DOI: http://dx.doi.org/10.18203/2349-3933.ijam20195667

A study of serum thyroid stimulating hormone levels, and its correlation with clinical features and delayed diagnosis of hypothyroidism in central India

Dharmendra Jhavar, Umesh Kumar Chandra, Shivshankar Badole, Anurag Rahekar, Sumit Vishwakarma

Abstract


Background: The clinical manifestations of hypothyroidism are variable, depending upon its cause, duration and severity. The spectrum extends from subclinical to overt hypothyroidism to myxedema coma. A high degree of suspicion is thus required in order to appreciate the clinical manifestation of the disorder to reach a diagnosis. Purpose of this study was to correlate serum TSH level with severity of clinical manifestations and evaluate possible cause of delay in the diagnosis.

Methods: A cross section observational and descriptive study for the assessment of severity of primary hypothyroidism at presentation and evaluation of the causes of delay in diagnosis in 86 patients was done from December 2012 to November 2013 in the Department of Medicine, MGM Medical College, Indore, MP, India.

Results: Illiterate patients had significantly (p value 0.002) higher TSH values at presentation. 34.8% of patients presented as severe hypothyroidism with TSH value >100 mIU/L. Delay of as much as 7 years was noted. Majority of patients had a delay of around 1 to 3 years in diagnosis. Only 4.6% patients were diagnosed without any delay due to high level of suspicion at presentation.

Conclusions: Due to non-specific symptomatology of hypothyroidism diagnosis is often delayed. Therefore, high index of suspicion is required at the physician’s level and test of thyroid function is available at subsided cost therefore it should be offered to all such patients.


Keywords


Background: The clinical manifestations of hypothyroidism are variable, depending upon its cause, duration and severity. The spectrum extends from subclinical to overt hypothyroidism to myxedema coma. A high degree of suspicion is thus required in order t

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References


Helfand M, Crapo LM. Screening for thyroid disease. Annal Int Med. 1990 Jun 1;112(11):840-9.

Desai MP. Disorders of thyroid gland in India. Ind J Pediatr. 1997 Jan 1;64(1):11-20.

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

Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clini Endocrinol. 1977 Dec;7(6):481-93.

Doeker B, Reinher T, Andler W. Autoimmune thyroiditis in children and adults: Clinical and laboratory findings. Klin Pediatric. 2000;212(3):103-7.

Chiu AC, Sherman SI. Clinical manifestations and differential diagnosis of hypothyroidism. Thyroid disease: Endocrinology, Surgery, Nuclear medicine and radiotherapy. 2nd ed. Philadelphia, PA: Lippincott-Raven; 1997: 379-392.

Smith TJ, Bahn RS, Gorman CA. Connective tissue, glycosaminoglycans, and diseases the thyroid. Endo Rev. 1989 Aug 1;10(3):366-91.

Gabrilove JL, Ludwig AW. The histogenesis of myxedema. J Clini Endocrinol Metab. 1957 Aug 1;17(8):925-32.

Watanakunakorn C, Hodges RE, Evans TC. Myxedema: a study of 400 cases. Archi Int Mede. 1965 Aug 1;116(2):183-90.

Rosário PW, Bessa B, Valadao MM, Purisch S. Natural history of mild subclinical hypothyroidism: prognostic value of ultrasound. Thyroid. 2009 Jan 1;19(1):9-12.