International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 13(16), August, 2021

Pages: 105-108

Date of Publication: 30-Aug-2021


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Prevalence of Subclinical Hypothyroidism in High-Risk Individuals Attending Medicine Outpatient Department (OPD) in Tertiary Care Hospital

Author: Anand D Bang, Nitin N Jadhav, Virendra C Patil, Aparna P Patange

Category: Healthcare

Abstract:Introduction: Nowadays Hypothyroidism is quite common. It results in many problems which ultimately hampers the quality of life. It is a common endocrine disorder in general practice. A textbook describes the classical hypothyroid state thus, the patients face looks grotesquely swollen and eyelids may be so infiltrated that the skin beneath hangs in sacs. The present study aims to study the magnitude and association of subclinical hypothyroidism in individuals having risk factors. (Females with age more than 50 years old and family history of hypothyroidism). Method: This is a Cross-sectional, observational hospital-based study design. The study was conducted on patients attending the medicine outpatient department in Krishna Hospital and Medical Research Centre, Karad. The study duration was from October 2018 to March 2020 (18 months). Result: A significant association between smoking and subclinical hypothyroidism was found (p < .05). It was observed that a comparatively larger proportion of subjects who consumed tobacco (smokeless form) developed subclinical hypothyroidism, but the statistical significance could not be established (p > .05). Subclinical hypothyroidism was observed significantly more among the subjects with a body mass index of more than 25 kg/m2 (p < .05). Conclusion: Present study provides valuable information regarding the presence of subclinical hypothyroidism in a significant proportion of subjects in context with the Indian population.

Keywords: Subclinical Hypothyroidism, High-Risk Individuals, Outpatient Department, History of cigarette smoking, Diabetes mellitus and obesity

Full Text:

INTRODUCTION

Hypothyroidism is a common problem; it causes symptoms that reduce the functional status and quality of life. It is a common endocrine disorder in general practice. A textbook describes the classical hypothyroid state thus, the patient's face looks grotesquely swollen and eyelids may be so infiltrated that the skin beneath hangs in sacs. Movements and speech are grossly retarded. The tongue may fill the mouth. The voice is hoarse, almost a croak. Skin is thickened, cold, rough and dry. Hair tends to dry and become brittle and sparse. A slow pulse rate may be found. Nonpitting edema can be recorded in third to half of patients. The Achilles reflex is prolonged. The disease may progress slowly without the patient being aware that he/she is ill.1, 2 The history pertaining to thyroid is summarized by Rolleston1 according to which Galen in his De voce briefly described the gland. Vesalius added to the anatomy of the gland. He suggested that the gland was there to round out and beautify the neck. Hypothyroidism as a clinical syndrome was described for the first time in London in 1870. In 1873 Sir William Gull was the first to understand that the cause of myxoedema is atrophy of thyroid gland.3

Ord coined the term Myxedema in 1878 and published the definitive account of myxedema. Later it was accepted widespread that cretinism, myxedema and post-thyroidectomy changes all were a result of the loss of function of the thyroid body. In 1896 Baumann suggested that iodine deficiency caused the malfunctioning of the thyroid. Kendall isolated thyroxin (thyroxyindole) for the first time in 1914. Harrington synthesized it for the first time in 1926. However, synthesis of thyroxine was done in large scale in 1949; later it became a universally accepted therapy for hypothyroidism.4 In 1951 T3 was found to be metabolically active in the treatment of hypothyroidism.5

Subclinical hypothyroidism was a new clinical entity described in early 1970s after TSH estimation became routine. It represents a form of mild thyroid failure. Large epidemiological studies indicate that subclinical hypothyroidism is the most prevalent thyroid disease in the community.6

AIM

To study the magnitude and association of subclinical hypothyroidism in individuals having risk factors. (females with age more than 50 years old and family history of hypothyroidism). At the same time we will study the magnitude and association of subclinical hypothyroidism in subjects having following risk factors

a)         Females more than 50 years old

b)         Family history of hypothyroidism

c)         History of cigarette smoking

d)         Diabetes mellitus and obesity

METHOD

This is a Cross-sectional, observational hospital-based study design. The study was conducted in patients attending the medicine outpatient department in Krishna Hospital and Medical Research Centre, Karad. The study duration was from October 2018 to March 2020 (18 months). Ethical committee clearance: This study was approved by Institutional Ethics and Protocol Committee (Protocol number 0252/2018-2019). The Sample size was calculated by using the following formula 

