue syndrome appear to be hypersensitive to even normal amounts of exercise and activity.

Why this occurs in some people and not others is still unknown. Some people may be born with a predisposition for the disorder, which is then triggered by a combination of factors. Potential triggers include:

• Viral infections. Because some people develop chronic fatigue syndrome after having a viral infection, researchers question whether some viruses might trigger the disorder. Suspicious viruses include Epstein-Barr virus, human herpes virus 6 and mouse leukemia viruses. No conclusive link has yet been found.
• Immune system problems. The immune systems of people who have chronic fatigue syndrome appear to be impaired slightly, but it’s unclear if this impairment is enough to actually cause the disorder
• Hormonal imbalances. People who have chronic fatigue syndrome also sometimes experience abnormal blood levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands. But the significance of these abnormalities is still unknown.

Diagnosis:

There’s no single test to confirm a diagnosis of chronic fatigue syndrome. Because the symptoms of chronic fatigue syndrome can mimic so many other health problems, you may need patience while waiting for a diagnosis.

Your doctor must rule out a number of other illnesses before diagnosing chronic fatigue syndrome. These may include:

• Sleep disorders. Chronic fatigue can be caused by sleep disorders. A sleep study can determine if your rest is being disturbed by disorders such as obstructive sleep apnea, restless legs syndrome or insomnia.
• Medical problems. Fatigue is a common symptom in several medical conditions, such as anemia, diabetes and underactive thyroid (hypothyroidism). Lab tests can check your blood for evidence of some of the top suspects.
• Heart and lung impairments. Problems with your heart or lungs can make you feel more fatigued. An exercise stress test can assess your heart and lung function.
• Mental health issues. Fatigue is also a symptom of a variety of mental health problems, such as depression, anxiety, bipolar disorder and schizophrenia. A counselor can help determine if one of these problems is causing your fatigue.

Treatment:

There is no cure for chronic fatigue syndrome. Treatment focuses on symptom relief.

Medications

Many people who have chronic fatigue syndrome are also depressed. Treating your depression can make it easier for you to cope with the problems associated with chronic fatigue syndrome. Low doses of some antidepressants also can help improve sleep and relieve pain.

Therapy

The most effective treatment for chronic fatigue syndrome appears to be a two-pronged approach that combines cognitive training with a gentle exercise program.

• Cognitive training. Talking with a counselor can help you figure out options to work around some of the limitations that chronic fatigue syndrome imposes on you. Feeling more in control of your life can improve your outlook dramatically.
• Graded exercise. A physical therapist can help determine what exercises are best for you. Inactive people often begin with range-of-motion and stretching exercises for just a few minutes a day. Gradually increasing the intensity of your exercise over time may help reduce your hypersensitivity to exercise, just like allergy shots gradually reduce a person’s hypersensitivity to a particular allergen.

Risk factors

Factors that may increase your risk of chronic fatigue syndrome include:

• Age. Chronic fatigue syndrome can occur at any age, but it most commonly affects people in their 40s and 50s.
• Sex. Women are diagnosed with chronic fatigue syndrome much more often than men, but it may be that women are simply more likely to report their symptoms to a doctor.
• Stress. Difficulty managing stress may contribute to the development of chronic fatigue syndrome.

Complications:

Possible complications of chronic fatigue syndrome include:

• Depression
• Social isolation
• Lifestyle restrictions
• Increased work absences

High blood cholesterol is best known for its effects on your heart in the form of heart disease, heart attack and stroke. It can, however, cause leg pain as well when the arteries in your legs suffer from restricted blood flow; this condition is known as peripheral artery disease. Although your doctor may prescribe cholesterol-lowering medications, these may also contribute to the pain and discomfort you feel.

Peripheral Artery Disease

Peripheral artery disease–PAD–can result from atherosclerosis, or hardening of the arteries. Plaque, a substance made of fat, cholesterol and various elements in your blood, is the cause of this condition. As plaque builds in the walls of your arteries, they begin to narrow, restricting blood flow to various areas of your body. The most common complications are heart attack and stroke; PAD is another. Affecting your arms, legs and pelvis, PAD can lead to numbness, pain and infection in these areas, according to the National Heart Lung and Blood Institute.

Autism spectrum disorder (ASD), also known as just autism, is an umbrella term for a group of complex brain development disorders.

Unlike cerebral palsy, which mostly affects a child’s motor functioning, autism affects the normal development of the brain in areas such as social interaction, problem-solving and communication.

