Holistic Health Articles and Research Related to Herbal Medicines, Foods and Phytochemicals

Tuesday 2 December 2014

(Preview) Most common diseases of 50 plus - Upper gastrointestinal (GI) diseases - Gastro-esophageal reflux disease (GERD): Preventions, Managements and Treatments

By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

              Upper gastrointestinal (GI) diseases

The prevalence of upper gastrointestinal (GI) diseases is increasing in subjects aged 65 years and over. Pathophysiological changes in esophageal functions that occur with aging may, at least in part, be responsible for the high prevalence of
1. Gastro-esophageal reflux disease (GERD) in old age.
2. The incidence of gastric and duodenal ulcers and their bleeding complications is increasing in old-aged populations worldwide.
3. H. pylori infection in elderly patients with H. pylori-associated peptic ulcer disease and severe chronic gastritis
4. Almost 40% of GU and 25% of DU in the elderly patients are associated with the use of NSAID(1) and/or aspirin(2).(a)

        Gastro-esophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD), also known as gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease, is a chronic condition of liquid stomach acid refluxing back up from the stomach into the esophagus, causing heartburn. According to the study of “Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease.” by DeVault KR, Castell DO; American College of Gastroenterology, GERD is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus.

I. The Symptoms
1. Heartburn
Heart burn is one of common symptom of Gastroesophageal reflux disease (GERD) in adult, as a result of acid reflux cause of burning sensation or pain in the middle of the chest mostly after meal(3)(4)(5).

2. Regurgitation
In gastroesophageal reflux disease (GERD), regurgitation is the expulsion of a small amount of digested foods to the mouth from esophagus. frequent or prolonged regurgitation can lead to acid-induced erosion of the teeth, bad breath or damage to the esophagus(3)(5).

3. Trouble swallowing(dysphagia)
It is caused by damage of the muscles and tissues that must flex for swallowing, as a result of prolonged period of acid reflux that has left untreated(6).

4. Pain when swallow
It may be caused by esophageal motility disorders, due to deglutitive contraction waves that die out in the upper esophagus(6a).

5. Asthma
Approximately, 59% of patients with GERD are experiences symptoms in asthma, according to the Baylor College of Medicine(7).

7. Other symptoms according to Texas A&M University(6) include
a, Stomach pain,
b. Stomach discomfort when eating,
c. Food and drink limits,
d. Nausea and vomiting,
e. Gas and bloating,
f. Constipation,
g. Blood, and
h. Diarrhea

II. The Causes
1. Slower in emptying of the stomach after eating
Most uncommon causes of Gastroesophageal reflux disease (GERD) is due to the distention of the stomach with food over prolonged period of time that can lead to reflux(7). Approximately 20% of Gastroesophageal reflux disease (GERD) are caused the reason above.

2. Cardia
Cardia is the area between the part of the stomach and the esophagus, a angle where the esophagus enters the stomach acted as a valve to prevent foods and others to reflux back to the esophagus. If the cardia is not functioning well(8), it can cause Gastroesophageal reflux disease (GERD with burning sensation of the esophagus(9).

3. Esophageal contractile defection(11)
If the esophageal contraction fails to performed its function of proper swallowing food, it may not generate enough waves of contractions to push the foods down to the stomach after swallowing and the acid back into the stomach(6a)(10).

4. Hiatal hernia
Hiatal hernia is a condition of a portion of the stomach protrudes upward into the chest, through a tear or weakness in the diaphragm. Hiatal hernia of the esophagus and GERD had been shown to induce hemorrhage(13). GERD patients consuming a late-evening meal had significantly greater supine acid reflux compared to when they consumed an early meal, especially in overweight patients, and in patients with esophagitis or HH(12).

5. Obesity
Obesity increase the risk of Gastroesophageal reflux disease (GERD). Weight loss, through caloric restriction and behavioral modification, may improve reflux inobese patient with GERD(14). Bariatric surgery and Roux-en-Y gastric bypass (RYGB) has been consistently associated with improvement in the symptoms of GERD(14).

6. Esophageal mucosa
Erosive changes in the esophageal mucosof of the lower esophagogastric junctionwere strongly associated with GERD(15).

7. Medication
The use of medication such as NSAIDs product can increase the risk of Gastroesophageal reflux disease (GERD)(16).

8. Chronic diseases
Chronic diseases, including cough(17)(18)(19)pulmonary fibrosis(21), earache and asthma(20) are also associated with the higher risk of develop Gastroesophageal reflux disease (GERD).

9. Infection
Infection caused by H. pylori can increase the risk of Gastroesophageal reflux disease (GERD)(22) through the bacteria pylori suppression of gastric acid secretion (Gastroenterology 1997 Jul;113(1):15-24).

10. Etc.

III. Complications In some severe cases as a result of frequent acid reflux.
1. Ulcers
Damage of the esophagus can lead to result of ulcers as a result of inflammation forming of scar(23).

2. Esophageal strictures
Prolonged period and frequent acid reflux, if keft untreated can lead to inflammation cause of narrowing of the esophagus(24)(25).

3. Barrett’s esophagus
Symptoms of gastroesophageal reflux disease (GERD) are the primary risk factor for Barrett's esophagus (BE)(26). The highest yield for Barrett’s is in older (age 50 or more) Caucasian males with longstanding heartburn(27).

4. Esophageal adenocarcinoma
In GICS 2009: EGF Genetic Variant Increases Risk for GERD-Associated Esophageal Adenocarcinoma ” by Roxanne Nelson posted by Medscape Newa Today, the author wrote that January 16, 2009 (San Francisco, California)

5. Etc.

IV. Diagnosis and tests
If you are experience some of the above symptoms, after recording your family history and physical exam, the following test may be recommended by your doctor.

1. Esophagogastroduodenoscopy (EGD)
Esophagogastroduodenoscopy (EGD) also known as upper gastrointestinal endoscopy is a diagnosis procedure allowed your doctor to check for any abnormality in the lining of the esophagus, stomach, and upper duodenum after a flexible endoscope inserted down the throat.

If any abnormality is found, your doctor order further examinations.
2. Barium swallow
Barium swallow is a medical imaging procedure allowed your doctor to examine the upper GI (gastrointestinal) tract, to exam the lining of the esophagus and the stomach, after you have drunk a suspension of barium sulfate.

3. Chest X-rays
A chest x-ray is an x-ray of the chest that allows your doctor to examine the lining of the esophagus, stomach, and upper duodenum.

4. Biopsy
A biopsy is a test of removal sample of cells or tissues for examination and determination of the grade and type of the tumors examined under a microscope by a pathologist or chemically, if the location of the tumor allows the test to be done without major risk to the patient.

4. Esophageal manometry
Esophageal manometry is a test with the use of a pressure-sensitive tube-like thin instrument passed through your mouth or nose and into your stomach to allow your doctor to examine the motor function of the Upper Esophageal Sphincter (UES), Esophageal body and Lower Esophageal Sphincter (LES).
5. Etc.

