Have a cough? Here are 10 health issues you might have

Coughing is one of those things we do for a variety of reasons.

It can be a social thing, where we cough to get attention; or it could be psychological, where we do it to clear our throats prior to speaking in public.

October 28, 2018 Health

By TAN SHIOW CHIN

A cough can be indicative of a range of respiratory conditions, ranging from the common cold to lung cancer.

But most often, we cough in response to something irritating our respiratory system, which includes the throat and the lungs.

This is most likely due to either an irritant in our environment, like smoke or the haze, or a respiratory infection like the cold or flu.

Says consultant physician and respiratory specialist Dr Kow Ken Siong: “Cough is not necessarily bad, to be honest, because the cough reflex is actually there to protect us. It is designed to keep foreign particles out of our airways, so it’s not always a bad thing.

“But of course, if it is very persistent and affects the quality of life of patients, obviously, we need to find out why this person is coughing incessantly.”

Most patients, he says, tend to see the doctor when their cough has lasted between three to eight weeks, also known as a subacute cough. Any cough lasting more than eight weeks is considered chronic.

Shares Dr Kow: “In terms of cough and/or breathlessness, I think these two symptoms are probably the most common symptoms that patients come to consult with a respiratory physician.

“For example, cough will probably be the main symptom in about half of all our patients. And I would say that even more patients come in with breathlessness.

“And there’s a good amount of patients who come in with both symptoms at the same time.”

A chest X-ray is a common investigation tool for cases with a chronic cough. — AFP

Subacute cough

For coughs that have been present between three to eight weeks, three conditions usually come to mind, says Dr Kow.

One of them is upper airway cough syndrome.

“This is an umbrella term just to make things easier,” he explains. “For example, upper airway cough syndrome would consist of something very common – post-nasal drip.”

This occurs when someone with rhinitis – which is when the mucous membrane of the nose is inflamed from allergies or infections – experiences excessive mucus accumulating at the back of their nose and dripping down to the throat.

This irritates the throat, resulting in a cough that tries to get rid of the mucus. Other symptoms usually include a stuffy and/or runny nose, sneezing and frequent throat-clearing in an attempt to get rid of the drip.

Another condition with subacute cough is gastroesophageal reflux disease (GERD).

“Generally, these patients will present with heartburn; so, they may complain of a retrosternal burning sensation and a bitter taste behind their tongue,” he says.

“But then again, sometimes, these symptoms might not be present; the only manifestation is actually the dry cough lasting three to eight weeks.”

The other condition a doctor would consider is asthma.

A history of heavy smoking, combined with a chronic cough, tends to point towards either COPD or lung cancer. — AP

This, Dr Kow says, is “a very common respiratory condition contributes to both symptoms of subacute and chronic cough, and breathlessness”.

He explains: “You can say that asthma is an inflammation of the airways due to triggers, which are particular to each patient.

“There are common triggers obviously, but every individual with asthma may have different triggers, resulting in inflammation of the airways leading to bronchospasm (which causes narrowing of the airways).

“It is this bronchospasm that gives rise to the symptoms of breathlessness and wheezing.”

Asthma typically runs in families as it has a genetic component, so family history of asthma is a strong indicator that the patient’s symptoms are a result of asthma.

While most patients develop asthma in their childhood, it can also first manifest in a patient’s 20s, especially if there is a strong family history of asthma and they become pregnant, as well as in their 40s or 50s, although these patients would have to be carefully examined to exclude chronic obstructive pulmonary disease (COPD), which is more common in that age group.

“It is about 20%-25% of patients who develop adult-onset asthma, and it is more common in females,” says Dr Kow.

Some childhood asthma patients who have outgrown their asthma may also find that it returns when they are adults.

Those with no family history of asthma may develop the condition due to environmental triggers like exposure to certain chemicals in childhood, or the body’s own immune response to respiratory infections, that both help to prime the respiratory system to develop asthma.

According to Dr Kow, patients usually experience cough and/or shortness of breath at night or early in the morning.

He notes that exercise can also bring on shortness of breath and coughing, along with chest tightness, and sometimes, wheezing. These symptoms usually start around three minutes after starting to exercise.

Chronic cough

For coughs that last longer than eight weeks, Dr Kow divides up the possible causes into diseases of the airway and diseases that affect the lung parenchyma – the “meat” of the lung.

Diseases of the airway include bronchiectasis – the abnormal, irreversible dilatation of the bronchi with bronchial wall thickening due to previous infection and inflammation – and COPD.

For COPD, Dr Kow notes that there is usually a very strong history of smoking at least one pack a day for a minimum of 20 years.

In addition, he says that while asthma patients may have good days where they do not have any symptoms at all, COPD patients never have such days, only times when their symptoms might be less bothersome.

Another airway disease is foreign body aspiration into the lung, leading to infection.

Says Dr Kow: “When a patient comes in with cough, if you don’t ask them, sometimes, they may not tell you that they tend to choke when they eat or drink, especially the elderly.