N=4×p×q/d2

With reference to previous studies, we found that prevalence of subclinical hypothyroidism was 9.4% constituted p in the above equation. Hence ‘q’ which is 100 - p became 90.6% (100-9.4). The ‘d’ is absolute allowable error taken as 5% (considering a confidence interval of 95%). Hence from the above equation, the estimated sample size for this study was 136.

Inclusion criteria

Subjects with high-risk factors for the development of hypothyroidism were included. We took the following high-risk factors for screening of subclinical hypothyroidism

1.         Females more than 50 years old

2.         Family history of hypothyroidism

3.         History of cigarette smoking

4.         Diabetes mellitus and obesity

Exclusion criteria

1.         Subjects already diagnosed to have hypothyroidism

2.         Cases of frank hypothyroidism

3.        Critically ill patients

Method: Demographic information such as age, gender, past medical history, personal history and general examination findings such as weight, height, body mass index were recorded with the help of standard, pre-validated, semi-structured case record proforma.

RESULT

Subclinical hypothyroidism is defined as an elevated serum thyroid-stimulating hormone (TSH) level associated with normal total tetra-iodothyronine (T4) and tri-iodothyronine (T3) levels. This is a much more common disorder than overt hypothyroidism. After institutional ethical clearance, with informed consent and with inclusion and exclusion criteria 136 cases with known high-risk factors in medicine outpatient department were included in the study and were evaluated on the basis of thyroid hormone profile. The data was entered in the master sheet and analyzed statistically. The salient of features of studied criteria in study population are summarized below: In the present study majority of the study, subjects were females (69.11%) whereas 30.88% of the subjects were males. The majority of the study subjects were in the age group of 46 to 55 years (41.91%)

A family history of hypothyroidism was present among 26.47% of study subjects, and in 22% of the subject's history of diabetes mellitus was seen. It was found that 19.85% of subjects were smokers, whereas 12.5% of the subject of tobacco consumption (smokeless) and 16.91% subjects were having the habit of alcohol consumption37.50% study subjects had body mass index between 17.5 - 25 i.e normal, followed by 33.82% with BMI 25 – 30 and 28.68% subjects were obese with BMI between 30 -40The presence of subclinical hypothyroidism in this study was 24.26%, whereas overt hypothyroidism was observed among 11.76% of the subjects. Hyperthyroidism was noted among 3.68% of the subjects and 60.29 % of the subjects were having normal thyroid function status. Subclinical hypothyroidism was significantly observed more among subjects with type 2 diabetes mellitus (p < .05)

A significant association between smoking and subclinical hypothyroidism was found(p < .05). It was observed that a comparatively larger proportion of subjects who consumed tobacco (smokeless form) developed subclinical hypothyroidism, but the statistical significance could not be established (p > .05). Subclinical hypothyroidism was observed significantly more among the subjects with a body mass index of more than 25 kg/m2 (p < .05). Subclinical hypothyroidism in the present study was seen in 35.13% of females with more than 50 years of age (p < .05)In the present study risk factors associated with subclinical hypothyroidism were female subjects with age more than 50 years, family history of hypothyroidism, obesity (BMI >30kg/m2), smoking, history of type 2 diabetes mellitus.

DISCUSSION

Age and gender-wise distribution

In the present study the majority of the study subjects were females (69.11%) whereas 30.88% of the subjects were males. The M:F ratio observed in the present study was 1:2.23. In the present study the age distribution of the study subjects was assessed. It was observed that majority of the study subjects belonged to the age group of 46 to 55 years (41.91%), followed by 56 to 65 years (22.06%) then 36 to 45 years (20.59%) and more than 66 years (7.35%). The mean age of the study subjects was 50.68 ± 9.76 years. Similar to present study, studies were conducted by Thakur V et al. [n=678, M:F ratio=1.06:1, age 49.4 ± 12.5], Eidan et al.[ n=394, M:F ratio= 1:1.11, age 41 ± 12] and Wang J et al.[n=4256, M:F ratio=1.06:1, age [50.51 ± 14.2].7,8,9 The observation of these studies were comparable to present study.