V. The GERD Diet
According to the GERD Diet (Gastroesophageal Reflux Disease) in McKinley Health Center of The university of Illinois at Urbana-Champaign
Dietary modifications are recommended to lessen the likelihood of reflux and to avoid irritation of sensitive or inflamed esophageal tissue. Listed below of several recommendations may help to manage GERD:
1. Decrease total fat intake – High fat meals and fried foods tend to decrease LES pressure and delay
2. Avoid large meals – Large meals increase the likelihood of increased gastric (stomach) pressure and reflux.
3. Decrease total caloric intake if weight loss is desired – Since obesity may promote reflux, weight loss
may be suggested by your healthcare provider to control reflux. Reducing both total fat and caloric intake will aid in weight loss.
4. Avoid chocolate – Chocolate contains methylxanthine, which has been shown to reduce LES pressure by causing relaxation of smooth muscle.
5. Avoid coffee depending on individual tolerance – Coffee, with or without caffeine, may promote gastroesophageal reflux. Coffee may be consumed if it is well tolerated.
6. Avoid other known irritants – Alcohol, mint, carbonated beverages, citrus juices, and tomato products all may aggravate GERD. These products may be consumed depending on individual tolerance.
B. Other modifications for treating GERD
7. Maintain upright posture during and after eating.
8. Stop smoking.
9. Avoid clothing that is tight in the abdominal area.
10. Avoid eating within 3 hours before bedtime.
11. Lose weight if you are overweight.
12. Sleep on your left side.
13. Chew non-mint gum which will increase saliva production and decrease acid in the esophagus.
14. Elevate the head of your bed 4-6 inches by placing bricks under the headboard. (Source)

VI. Treatments
A. Conventional medicine
A.1. Medication
1. Proton-pump inhibitors
Proton-pump inhibitors including omeprazole, esomeprazole, pantoprazole, are used to reduce the production of gastric acid in the stomach(28)(29).

2. H₂ receptor blocker(30)
H₂ receptor blockers include ranitidine, famotidine, cimetidine, etc., Over-the-counter medications are effective in treating symptomatic gastro-oesophageal reflux disease, with 41% with histamine-2 receptor antagonists, 60% with alginate/antacid combinations, and 11% with antacids(31).

3. 5HT₄ agonist
Mosapride 40 mg q.d.s. is effective in decreasing acid reflux in the oesophagus in patients with GERD(32).

4. GABA-B Receptor Agonists
Baclofen, a GABA-B agonist, showed effectively in the treatment of patients with GERD, through inhibition pf 34% to 60% of Transient Lower Esophageal Sphincter Relaxation (TLESR) and improvement of basal lower esophageal sphincter pressure(33).

5. Antacids
Antacids are oral medicine used to relieve symptom of heartburn of gastroesophageal reflux disease (GERB)(34)(35).

4. Pro motility Agents
Promotility Agents are used to improve GERD symptoms for patients with slow gastric emptying by stimulating the muscles of the gastrointestinal tract to reduce acid reflux into the esophagus(36).
5. Etc.

A.2. Surgery: Fundoplication Surgery
The aim of the surgery is to reduce heartburn caused by acid reflux, in severe case of inflammation, such as hiatal hernia, damage of esophagus, etc.. Fundoplication surgery(37)(38) is the procedure to treat Gastroesophageal Reflux Disease (GERD) by strengthening the valve between the esophagus and stomach as the upper curve of the stomach wrapped and satured around the lower end of the esophagus to prevent acid from backing up into the esophagus with a laparoscopic with a small tunnel made from the stomach muscle to allow foods of the lower part of the esophagus to pass through. The surgery is also by times for the esophagus to heal.
Laparoscopic fundoplication is effective in controlling symptoms in the majority of patients with Barrett's esophagus(BE) to orevent the possibility of developing esophageal adenocarcinoma(39)

B. Herbs
1. Deglycyrrhizinated licorice
Deglycyrrhizinated licorice used by people with gastric and peptic ulcers for nearly a hundred years. its three antiulcer agents FM 100, plaunotol, and teprenon showed to increase the content of endogenous prostaglandins in the gastric mucosa, through its endogenous secretin released and antiulcer effect(40).

2. Aloe Vera
According to the article of “Effect Of Orally Consumed Aloe Vera Juice On Gastrointestinal Function In Normal Humans, excerpts By Jeffrey Bland, Ph.D. (Linus Pauling Institute of Science & Medicine) involved ten healthy subjects – five men (median age: 42; standard deviation: 14 years), and five women (median age: 32; standard deviation: 5 years) – engaged Aloe vera juice oral supplementation in in a semicontrolled study, promotes proper gastrointestinal function, such as gastrointestinal motility, increasing stool specific gravity etc. through its regulate gastrointestinal pH effect(41),

3. Mastic gum
Mastic gum. a resin obtained from the mastic tree (Pistacia lentiscus), showed to consist an ability to support the health of patients with ulcers, GERD and acid reflux, according to the article of Strategies to Protect Against Potential Bone-Destroying Effects”By Chris D. Meletis, ND,

4. Ginger
Ginger has been used for thousands of years to enhance the function of digestive system and treated stomach distress including nausea, vomiting, diarrhea and in digestion, acid reflux, motion sickness, dyspepsia, etc. due to its anti-inflammatory, antimicrobial and analgesic properties.
The methanol extract of ginger rhizome showed to inhibite the growth of all 19 strains of bacteria in vitro with a minimum inhibitory concentration range of 6.25-50 micrograms/ml(42)

5. Peppermint
In vitro, peppermint exhibited significant antimicrobial and antiviral activities, strong antioxidant and antitumor actions, and some antiallergenic potential. Animal model studies demonstrate a relaxation effect on gastrointestinal (GI) tissue, analgesic and anesthetic effects in the central and peripheral nervous system etc.,… Caution are necessary for using peppermint oil therapy in patients with GI reflux, hiatal hernia(43).

6. Etc.

C. Traditional Chinese medicine
a. Ban Xia Xie Xin Wan, also known as "Pinellia Drain Epigastrium Pills" was recorded in classic texts around 210 C.E. used in TCM to treat various gastrointestinal disorders such as gastritis, enteritis, gastric ulcer, gastralgia exhibits its anti-ulcer action (probably based on its ability to protect the gastric mucosa), through improvement of gastric emptying and an anti-emetic action,
according to the study of the effects of hange-shashin-to on gastric function in comparison with sho-saiko-to" by Y Kase, M Yuzurihara, S Iizuka, A Ishige, Y Komatsu,

b. Ingredients
b.1. Ban Xia (Pinellia Tuber)
Main use: Dries Dampness, Transforms Phlegm, Stops vomiting, Resolves masses, Disperses nodules....
b.2. Huang Qin (Skullcap Root)
Main use: Clears Heat, Dries Dampness, Expels toxins, Stops bleeding...
b.3. Dang Shen (Codonopsis Root)
Main use: Tonifies the Middle Burner, Strengthens Qi, Promotes generation of Body Fluids, Nourishes Blood....
b.4. Gan Cao ( Licorice Root)
Main use: Tonifies the Spleen, Benefits the Qi, Moistens the Lungs, Calms cough...
b.5. Huang Lian (Coptis Rhizome)
Main use: Clears Heat, Dries Dampness, Expels toxins...
b.6. Bai Shao
Main use: Nourishes Blood, Preserves the Yin, Nourishes the Liver, Calms pain....
b.7. Chen Pi
Main use: Regulates the Qi, Regulates the Middle, Dries Dampness, Transforms Phlegm...

Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer

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References
(a) http://www.ncbi.nlm.nih.gov/pubmed/15588798
(1) http://www.ncbi.nlm.nih.gov/pubmed/16001646
(2) http://www.ncbi.nlm.nih.gov/pubmed/22542157
(3) http://www.ncbi.nlm.nih.gov/pubmed/25232262
(4) http://www.ncbi.nlm.nih.gov/pubmed/25212408
(5) http://www.ncbi.nlm.nih.gov/pubmed/24347282
(6) http://www.ncbi.nlm.nih.gov/pubmed/25148757
(6a) http://www.ncbi.nlm.nih.gov/pubmed/2237280
(7) http://www.ncbi.nlm.nih.gov/pubmed/17682001
(8) http://www.ncbi.nlm.nih.gov/pubmed/16377311
(9) http://www.ncbi.nlm.nih.gov/pubmed/?term=Cardia+and+burning+sensation
(10) http://www.ncbi.nlm.nih.gov/pubmed/24330081
(11) http://www.ncbi.nlm.nih.gov/pubmed/8608873
(12) http://www.ncbi.nlm.nih.gov/pubmed/?term=Administration+of+a+Standardized+Meal.+Does+Timing+Matter
(13) http://www.ncbi.nlm.nih.gov/pubmed/17633874
(14) http://www.ncbi.nlm.nih.gov/pubmed/?term=weight+loss%2C+through+caloric+restriction+and+behavioral+modification+in+obese+with+GERD
(15) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956342/
(16) http://www.ncbi.nlm.nih.gov/pubmed/23265146
(17) http://www.ncbi.nlm.nih.gov/pubmed/18046990
(18) http://www.ncbi.nlm.nih.gov/pubmed/25374758
(19) http://www.ncbi.nlm.nih.gov/pubmed/25327320
(20) http://www.ncbi.nlm.nih.gov/pubmed/16430100
(21) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115688/
(22) http://www.ncbi.nlm.nih.gov/pubmed/10378360
(23) http://www.ncbi.nlm.nih.gov/pubmed/14986731
(24) http://www.ncbi.nlm.nih.gov/pubmed/24564071
(25) http://www.ncbi.nlm.nih.gov/pubmed/24482901
(26) http://www.ncbi.nlm.nih.gov/pubmed/23567358
(27) http://www.ncbi.nlm.nih.gov/pubmed/18341497
(28) http://www.ncbi.nlm.nih.gov/pubmed/21235462
(29) http://www.ncbi.nlm.nih.gov/pubmed/20124466
(30) http://www.ncbi.nlm.nih.gov/pubmed/11552905
(31) http://www.ncbi.nlm.nih.gov/pubmed/17229239
(32) http://www.ncbi.nlm.nih.gov/pubmed/9692698
(33) http://www.medscape.org/viewarticle/434528
(34) http://www.ncbi.nlm.nih.gov/pubmed/10886047
(35) http://www.ncbi.nlm.nih.gov/pubmed/15540548
(36) http://www.ncbi.nlm.nih.gov/pubmed/1349550
(37) http://www.ncbi.nlm.nih.gov/pubmed/25386679
(38) http://www.ncbi.nlm.nih.gov/pubmed/23943388
(39) http://www.ncbi.nlm.nih.gov/pubmed/14759403
(40) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1156688/
(41) http://www.desertharvest.com/physicians/documents/DH127.pdf
(42) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761965/
(43) http://onlinelibrary.wiley.com/doi/10.1002/ptr.1936/abstract

The Best Gravy for Chicken: Apple Cider Gravy

Posted By Kyle J. Norton Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.
Recipe contributed by Yum-O, the family cook book by Rachel Ray, Published by Clarkson Potter, New York.You can view her website at yum-o.org

Here are one of 3 toppers for chicken that you can make with ingredients you have on hard, each in less than 5 minutes. Serve up your veggies of choice and some couscous, along with a 5-minutes super-side dish. and you have a jazzy new twist on the same ol' supper.

Each recipe will top 4 chicken breasts. Slice the breasts on an angle and fa them out on the plates before topping.

Ingredients
2 tablespoons butter
2 tablespoons all-purpose flour
1 1/2 cups chicken stock
1/2 cup apple cider salt and freshly ground black pepper

Instructions
Melt the butter in a saucepan over medium-high heat. Stir in the flour and cook, whisking, until it is light brown, 1 to 2 minutes. Whisk in the chicken stock and barbecue sauce and season with salt pepper. Continue whisking and cook until thickened, about 3 minutes.

Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer

Back to Obesity's Complications http://kylejnorton.blogspot.ca/p/obesitys-complications.html

Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca

Monday 1 December 2014

Women's Health - Premenstrual syndrome(PMS): The Adverse effects of Dairy Foods

The Best Gravy for Chicken: Skillet barbecue Gravy

Posted By Kyle J. Norton Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.
Recipe contributed by Yum-O, the family cook book by Rachel Ray, Published by Clarkson Potter, New York.You can view her website at yum-o.org

Here are 3 toppers for chicken that you can make with ingredients you have on hard, each in less than 5 minutes. Serve up your veggies of choice and some couscous, along with a 5-minutes super-side dish. and you have a jazzy new twist on the same ol' supper.

Each recipe will top 4 chicken breasts. Slice the breasts on an angle and fa them out on the plates before topping.

Ingredients
2 tablespoon butter
2 tablespoon all-purpose flour
1 1/2 cups chicken stock
1/4 cup bottled barbecue sauce salt and freshly ground black pepper

Instructions
Melt the butter in a saucepan over medium-high heat. Stir in the flour and cook, whisking, until it is light brown, 1 to 2 minutes. Whisk in the chicken stock and barbecue sauce and season with salt pepper. Continue whisking and cook until thickened, about 3 minutes.

Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer

Back to Obesity's Complications http://kylejnorton.blogspot.ca/p/obesitys-complications.html

Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca

Sunday 30 November 2014

(Preview) Most common diseases of 50 plus - Thyroid Disease - Acute thyroiditis: Preventions, Managements and Treatments

Thyroid Disease : Acute thyroiditis

Acute thyroiditis is a condition of relatively high amount of iodine in the tissue caused by microbial inflammatory thyroiditis, pyrogenic thyroiditis and bacterial thyroiditis. Acute infectious thyroiditis is very rare, accounted for about 0.1-0.7% of all thyroiditis.