“So, we’re more likely to see these sort of symptoms due to foreign body aspiration in the elderly and those who have underlying co-morbidities, for example, if they have had strokes before or radiotherapy treatment to their upper airways, affecting their swallowing ability.”

Dr Kow notes that in about one-third of cases with cough, investigations like blood tests, chest X-rays and a lung function test, are necessary to help determine the diagnosis. — SAM THAM/The Star

He adds that the aspirated foreign body need not necessarily be a big piece of food, but could be something small that often goes unnoticed, for example, a grain of rice, or even water.

Lung tumours can also cause chronic coughing.

However, Dr Kow says: “To be honest, they are responsible for symptoms like cough and shortness of breath less than 5% to 10% of the time.”

More common symptoms of a lung tumour would be weight loss, loss of appetite and coughing up blood (haemoptysis). A history of smoking is also quite common.

Meanwhile, among the diseases that affect the lung parenchyma resulting in chronic cough is interstitial lung disease.

This disease, which affects the tissue and space around the air sacs of the lungs (the interstitium), tends to cause a dry cough and shortness of breath that gets worse with time.

“One of the more common interstitial lung diseases that can cause these symptoms is pulmonary fibrosis, of which idiopathic pulmonary fibrosis is the most common,” he says, adding that these patients tend to be in their 70s and male.

Another condition is a lung abscess.

“It’s not so common, but if patients present with shortness of breath and cough with a productive sputum, which tends to be quite mucopurulent (pus-like) and foul-smelling, and if they’ve had an underlying lung infection prior to this, a pneumonia for example, then you might suspect a lung abscess if the pneumonia didn’t heal well,” he says.

Finally, Dr Kow says that there is the 10% of patients with cough in whom, despite proper history-taking, physical examination and investigation, no cause can be found for the cough.

“We will probably categorise these patients as having idiopathic chronic cough,” he says, adding that this is more likely in females as it is hypothesised that females tend to have a more sensitive cough reflex, compared to males.

https://www.star2.com/health/2018/10/28/10-conditions-a-cough-can-indicate

Should I take antibiotics for a cough that won’t go away?

Although this has long been known, it hasn’t been a very easy message to get across to people who are sick with cold symptoms and want something to make them feel better fast.

Over the years, overuse and abuse of antibiotics have resulted in a big problem. Many bacteria have become resistant to the antibiotics that once were able to kill them.

APRIL 9, 2016

Most bronchitis is viral and shouldn't be treated with antibiotics. Photo: TNS

Newer, stronger antibiotics have been developed to fill the gap, but some bacteria are even resistant to the most powerful agents we have.

That’s why health officials at the federal, state and local levels in the US have been waging a campaign to educate both doctors and patients about the dangers of taking antibiotics when they aren’t really warranted.

A few weeks ago, I wrote about the long-lasting hacking coughs that have accompanied so many upper respiratory infections for so many people I know. I mentioned what I’ve heard so many times: That antibiotics should be avoided unless a viral infection lingers and turns into a bacterial infection, such as bronchitis, sinusitis or pneumonia.

In response, I heard from Dr Janice Huff, a family physician, who pointed out that most bronchitis is viral and that antibiotics are often inappropriately prescribed. “Too many people think they need antibiotics for bronchitis, and we need to combat this ignorance.”

Although viral infections are sometimes followed by bacterial infections, which may be treated with antibiotics, Huff said distinguishing one from another is very difficult.

For many years, patients with upper respiratory infections have been coming to doctors after being sick for a day or two and asking for antibiotics. “Two days of cold symptoms is not usually bacterial,” Huff said.

She said doctors should not consider giving antibiotics unless a patient has already been sick for 10 to 14 days or has complications such as high fever and severe facial pain.

Such patients should see their doctors because they may have developed bacterial infections. “There is a small percentage of people who really do need antibiotics,” Huff said. “I don’t want anybody not to take them when they need them.”

Some companies offer rapid tests for influenza and other viruses, but doctors say they’re not always accurate, and wonder if the expense is worth it, especially because the illness would likely have improved on its own with time.

But it takes a determined doctor to refuse antibiotics for patients who have paid to come to the office and expect a prescription.

“It takes a lot longer to have the conversation with people about why we’re not going to give the antibiotics,” Huff said. “A lot of doctors just give antibiotics because it’s faster and easier. But it’s wrong. We should spend time talking to each other to make the right decision.”

Dr David Priest, medical director for infection prevention for Novant Health, leads the Winston-Salem, North Carolina-based hospital system’s effort to reduce inappropriate antibiotic use. He says patients should be as concerned as doctors.

For example, if you give a healthy volunteer an unneeded antibiotic, his remaining natural bacteria will be resistant to that specific antibiotic for six to 12 months, Priest said.

The antibiotic will have killed off susceptible bacteria, leaving only the resistant ones.

“The danger is that if you do that many times over, the whole population will be resistant to the last antibiotic they got,” Priest said. “If the public and the physicians thought about it that way, they would be a little more hesitant to take antibiotics unless it was absolutely necessary.”

