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IJCRR - 8(21), November, 2016

Pages: 06-11

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HOSPITAL BASED STUDY OF THYROID DISORDERS IN RURAL POPULATION OF GURGAON, HARYANA

Author: Poonam Arora, Smita Prasad, Busi Karunanand

Category: Healthcare

Abstract:Introduction: Endocrine disorders pose a major threat to public health. Current research shows that 300 million people are suffering from thyroid disorders globally and 42 million among them reside in India.
Objective: Our objective is to find the prevalence of thyroid disorders in rural population of Gurgaon, Haryana.
Materials and Methods: This study was conducted in SGT Medical College and Hospital, Budhera, Gurgaon, Haryana from January, 2015 to July, 2016. 3940 patients were screened for thyroid function. Thyroid function was assessed by quantitative estimation of T3 (Triiodothyronine), T4 (Thyroxine) and TSH (Thyroid Stimulating Hormone) in serum by chemiluminscent immuno assay.
Results: 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 (11.70% primary, 3.20% sub clinical and 3.24% clinically euthyroid) and 8.29% (327) to hyperthyroidism group (2.66% primary, 0.15% T3 thyrotoxicosis, 0.58% sub clinical and 4.89% central)
Conclusion: 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.

Keywords: Hypothyroidism, hyperthyroidism, thyroid dysfunction

Full Text:

Introduction:

Endocrine disorders pose a major threat to public health. Thyroid dysfunction due to abnormal production of thyroid gland hormones (T3-Triiodothyronine and T4-Thyroxine) forms a major proportion of endocrine disorders after diabetes1. Thyroid hormones are metabolic hormones and are regulated by Thyroid Stimulating Hormone (TSH) secreted by pituitary gland.

Current research shows that 300 million people are suffering from thyroid disorders globally and 42 million among them reside in India2. Genetic and various environmental factors including geographical location, nutrition and diet especially iodine intake affect the prevalence of thyroid disorders. The utility of symptoms for screening of patients with thyroid disorders has become limited considering the recent trend of asymptomatic patients. Thyroid disorders are usually associated with additional morbidities: hypercholesterolemia, hypertension, infertility, adverse pregnancy outcomes and neuropsychiatry diseases, causing its under diagnosis. Even though there is no permanent cure, the patient can lead a normal life after diagnosis and treatment3.

Despite the optimal iodine nutrition status of India classified by WHO in 2004, many parts of India are still iodine deficient4,5.

Paucity of data and the fact that Budhera and its surrounding region has iodine deficient status even in post iodization phase of India warrants for thyroid status surveillance of this region.

Materials and methods:

This study was conducted in the SGT Medical College, Budhera, Gurgaon, Haryana from January, 2015 to July, 2016.  The study proposal was reviewed and approved by hospital ethical committee. A Total of 3940 outpatient department patients suspected of thyroid disorders were screened for thyroid function after obtaining consent from all the patients.

4 ml of fasting blood sample was collected and centrifuged for serum separation. Thyroid function was assessed by quantitative estimation of T3, T4 and TSH levels in serum performed using SEIMENS-Centaur CP analyzer based on chemiluminescent immuno assay (CLIA).

The subjects were categorized as euthyroid (normal TSH), hypothyroid (high TSH) and hyperthyroid (low TSH) based on serum thyroid hormone levels.

Normal thyroid hormone levels:

  1. Triiodothyronine (T3) (ng/ml) : 0.45-2.0
  2. Thyroxine(T4) (µg/ml) : 4.4-11.6
  3. Thyroid Stimulating Hormone (TSH) (µIU/ml): 0.39-5.0

Further classification of hypothyroid and hyperthyroid patients was done using following definitions6:

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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  2. Nimmy NJ, Aneesh PM, Narmadha MP, Udupi RH, Binu KM. A Survey on Prevalence of Thyroid Disorders Induced by Demography and Food Habits in South Indian population. Ind J Pharm Prac 2012;5:49-52.
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  6. Burtis CA and Bruns DE. Tietz fundamentals of Clinical Chemistry and Molecular Diagnostics. 7th ed. Saunders;2015.p.819.
  7. Laurberg P, Pederson KM, Hreidarsson A, Sigfussen N, Iversen F et al. Iodine intake and the pattern of thyroid disorders: a comparative epidemiological study of thyroid abnormalities  in the elderly  in Icelend  and in Jutland. Denmark J Clin Endocrinol Metab 1998;83:765-769.
  8. Sheila C. Current Status of Iodine Deficiency Diseases and Strategy for its control in India. Indian J of  Pediatr 2002;69: 589-96.
  9. Chandra AK, Tripathy S, Lahari D, Mukhopadhyay S. Iodine nutritional status of school children in a rural area of Howrah district in the Gangetic West Bengal. Indian L Physiol Pharmacol 2004;48:219-24.
  10. Chandra AK, Mukhopadhyay S, Lahari D, Tripathy S. Goitrogenic content of Indian cyanogenoc plant foods and their in vitro anti thyroidal activity. Indian J Med Res. 2004;119:180-5.
  11. Dhok AJ, Adole PS, Puppalwar PV, Agrawal U. Status of Thyroid disorders at Acharya Vinobha Bhave Rural Hospital, Sawangi(Meghe), Wardha, India. Thyroid Research and Practice 2105;12(2):62-66.
  12. Skaria LK, Sarkar PD, Agnihotram G, Thakur AS, Pamidamarri G. Thyroid Dysfunction in Tribal Women of the Bastar Region of Chattisgarh, India. Thyroid Science 2011;6(6):5.
  13. Bhutia SC, Bhutia KL, Singh TA. Thyroid Dysfunction in Central Referral Hospital, Sikkim. Asian J Biomed Pharmaceu  Sci 2016;6(56):17-19.
  14. Kalra S, Unnikrishnan AG, Sahay R. Thyroidology and public health: The challenges ahead. Indian J Endocrinol Metab. 2011;15:S73-5.
  15. Siddhanti SR, King MW, Tove SB. Influence of dietary fat on factors in serum that regulate thyroid cell metabolism. J Nutr. 1990;120(11):1297-304.
  16. Hollowel JG, Staehling NW, Flanders DW, Hannon WH, Gunter EW, Spencer CA et al. Serum TSH, T4, and Thyroid Antibodies in the United States Population (1988-1994):National Health and Nutrition Examination Survey(NHANES III). J Clin Endocrinol Metab 2002;87:489-99.
  17. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado Thyroid Disease Prevalence Study. Arch of Intern Med 2000;160:526-34.
  18. Mahto RV, Jha B, Singh KP, Yadav BK, Shah SK, Lamsal M. Status of Thyroid disorders in Central Nepal: A Tertiary care Hospital based study. Int J App Sci Biotechnol. 2015;3(1):199-222.
  19. Freidman MN. Screening for thyroid disease. Ann Med. 1999;130:161-162
  20. Rama J, Shivashankara AR, Vidya SP, Sameena. A hospital based study of prevalence study of thyroid dysfunction in Srinagar. Int J Med Sci Public Health 2015;4(2):151-154.
  21. Mayo Foundation for Medical Education and Research (MFMER)

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A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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