A. Symptoms
1. Fever and swelling and tenderness in the neck
Patient with thyrotoxicosis may be experience symptoms of fever due to neck inflammatory changes, pus and with anterior neck tender swelling and odynophagia(1).

2. Infectious hip arthritis, spondylitis and Roth’s spots
Acute right-sided suppurative thyroiditis may enhance infectious hip arthritis, spondylitis and Roth’s spots(2).

3. Chills, dysuria and recent painful neck swelling
Patients with acute suppurative thyroiditis secondary to Escherichia coli (E. coli) infection are more likely presented with fevers, chills, dysuria(3).

4. Firm, livid, hardly mobile cervical swelling
Patient with acute suppurative thyroiditis and right lobe thyroid abscess caused by Klebsiella spp are shown to present with firm, livid, hardly mobile cervical swelling, due tosoft-tissue swelling, thyroid lobe and swelling of the thyroid gland(4).

5. Impaired vocal cord mobility
Although it is rare, acute suppurative thyroiditis also induces symptoms of unilateral vocal cord paralysis (5).

6. Swollen, red, hot, and tender, and limited neck movement
Fever, swollen, red, hot, and tender, and neck movement limited due to left lobe of the thyroid gland also are considered as symptoms of acute thyroiditis (6).

7. Severe odynophagia and dysphagia, fever, chills, sore throat and right ear pain
Suppurative thyroiditis caused by Salmonella enteritidis in patients with diabetes mellitus type 2 may present with severe odynophagia and dysphagia associated with fever, chills, sore throat and right ear pain(6a).

8. Dysphonia, myalgia, swelling of the small joints of the hands, weight loss, and erythematous malar rash
Acute suppurative thyroiditis associated with juvenile systemic lupus erythematosus (JSLE) onset may present with a painful voluminous swelling in the anterior cervical region with fever, myalgia, swelling of the small joints of the hands, weight loss, and erythematous malar rash(6b).

B. Causes and Risk Factors
B.1. Causes
According to Georgetown University, the most common anaerobic bacteria are Gram-negative bacilli and Peptostreptococcus spp. agents, including Streptococcus anginosus(8)(9), piriform sinus fistula with thyrotoxicosis(10), etc.
Viruses have also shown to associate with subacute thyroiditis, and include measles, mumps, influenza, enterovirus Epstein-barr, adenovirus, echovirus, and St Louis encephalitis(7).
Other causes of acute thyroiditis also include cervical thymic cyst(11) fungi and parasites(12).

B.2. Risk Factors
1. Immunocompromised patients
People who have weakened immune system are at increased risk of bacterial, virus and fungal causes of cute infectious thyroiditis.

2. Elderly
If you are elder, you are associated with increased risk of cute infectious thyroiditis.

3. Pre-existing thyroid diseases
Risk of acute thyroiditis increase for patient with hypothyroidism due to Hashimoto’s thyroiditis and mycobacterium avium intracellulare suppurative thyroiditis(13).

4. Congenital defect and infection
4.1. Complete congenital third branchial fistula
History of a small opening in the middle third of the anterior neck since birth, with recurrent surrounding swelling is associated to increased risk of infection of thyroid gland (14).
4.2. Fourth branchial arch anomalies
Fourth branchial arch anomalies represent <1% of all branchial anomalies may contribute to recurrent neck infections or suppurative thyroiditis(14a).
4.1. Persistent thyroglossal duct
Persistent thyroglossal duct infection may contribute to acute suppurative thyroiditis with abscess (15).
4.2. Piriform sinus fistula
Infected piriform sinus fistula with thyrotoxicosis is also associated to risk of acute suppurative thyroiditis(16).

C. Diseases associated to Acute thyroiditis
1. Tonsillitis
Patients with tonsillitis are shown to associate with the existence of suppurative thyroiditis complicated by thyrotoxicosis, in  causation of trachea deviation and compressed large vessels; associated with internal jugular vein thrombosis, and sepsis(17).

2. Bacterial throat infection
Thyroid abscesses are rare complications of neck infections, but it can occur in patients with acute thyroiditis, with symptoms of increased neck pain and swelling(18).

3. Thyroid papillary carcinoma
Suppurative thyroiditis, thyroid cancer and chronic thyroiditis combination have been observed in elderly(19).

4. Esophageal carcinoma
Right-sided thyroid abscess with fistulous connection to the upper of two oesophageal carcinomas hasbeen found in patients with acute thyroiditis, may cause dysphagia, weight loss and a neck swelling(20).

5. Laryngologic problem
Acute pharyngitis or laryngitis associated with acute suppurative thyroiditis could be life threatening, according to the Klinika Otolaryngologii CMKP w Warszawie(20a).

6. Diabetes mellitus
Diabetes mellitus (DM) patients showed to be a precipitating factor for acquiring unusual infectious thyroiditis(20b).

D. Complications
According to the study by the Universidade do Estado do Rio de Janeiro, acute suppurative thyroiditis is a rare disorder, most often caused by Staphylococcus aureus or Streptococcus pneumoniae, inducing complication of pyriform sinus fistula in children, infection in the oropharynx or respiratory tract in adult. Delays diagnosis also showed to increase the risk of complications(21). Sacroileitis is also a frequently rare complication of brucellosis, endocarditis, thyroiditis and pyelonephritis are among the rare complications(21a).

F. Misdiagnosis
1. Thyroid cancer
Patients with thyrotoxicosis presented with anterior neck tender swelling and odynophagia can be diagnosed as thyroid cancer due to the misleading computed tomography report, according to Fudan University(22).

2. Acute bacterial thyroiditis
Acute bacterial thyroiditis may be misdiagnosed if it is presented with absence of leucocytes and bacteria couple with initial borderline clinical and sonographic data(23).

3. Juvenile systemic lupus erythematosus
Although it is unusual, acute suppurative thyroiditis in at least one case is associated with juvenile systemic lupus erythematosus (JSLE) onset(24).

4. Hashimoto’s thyroiditis
Hashimoto’s thyroiditis has been misdiagnosed as thyroid abscess in cervical ultrasonograph
(25).

G. Diagnosis
If you are experience certain symptoms of the above and your doctor suspects that you have developed acute thyroiditis, after recording the past and present history and completing a physical exam, including assessing symptoms and complaints commonly seen including enlarged thyroid gland, heart rate, shaking hand etc., the tests ordered may include
1. Blood test
The aim of the test is to check for the elevation of white blood cell count, erythrocyte sedimentation(red blood cells/ hour) rate, abnormal thyroid hormone levels and alkaline phosphatase(measuring the amount of the enzyme transaminase(ALP) in the blood)26).

2. Needle aspiration
Needle aspiration of thyroid is a diagnostic procedure used to check for lumps or masses of thyroid gland. The procedure is safe, but in some cases, it can cause painful cervical swelling, fever, and chills due to infection, induced acute suppurative thyroiditis, according to Ankara University School of Medicine(27).