Causes and Risk Factors

Autism is a complex disorder that can be caused by an array of factors. ASDs have no single known cause, but there are at least three aspects that researchers agree contribute to the development of autism, including:

• Genetics
• Environmental factors
• Maternal illness during pregnancy

Genetics

There are several biological differences in children with ASDs compared to children who do not have autism. Some of these genes can affect brain development and the ways in which brain cells communicate. Some genetic problems appear to be inherited, while others can occur spontaneously.

Due to the relationship between genetics and autism, parents who have one child with autism have an increased risk that their next child will also have an ASD. Additionally, if you have two children with autism, the chances that your third child will have autism increase to about 35%.

Environmental Factors

Environmental factors have recently been recognized as a potential cause of autism. Researchers are currently investigating the connection between things such as viral infections and air pollutants and the subsequent development of autism.

Maternal Conditions

There are various maternal conditions or illnesses that have been tied to autism in children. These include diabetes, hypertension and obesity during pregnancy. Additionally, a mother’s use of drugs or alcohol while pregnant has been linked as a potential cause of autism in children.

Risk Factors For Developing Autism

Autism can affect individuals of every gender, race and socioeconomic status. However, there are certain aspects that can increase the likelihood that a child will develop an ASD.

Some risk factors that increase the chances of developing an ASD are:

• Family history – Families who have one child or more with an ASD have an increased risk of having a second or third child with the disorder.
• A child’s sex – Males are four times more likely to develop an ASD than females.
• The parent’s age – Children born to older parents have a higher chance of developing an ASD.
• A premature birth – Babies born before 26 weeks have an increased risk of developing an ASD.

Types of Autism Spectrum Disorders

Individuals with an ASD have different ways of learning, paying attention and reacting to sensations and situations. The comprehension and learning capabilities of individuals with an ASD can vary from being extremely gifted in one field to severely challenged in others.

The five general types of ASDs are:

• Autistic Disorder
• Asperger’s Syndrome
• Pervasive developmental disorder
• Rett syndrome
• Childhood disintegrative disorder

Autistic Disorder

Autistic disorder is a brain development disorder that is often present during early childhood. This type of ASD is characterized by difficulty communicating and forming relationships with others, as well as trouble grasping language and abstract concepts.

Signs of autistic disorder include:

• Failure to respond to his or her name, or not hearing people speaking to them
• Has poor eye contact and lacks facial expression
• Resists cuddling or holding and seems to prefer playing alone
• Delayed speech and language development
• Speaks with an abnormal tone or rhythm – may use a “singsong voice” or robot-like speech
• Performs repetitive movements, such as rocking, spinning or hand-flapping
• Being fascinated by details of an object, such as the wheels of a toy car, but doesn’t understand the “big picture” of the subject

Asperger’s Syndrome

Also referred to as Asperger’s disorder, Asperger’s syndrome is a developmental disorder that involves a delay in the development of many basic skills. While Asperger’s syndrome is similar to autistic disorder, there are a few distinct differences.

Children with Asperger’s syndrome are typically higher functioning than those with autism, and they usually have normal intelligence and language development.

Signs of Asperger’s syndrome include:

• Slow development of social skills
• Eccentric or repetitive behaviors, such as hand wringing or finger twisting
• Unusual preoccupations or rituals
• Limited range of interest
• Poor coordination
• Exceptional skills or talents, such as in music, art or math

Pervasive Development Disorder

Individuals who meet some, but not all, of the criteria for autistic disorder and Asperger’s syndrome may be diagnosed with Pervasive Development Disorder, or PDD. Children with PDD usually have fewer and milder symptoms of autistic behavior and development. The symptoms of PDD mostly cause challenges in regards to social interaction and communication.

Signs of Pervasive Development Disorder include:

• Difficulty with verbal communication and understanding spoken language
• Challenges exhibiting nonverbal gestures, such as hand motions and facial expressions
• Difficulty with social interaction, relating to others and their surroundings
• Repetitive body movements or patterns of behavior, such as spinning or head banging
• Temper tantrums
• Aggressive behavior
• Trouble sleeping or staying asleep
• Difficulty adjusting to changes in routine or familiar surroundings

Rett Syndrome

Rett syndrome is a rare neurological disorder that occurs almost exclusively in girls, however it is possible in boys as well. This condition can lead to severe impairments that affect nearly every aspect of a child’s life. Rett syndrome can hinder a child’s ability to speak, walk, eat and even breathe easily on their own. A distinct symptom associated with this syndrome is constant, repetitive hand movements.

