THYROID DISORDERS
Thyroid disorders are common medical problems, affecting about 200 million people worldwide. It affects 10 percent of population in United States of America. However, it affects 30 percent of population in Middle East and Far East countries. In certain endemic areas with iodine deficiency in food, it can affect nearly 80 percent of their population. Thyroid cancer is 10th most common cancer, resulting in 47,000 deaths per year worldwide.
Thyroid is an endocrine organ, situated in front of the neck, striding on the two sides of upper part of trachea. It is an important organ controlling metabolism of the whole body through the hormones it secrets. It makes three hormones namely thyroxin (T-4), Triiodothyronine (T-3) and Calcitonin. It manages energy production and metabolic consumption, along with controlling chemical balance, particularly calcium levels.
The enlargement of thyroid gland is called goiter. They can present as diffuse enlargement of the whole gland filling both sides of front of neck, or enlarge one side disproportionately, or there can be one or more palpable nodules in it. Careful palpation of the gland is done by standing behind the neck as well as from the front of the neck to evaluate the nodules. One key feature of nodule of thyroid origin is that it moves with deglutition. The doctor may ask you to swallow your saliva when feeling the thyroid.
Causative factors for thyroid problems include iodine deficiency in food, genetic factors, autoimmune problems, environmental and lifestyle problems. Certain medications, previous radiation exposure, female gender and older age group are risk factors. Smoking, obesity and metabolic syndrome increase risk. Certain hereditary hormonal conditions can happen to include thyroid gland disorder. In addition to iodine, other trace metals such as selenium, iron, calcium, vitamin D and zinc also influence thyroid function.
Disorders of the thyroid gland include overactive (hyperthyroidism) or underactive (hypothyroidism) functioning of the gland. Both are not good and need to be corrected. Other disorders can be due to infections or autoimmune conditions. It is possible to have cysts and nodules of varying sizes which may not be cancers. However, cancer of the thyroid gland must be ruled out in such instances. Fortunately, vast majority of thyroid problems are benign or non-cancerous. Even most of the cancers of thyroid gland can be effectively treated and controlled.
Excessively overactive thyroid gland is termed hyperthyroidism, thyrotoxicosis or Grave’s disease. These patients may have fine tremors of hands, bulging eyes (exophthalmos), rapid heart beats (tachycardia), restlessness, heat intolerance, irregular heart beats (atrial fibrillation), weight loss, muscle weakness, fatigue, menstrual irregularities, sweating and anxiety. First line of treatment is with antithyroid medications such as methimazole, propylthiouracil, iodine supplements and beta blockers. One may consider radio-iodine ablation therapy or subtotal thyroidectomy based on recommendations of the endocrinologist for more definitive treatment.
Excessively underactive thyroid gland is called hypothyroidism or myxedema. These patients may have weight gain, pretibial edema, loss of appetite, fatigue, cold intolerance, sluggishness, dry skin, facial puffiness, hoarseness, constipation, bradycardia, depression, memory loss and menstrual irregularities. Treatment is by administering thyroid supplements.
Thyroid cancers are of four varieties – papillary, follicular, medullary and anaplastic. Fortunately, majority of them are papillary or follicular that carry good prognosis as they can be treated effectively if diagnosed and treated early. Medullary has less favorable outcome, while anaplastic is the worst one with high mortality rate. First line of treatment is by surgical removal of the thyroid gland and the related lymph nodes. Radio-iodine treatment, chemotherapy or immunotherapy are other modalities.
Many patients present for evaluation of a goiter which is appearance of an enlarged thyroid. They may have palpable nodules of different sizes, called nodular goiter. At times the patients come for cosmetic correction. Important items to consider are 1. any pressure symptoms caused by the goiter that may cause hoarseness of voice, or deviation of trachea, 2. functional status of the thyroid gland being hyper or hypo active and finally 3. whether any of the nodules can be cancer or not.
Evaluation of thyroid gland involves careful history taking and physical examination followed by blood tests called thyroid function tests. Measurements of hormones such as TSH (Thyroid stimulating hormone), T-3 and T-4 levels give an idea as to how the gland is functioning. Next set of tests are to ensure that there are no cancers in the gland. An ultrasound is done followed by fine needle aspiration cytology (FNA) of any suspicious nodule. At times additional tests such as radio-iodine scan and uptake or CT scan of neck are done.