3. Ultrasound and oesophagography
The thyroid infection in children may induce abnormality of pyriform fossa sinus.
According to the Prince of Wales Hospital, ultrasound and oesophagography are helpful tools used to diagnose pyriform fossa sinus associated with suppurative thyroiditis(28).

4. CT scan
CT scan can be useful in identifying the location of the abscess, in unusual situations.

H. Prevention
H.1. Diet to prevent Acute infectious thyroiditis
1. Broccoli
Sulforaphane (SFN), a natural constituent of cruciferous vegetables such as broccoli, Brussels sprouts, etc. is considered as one of most potent anti-oxidant and anti-inflammatory agent and probably a promising reagent for intervention of multiple sclerosis and other autoimmune diseases through its anti-oxidant activity and antagonizing autoimmune inflammation(29).

2. Fresh ginger
Several chemical constituents of Zingiber officinale Rosc. (Zingiberaceae) showed to inhibit reactive oxygen species (ROS), immune system response to the inflammation)(30).

3. Catechu
Catechu, used as a food additive, astringent, tannin, and dye extracted from Acacia catechu
showed to exhibit a significantly strong anti inflammatory effect in vitro in study of rats, in concentration-depended manner(31).

4. Legume
20 g of soy protein with 160 mg of total isoflavones (64 mg genistein, 63 mg daidzein, and 34 mg glycitein) in 12 weeks enhanced serum adiponectin levels involved in regulating glucose levels as well as fatty acid breakdown, according to the study of 75 healthy postmenopausal women(32).

5. Turmeric
According to the study, curcumin (diferuloyl methane) was found effectively for treatment in patients with postoperative inflammation(33).

H.2. Phytochemicals and antioxidants to prevent Acute infectious thyroiditis
1. Alliin (S-allyl-L-cysteine-S-oxide)
Alliin (S-allyl-L-cysteine-S-oxide), an antimicrobial sulfur compound newly isolated from heated garlic extract, showed to exhibit its strong anti-yeast activity and rather weak antibacterial activity, similar to other antimicrobial compounds in garlic,(34).

2. Allyl sulfides
Antibacterial properties of Crushed garlic have been known for a long time for its anti bacterial activities including species of Escherichia, Salmonella, Staphylococcus, Streptococcus, Klebsiella, Proteus, Bacillus, and C!ostridium, according to “Allicin from fresh Garlic Nature’s Original Antimicrobial”, The Englishman’s Doctor (Harrington, 1609),

3. Triterpenoids
Triterpenoids, major chemical compound of several species showed a total antioxidant capacity of 42.94% as compared to ascorbic acid.

4. Lycopene
According to University of Milan, regular consumption of tomato drink, promoted DNA protection from oxidative stress, modulation of immune and inflammatory activity in young healthy volunteers(35).

5. Resveratrol
Resveratrol, a natural polyphenol with antioxidant, anti-inflammatory, and anticancer properties may be effectively in induced expression of microRNAs for prevention of cancer(36).

I. Treatments
I.1. In conventional medicine perspective
Drainage of the mass or lump and antibiotics and surgical resection
Administration of antibiotics has shown effectively for treatment of acute thyroiditis against the causative pathogen(s). Surgical drainage may be necessary in case of suppuration.  In treatment of an acute thyroiditis in children, surgical removal of the fistula combined with partial thyroidectomy may decrease the recurrence rate but it should be delayed until the inflammatory process is resolved, according to Georgetown University(36).

I.2. In herbal medicine perspective
1. Aloe Vera
Aloe Vera also is popular used in treating infection and inflammation(38) through its antioxidant property(38) and as immune system enhancer in regulating the immunological parameters in cellular immune response and phagocytosis(39).

2. Black Walnut
Tannins extract of phenolic compounds from several herbal plants, including black walnut not only  have exerted the relatively high level of anti bacterial activity (62.5 to 125 microg/ml) in fighting against Listeria monocytogenes(40) but also can fight the forming of free radical cause of DNA damage of irregular cells growth and enhance the immune system guarding our body from foreign invasion cause of inflammation and infection(41).

3. Cinnamon
3.1. Immunomodulatory effect
Cinnamon is a popular herb used in traditional medicine to treat various disorders such as chronic gastric symptoms, arthritis, and the common cold through its immunomodulatory effect(42)

3.2. Antimicrobial Activities
Cinnamon oil-chitosan film promotes better antimicrobial activity than the clove bud oil-chitosan film(43).

3.3. Anti-inflammatory activity
Myristicin (1-allyl-5-methoxy-3,4-methylenedioxybenzene) is an active aromatic compound found in nutmeg, carrot, basil,cinnamon, and parsley showed significantly in inhibition of the production of calcium, nitric oxide (NO), etc. through its anti-inflammatory effect.(44).

4. Garlic
Extracts of aged fresh garlic, aged over a prolonged period and its antioxidant effects showed the ability of AGE to protect against oxidant-induced disease, acute damage from aging, radiation and chemical exposure, and long-term toxic damage, etc.(45).

5. Kelp
5.1. Thyroid function
Short-term dietary supplementation with kelp significantly increases both basal and poststimulation TSH(46).

5.2. Antioxidants
Brown algae of the Laminariales (kelps) exhibits  strong antioxidant effect through iodide accumulation and impact of atmospheric chemistry(47).

I.3.Treatments in traditional Chinese medicine perspective
1. Ba Jiao Hui Xiang
Ba Jiao Hui Xiang also known Chinese Star Anise is a spice used in traditional Chinese cooking and in TCM an antibiotic agent and to for treatment of hernia, chronic lower back pain, vomiting due to coldness in stomach, pain and coldness in stomach. etc. for thousand of years from a small evergreen tree, native in southwest China.
Extract from Bai Jiao hui xiang has showb to exert its antibacterial activity against 67 clinical drug-resistant isolates, including 27 Acinetobacter baumannii, 20 Pseudomonas aeruginosa, and 20 methicillin-resistant Staphylococcus aureus(48). Its essential oil has also exhibited strong inhibitory effect against fungi(49).

2. Black pepper and cardamom
Black pepper (Piper nigrum) and cardamom (Elettaria cardamomum) extracts significantly enhance the cytotoxic activity of natural killer cells by exerting immunomodulatory roles and antitumor activities50).

3. Radix et Rhizoma Rhei and Rhizoma Polygoni Cuspidati
Processed products of Radix et Rhizoma Rhei and Rhizoma Polygoni Cuspidati showed to scavenge superoxide radical (O2-.) generated through hypoxanthine-oxidase system and (.OH) generated through Fenton action(52).

3. Long Kui
Solanum nigrum fruit extract (SNFEt), in ethanol-induced toxicity in rats improved the antioxidant status by decreasing the levels of TBARS( a byproduct of lipid peroxidation) and altering the lipid profiles to near normal(53). The methanol and chloroform extracts of Solanum nigrum (SN) seeds also exhibited more than 50% inhibition of HCV at non toxic concentration(54).

