DOI: http://dx.doi.org/10.18203/2349-3933.ijam20192588

A clinico-epidemiological analysis of subclinical hypothyroidism in a tertiary care health center

Vaibhav Agrawal, Virendra Patil, Ashok Kshirsagar

Abstract


Background: Subclinical hypothyroidism (SCH) is defined by increase in serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) and free triiodothyronine (FT3) levels within normal range, coupled with absence of typical clinical symptoms. The present study was undertaken to analyse the SCH associated comorbidities, especially lipid disturbances, thyroid autoantibodies, etc.

Methods: The present study was retrospective observational study, which was carried out at a tertiary health care center.

Results: Out of the 100 patients, majority were in the age group 21 to 30 years (31 patients), followed by 26 patients in age group >51 years and least in age group 41 to 50 years. Prevalence showed female predilection, with female: male ratio of 1.9:1. Most common symptom reported was general fatigue, which was encountered in 40 patients, followed by weight gain, menstrual abnormalities, and constipation. 10 patients were asymptomatic. Serum TSH range in the patients was 5 to 21.1 µIU/l, while mean TSH was 10.9 µIU/l. 20 patients were found to have serum TSH>10.

Conclusions: Despite high prevalence, detection rate of subclinical hypothyroidism is very low. Carrying out epidemiological study on national scale is need of the hour, as lack of typical clinical features makes the detection less likely and it has numerous complications, if untreated.


Keywords


Subclinical hypothyroidism, T3, T4, Thyroxine, TSH

Full Text:

PDF

References


Douglas S. Ross subclinical hypothyroidism. In: Braverman LE, Utiger RD. Werner and Ingbar's The Thyroid: A fundamental and clinical text. 8th Ed. Philadelphia:Lippincott Williams and Wilkins;2000:1001-1006.

Sawin CT, Castelli WP, Hershman JM, McNamara P, Bacharach P. The aging thyroid: thyroid deficiency in the Framingham study. Arch Intern Med. 1985 Aug 1;145(8):1386-8.

Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in community: A 20 year follow up of the Wickham survey. Clin Endocrinol. 1995;43(1):55-68.

Szavolcs I, Podoba J, Feldkamp J, Dohan O, Farkas I, Sajgó M, et al. Comparative screening for thyroid disorders in old age in areas of iodine deficiency, long term iodine deficiency, long term iodine prophylaxis and abundant iodine intake. Clin Endocrinol. 1997;47(1):87-92.

Shetty M, Adiraju KP, Modugu NR. Clinical profile of subclinical hypothyroidism: A retrospective study. Int J Med and Dent Sci. 2017;6(2):1475-82.

Deshmukh V, Behl A, Iyer V, Joshi H, Dholye JP, Varthakavi PK. Prevalence, clinical and biochemical profile of subclinical hypothyroidism in normal population in Mumbai. Indian J Endocrinol Metab. 2013 May-Jun;17(3):454-9.

Althaus BU, Staub JJ, Ryff-deleche A, Oberhänsli A, Stähelin HB. LDL/HDL- changes in subclinical hypothyroidism: Possible risk factors for coronary heart disease. Clin Endocrinol (Oxf). 1988;28(2):157-63.

Madhuvan HS, Rayshankar SN, Reddy S, Chandrasekhar P, Nikhil. A prospective study of thyroid dysfunction in elderly patients and its clinical correlation. Arch Med. 2013;5(2:1):1-11.

Iervasi G, Molinaro S, Landi P, Taddei MC, Galli E, Mariani F, et al. Association between increased mortality and mild thyroid dysfunction in cardiac patients. Arch Intern Med. 2007;167(14):1526‑32.

Leentjens AF, Kappers EJ. Persistent cognitive defects after corrected hypothyroidism. Psychopathology. 1995;28(5):235-7.

Reuters VS, Teixeira Pde F, Vigario PS, Almeida CP, Buescu A, Ferreira MM, et al. Functional capacity and muscular abnormalities in subclinical hypothyroidism. Am J Med Sci. 2009 Oct;338(4):259-63.

Baldini IM, Vita A, Mauri MC, Amodei V, Carrisi M, Bravin S, et al. Psychopathological and cognitive features in subclinical hypothyroidism. Prog Neuropsychopharmacol Biol Psychiatry. 1997;21(6):925‑35.

Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witteman JC. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam Study. Ann Intern Med. 2000;132(4):270‑8.

Bemben DA, Hamm RM, Morgan L, Winn P, Davis A, Barfen E, et al. Thyroid disease in the elderly. Part 2. Predictability of subclinical hypothyroidism. J Fam Pract. 1994;38(6):583-8.

Esposito S, Prange AJ, Golden RN: The thyroid axis and mood disorders: overview and future prospects. Psychopharmacol Bull. 1997;33(2):205-17.

Senthilkumaran S, Sathyaprakash V, Sundararajan A. A Study on Prevalence and Distribution of Subclinical Hypothyroidism in Rural Women. Sch J App Med Sci. 2015;3(1D):287-90.

Mukherjee S, Dutta S, Mandal S. Prevalence of Subclinical Hypothyroidism in Acute Coronary Syndrome in Nondiabetics: Detailed Analysis from Consecutive 1100 Patients from Eastern India. J Thyroid Res. 2018 Sep 4;2018:9030185.

Raza SA, Mahmood N. Subclinical hypothyroidism: Controversies to consensus. Indian J Endocr Metab. 2013;17(9):S636-42.

Bauer DC, Ettinger B, Browner WS. Thyroid functions and serum lipids in older women: A population-based study. Am J Med. 1998;104(6):546-51.

Unnikrishnan AG, Menon UV. Thyroid disorders in India:An epidemiological perspective. Indian J Endocr Metab. 2011;15(Suppl 2):S78-81.

Goulis DG, Tsimpiris N, Delaroudis S, Maltas B, Tzoiti M, Dagilas A, et al. Stapedial reflex: a biological index found to be abnormal in clinical and subclinical hypothyroidism. Thyroid. 1998;8(7):583-7.

Mahanta N, Saikia A, Das R. Prevalence, clinical presentation and aetiology of hypothyroidism in elderly: A hospital-based study from Assam, India. Indian J Basic Applied Med Res. 2017 September;6(4):450-6.

Chen LM, Du WJ, Dai J, Zhang Q, Si GX, Yang H, et al. Effects of subclinical hypothyroidism on maternal and perinatal outcomes during pregnancy: a single-center cohort study of a Chinese population. PLoS One. 2014 Oct 29;9(10):e109364.