Treatment is individualized in consultation with an endocrinologist, head and neck surgeon, radiation oncologist and medical oncologist. Most of the goiters are benign and require only dietary advice and close observation. They may need thyroid supplements in addition. If there is suspicion of cancer based on fine needle aspiration cytology, they are recommended to have surgery as the first line of treatment. Surgery has small chance of complications such as hoarseness of voice or parathyroid deficiency but still provides the best outcome. Patients will need lifelong follow up and intake of thyroid supplements.
What can one do to reduce chances of getting thyroid related problems? A well-balanced diet with enough amounts of iodine, selenium, zinc, iron and vitamins, such as a plant-based Mediterranean diet is good. Lifestyle measures reducing smoking, obesity and alcohol are helpful. Avoiding environmental pollution or radiation exposure, living in a non-endemic area are other considerations. Routine medical checkups will help early detection of correctable problems.
EYE CARE
Reading Vision Problems? FDA HAS approved a New Eye drop
By Dr. ARUN GULANI
One of the most common frustrations that quietly creeps up after age 40 is this: menus start getting longer arms, phones are held farther away, and fine print suddenly seems to shrink. This natural change is called presbyopia — the gradual loss of near-focusing ability that affects nearly everyone with age.
Until recently, reading glasses, multifocal contacts, or surgical options were the main choices. But now, a newly approved prescription eye drop may offer an additional way to address this daily challenge.
The U.S. Food and Drug Administration has approved Vizz (aceclidine ophthalmic solution 1.44%) for the treatment of age-related blurry near vision in adults with presbyopia. This makes Vizz the second prescription drop of its kind in the U.S., following Vuity (pilocarpine), approved in 2021.
In my experience of having pioneered presbyopia Laser techniques, and also successfully performing custom-designed cataract surgery with presbyopic, multifocal, trifocal and accommodative lens implants, this drop is a non-surgical option for patients with early presbyopia (reading vision) and certainly adds to the choices available for patients.
Vizz works by modulating the pupil size. It causes the pupil to constrict, creating a “pinhole effect” that increases depth of focus, bringing near objects into clearer view while maintaining distance vision. This is similar to how a camera’s small aperture sharpens the entire image.
Clinical studies showed that near vision improvements typically begin within 30 minutes of being instilled and can last up to 10 hours for many users. Side effects are generally mild and include temporary dim vision, mild irritation or headache. Because it acts mainly on the pupil rather than the focusing muscle, it tends to cause fewer shifts in distance vision than older pharmacologic approaches.
Vizz joins a growing class of presbyopia-correcting drops, offering a non-surgical, reversible option for people in the early stages of presbyopia who want more freedom from readers. It does not cure presbyopia, and the effects are temporary, usually lasting for several hours a day. These pharmacologic solutions fit within a larger spectrum of modern presbyopia management. Options now range from glasses and contacts to advanced corneal laser procedures and high-precision lens implant surgeries.
Not every eye or lifestyle is the same. Some patients benefit greatly from these drops, especially those in the early or moderate stages of presbyopia, while others may eventually require surgical or lens-based solutions for stable, long-term results. When I evaluate patients, I consider their daily visual demands, lighting environments, tolerance for temporary changes, and the presence of any other eye conditions such as cataracts, corneal irregularities, or previous surgeries. Drops like Vizz may be an excellent bridge for some patients, or part of a customized plan that evolves over time.
There are a few points to keep in mind. Because the pupil is constricted, some users may notice dimmer vision in low-light settings such as restaurants or night driving. These drops work for hours, not days, and they don’t reverse the natural aging process of the lens. Not everyone achieves the same degree of improvement. And as always, a comprehensive eye exam is essential since blurry near vision can sometimes mask other eye diseases.
The approval of Vizz represents an exciting evolution in presbyopia care. For many entering their 40s and 50s who are not ready for surgery or prefer a temporary, adjustable option, eye drops may offer a simple way to reduce dependence on reading glasses. As technology advances, the future of presbyopia management is no longer limited to one-size-fits-all. Instead, it’s about tailoring solutions to each patient’s eyes, goals, and lifestyle — from drops to lasers to lens implants — giving people more control over how they see and live.
Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at [email protected] or visit www.gulanivision.com