Hair Loss and Thyroid

Thyroid and Hair Loss

Thyroid and Hair Loss

Thyroid is a small gland which has the shape like a butterfly that sits low on the front of the neck. It helps to regulate many body functions by constantly releasing a steady amount of thyroid hormones into the bloodstream.

The important hormones produced by thyroid gland are thyroxine (T4) and triiodothyronine (T3)

Furthermore, thyroid conditions occur when your thyroid gland is not producing enough hormones Or producing too much of hormones. The most common type of thyroid conditions are as following:

Both conditions (Hypothyroidism & Hyperthyroidism) can cause dry, brittle hair or thinning hair on your scalp and body.

Thyroid conditions can cause hair loss if they are severe and left untreated. But, before understanding how these conditions cause hair loss, let us first understand the hair growth process.

  1. Hair starts growing from the roots (bottom of your hair follicles) on your scalp.
  2. Your scalp’s blood vessels provide nutrients to the root and help in hair growth.
  3. Hair pushes up and out through your skin. The hair passes through the oil glands that help maintain the required moisture in the hair.
  4. Hair grows for sometime and then falls off as a new hair growth cycle starts.

Kindly note, the thyroid hormones (T3 and T4) directly affect hair growth and its development. When the hormone production is disturbed, it can lead to hair thinning across your scalp and other areas such as your eyebrows.

Hair loss due to Autoimmune thyroid disease

Most people with Hypothyroidism or Hyperthyroidism have autoimmune thyroid disease. If someone has one type of autoimmune disease, he/she is more likely to develop another autoimmune condition for example: 

Alopecia areata: Alopecia areata is an autoimmune condition that causes hair loss in people having autoimmune thyroid disease.

It causes circular patches of hair loss in more discrete areas. In most cases this is temporary and does not progress, but unfortunately it can cause significant baldness. 

There are other rare autoimmune conditions that can also cause hair loss :

Hair loss due to Antithyroid Drugs

Some antithyroid drugs such as (carbimazole and propylthiouracil) can, in rare cases, cause hair loss. But, it may be very difficult to tell whether the drug or your thyroid condition is causing hair loss.

Furthermore, it is very rare for anti-thyroid drugs or treatment to cause hair loss. Kindly note, Antithyroid drugs are used to treat an overactive thyroid (Hyperthyroidism).

Slow and gradual thinning of hair is the most common symptom of thyroid related hair loss. You may notice more than usual hair lose while combing.

Furthermore, hair loss may develop slowly with hypothyroidism and hyperthyroidism. You won’t necessarily see patches or bald spots on your scalp, but, your hair may seem thinner all over.

In most cases, hair loss caused by thyroid conditions is temporary, but regrowth of hairs may take several months.

It is important to note here that, you can still experience hair loss even after starting medicines for your thyroid condition. This is because the hair growth cycle is a months long process. But some people start wrongly blaming the thyroid medicines for hair loss. Unfortunately, if they stop their thyroid medicines, the hair loss problem will become worse.

Kindly note, it is perfectly normal to lose 50–100 hairs from your head each day. However, hair loss beyond this needs medical attention and may be related to thyroid problem.

Dear Reader, always remember that, “Treating thyroid related hair loss requires treating the Thyroid Problem“.

Working with your doctor to keep your thyroid disorder under control with medication may keep your hair thicker and can regenerate hair growth. But try to be patient because, regrowth of hairs can be unpredictable and may take several months.

Treatment for an underactive thyroid – (hypothyroidism):

  • levothyroxine: Your doctor will usually prescribe a synthetic hormone called levothyroxine to treat an underactive thyroid (hypothyroidism).

    This medicine is given when your thyroid gland does not produce enough of this hormone on its own.

Treatment for an overactive thyroid – (hyperthyroidism):

  • Antithyroid medications: Antithyroid medications, such as (propylthiouracil and methimazole) decrease the thyroid gland’s ability to make the thyroid hormone. It is used to treat overactive thyroid (hyperthyroidism).
  • Radioactive iodine: This treatment kills some cells in the thyroid gland and reduce the amount of hormones that the gland produces. This treatment induces hypothyroidism, which is then managed by using thyroid hormone replacement therapy for the rest the life.
  • Surgery: Your doctor will monitor your thyroid levels while you are on medication. In some cases, surgery may be necessary. It involves the removal of some or all of the thyroid gland, which may lead to hypothyroidism.