One significant problem is the rise of C. diff, short for Clostridium difficile, a diarrhoeal infection most likely to affect patients in hospitals or long-term care centres.

Victims often have conditions that required treatment with antibiotics, and those drugs killed off the intestinal bacteria that had kept C. diff bacteria in check. The infection is potentially life-threatening because C. diff has also become resistant to many antibiotics.

It’s one more reason why everyone should think seriously before assuming antibiotics are the answer.

“We live in a world that wants things fixed quickly,” Priest said. “People underestimate how long it takes to get over a bad viral bronchitis. Weeks and weeks and weeks.” – The Charlotte Observer/Tribune News Service

http://www.star2.com/health/wellness/2016/04/09/should-i-take-antibiotics-for-a-cough-that-wont-go-away/

This post is on Healthwise

What's causing that cough? 10 causes and how to deal with them

Many of us nurse a nasty bark as winter ends but to beat it you must find out what's behind it

• UPDATED 12:08, 27 MAR 2014
• BY CAROLINE JONES

So your cold's long gone, but have you now been left with a lingering cough that is keeping everyone awake and annoying colleagues?

New US research shows the average time for a cough to last after a virus is an exhausting 18 days - with many coughs sticking around even longer.

GPs admitted they have been inundated over the winter with patients complaining that they just can't shift their persistent coughs, so what can you do?

"Coughing actually has an important purpose," explains Professor Ron Eccles, director of the Common Cold Centre at Cardiff University.

"It's your body's way of keeping unwanted stuff from getting into your lungs. But unfortunately, post-virus, this irritating symptom can really linger.

"The majority of viral coughs are safe to treat at home, but you may need your GP's help to shift it if it develops into a secondary chest infection."

However, some persistent coughs aren't viral at all.

"Anything still bashing away after three weeks needs investigating," says Professor Stephen Spiro, medical adviser with the British Lung Foundation.

"Prolonged coughs can be a sign of anything from asthma and heartburn to more serious lung disease - especially in smokers who often wrongly assume their cough is just par for the course."

Here are the 10 most common cough causes - and their treatments.

Post-viral cough

Symptoms: An irritating cough following a cold.

Causes: It's normal to have a cough with a virus, as it's triggered by mucus draining down the back of the throat. The inflammation this causes often stays long after the initial illness.

Treat it: Some 90% of cases aren't bacterial, so antibiotics won't help. Prof Eccles advises using an over-the-counter syrup (try Covonia Chesty Cough Mixture, £3.98, from chemists) to loosen phlegm, or even just a hot drink, which promotes secretions in the airways, soothing irritation. If your sinuses are still inflamed, your GP can prescribe a steroid nose spray.

Asthma

Symptoms: A chronic dry cough that's worse at night, disturbing sleep, and sometimes with wheezing and shortness of breath.

Causes: An irritating night cough is often the first sign of asthma, especially in children, but you can develop it at any age. It's also a sign asthma is worsening or not being well controlled.

Treat it: The first thing your GP will try is a blue'reliever' inhaler, which releases medication to open the airways. In more severe cases, a brown 'preventer' inhaler is prescribed, which contains a steroid to reduce airway inflammation.

Heartburn

Symptoms: A 'throat' cough following a meal, or waking you at night, often with a nasty acid taste in your mouth.

Causes: Heartburn, or acid reflux, occurs when stomach acid flows back up the oesophagus, irritating the throat and triggering a cough. Large or rich meals late at night are triggers.

Treat it: Sleeping with an extra pillow can help reduce the backflow of acid. If it's occasional, a simple over-the-counter anti-reflux treatment, such as Zantac, will reduce the production of stomach acid. If it's frequent, talk to your GP who may want to investigate.

Chest infection

Symptoms: A hacking cough with greenish phlegm, plus a fever that follows after a cold.

Causes: A chest infection, or acute bronchitis, affects the lower airways. It's generally caused by the same viruses that cause colds, but inflammation spreads lower into the lungs, leaving the area open to attack by bacteria.

Treat it: Drink plenty of fluids and take paracetamol to reduce a fever. Because most bronchitis is caused by a virus, your doctor will only prescribe antibiotics if he suspects a secondary bacterial infection has occurred.

Whooping cough

Symptoms: Uncontrollable coughing fits, which may produce a 'whoop' sound.

Causes: This highly contagious disease has been on the rise again in recent years, and spreads when an infected person coughs and another person inhales the bacteria. A vaccine is given to babies and since last year, pregnant women, but protection fades so you can still get it as an adult.

Treat it: Babies are at the highest risk of severe complications and death and need close monitoring. In older children and adults it's generally unpleasant, but not serious, lasting up to six weeks. Drink plenty of fluids and take ibuprofen to ease a sore throat.

Medication cough

Symptoms: A dry, niggling cough, often worse at night.

Causes: ACE inhibitors, a drug used to control high blood pressure, can cause a chronic cough in 20% of patients.

Treat it: If your cough coincided with starting medication, talk to your doctor who can supply alternative blood pressure drugs.

