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S.No. |
Type of thyroid disorder |
Definition |
A. |
Hypothyroidism |
High TSH (>5.0) |
I. |
Primary |
Low T3 and/or low T4 with high TSH |
II. |
Sub-clinical |
Normal T3, T4 with high TSH |
III. |
Clinically euthyroid |
Normal/high T3, high T4 with high TSH |
B. |
Hyperthyroidism |
Low TSH (<0.39) |
I. |
Primary |
Normal/high T3, high T4 with low TSH |
II. |
T3 toxicosis |
High T3, normal T4 with low TSH |
III. |
Sub clinical |
Normal T3, T4 with low TSH |
IV. |
Central |
High T3 and/or high T4 with normal TSH |
Statistical Analysis:
Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 24.0.The data were represented as counts, percentage and mean + standard deviation. Comparison of thyroid hormone levels among different thyroid disorder groups was analyzed by one way analysis of variance (ANOVA). Chi test was used to assess the prevalence of thyroid disorders in different age groups and gender (Males vs Females).
Results:
3940 patients suspected of thyroid dysfunction visited Clinical Biochemistry Lab for thyroid hormone investigations from January, 2015 to July, 2016. The prevalence of thyroid disorder was found to be 25.17% (992) in the study population. 74.82% (2948) patients were euthyroid. Among the thyroid dysfunction patients 16.85% (665) belonged to hypothyroidism group and 8.29% (327) to hyperthyroidism group.
Hypothyroidism
In this study, out of 665, maximum number of patients 461(69.32%) were diagnosed with primary hypothyroidism followed by 128 (19.24%) with sub clinical hypothyroidism and 76(11.42%) with clinically euthyroid. A significant difference in the thyroid levels between these groups was found by one way ANOVA.
Out of 665, 547 (82.25%) were females and 117 (17.59%) were males. Chi test showed significant difference (p<0.0001) for association of the gender groups with hyperthyroidism.
Effect of age groups was also studied. 57% (389) of hypothyroidism patients fall in the age group of 21-40.Very few patients in the age group of 0-10 had hypothyroidism. A Significant difference was found with P<0.0001 for association of age group with hypothyroidism by chi test.
Hyperthyroidism
Out of 327, 193(59%) of patients belonged to central hyperthyroidsim group followed by 105(32.11%) in primary hyperthyroidism, 23(7.03%) in sub clinical hyperthyroidism and 6(1.83%) in T3 thyrotoxicosis. One way ANOVA showed significant difference between the thyroid levels of these groups
In the hyperthyroidism study group, 278 (85.01%) were females and 49(14.98%) were males. Significant difference was found by chi test.
More than 60% of hyperthyroid patients were in the age group of 21-40 (199). The Least number of patients were in the age group of >61.A Significant difference was found with P<0.0001 for association of age groups with hyperthyroidism by chi test.
Discussion:
Thyroid disorders are amongst the most common endocrine diseases in India. The prevalence and pattern of thyroid disorders depend on sex, age, ethnicity, geographical factors and nutrition especially on iodine intake. A high iodine intake is associated with lower prevalence of goiter and higher prevalence of hypothyroidism. Low intake is associated with a higher prevalence of hyperthyroidism 7. Despite the coverage of National iodine deficiency control programmes (NIDDCP) in India, thyroid disorders are not confined to the conventional iodine deficient sub Himalayan zone but also extended to the plain fertile lands8. A possible etiological role of cyanogenic foods acting as goitrogens to interfere with iodine nutrition has been previously suggested 9, 10,11,12,13. Increasing exposure to thyroid disruptors, including industrial and agricultural contaminants has been identified as a growing health concern throughout India.14
In the present study, out of 3940 patients suspected with thyroid disorder, highest number (74.82%) of subjects was found to be euthyroid. A hospital based study conducted by Rebecca et al also reported that about 80% of patients were found to be euthyroid 3, 13. Among the thyroid dysfunction patients (25.17%), 16.8% were hypothyroid (11.7% primary, 3.2% sub clinical and 1.9 % clinically euthyroid) and the results were found to be in contrast with the findings of Rebecca et al.
The strikingly larger percentage of subjects with primary hypothyroidism in our study is most likely based on the subjects’ high iodine and goitrogenic foods intake such as brassica, cabbage, cauliflower, fast food, chocolates, milk, eggs and other vitamin E rich compounds which stimulate iodine absorption. Most goitrogens are naturally occurring chemicals that are ingested in foods or drugs. These chemicals can interfere with thyroid function in different ways. Some goitrogenic compounds induce antibodies that cross-react with the thyroid gland, other interferes with thyroid peroxidase, the enzyme that organifies iodide to iodine and adds the iodine to tyrosine residues on thyroglobulin during the synthesis of thyroid hormones. Either way, thyroid is unable to produce as many of thyroid hormones as are needed to regulate metabolism 15.
Hyperthyroidism was seen in 8.2% (2.6% primary, 4.8% central, 0.58% sub clinical and 0.15% T3 thyrotoxicosis) and is comparable to many studies12,16,17.The number of females was higher (n=825) indicating a high prevalence of thyroid dysfunction in women than men. This finding is supported by various studies 18, 19.
The thyroid disorder cases were classified into seven age groups to determine the occurrence of various thyroid disorders in different age groups. Various studies support the observation that maximum number of patients were seen in the age group of 21-30 years (33.3% hypothyroid and 39.7% hyperthyroid) followed by 31-40 age group ( 24.9% hypothyroid and 21.1 % hyperthyroid) 20.
Our findings show that the major burden of thyroid disorders is on reproductive age groups. If left untreated, hypothyroidism can cause elevated cholesterol levels, an increase in blood pressure, an increased rate of cardiovascular complications, decreased fertility, and depression; and in pregnant women, placental abnormalities and increased risks for the baby’s well being. These symptoms are often confused with other disorders, thus making thyroid disorders one of the most under diagnosed disorders in India21. This indicates that thyroid diseases should be considered during routine evaluation of this susceptible group and should be followed by appropriate detection and treatment. This problem must be addressed immediately to avoid deleterious effects of abnormal thyroid dysfunction on the patients as well as on their offspring11. There is a need for further studies to evaluate the affect of environmental and etiological factors such as auto immunity, drugs, iodine and non thyroid illness on thyroid dysfunction in this area.
Conclusion:
Based on our findings, we first believe that widespread routine screening is important to identify those individuals susceptible to or afflicted by thyroid disorders. This is especially important in that the signs and symptoms of thyroid dysfunction mimic those of many other common diseases.
Second, the study findings call for a review of current practices in the management of thyroid disorders because of high prevalence of thyroid disorder in the reproductive age group (21-40). Thyroid disorders must be actively screened and monitored and to be effectively treated in diagnosed patients.
Acknowledgement
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/ editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
References:
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