Kindly note, with the treatment, hair growth may be noticeable within several months. But be aware that the new hair may differ in color or texture from your original hair.

Along with medication suggested by your doctor, you may try different home remedies to slowdown hair loss or regenerate hair growth. While the home remedies given below do not hold any scientific evidence, but you can give them a try to boost your hair growth.

1. Eating a balanced diet can help in growth and improve the condition of your hair. Foods that can increase the chances of having healthy hair include:

  • Fish: Oily fish contains omega-3 fatty acids that can help prevent a dry scalp.
  • Green vegetables: Vegetables such as spinach have high levels of vitamins A and C. These vitamins can improve the condition of hair.
  • Protein rich foods: Eating foods rich in protein can help prevent weak hair. Dairy products, nuts and lean meats all contain high levels of protein.
  • Calcium rich foods: Calcium is key to hair growth. Dairy products, such as milk and cheese are Good sources of calcium.
  • Iron Rich Foods: Iron deficiency and thyroid related hair loss are related. You can get tested for iron levels in your body and consider supplements for iron rich foods like liver, eggs, lamb, green leafy vegetables and so on.

2. Apply Essential Oils: Essential oils like eucalyptus oil and other plant extracts are known to improve hair growth. But, it’s important to talk with your doctor before using essential oils and use caution while choosing a quality brand.

Furthermore, you should also always do a patch test before using any essential oil for hair growth.

3. Control Iodine Intake: People with autoimmune thyroid disorders should check their iodine consumption. The body uses iodine to make thyroid hormone, so too much of iodine consumption may lead to imbalances.

Therefore, It is very important to understand how much iodine you would require in a day.

4. Yoga Asanas: A healthy lifestyle, which includes balanced diet and regular exercise, can help you live well with thyroid disease. Furthermore, adding yoga to your daily routine may help improve your thyroid function and hair growth.

Yoga for healthy thyroid and hair growth

Dear Reader, please discuss the above mentioned home remedies with your doctor before you start.

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What is an Endocrinologist

What is an Endocrinologist

An endocrinologist is a specially trained doctors who is qualified to diagnose diseases that affect the hormone making glands.

The conditions that are treated by an endocrinologist are as following:

  • Thyroid diseases
  • Diabetes
  • Hypertension
  • Menopause
  • Over or under production of hormones
  • Lack of growth
  • Metabolic disorders
  • Lipid disorders
  • Cancers of the endocrine glands
  • Osteoporosis

The common diseases and disorders that endocrinologists deal with include diabetes and thyroid disorders.

An Endocrinologist is a True Specialist

An endocrinologist is a specialist who has thoroughly studied hormonal conditions and knows the best possible treatments, even when conventional treatments do not work well. Unlike a family doctor or general practitioner, an endocrinologist studies hormones and hormonal diseases in depth. Hence, this specialist will be able to provide the best possible treatment. 

What to expect at your first appointment with an endocrinologist

Your endocrinologist is likely to ask you a number of questions. So being prepared before you see him will be of great help to you, as this may save time to go over any particularly important points you feel the need to spend more time on.

He will ask in detail about the symptoms you are experiencing, specifically related to the deficiency or excess of a hormone you may have.

Your doctor may ask:

  • What are your symptoms, and when did you first notice them?
  • How have your symptoms changed over time?
  • Has your appearance changed, including your weight or the amount of your body hair?
  • Have any of your family members been diagnosed with thyroid disease, hormonal or autoimmune conditions?
  • Are you currently being treated or have you recently been treated for any other medical conditions?
  • Have you recently had a baby?
  • Have you lost interest in sex? If you’re a woman, has your menstrual cycle changed?
  • Have you had any recent head injuries or have you had neurosurgery?

Further, your examination will depend on the type of problem you have. Your endocrinologist will look for signs of a disease as well as complications of the disease and treatments.

An Endocrinologist Works with Your Primary Care Doctor

Visiting an endocrinologist does not mean you will never see your primary care doctor again. Going to an endocrinologist when struggling with a hormonal condition gives you another set of eyes to ensure your health is as good as it can be.

Remember, your goal when facing a hormonal disease diagnosis should be to take care of your disease as best as possible. This is often done with the support of an endocrinologist. 