Tuberculosis

Symptoms: A persistent cough, often with extreme tiredness, weight loss, night sweats and coughing up blood.

Causes: Another highly infectious illness, once thought to be wiped out, current TB rates are the highest for 40 years.

Treat it: Because TB awareness is low these days, it's worth mentioning the condition to your GP if your symptoms fit those described above. If they suspect TB you'll have a skin test to check for antibodies and be sent for a lung X-ray. Treatment involves six months of strong antibiotics that cures 99% of cases.

Smokers' cough

Symptoms: It's easy to get used to a 'smokers' cough' but if it changes in any way, for example, becomes more frequent or you cough up blood, it needs checking out immediately.

Causes: Smoking irritates the airways causing a cough, which in the long-term can be a sign of COPD - chronic obstructive pulmonary disease, including emphysema and chronic bronchitis - meaning there's irreversible damage to your airways, worsening if you continue puffing away.

Treat it: If you're a smoker or ex-smoker with a persistent cough, your GP should send you for X-ray. It's never too late to quit - giving up will lessen or abolish a smokers' cough in 94% of people within four weeks, and will stop the rate of deterioration in COPD cases.

Lung cancer

Symptoms: A new cough lasting longer than three weeks, a long-standing cough that gets worse, coughing up blood, unexplained breathlessness, weight loss, tiredness or chest pain.

Causes: Lung cancer is now the second most common cancer in the UK and smoking accounts for 90% of cases. Treat it: If an X-ray confirms it, treatment combining surgery, chemotherapy and radiotherapy depends on the stage of the cancer.

Heart problems

Symptoms: Persistent coughing or wheezing, plus extreme tiredness, breathlessness on exertion and fluid retention.

Causes: When you suffer heart failure, fluid can build up in the lungs and cause a lingering cough.

Treat it: See your GP immediately. If they suspect heart failure you'll be referred to a specialist hospital clinic for an ECG and blood tests. Treatments include ACE inhibitors to prevent fluid build-up and beta-blockers to slow the heart rate.

http://www.mirror.co.uk/lifestyle/health/whats-causing-cough-10-causes-1758473

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What You Need to Know About Your Thyroid Health - MUST READ

Your thyroid, one of the largest endocrine glands, greatly influences almost every cell in your body. Aside from regulating your metabolism and weight by controlling the fat-burning process, thyroid hormones are also required for the growth and development in children and in nearly every physiological process in your body.

Dr Mercola

Story at-a-glance

• The thyroid gland is a butterfly-shaped gland found inside your neck, right under your larynx or voice box.
• Your thyroid is responsible for producing the master metabolism hormones that control every function in your body.
• Hypothyroidism occurs when your thyroid produces too little thyroid hormone, a condition that is often linked to iodine deficiency.

When your thyroid levels are out of balance, so are you. Too much or too little hormone secretion in this gland can spell trouble for your overall health and well-being.

Mounting research shows that 10 to 40 percent of people living in the United States have suboptimal thyroid function.1 Poor thyroid function has been linked to serious health conditions like fibromyalgia, irritable bowel syndrome, acne, eczema, gum disease, infertility, and autoimmune diseases, which is why it's imperative that you to learn how your thyroid works and what can cause it to go off kilter.

The Thyroid Gland: Understanding How It Works

The thyroid gland is a butterfly-shaped gland found inside your neck, right under your larynx or voice box. A two-inch long, brownish red, highly vascular gland, it has two lobes located on each side of the windpipe that are both connected by a tissue called the isthmus. A normal thyroid gland weighs somewhere between 20 and 60 grams.

Your thyroid is responsible for producing the master metabolism hormones that control every function in your body. It produces three types of hormones:

• Triiodothyronine (T3)
• Thyroxine (T4)
• Diiodothyronine (T2)

Hormones secreted by your thyroid interact with all your other hormones, including insulin, cortisol, and sex hormones like estrogen, progesterone, and testosterone. The fact that these hormones are all tied together and are in constant communication explains why a less-than-optimal thyroid status is associated with so many widespread symptoms and diseases.

Almost 90 percent of the hormone produced by your thyroid is in the form of T4, the inactive form. Your liver then converts the T4 into T3, the active form, with the help of an enzyme. T2, however, is currently the least-understood component of thyroid function and the subject of a number of ongoing studies.

If everything is working properly, you will make what you need and have the correct amounts of T3 and T4, which control the metabolism of every cell in your body. If your T3 is inadequate, either by scarce production or not converting properly from T4, your whole system suffers. T3 is critically important because it tells the nucleus of your cells to send messages to your DNA to rev up your metabolism by burning fat. This is how T3 lowers cholesterol levels, regrows hair, and helps keep you lean.

Your T3 levels can be disrupted by nutritional imbalances, toxins, allergens, infections, and stress, and this lead to a series of complications, including thyroid cancer, hypothyroidism, and hyperthyroidism, which today are three of the most prevalent thyroid-related diseases.

Now, let's discuss and delve deeper into these thyroid problems.