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References
(1) http://www.ncbi.nlm.nih.gov/pubmed/23435638
(2) http://www.ncbi.nlm.nih.gov/pubmed/22129504
(3) http://www.ncbi.nlm.nih.gov/pubmed/17259797
(4) http://www.ncbi.nlm.nih.gov/pubmed/19499695
(5) http://www.ncbi.nlm.nih.gov/pubmed/9142526
(6) http://www.ncbi.nlm.nih.gov/pubmed/20424880
(6a) http://www.ncbi.nlm.nih.gov/pubmed/22069108
(6b) http://www.ncbi.nlm.nih.gov/pubmed/19554814
(7) http://www.ncbi.nlm.nih.gov/pubmed/12697345
(8) http://www.ncbi.nlm.nih.gov/pubmed/23435638
(9) http://www.ncbi.nlm.nih.gov/pubmed/1298872
(10) http://www.ncbi.nlm.nih.gov/pubmed/11916288.
(11) http://www.ncbi.nlm.nih.gov/pubmed/2243452
(12) http://link.springer.com/article/10.1007%2Fs11908-000-0027-7
(13) http://www.ncbi.nlm.nih.gov/pubmed/8006334
(14) http://www.ncbi.nlm.nih.gov/pubmed/20156371
(14a) http://www.ncbi.nlm.nih.gov/pubmed/23478017
(15) http://www.ncbi.nlm.nih.gov/pubmed/8074961
(16) http://www.ncbi.nlm.nih.gov/pubmed/11916288
(17) http://www.ncbi.nlm.nih.gov/pubmed/22990644
(18) http://www.ncbi.nlm.nih.gov/pubmed/22470780
(19) http://www.ncbi.nlm.nih.gov/pubmed/8262271
(20) http://www.ncbi.nlm.nih.gov/pubmed/1437962
(20a) http://www.ncbi.nlm.nih.gov/pubmed/1652146 4
(21) http://www.ncbi.nlm.nih.gov/pubmed/22990644
(21a) http://www.ncbi.nlm.nih.gov/pubmed/19334391
(20b) http://www.ncbi.nlm.nih.gov/pubmed/9134826
(21) http://www.ncbi.nlm.nih.gov/pubmed/22990644
(21a) http://www.ncbi.nlm.nih.gov/pubmed/19334391
(22) http://www.ncbi.nlm.nih.gov/pubmed/23435638
(23) http://www.ncbi.nlm.nih.gov/pubmed/11251375
(24) http://www.ncbi.nlm.nih.gov/pubmed/19554814
(25) http://www.ncbi.nlm.nih.gov/pubmed/18604385
(29) http://www.ncbi.nlm.nih.gov/pubmed/24120440
(30) http://www.ncbi.nlm.nih.gov/pubmed/19833188
(31) http://www.ncbi.nlm.nih.gov/pubmed/22256752
(32) http://www.ncbi.nlm.nih.gov/pubmed/18981951
(33) http://www.ncbi.nlm.nih.gov/pubmed/20828317
(34) http://www.ncbi.nlm.nih.gov/pubmed/19105898
(35) http://www.ncbi.nlm.nih.gov/pubmed/16569044
(36) http://www.ncbi.nlm.nih.gov/pubmed/12697345
(37) http://www.thyroidmanager.org/chapter/acute-and-subacute-and-riedels-thyroiditis/
(38) http://www.ncbi.nlm.nih.gov/pubmed/21452374
(39) http://www.ncbi.nlm.nih.gov/pubmed/12687115
(40) http://www.ncbi.nlm.nih.gov/pubmed/18325686
(41) http://www.ncbi.nlm.nih.gov/pubmed/21925860
(42) http://www.ncbi.nlm.nih.gov/pubmed/22053946
(43) http://www.ncbi.nlm.nih.gov/pubmed/22034912
(44) http://www.ncbi.nlm.nih.gov/pubmed/21991618
(45) http://www.ncbi.nlm.nih.gov/pubmed/11238807
(46) http://www.ncbi.nlm.nih.gov/pubmed/14583417
(47) http://www.ncbi.nlm.nih.gov/pubmed/18458346
(48) http://www.ncbi.nlm.nih.gov/pubmed/20828316
(49) http://www.ncbi.nlm.nih.gov/pubmed/21030909
(50) http://www.ncbi.nlm.nih.gov/pubmed/20210607
(51) http://www.ncbi.nlm.nih.gov/pubmed/12528506
(52) http://www.ncbi.nlm.nih.gov/pubmed/20418062
(53) http://www.phcog.com/article.asp?issn=0973-1296;year=2010;volume=6;issue=21;spage=42;epage=50;aulast=Arulmozhi
(54) http://www.ncbi.nlm.nih.gov/pubmed/21247464

All rights reserved 2014. Any reproduction of this book in whole or parts are prohibited without permission of the writer. All articles and research papers written by Kyle J. Norton are for information & education only, please consult your Doctor & Related field specialist before applying

Quick and #healthy #recipe: Health #nut Oatmeal

Posted By Kyle J. Norton Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.
Recipe contributed by Yum-O, the family cook book by Rachel Ray, Published by Clarkson Potter, New York.You can view her website at yum-o.org

Swap
1/2 cup honey for the brown sugar
1 cup craisins (dried cranberries) for the dates and currants

Add
1/4 cup flaxseeds meal
1/2 cup toasted, unsalted sunflower seeds
1/2 cup Grape-Nuts cereal

Instructions
Follow the directions for the original recipe, stirring in the flax seed meal and sunflower seeds along with the craisins. Serve with additional milk and sprinkle with a tablespoon of the Grape-Nuts cereal if desired.

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Saturday 29 November 2014

(Preview) Most common diseases of 50 plus - Thyroid Disease - Silent thyroiditis: Preventions, Managements and Treatments

Thyroid Disease : Silent thyroiditis

Silent thyroiditis is the inflammation of the thyroid gland. Patients with silent thyroiditis are experience back and forth between hypothyroidism and hyperthyroidism. The disease classically present with a triphasic course: a brief period of hyperthyroidism due to release of preformed thyroid hormone that lasts for 1 to 3 months, followed by a more prolonged hypothyroid phase lasting up to 6 months, and eventually return to a euthyroid state. However, the types and degree of thyroid dysfunction, individual patients may present with mild or more severe cases of hyperthyroidism alone, hypothyroidism alone, or both types(a).

A. Symptoms
Symptoms are associated to the stage of the diseases and may include
1. Chronic fatigue
Chronic fatigue is associated to the presence of chronic lymphocytic thyroiditis, according to Bo Wikland and colleagues (March 24, p 956)1 report. Thyroxine, the primary medication may be used to relief the symptom(b).

In the phase of hyperthyroidism
2. Heat intolerance
Patient with silent thyroiditis may be experience the symptoms of heat intolerance, according to the Gifu Red Cross Hospital, Japan(c).