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Hashimoto’s Disease

Hashimoto’s Disease

Hashimoto’s Disease is an autoimmune disorder in which the immune system mistakenly attacks the thyroid gland. This can lead to hypothyroidism, a condition in which thyroid does not make enough hormones for body’s need. Hashimoto is the most common cause of hypothyroidism (an underactive thyroid).

Generally immune system protects body against bacteria and viruses. But in Hashimoto’s Disease, immune system make antibodies, which attacks the cells of thyroid gland. Doctors do not know why this happens, but some scientists believe genetic factors may be involved. The disease affects more women than men.

Causes of Hashimoto’s disease

The exact cause of the disease is not known, but many factors are believed to play a role:

Genetic: You are at higher risk of Hashimoto’s disease, if others in your family have thyroid disease or other autoimmune disorder. This suggests a genetic component to the disease.

Hormones: It is seven times more likely to occur Hashimoto’s Disease in women than men. Furthermore, some women have thyroid problems during the first year after having a baby called postpartum thyroiditis. Although the problem usually goes away, but some of these women develop Hashimoto’s years later.

Radiation exposure. People exposed to excessive levels of environmental radiation are more prone to Hashimoto’s disease.

Age. Hashimoto’s disease can occur at any age but more commonly occurs during middle age.

Symptoms of Hashimoto’s disease

You may have Hashimoto’s disease for many years before you experience any symptoms. The disease can progress for a long time, before it causes noticeable thyroid damage. The first sign is often an enlarged thyroid, called a goiter. The goiter may cause the front of your neck to look swollen. You may feel it in your throat, or it may be hard to swallow. Other sign and symptoms of an underactive thyroid due to Hashimoto’s may include:

  • Constipation
  • Dry, pale skin
  • Hoarse voice
  • Depression
  • Inability to get warm
  • Joint and muscle pain
  • Hair loss
  • Irregular menstrual periods
  • Slowed heart rate
  • Puffiness of the face
Symptoms of Hashimoto’s disease
Symptoms of Hashimoto’s disease

Because the symptoms of Hashimoto’s thyroid may be similar to those for other medical conditions, it is important to see your doctor for a diagnosis.

Diagnosis of Hashimoto’s disease

In general, your doctor may test for Hashimoto’s disease if you’re feeling increasingly tired or sluggish, have dry skin, constipation, and a hoarse voice, or have had previous thyroid problems or a goiter.

Diagnosis of Hashimoto’s disease is based on your signs and symptoms and the results of blood test. These may include:

Thyroid function test: This blood test tells whether your body has the right amounts of thyroid stimulating hormone (TSH) and thyroid hormone. A high level of TSH is a sign of an underactive thyroid. When the thyroid begins to fail, the pituitary gland makes more TSH to trigger the thyroid to make more thyroid hormone. When the damaged thyroid can no longer keep up, your thyroid hormone levels drop below normal.

An antibodies test: This test confirm the presence of antibodies against thyroid peroxidase (TPO antibodies). The presence of TPO antibodies in your blood suggests that, the cause of thyroid disease is an autoimmune disorder. Furthermore, TPO antibody test isn’t always positive in everyone with Hashimoto’s thyroiditis. However, many people have TPO antibodies present, but don’t have a goiter, hypothyroidism or other problems.

Treatment of Hashimoto’s disease

Most patients with Hashimoto’s thyroiditis will require lifelong treatment with levothyroxine. Furthermore, synthetic levothyroxine taken orally at an appropriate dose, is an inexpensive and very effective in restoring normal thyroid hormone levels. It results in an improvement of symptoms of hypothyroidism.

In addition, Regular use of levothyroxine can return your thyroid hormone levels to normal. However, you’ll probably need regular tests to monitor your hormone levels. This allows your doctor to adjust your dose as necessary.

Complications of Hashimoto’s disease

Left untreated, an underactive thyroid gland (hypothyroidism) caused by Hashimoto’s disease can lead to a number of health problems:

  • Goiter
  • depression
  • Heart problems
  • Mental health issues
  • Myxedema
  • Birth defects

Hashimoto’s can also cause problems during pregnancy. Furthermore, babies born to women with untreated hypothyroidism due to Hashimoto’s disease may have a higher risk of birth defects than do babies born to healthy mothers. Doctors have long known that these children are more prone to intellectual and developmental problems. There may be a link between hypothyroid pregnancies and birth defects, such as a cleft palate.