Hypothyroidism: The Sluggish Thyroid Syndrome

Hypothyroidism occurs when your thyroid produces too little thyroid hormone, a condition that is often linked to iodine deficiency.

Dr. David Brownstein, a board-certified holistic practitioner who has been working with iodine for the last two decades, claims that over 95 percent of the patients in his clinic are iodine-deficient.

In addition, 10 percent of the general population in the United States, and 20 percent of women over age 60, have subclinical hypothyroidism,2 a condition where you have no obvious symptoms and only slightly abnormal lab tests.

However, only a marginal percentage of these people are being treated. The reason behind this is the misinterpretation and misunderstanding of lab tests, particularly TSH (thyroid stimulating hormone). Most physicians believe that if your TSH value is within the "normal" range, your thyroid is fine. But as I always say, the devil is in the details. More and more physicians are now discovering that the TSH value is grossly unreliable for diagnosing hypothyroidism.

How to Know If You Are Hypothyroid

Identifying hypothyroidism and its cause is tricky business. Many of thesymptoms of hypothyroidism are vague and overlap with other disorders. Physicians often miss a thyroid problem since they rely on just a few traditional tests, leaving other clues undetected.

The most sensitive way to find out is to listen to your body. People with a sluggish thyroid usually experience:

• Lethargy - Fatigue and lack of energy are typical signs of thyroid dysfunction. Depression has also been linked to the condition. If you've been diagnosed with depression, make it a point that your physician checks your thyroid levels.
It's essential to note that not all tiredness or lack of energy can be blamed on a dysfunctional thyroid gland. Thyroid-related fatigue begins to appear when you cannot sustain energy long enough, especially when compared to a past level of fitness or ability. If your thyroid foundation is weak, sustaining energy output is going to be a challenge. You will notice you just don't seem to have the energy to do the things like you used to.
Some of the obvious signs of thyroid fatigue include:
• Feeling like you don't have the energy to exercise, and typically not exercising on a consistent basis
• A heavy or tired head, especially in the afternoon; your head is a very sensitive indicator of thyroid hormone status
• Falling asleep as soon as you sit down when you don't have anything to do

• Weight gain – Easy weight gain or difficulty losing weight, despite an aggressive exercise program and watchful eating, is another indicator.
• Rough and scaly skin and/or dry, course, and tangled hair – If you have perpetually dry skin that doesn't respond well to moisturizing lotions or creams, consider hypothyroidism as a factor.
• Hair loss – Women especially would want to pay attention to their thyroid when unexplained hair loss occurs. Fortunately, if your hair loss is due to low thyroid function, your hair will come back quickly with proper thyroid treatment.
• Sensitivity to cold – Feeling cold all the time is also a sign of low thyroid function. Hypothyroid people are slow to warm up, even in a sauna, and don't sweat with mild exercise.
• Low basal temperature - Another telltale sign of hypothyroidism is a low basal body temperature (BBT), less than 97.6 degrees Fahrenheit averaged over a minimum of three days. It is best to get a BBT thermometer to assess this.

Any of these symptoms can be suggestive of an underactive thyroid. The more of these symptoms you have, the higher the likelihood that you have hypothyroidism. Furthermore, if you have someone in your family with any of these conditions, your risks of thyroid problems become higher:

Goiter	Diabetes	Multiple sclerosis (MS)
Prematurely gray hair	Autoimmune diseases, (i.e. rheumatoid arthritis, lupus, sarcoidosis, Sjogren's)	Elevated cholesterol levels
Left-handedness	Crohn's disease or ulcerative colitis	High or low thyroid function

The more vigilant you are in assessing your own symptoms and risk factors and presenting the complete picture to your physician, the easier it will be for you to get the proper treatment.

How About If You Have a Hyperactive Thyroid?

Thyroxine or T4 is a hormone made by the thyroid gland carried throughout your body in your bloodstream. Many of your cells and tissues depend on thyroxine to work properly.

An overactive thyroid secretes too much T4, causing some of your body functions to accelerate. Physicians may use the term "thyrotoxicosis" instead of "hyperthyroidism." This condition is more common in women – about eight in 100 women and one 1 in 100 men develop hyperthyroidism at some point in their lives. It can occur at any age.3

Patient.co.uk lists several symptoms of hyperthyroidism:

• Feeling restless, nervous, emotional, irritable, sleeping poorly, and as if you're always on the go
• Difficulty concentrating
• Frequent bowel movements
• Irregular menstrual periods in women
• Weight loss (or weight gain, in rare cases)
• Rapid, forceful, or irregular heartbeat
• Lack of menstrual periods in women
• Protruding eyes or exophthalmos

Some of these symptoms may be unnoticeable at first and then become worse as your thyroxine levels start to shoot up even higher.

Untreated hyperthyroidism can lead to heart problems like atrial fibrillation, cardiomyopathy, angina, and heart failure. Hyperthyroid women can potentially have difficulty giving birth.