3. Hypertension
Hyperthyroidism is associated with unpleasant symptoms and hypertension due to increased adrenergic tone, according to the study by the Harran University Faculty of Medicine(d).

4. Tachycardia, fatigue, and weight loss, hyperactive reflexes, increased sweating, heat intolerance, tremor, nervousness, polydipsia, and increased appetite, anorexia, atrial fibrillation and goiter
Depending to the age, patients with Thyroid adenoma with the presence of hyperthyroidism may be experience certain above symptoms, according to the study by the Centre Hospitalier et Universitaire de Rouen(e).

In the phase of hypothyroidism

1. Weight gain and fatigue
Hyperthyroidism is associated to weight gain, especially in patients with co-existence of diabetes(1).
The comparable study of patients with thyroid carcinoma (DTC) and 138 with autoimmune hypothyroidism (AIH), also indicated a significantly higher levels of fatigue in hypothyroidism patients(1b). Statistics of study of 198 consecutive breast cancer patients receiving adjuvant chemotherapy, 22.2% of this patient population showed a significant and progressive weight gain of 6.7 lbs, and 94% of all patients reported fatigue, due to cytotoxic agents influence hypothyroidism in breast cancer patients(1a).

2. Vitiligo and alopecia areata
Vitiligo is associated with autoimmune endocrine disorders, especially withhypothyroidism(2). Primary hypothyroidism patients is at increased risk to develop vitiligo, depigmentation of parts of the skin and hair lost from some or all areas of the body, especially in the scalp(2a)

3. Chronic constipation(3a)
Hypothyroidism may induce the pathogenesis of constipation, according to the study by the University of California at Los Angele(3).

4. Hypothyroid women showed also significantly higher frequency of urticaria and puffiness of hands and feet, yellow ivory skin, coarse rough dry skin(4).

5. Depression
Patients with hypothyroidism have a higher occurrence of depressivesyndrome, these may be result of alterations in blood flow and glucose metabolism in the brain(5).

6. Mood and motor learning
Oral administration of usual dose l-T(4) (euthyroid arm) vs. higher dose l-T(4) (subclinical thyrotoxicosis arm) , showed to improve confusion, mood and motor learning in patients with hypothyroidism(6).

B. Causes and Risk factors
B.1. Causes
The cause of silent thyroiditis is unknown. The autoimmune thyroiditis processes progressively and slowly tinduce necrosis/apoptosis of thyroid cells, causing functional impairment of thyroid gland. Other forms of autoimmune thyroiditis includes postpartum thyroiditis and silent thyroiditis(11). Other researchers suggested that silent thyroiditis is an autoimmune disease characterized by lymphocytic(white blood cells) infiltration of the thyroid and by transient hyperthyroidism, followed occasionally by transient hypothyroidism and eventual recovery(12).

B.2. Risk factors
1. Gentic and environment factors
Genetic and/or environmental factors are important in the development of familial type of silent thyroiditis, according to the study by the Gifu Red Cross Hospital(14). Other study indicated that antecedent infection or exposure to antigen may cause the development of silent thyroiditis(15).

2. Adrenalectomy
Patients with unilateral adrenalectomy for treatment of Cushing’s syndrome are associated to increased risk of silent thyroiditis(16).

3. Lithium therapy
While hypothyroidism secondary to treatments by lithium are well known, cases of hyperthyroidism are less common. Lithium carbonate treatment in a long period of time without any auto-immunity biological markers, associated with a very low thyroid tracer uptake on scintigraphy(17).

4. Alpha-interferon therapy
Alpha-interferon therapy treatment in patients with chronic active hepatitis C develops may induce silent thyroiditis(18). Other study report indicated the development of a episode of silent thyroiditis in a patient with chronic thyroiditis and papillary adenocarcinoma following alpha interferon treatment for hepatitis C(19).

5. Thyroid-stimulation-blocking antibodies (TSBAb)
Thyroid-stimulation-blocking antibodies (TSBAb) showed to induce thyrotoxic symptoms with hypokalemic periodic paralysis, a disorder that causes occasional episodes of muscle weakness and sometimes a lower than normal level of potassium in the blood(20).

6. Infections
Viral infection such as rubella could cause the development of silent thyroiditis with synptoms of heat intolerance(21).

7. Gender
If you are women, you are associated to increased risk of silent thyroiditis.

8. Low level of selenium
Se levels were significantly decreased in cases of sub-acute and silent thyroiditis. according to WOMED(22).

9. Postpartum period
Silent or painless thyroiditis is a frequent cause of transient hyperthyroidism characterized by the onset of symptoms patient with a normal to modestly enlarged and firm thyroid gland, particularly in the postpartum patient(22a).

10. Autoimmune type 1 diabetes mellitus
Patients with autoimmune type 1 diabetes mellitus have often, besides immune diabetes markers, also other organ-specific antibodies, particularly thyroid autoantibodies(22b).

11. Thyroid peroxidase autoantibodies
Thyroid peroxidase (TPO) is a key enzyme in the formation of thyroid hormones and a major autoantigen in autoimmune thyroid diseases, depending to the degree of lymphocytic infiltration in euthyroid subjects, with prevalence rate of 12-26%(22c).

C. Complications
1. Sudden unexpected death
Silent (painless) thyroiditis, especially, is easily overlooked at autopsy as there are no macroscopic changes and often no prior symptoms or history of thyroid disease pointing towards this condition.
Extensive lymphocytic infiltration of the thyroid parenchyma has found to cause‘unknown cause of death’ in some patients with silent (painless) thyroiditis. (23).

2. Oncocytic follicular nodules
Oncocytic follicular (OF) cells, arising in multinodular goiter and chronic lymphocytic thyroiditis (CLT) has beed used as a prominent component of fine needle aspiration (FNA) specimens from neoplasms (adenomas and carcinomas) and nodules(24).

3. Recurrent Silent thyroiditis (ST)
Silent thyroiditis (ST) recurred with a high incidence (65%, 35/54), according to the study by the Department of Endocrinology and Metabolism, Toranomon Hospital(25).

4. Hashimoto’s thyroiditis and lymphoid follicles
Patient with silent thyroiditis, during the thyrotoxic phase, and 15 specimens during the early or late recovery phase are susceptible to develop chronic thyroiditis and lymphoid follicles(26).

D. Diseases associated to Silent thyroiditis
1. Hyperprolactinemia
Hyperprolactinemia may presents in patients with silent thyroiditis due to its influence in the active phase of some non organ-specific autoimmune diseases, including autoimmune thyroid diseases(29).

2. Graves’ disease
Graves’ disease, an autoimmune disease as a result of overproduction of thyroid hormones have associated to the presence of silent thyroiditis, according to the study by the Fourth Department of Internal Medicine, Saitama Medical School(30). The two diseases are closely linked because sequential development of GD followed by ST, or the reverse course of events(31).