A connection also exists between hypothyroid pregnancies and heart, brain and kidney problems in infants. If you’re planning to get pregnant or if you’re in early pregnancy, be sure to have your thyroid level checked.

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Symptoms of Hyperthyroidism

Hyperthyroidism is a condition in which your thyroid gland produces too much thyroid hormones. It refers to a state in which your thyroid hormones production is above normal level. It is also called overactive thyroid. Hyperthyroidism can accelerate the metabolism rate of your body. As a result, it can cause weight loss and irregular heart activity. It is more common in women than men. Blood tests are the only way to reliably confirm a diagnosis.

Furthermore, having too much of thyroid hormones can cause unpleasant and potentially serious problems that may need treatment.

Signs and Symptoms of Hyperthyroidism

Some symptoms of hyperthyroidism can be easily confused with other disease, which can make it difficult to diagnose. Moreover signs and symptoms of hyperthyroidism varies from person to person. It can also cause a wide variety of signs and symptoms, including:

  • Bulging Eyes
  • Abnormal Heart Rate
  • Diarrhea
  • Weight Loss
  • Irritability
  • Itching
  • Heat Intolerance
  • Stress
  • Sleeplessness
  • Vision Problem
  • Frequent Sweating
  • Irregular Mensuration
  • Nervousness

If you suspect your symptoms are the result of a thyroid problem, it is most important you talk with your doctor. They can order a blood test to measure the amount of thyroid hormones in your blood. Because high levels of Thyroxine (T4) and low amounts of TSH (Thyroid Stimulating Hormone) in blood indicates an overactive thyroid.

What causes Hyperthyroidism?

Several diseases and conditions can cause hyperthyroidism, including:

  • Graves’ Disease: It is an autoimmune disorder that cause over production of thyroid hormones in your body. In this disease, your immune system creates antibodies known as thyroid-stimulating immunoglobulins (TSI). These antibodies then attach to the healthy thyroid cells and can cause your thyroid to create too much thyroid hormone. It is the most common cause of hyperthyroidism. (read more)
  • Thyroid Nodules: The term thyroid nodule refers to an abnormal growth of thyroid cells that forms a lump in your thyroid gland. These Nodules can become overactive and may produce excess thyroid hormones than your body needs, resulting in hyperthyroidism. Thyroid nodules are more common in older adults. (read more)
  • Thyroiditis: Thyroiditis is inflammation of your thyroid gland, which may be painful or painless. Sometimes your thyroid gland can become inflamed after pregnancy, due to an infection or an immune system problem. Further, the inflammation can cause thyroid hormone to leak out of your thyroid gland into your bloodstream. As a result, you may develop symptoms of hyperthyroidism. Types of thyroiditis that can cause hyperthyroidism include:
    1. Subacute Thyroiditis: A painful enlarged thyroid, possibly from a virus or bacteria.
    2. Postpartum Thyroiditis: It can develop after a woman gives birth.
    3. Painless/Silent Thyroiditis: Your thyroid gland may be enlarged due to an autoimmune condition (in which your immune system mistakenly attacks your thyroid).
  • To much Iodine: Excess iodine can cause temporary hyperthyroidism. Please note, iodine is a mineral that your thyroid gland uses to create thyroid hormone. Some foods and medications contain iodine and taking too much of them can cause your thyroid to produce too much thyroid hormone.

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How is Hyperthyroidism diagnosed?

Your doctor can diagnose hyperthyroidism by several methods, including:

  • Analysis of your medical history and symptoms: Your doctor will ask about your personal and family medical history and look for symptoms including a swollen thyroid, a fast pulse, moist skin, and shaking in your hands or fingers.
  • A physical examination: If you are experiencing symptoms of hyperthyroidism, your doctor may check the following during a physical examination:
    1. Your Thyroid gland: Your doctor may gently feel your thyroid gland through the outside of your neck to check if it is enlarged, bumpy or tender.
    2. Your Hand or Fingers: Your doctor may try to detect a tremor (slight shaking) in your hands or fingers when they are extended.
    3. Your Eyes: Your doctors may check your eyes for the abnormalities such as swelling, redness, bulging and other signs of Graves’ disease.
    4. Your Skin: Your doctor may check your skin to see if it is moist (slightly damp or wet).
  • Blood tests for diagnosing hyperthyroidism: The diagnosis of hyperthyroidism can be confirmed by blood tests. Therefore, your doctor may recommend a blood test to measure the levels of thyroid hormones and related substances such as T3, T4 and TSH in your body. The test is known as a Thyroid Function Test. This test checks the levels of:

    1. Thyroid stimulating hormone (TSH): It is produced and released into the bloodstream by the pituitary gland (a pea-sized structure) which is located at the base of your brain. TSH tells the thyroid gland how much T4 and T3 to make. (read more)
    2. Triiodothyronine (T3): It is one of the main thyroid hormones, containing three atoms of iodine. (read more)
    3. Thyroxine (T4) : Another of the main thyroid hormones, containing four atoms of iodine. (read more)

    Please note, when you have hyperthyroidism, levels of thyroid hormones (T3 and T4) are above normal and level of TSH is lower than normal. In other words, high levels of thyroid hormones (T3 and T4) and low amount of TSH indicate hyperthyroidism (an overactive thyroid).

    Further Blood Test: In addition to above mentioned blood tests, your doctor may also order thyroid antibody tests.

    1. Thyroid Antibody Test: This test measures the level of thyroid antibodies in your blood. Thyroid antibodies are made when your immune system mistakenly attacks the healthy cells of your thyroid gland. This is known as an autoimmune disorder. Moreover, the presence of thyroid antibodies in your blood suggests that the cause of thyroid disease is an autoimmune disorder, such as Hashimoto’s disease or Graves’ disease. There are three major types of thyroid antibodies:

    • Thyroid peroxidase antibodies (TPO): These antibodies can be a sign of Hashimoto’s disease or Graves’ disease.
    • Thyroglobulin antibodies (Tg): These antibodies can also be an indication of Hashimoto disease. Most people with Hashimoto disease have raised levels of both Tg and TPO antibodies.
    • Thyroid stimulating hormone (TSH) receptor: These antibodies can be a sign of Grave’s disease.
  • Imaging Tests for diagnosing hyperthyroidism: If your blood tests indicate hyperthyroidism, your doctor may order one of the following imaging tests to diagnose and find the cause why your thyroid is overactive.
    1. Ultrasound of thyroid: This test is most often used to look for thyroid nodules in your thyroid gland. Ultrasound uses high-frequency sound waves to create images of your thyroid gland. For an ultrasound, a technician will run a device called a transducer over your neck. Further, the transducer bounces safe and painless sound waves off your neck to make pictures of your thyroid. Ultrasound can help your doctor to detect if the nodules are more likely to be cancerous.

    2. Radioactive iodine uptake test: This test helps your doctor to find the cause of hyperthyroidism by measuring how much radioactive iodine your thyroid gland absorbs/takes up from your blood after you swallow a small, safe dose of radioactive iodine. During this test, you will sit on a chair while a technician scan your neck with a device called a gamma probe. Further, the probe measures how much radioactive iodine your thyroid absorbs from your blood. Measurements are often taken 4 to 6 hours after you swallow the radioactive iodine and again at 24 hours.

      If your thyroid collects a large amount of radioactive iodine, you probably have Graves’ disease or thyroid nodules. Please note, women should always tell their doctor and technician if they are pregnant or breastfeeding.

    3. Thyroid scan: For thyroid scan, a technician injects a small amount of radioactive iodine or a similar substance into your vein that will be absorbed by your thyroid. Further, during the scan, you will lie on a moveable examination table with your head stretched backward and neck extended. The gamma camera will then take a series of images of your thyroid gland from different angles and display them on computer screen. The radioactive substance makes all or certain parts of your thyroid gland appear “bright” on the screen. Moreover, thyroid nodules that make too much thyroid hormone show up clearly in the images.

      Furthermore, a thyroid scan can also reveal whether the entire thyroid gland or just a single area is causing the problem. Your doctor may use a thyroid scan to look for nodules, inflammation and thyroid cancer. Please note, women should always tell their doctor and technician if they are pregnant or breastfeeding.