Diagnosing a Thyroid Issue

There are a few ways to diagnose an underactive or hyperactive thyroid, but I prefer using the following laboratory tests if you want to get the real score of your thyroid health:

TSH Test	The higher your level of TSH, the higher the likelihood that you have hypothyroidism. The ideal level for TSH is between 1 and 1.5 milli-international units per liter.
Free T4 And Free T3	The normal level of free T4 is between 0.9 and 1.8 nanograms per deciliter. T3 should be between 240 and 450 picograms per deciliter.
Thyroid Antibody Testing	This includes thyroid peroxidase antibodies and anti-thyroglobulin antibodies. This measure helps determine if your body is attacking your thyroid, overreacting to its own tissues (i.e., autoimmune reactions). Physicians nearly always leave this test out.
Basal Body Temperature	Although there are a few different protocols, the most commonly used is the Broda Barnes system,4 which is a measure of your basal body temperature at rest.
TRH Stimulation Test	For more difficult cases, TRH can be measured using the TRH stimulation test. TRH helps identify hypothyroidism that's caused by inadequacy of the pituitary gland.

Other tests that might be indicated for more complex cases are a thyroid scan, fine-needle aspiration, and thyroid ultrasound. But these are specialized tests that your physician will use only in a small number of cases, or in special situations.

Even if all your lab tests turn out normal, you still likely have subclinical hypothyroidism if you have multiple thyroid symptoms.

Are Your At Risk of Thyroid Cancer?

According to the National Cancer Institute at the National Institutes of Health, there is an estimated 60,220 new cases and 1,850 deaths from thyroid cancer in the United States alone.5 Thyroid cancer is classified into four different types: papillary thyroid cancer, follicular thyroid cancer, medullary thyroid cancer, and anaplastic thyroid cancer.

Just like with any type of cancer, early intervention heightens your chances of remission and recovery. This is why you should always be on the lookout for possible clues. Below is a list of potential warning signs of thyroid cancer from Roswell Park Cancer Institute:6

• Unusual lumps, nodules, bumps or swelling in the neck
• Pain in the front of the neck or throat
• Hoarseness or other voice changes that do not go away
• A constant cough that is not due to a cold

The Cancer Treatment Centers of America explains that there are certain components that may heighten an individual's overall risk for this disease. These include:

GENDER	Females are three times more vulnerable to developing thyroid cancer than males. Papillary thyroid cancer is typically found in women of childbearing age.
AGE	Two-thirds of thyroid cancer cases occur between ages 20 and 55.
FAMILY HISTORY	Familial medullary thyroid cancer, which is a rare type of thyroid cancer, is caused by an inherited mutation in the RET proto-oncogene. If you have inherited this gene mutation from your parents, your likelihood of contracting this disease is twice higher than other people. Having someone in the family with goiter, thyroid cancer, or other thyroid-related diseases.
IODINE DEFICIENCY	Iodine is an essential ingredient for the secretion of thyroid hormones. An insufficiency in this nutrient can impair the thyroid significantly.
ENVIRONMENT	Individuals who are exposed excessively or repeatedly toradiation, including routine diagnostic X-rays (i.e. chest or dental X-ray) and other radioactive materials are, especially during childhood, can potentially incur thyroid cancer and/or other forms of cancer.

4 Things That Wreak Havoc on Your Thyroid

These are some key contributing factors that can ruin your healthy thyroid function:

1. Gluten – Gluten, along with other food sensitivities, is a notorious culprit of thyroid dysfunction, as they cause inflammation. Gluten causes autoimmune responses in many people and can be responsible for Hashimoto's thyroiditis, a common autoimmune thyroid condition. Approximately 30 percent of the people with Hashimoto's thyroiditis have an autoimmune reaction to gluten, and it usually goes unrecognized.
Gluten sensitivity can cause your gastrointestinal system to malfunction, so foods you eat aren't completely digested, often leading to a leaky gut syndrome. These food particles can then be absorbed into your bloodstream, where your body misidentifies them as antigens – substances that shouldn't be there – and then produces antibodies against them.
These antigens are similar to the molecules in your thyroid gland. Because of this, your body accidentally attacks your thyroid. This is known as an autoimmune reaction, in which your body actually attacks itself.
Testing can be done for gluten and other food sensitivities, which involves measuring your IgG and IgA antibodies.
Chris Kresser, an integrative medicine practitioner, recommends The Gluten-Free Challenge. This involves completely removing gluten from your diet for at least 30 days, and then adding it back right after.

"If symptoms improve during the elimination period, and return when gluten is reintroduced, a diagnosis of non-celiac gluten sensitivity (NCGS) can be made," Kresser explains.

2. Soy - Believe it or not, soy is not the wholesome health food the agricultural and food companies have led you to believe.