Signs of Rett syndrome include:

• A slowing of head growth between 6 and 18 months of age
• Loss of muscle tone
• Habitually wringing or rubbing hands together
• Deteriorating language skills
• Development of extreme social anxiety or withdrawing from others
• A jerky, stiff-legged walk
• Uncoordinated breathing
• Seizures

Childhood Disintegrative Disorder (CDD)

Childhood disintegrative disorder, or Heller’s syndrome, is a rare condition characterized by a gradual decrease in development. Children with PDD usually show signs of a typical development up until the age of 3 or 4. Then, over usually a few months, children lose language, motor, social and other skills that they have already acquired. For example, a child who previously spoke in phrases of a few words will gradually or abruptly lose the ability to communicate altogether.

Signs of Childhood Disintegrative Disorder include:

• Delay or regression of spoken language
• Impairment in nonverbal behaviors
• Inability to start or maintain conversations
• Lack of bowel or bladder control
• Loss of motor skills
• Problems forming relationships with other children or family members

Conversely, goiter is often caused by — and a symptom of — hyperthyroidism in the United States, where iodized salt provides plenty of iodine.

Goiter can affect anyone at any age, especially in areas of the world where foods rich in iodine are in short supply. However, goiters are more common after the age of 40 and in women, who are more likely to have thyroid disorders. Other risk factors include family medical history, certain medication usage, pregnancy, and radiation exposure.

There might not be any symptoms if the goiter isn’t severe. The goiter may cause one or more of the following symptoms if it grows large enough, depending on the size:

• swelling or tightness in your neck
• difficulties breathing or swallowing
• coughing or wheezing
• hoarseness of voice

Symptoms

The degree of swelling and the severity of symptoms produced by the goiter depends on the individual.

Most goiters produce no symptoms. When symptoms do occur, the following are most common:

• throat symptoms of tightness, cough, and hoarseness
• trouble swallowing
• in severe cases, difficulty breathing, possibly with a high-pitch sound

Other symptoms may be present because of the underlying cause of the goiter, but they are not because of the goiter itself. For example, an overactive thyroid can cause symptoms such as:

• nervousness
• palpitations
• hyperactivity
• increased sweating
• heat hypersensitivity
• fatigue
• increased appetite
• hair loss
• weight loss

In cases where goiter is a result of hypothyroidism, the underactive thyroid can cause symptoms such as:

• cold intolerance
• constipation
• forgetfulness
• personality changes
• hair loss
• weight gain

Aside from the swelling itself, many people with goiter present no symptoms or signs at all.

Causes

Goiter can be caused by a number of different conditions:

Iodine deficiency:

Iodine deficiency is the major cause of goiter worldwide, but this is rarely a cause in more economically developed countries where iodine is routinely added to salt.

As iodine is less commonly found in plants, vegan diets may lack sufficient iodine. This is less of a problem for vegans who live in countries such as the United States that add iodine to salt.

Dietary iodine is found in:

• seafood
• plant food grown in iodine-rich soil
• cow’s milk

In some parts of the world, the prevalence of goiters can be as high as 80 percent, such as in the remote mountainous regions of southeast Asia, Latin America, and central Africa. In these places, daily intake of iodine can fall below 25 micrograms (mcg) per day, and children are often born with hypothyroidism.

The thyroid gland needs iodine to manufacture thyroid hormones, which regulate the metabolism.

Other causes

Less common causes of goiter include the following:

• Smoking: Thiocyanate in tobacco smoke interferes with iodine absorption.
• Hormonal changes: Pregnancy, puberty, and menopause can affect thyroid function.
• Thyroiditis: Inflammation caused by infection, for example, can lead to goiter.
• Lithium: This psychiatric drug can interfere with thyroid function.
• Overconsumption of iodine: Too much iodine can cause a goiter.
• Radiation therapy: This can trigger a swollen thyroid, particularly when administered to the neck.

Goiter diagnosis and treatment

Your doctor will feel your neck area and have you swallow during a routine physical exam. Blood tests will reveal the levels of thyroid hormone, TSH, and antibodies in your bloodstream. This will diagnose thyroid disorders that are often a cause of goiter. An ultrasound of the thyroid can check for swelling or nodules.

Goiter is usually treated only when it becomes severe enough to cause symptoms. You can take small doses of iodine if goiter is the result of iodine deficiency. Radioactive iodine can shrink the thyroid gland. Surgery will remove all or part of the gland. The treatments usually overlap because goiter is often a symptom of hyperthyroidism.

Goiters are often associated with highly treatable thyroid disorders, such as Graves’ disease. Although goiters aren’t usually a cause for concern, they can cause serious complications if they’re left untreated. These complications can include difficulty breathing and swallowing.