When Nandini Sharma first complained of fatigue, depression and weight gain, her doctor suggested she needed exercise. Nandini enrolled into a gym, but her weight problem persisted. Her doctor then referred her to a psychiatrist.

Eventually Nandini was diagnosed -- she did not suffer from depression; she had a problem with her thyroid, a small butterfly shaped gland located in the neck below the Adam's gland.

Most of us are unaware of this gland, let alone its functions, yet it influences many parts of our body and can cause a wide variety of symptoms.

Although not usually life-threatening, a thyroid problem can adversely affect your well-being. They can influence a person's moods, energy levels, tolerance to heat and cold and, in the case of women, their menstrual cycle and fertility.

What does your thyroid gland really do?

It produces thyroid hormones, which perform many important functions.

Thyroid hormones: 

~ Stimulate oxygen consumption.

~ Stimulate milk production in lactating mothers. 

~ Help ensure nerve impulses are transmitted through the nervous system quickly and efficiently. 

~ Have a dramatic effect on the normal development of the brain in the foetus and in young children. 

~ Are essential for normal menstrual cycles and fertility. 

~ Play an essential role in the normal growth and development of infants and children.

Your thyroid produces two main hormones, thyroxine and triiodothyronine. These hormones:

~ Maintain the rate at which your body uses fats and carbohydrates.

~ Help control your body temperature.

~ Influence your heart rate and helps regulate the production of protein.

~ Produce calcitonin, a hormone that regulates the amount of calcium in your blood.

What causes thyroid disease

There are a variety of factors that can contribute to the development of thyroid problems:

~ Too much or a shortage of iodine in the diet.

~ Too much consumption of some soy products, such as soy protein, capsules and powders.

~ Radiation treatment to the head, neck or chest. Radiation treatment for tonsils, adenoids, lymph nodes, thymus gland problems or acne.

~ Over-consumption of uncooked 'goitrogenic' foods such as Brussel sprouts, broccoli, turnip, radish, cauliflower, cassava, millet, cabbage and kale.

Nandini's problem turned out to be a thyroid that was producing too little hormone; this is also known as hypothyroidism.

Alternately some people produce excess thyroid hormones; this causes the body to speed up and can cause weight loss and a rapid heartbeat. This condition is known as hyperthyroidism. Although it usually occurs in young or middle aged adults, it can affect adolescents and older adults as well.

Symptoms of hypothyroidism

When people eat foods that are deficient in iodine, they develop hypothyroidism.

The most common symptoms are:

• Fatigue
• Lethargy
• Unexplained weight gain of about three to four kilos
• Forgetfulness
• Difficulty in concentrating
• Dry, coarse hair
• Hair loss
• Loss of eyebrow hair
• Dry skin
• Heavy menstrual periods
• Brittle nails
• Constipation
• Feeling cold/ cold intolerance
• Depression
• Low energy levels

If hypothyroidism isn't treated, the symptoms can gradually become severe. The constant stimulation of your thyroid to release more hormones may lead to an enlarged thyroid (goitre). You may become forgetful and your thought processes may slow down.

Advanced hypothyroidism, known as myxedema, is very rare. When it occurs, though, the condition can be life threatening. Its symptoms include:

• Drowsiness
• Intense intolerance to cold followed by profound lethargy and unconsciousness.

Healthy eating habits

~ Some foods, such as rapeseed (used to make canola oil) and brassica vegetables (cabbage, Brussel sprouts, broccoli, cauliflower, turnip) contain natural goitrogens; these are chemicals that cause the thyroid gland to enlarge by interfering with the thyroid hormone synthesis. Avoid these vegetables if you are suffering from hypothyroidism.

~ Other foods that have goitrogens include maize, millets, sorghum, sweet potatoes, soy and its products.
 
~ Your fat intake should come mainly from vegetable oil, which is rich in essential fatty acids. You should not have more than 30 grams of fat (which is about two teaspoons of oil per day).

~ Your vitamin and mineral intake should meet your daily requirement.

~ Use very little sodium chloride (common salt). Avoid salted confectioneries, chips and pickles.

~ Your symptoms could also reduce if you limit smoking, alcohol and caffeine (found in tea, coffee, cola and chocolate); these can raise your metabolic rate.

~ Increase your iodine consumption by eating the following: 

• Seafood -- fish, fresh and canned oysters, prawns, shrimps, mussels and seaweed. 
• The iodine content of other foods such as cereals, fruits, vegetables, meat, milk and eggs depends on the iodine of the soil and water in the area where they have been cultivated. Food products cultivated along the coastline will contain more iodine than food grown at inland farms.
• Finally. there is iodised table salt, which is now available -- in fact, table salt is now compulsorily iodised -- in our country.
• The best way of making sure you are getting enough iodine is to eat fish three times a week.

Symptoms of hyperthyroidism 

When your thyroid gland produces too much of the hormone thyroxine, you suffer from a condition known as hyperthyroidism (overactive thyroid gland disease). This can accelerate your body's metabolism -- sometimes as much as 60 to 100 percent.

The most common symptoms are:

• Irritability and nervousness
• Tremors
• Depression
• Insomnia
• Bulging eyes
• An unblinking stare
• Rapid or irregular heart rate or pounding of your heart
• Sudden weight loss even when your appetite and food intake remain normal or increases
• Intolerance to heat
• Diarrhoea
• Changes in bowel patterns
• Specially more frequent bowel movements
• An enlarged thyroid (goitre) which may appear as a swelling at the base of your neck
• Fatigue and muscle weakness

Healthy eating habits

~ Your intake of Vitamin A, B complex and C should be increased to twice the daily requirement. Your diet could include:

• A combination of pulses and wheat sprouts; this will give you the Vitamin B complex and Vitamin C that you need.
• Carotene rich foods like papaya, mango, fenugreek leaves and spinach. This will ensure you have enough Vitamin A as your body will convert the carotene to Vitamin A.

~ When you suffer from hyperthyriodism, calcium and phosphorous excretion is greatly increased. Hence, calcium and phosphorus rich food like milk, milk products (yoghurt and cottage cheese) and dark green leafy vegetables (spinach) must be part of your daily diet.

Ragi prepared with milk is an excellent source of calcium and phosphorus. Fish is also a good source of calcium, especially small fish, which can be eaten with the bones.

~ Beef, poultry, fish, eggs, pork, lamb, veal, chicken, ham, and bacon can form a part of your diet.

~ Avoid special dietary products like Ensure, Slimfast, Boost (liquids, powders, bars) in either of these conditions. 

How to detect thyroid disease

~ Get a thyroid profile blood test done at any pathology laboratory.  

~ The test costs approximately Rs 600 to Rs 800.

~ You will get the results in two or three days. 
 
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Seemaa Tarneja and Priya Khanna have a specialisation in nutrition from SNDT University, Mumbai, and currently manage their own practice.