Virtually thousands of scientific studies now link soy foods to malnutrition, digestive stress, immune system weakness, cognitive decline, reproductive disorders, infertility, and a host of other problems, on top of the damage it causes your thyroid. Soy phytoestrogens are potent anti-thyroid agents that cause hypothyroidism and may cause thyroid cancer. In infants, consumption of soy formula has been linked to autoimmune thyroid disease.
Properly or traditionally fermented, organic, and unprocessed soy products such as natto, miso, and tempeh are fine – it's the unfermented soy products that you should stay away from, like soy meat, soy milk, soy cheese, etc.
To know more about the evils of soy, read The Whole Soy Story: The Dark Side of America's Favorite Health Food.
1. Bromines – Bromines are a common endocrine disruptor. Because bromide is also a halide, it competes for the same receptors that are used in the thyroid gland to capture iodine. This will inhibit thyroid hormone production resulting in a low thyroid state.
When you ingest or absorb bromine, it displaces iodine, and this iodine deficiency leads to an increased risk for cancer of the breast, thyroid gland, ovary, and prostate – cancers that we see at alarmingly high rates today. This phenomenon is significant enough to have been given its own name: the Bromide Dominance Theory.7
In addition to psychiatric and thyroid problems, bromine toxicity can manifest as skin rashes and severe acne, loss of appetite and abdominal pain, fatigue, a metallic taste in the mouth, and cardiac arrhythmias.
Bromine can be found regularly in a number of places, including:

Pesticides, specifically methyl bromide, used mainly on strawberries, predominantly in California	Plastics, such as those used to make computers	Bakery goods and some floursoften contain a "dough conditioner" called potassium bromate
Soft drinks, including Mountain Dew, Gatorade, Sun Drop, Squirt, Fresca, and other citrus-flavored sodas – in the form of brominated vegetable oils (BVOs)	Medications such as Atrovent inhaler, Atrovent Nasal Spray, Pro-Banthine (for ulcers), and anesthesia agents	Fire retardants like polybromo diphenyl ethers or PBDEs is used in fabrics, carpets, upholstery, and mattresses

The more you can free your body of the toxic halides, the more iodine your body will be able to hang onto, and the better your thyroid will function. Laura Power, a nutritional biochemist, offers these suggestions for increasing secretion of fluorine and bromine:
• Increase your iodine and vitamin C intake
• Opt for unrefined sea salt
• Have Epsom salts baths
• Sweat in a far-infrared sauna
2. Stress and Adrenal Function – Stress is one of the worst thyroid offenders. Your thyroid function is intimately tied to your adrenal function, which is intimately affected by how you handle stress.
Many of us are almost always under chronic stress, which results in increased adrenaline and cortisol levels, and elevated cortisol has a negative impact on thyroid function. Thyroid hormone levels drop during stressful times, which is when you actually need it the most.
When stress becomes chronic, the flood of stress chemicals – adrenaline and cortisol – produced by your adrenal glands interfere with your thyroid hormones, causing a whole gamut of health-related issues like obesity, high blood pressure, high cholesterol, and/or unstable blood sugar levels. A prolonged stress response can lead to adrenal exhaustion, which is also known as adrenal fatigue and which is often found alongside thyroid disease.
But that's not all. Environmental toxins place extra stress on your body, too. Pollutants such as petrochemicals, organochlorines, pesticides, and chemical food additives negatively affect thyroid function.
For ultimate stress relief, I recommend you to read my article 8 Expert Stress-Busting Tips.

Iodine: Probably Your Best Weapon Against Thyroid Problems

Iodine is perhaps the biggest piece of the puzzle when it comes to thyroid hormones. It is a vitally important nutrient that is detected in every organ and tissue. It is essential for healthy thyroid function and efficient metabolism, and there is increasing evidence that relates low to numerous diseases, including cancer.

Iodine is a potent anti-bacterial, anti-parasitic, anti-viral and anti- cancer agent. It has four significant roles in your body, namely to maintain your weight and metabolism, to develop brain and cognitive function in children, to optimize fertility, and to strengthen your immune system.

Though thyroid health is often what people think of when they think of iodine, other tissues also absorb and use large amounts of iodine,8 including your breasts, skin, salivary glands, pancreas, brain, stomach, cerebral spinal fluid, and thymus

Iodine deficiency or insufficiency in any of these tissues will lead to tissue dysfunction. Hence the following symptoms could provide clues that you're not getting enough iodine in your diet. For example, iodine deficiency in:

Salivary glands	Disables your saliva production, making your mouth dry
Skin	Results in rough and dry skin and inability to sweat normally
Brain	Lowers alertness and intelligence quotient (IQ) levels
Muscles	Produces nodules, scar tissue, pain, fibrosis, fibromyalgia

The Total Diet Study, performed by the FDA, reported an iodine intake of 621 micrograms for two-year-olds between 1974 and 1982, compared with 373 micrograms between 1982 and 1991. During the same time period, the baking industry replaced iodine-based anti-caking agents with bromine-based agents.9

In addition to iodine's disappearance from our food supply, exposure to toxic competing halogens –bromine, fluorine, chlorine, and perchlorate– has dramatically increased. You absorb these halogens through your food, water, medications, and environment, and they selectively occupy your iodine receptors, worsening your iodine deficit.