3. Progressive systemic sclerosis (PSS)
Patients with progressive systemic sclerosis (PSS) with increased serum T3 and T4 and low 24-h thyroidal uptakeare more likle to be presence with silent thyroiditis(32).

4. Idiopathic thrombocytopenic purpura (I.T.P.)
Patients with diopathic thrombocytopenic purpura, a disorder of easy or excessive bruising and bleeding on the presence of symptoms of thyrotoxicosis. accompanied with the diagnosis of low uptake of radioactive iodine and technesium(chemical Tc) with may develop silent thyroiditis(33).

5. Thymoma
Thymoma often accompanies an autoimmune disease, is thought to be involved in the onset of silent thyroiditis(34).

6. Chronic adrenocortical insufficiency
chronic adrenocortical insufficiency (Addison’s disease), a autoimmune disorder is associated to the prevalence of silent thyrotoxic thyroiditis(35).

E. Misdiagnosis and diagnosis
E.1. Misdiagnosis
Silent thyroiditis in some cases has misdiagoesd as malignant lymphoma of the thyroid. Clinically and cytologically, it is difficult to make a distinction of diagnosis if immune response phenomena with invasion of lymphocyte and appearance of lymph follicle are the strongest(36).

E.2. Diagnosis
After recording the past and present history and completing a physical exam, including assessing symptoms and complaints commonly seen including enlarged thyroid gland, heart rate, shaking hand etc. The tests which your doctor orders may include
1. Radioactive iodine uptake test, or RAIU test
Radioactive iodine uptake (RAIU) test measures how much tracer the thyroid gland absorbs from the blood with radioactive tracer. In mast cases, patients with either Graves' diseases and silent thyroiditis are undergone iodine restriction before taking the test(37).

2. Blood test for blood levels of the thyroid hormones T3 and T4
The aim of the test is to the level of free T4 and thyroid stimulating hormone (TSH) levels to exclude thyroid dysfunction(38), if normal value of TSH is presented(38).

3. Thyroid scintigraphy
Thyroid scintigraphy, the test used to establish the functional characteristics of thyroid nodules (warm or cold) and to precise the origin of a thyrotoxicosis(hyperthroidism) of sub acute or silent thyroiditis(39).

4. Thyroid biopsy
In thyrroid biopsy, removed small sample of tissue from the thyroid gland is examined under a microscope for sign of unusual thyroid function(40).

F. Prevention
F.1. Diet to prevent silent thyroiditis
1. Broccoli
Sulforaphane (SFN), a natural constituent of cruciferous vegetables such as broccoli, Brussels sprouts, etc., exhibits its anti inflammatory effect against LPS-induced inflammation in RAW 264.7 cells(41).

2. Cherry
Anthocyanin-rich cherries, tested in the Zucker fatty rat model of obesity and metabolic syndrome, significantly attenuated the postprandial inflammatory response in a cross -over design of overweight adults consumed a high-carbohydrate, moderate-fat meal (HCFM) accompanied by either a strawberry or a placebo beverage(42).

3. Walnut
Walnut consumption showed to increase levels of apolipoprotein A, a protein played an important role in lipid metabolism with anti-inflammatory effects in adipocytes(fat cells) and adipose(fat) tissue similar in other cell types(43)

4. Garlic
1,2-vinyldithiin, a chemical ingredient from garlic inhibits differentiation and inflammation of human preadipocytes( precursor cells for the development of fat cells)(44).

F.2. Phytochemicals and antioxidants to prevent silent thyroiditis
1. Resveratrol
Resveratrol (trans-3,4′,5-trihydroxystilbene), a natural polyphenol with antioxidant, anti-inflammatory, and anticancer properties, showed to induce the expression of a tumor-suppressor and anti-inflammatory microRNA(44).

2. Pterostilbene
Pterostilbene showed to inhibit inflammatory effects in patients with colon cancer through controlling cellular responses to cytokines(45).

3. Phytofluene
Combination of CoQ10 and colorless carotenoids (phytoene and phytofluene, or to combinations of these antioxidants) treatment showed to enhance protection from inflammation and premature aging caused by sun exposure46).

4. Selenium
Se levels were significantly decreased in cases of sub-acute and silent thyroiditis as well as in follicular and papillary thyroid carcinoma(48).

G. Treatments
G.1. In conventional medicine perspective
Treatment of the disease is to relieve the symptoms and most of the patients show complete recovery and return of the thyroid gland to normal after 3 months as the disease rarely lead to permanent thyroid disease, although some loss of thyroid reserve may occur(49). Also, in some study thyroid suppression with thyroid hormone showed to be ineffective in preventing this disease(50).

G.2. In herbal medicine perspective
The below herbal medicine has been proven to be effective in treating inflammatory diseases
1. Myrrh
According to the study by the Shandong University, the resins of Commiphora species have emerged as a good source of the traditional medicines for the treatment of inflammation, arthritis, obesity, microbial infection, wound, pain, fractures, tumor and gastrointestinal diseases(54).

2. Desmodium gangeticum (L.) DC. and Desmodium adscendens (Sw.) DC.
Desmodium gangeticum is used as a tonic, febrifuge, digestive, anticatarrhal, antiemitic, in inflammatory conditions of chest and in various other inflammatory conditions in the Ayurvedic System of Medicine while Desmodium adscendens is widely used for the treatment of asthma in Ghana, Africa(55).

3. Senecio scandens
Senecio scandens is a medicinal plant with a climbing woody stem. Extracts and compounds isolated from Senecio scandens show a wide spectrum of pharmacological activities, including anti-inflammatory, antimicrobial and toxicological activities(56).

G.3. In traditional Chinese medicine perspective
The below TCM herbal medicine has been proven to be effective for treatment of inflammatory diseases
1. Deer antler
Deer antler base (Cervus, Lu Jiao Pan) has been recorded in the Chinese medical classics Shen Nong Ben Cao Jing 2000 years ago and has been extensively used in traditional Chinese medicine (TCM) to treat a variety of diseases including mammary hyperplasia, mastitis, uterine fibroids, malignant sores and children’s mumps. According to the study by the Dalian University of Technology, both in vitro and in vivo, deer antler base possess immunomodulatory, anti-cancer, anti-fatigue, anti-osteoporosis, anti-inflammatory, analgesic, anti-bacterial, anti-viral, anti-stress, anti-oxidant, etc.(51).

2. Brown seaweed Sargassum
According to the study by the Southern Cross University, Sargassum spp. showed to exhibit it anticancer, anti-inflammatory, antibacterial and antiviral activities in vivo and in vitro(52).

3. Callicarpa L. (Verbenaceae)
According to the study by the Second Military Medical University, isolates and crude extract containing Callicarpa species, exhibited anti-inflammatory, hemostatic, neuroprotective, anti-amnesic, antitubercular, antioxidant, antimicrobial, etc. effects in vitro and in vivo(53).

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References
(a) http://www.ncbi.nlm.nih.gov/pubmed/22443972