Hyperthyroidism Treatment

The treatment of your hyperthyroidism depends on the cause of hyperthyroidism, how severe it is, your age and physical condition. Further, hyperthyroidism is usually treated with one or more of the following:

  • Antithyroid medicines: These medicines stop your thyroid gland from producing too much thyroid hormone. The antithyroid medicines may take several weeks or months to bring your thyroid hormone levels into the normal range and also gradually reduce your symptoms of hyperthyroidism. However, you probably need to take the medicines for 1 to 2 years, but can continue for many years.

    Moreover, according to the National Institutes of Health (NIH), antithyroid medicines can cause side effects, including:

    • Allergic reactions, such as rashes and itching.
    • Joint Pain.
    • Reduced white blood cells in your body, which can increase the chance of infections.
    • Liver failure, in rare cases.

    So call your doctor immediately if you have symptoms such as yellow skin or eyes, fatigue, fever, sore throat, or pain in your belly. Furthermore, you should also follow up regularly with your doctor to determine whether or not the dose needs to be adjusted based on your thyroid function test results.

    Also make sure to tell your doctor if you are pregnant or planning for the same, and if you take other medications. Please always take medication as advised by your doctor.

  • Beta blocker medicines: Your doctor may prescribe a medicine known as beta blocker. These drugs cannot treat the high levels of thyroid hormone in your blood, but can help to reduce the symptoms of hyperthyroidism such as nervousness, anxiety, shaking, or a fast heartbeat.

    Therefore, your doctor may prescribe these drugs to help you feel better until other treatments take effect. Please note, this treatment is not used alone and is usually paired with another option to treat hyperthyroidism.

  • Radioactive iodine therapy: Radioactive iodine is usually taken by mouth as a tablet or liquid, that contains iodine and a low dose of radiation. Once swallowed, the radioactive iodine gets into your bloodstream and quickly absorb by your overactive thyroid cells. Further, radioactive iodine slowly destroys the cells of the thyroid gland. As a result, your thyroid shrink in size and your levels of thyroid hormone go down. This treatment may cause your thyroid activity slow enough to be considered as hypothyroidism, which is easier to treat than hyperthyroidism.

    Radioactive iodine therapy is a common and effective treatment for hyperthyroidism. However, this therapy is not suitable for women who are pregnant or breastfeeding. It can harm the fetus’ thyroid and can be passed from mother to child through breast milk.

  • Surgery of the Thyroid Gland: During surgery, all or part of your thyroid gland is removed by your doctor. This is also known as thyroidectomy. Your doctor may recommend surgery if you do not respond to other treatments or cannot tolerate other therapies for hyperthyroidism. However, surgery is used in rare cases to treat hyperthyroidism.

    Furthermore, after surgery, if all of your thyroid gland is removed, you will become hypothyroid. As a result, you will need to take levothyroxine (a synthetic form of thyroid hormone) for the rest of your life. It is usually prescribed by the doctor as one small pill a day. Taking this drug prevents hypothyroidism.

    In addition, thyroid surgery comes with small risk of injury to structures near the thyroid gland in the neck. It can damage the nerves of your vocal cords and your parathyroid glands.

What Foods are Good and Bad for Hyperthyroidism?

Your thyroid gland uses iodine to make thyroid hormones. Therefore, eating foods that have large amounts of iodine may cause hyperthyroidism or make it worse. Hence, it is important to watch your iodine intake if you have been diagnosed with hyperthyroidism.

Furthermore, if we talk about diet plan, then there are certainly many do’s and dont’s. Although a healthy diet cannot cure or prevent hyperthyroidism, however, eating healthy foods may help ease hyperthyroidism symptoms.

What to Eat
  • Fruit and fruit juices
  • Lentils
  • Mushrooms
  • Spinach
  • Potato
  • Honey
  • Cauliflower, Broccoli
  • Unsalted Nuts
  • Egg whites
  • Radishes 
  • Moderate portions of Red Meat, Chicken
What to avoid
  • Dairy Products
  • Soy Products
  • Salted Nuts and Seeds
  • Caffeine
  • Fish and Shellfish
  • Seaweed
  • Egg yolks
  • Chocolate

Please note, talk to your doctor about which foods, supplements, and medicines you need to avoid. Your doctor or dietitian will be able to provide more information about dietary changes for hyperthyroidism. Always consult your doctor or a registered dietician before making any drastic changes to your diet.

In addition, stress management and exercising can help ease hyperthyroid symptoms. So you can start with some simple exercises like walking, aerobics, pushups and yoga.

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