Here are more factors contributing to falling iodine levels:

• Diets low in fish, shellfish and seaweed
• Vegan and vegetarian diets
• Less use of iodide in the food and agricultural industry
• Fluoridated drinking water
• Rocket fuel (perchlorate) contamination in food
• Decreased use of iodized salt
• Less use of iodide in the food and agricultural industry
• Use of radioactive iodine in many medical procedures, which competes with natural iodine

How to Increase Your Iodine Levels Naturally

Sadly, it's thought that up to 40 percent of the population worldwide is at risk for iodine deficiency.10 As a matter of fact, iodine deficiency is one of the three most common nutritional deficiencies, along with magnesium and vitamin D.11

But this doesn't mean that you should start popping iodine supplement pills to fix this issue. Ironically, research has shown that taking too much iodine may also lead to a subclinical version of the condition, which is a milder form that is often missed by laboratory tests.

In fact, the American Thyroid Association (ATA) has issued a statement warning about the risks of too much iodine, especially from iodine, potassium iodide, and kelp supplements. According to the ATA, such supplements may "contain iodine in amounts that are up to a thousand times higher than the daily Tolerable Upper Limits for iodine."

Moreover, they advised against the ingestion of iodine or kelp supplements containing in excess of 500 micrograms iodine daily, and noted that ingesting more than 1,100 micrograms of iodine per day (the tolerable upper limit) may cause thyroid dysfunction.

Personally, I do not advise taking iodine supplements, as their risks usually far outweigh their benefits.

Instead, you can follow these helpful strategies:12

1. Eat organic as often as possible. Wash all produce thoroughly to minimize your pesticide exposure.
2. Avoid eating or drinking from (or storing food and water in) plastic containers. Use glass and safe ceramic vessels.
3. If you have to eat grain, look for organic whole-grain breads and flour. Grind you own grain, if possible. Look for the "no bromine" or "bromine-free" label on commercial baked goods.
4. Avoid sodas. Make natural, filtered water your beverage of choice.
5. If you own a hot tub, look into an ozone purification system. Such systems make it possible to keep the water clean with minimal chemical treatments.
6. Look for personal care products that aren't laced with toxic chemicals. Remember: anything you put on your skin can potentially go into your bloodstream.
7. When in a car or a building, open windows as often as possible, preferably on opposing sides of the space for cross ventilation. Utilize fans to circulate the air. Chemical pollutants are in much higher concentrations inside buildings (and cars) than outside.

If you suspect that you are iodine-deficient, I strongly encourage you to visit your healthcare provider for a urine iodine challenge test.

You can also get an affordable prescription for SSKI or super-saturated potassium iodine, which you apply on your skin once a day. If when you touch something with slightly wet fingertips you see a yellowish stain, it means the iodine is coming out of your skin, indicating that your body has enough supply of iodine inside.

Simple Steps That You Can Do to Improve Your Thyroid Health

Here are simple ways that you can take in order to improve the performance of your thyroid:

• Identify and treat the underlying causes. Find out what's really triggering your thyroid problems – whether it's iodine deficiency, hormone imbalance, environmental toxicity, or inflammation – to address it appropriately. For best results, consult an integrative medical practitioner.
• Load up on fresh iodine-rich foods. As an alternative to iodine supplementation, eat enormous amounts of toxin-free sea vegetables or sea weeds like spirulina, hijiki, wakame, arame, dulse, nori, and kombu, which are loaded with the thyroid-friendly nutrient, iodine, and other beneficial minerals. However, make sure that these are harvested from uncontaminated waters. The recommended dose is about five grams a day or about one ounce per week. Raw milk and eggs contain iodine as well.
• Pay attention to other key aspects of your diet. Munch on Brazil nuts, which are rich in selenium. Load up on foods high in vitamin A and omega-3 fatty acids. Consume coconut oil. Veer away from gluten and soy-containing foods and beverages.
• Minimize your stress levels. Take a break, meditate, soak in the tub, go on vacation – do whatever works for you. Practice Emotional Freedom Technique (EFT), an energy psychology tool that excellently reduces stress.

• Make an effort to limit your exposure to toxins. Filter your air and water to avoid contact with poisonous contaminants. Use an infrared sauna and hot soaks to help your body combat infections and detoxify from petrochemicals, metals, PCBs, pesticides, and mercury. Taking chlorella for detoxification is also advised.
• Avoid all sources of bromide as much as possible - Bromides are a menace to your endocrine system and are present all around you. Despite a ban on the use of potassium bromate in flour by the World Health Organization (WHO), bromides can still be found in some over-the-counter medications, foods, and personal care products. Being a savvy reader of labels can save you from tons of toxic trouble.
• Get adequate amounts of sleep. Inadequate sleep contributes to stress and prevents your body from regenerating fully. For more helpful tips on getting high-quality sleep, please review my 33 Secrets to a Good Night's Sleep.
• Exercise. Exercise directly stimulates your thyroid gland to secrete more thyroid hormone and increases the sensitivity of all your tissues to thyroid hormone. It is even thought that many of the health benefits of exercise stem directly from improved thyroid function.
Walk your dog in the park, jog in the morning, and incorporate strength training and other core-building routines. You can also give Peak Fitness a try.

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