Family history of hypothyroidism

In the present study, the family history of hypothyroidism of the study subjects was assessed. It was observed that the family history of hypothyroidism was present among 25.73% of study subjects and subclinical hypothyroidism was observed more among cases with a family history of hypothyroidism. [chi-square statistic is 11.6246. ‘p’-value is 0.0006. Odds ratio= 4.2. Relative risk = 2.63] Eidan et al. in their study observed the odds of developing subclinical hypothyroidism among the cases with a family history of hypothyroidism as 2.8. These findings are not comparable with our study which is due to the ethnicity of the study population.7

History of type 2 diabetes mellitus

In the present study, the history of type 2 diabetes mellitus among the study subjects was evaluated. It was found that in 22% of the subjects history of type 2 diabetes mellitus was present and subclinical hypothyroidism was significantly observed more among cases with type 2 diabetes mellitus. [chi-square statistic is 31.5842. The ‘p’-value is < 0.00001. Relative Risk = 3.85. Odds Ratio = 8.76] Thakur V et al in their study compared the presence of type 2 diabetes mellitus among subclinical hypothyroidism and euthyroid subjects. They observed 19.80% euthyroid subjects and 14.70% subclinical hypothyroidism subjects. The findings were not statistically significant. These findings were not consistent with our results due to the difference in duration of diabetes at the time of screening.9

CONCLUSION

Subclinical hypothyroidism is a common clinical problem and is associated with various high-risk factors. Thyroid disorders in such patients having these associated high-risk factors have significant morbidity if they are not treated and subsequently, these patients may develop clinical hypothyroidism. In the present study, the clinical presentation of the patients with subclinical hypothyroidism was mostly nonspecific, which were mostly undiagnosed compared to euthyroid; so, screening of these patients is required to find out subclinical hypothyroidism and early intervention can be done. The risk factors associated with increased risk of development of subclinical hypothyroidism in the present study population were female subjects with age more than 50 years, family history of hypothyroidism, obesity, smoking, history of diabetes mellitus. The present study provides valuable information regarding the presence of subclinical hypothyroidism insignificant proportion of subjects in context with the Indian population.

Conflict of Interest: There is no conflict of Interest 

Source of Funding: No Source of Funding

Authors Contribution: This is a collaborative work among all authors. Dr. Anand D Bang, and Dr. Nitin N Jadhav performed the statistical analysis, wrote the protocol, and wrote the first draft of the manuscript. Dr. Virendra C Patil, Dr. Aparna P Patange managed the literature searches. All authors read and approved the final manuscript.

References:

1.         Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease scientific review and guidelines for diagnosis and management. J Ame Med Assoc. 2004; 291(2):228–238.

2.         Gillett M. Subclinical hypothyroidism: subclinical thyroid disease: scientific review and guidelines for diagnosis and management. Clin Biochem Rev. 2004;25(3):191–94.

3.         Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87(2):489–499.

4.         Cooper DS. Subclinical hypothyroidism. N Engl J Med. 2001;345:260 – 64.

5.        Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, Pessah-Pollack R, Singer PA, Woeber KA, American Association Of Clinical E, American Thyroid Association Taskforce On Hypothyroidism In A 2012Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012; 22:1200–1235

6.         White GH, Walmsley RN. Can the initial clinical assessment of thyroid function be improved? Lancet. 1978; 2: 933-935.

7.         Al Eidan E, Ur Rahman S, Al Qahtani S, Al Farhan AI, Abdulmajeed I. Prevalence of subclinical hypothyroidism in adults visiting primary health-care setting in Riyadh. J Community Hosp Intern Med Perspect. 2018 Feb 6;8(1):11-15.

8.         Wang J, Ma X, Qu S, et al. High prevalence of subclinical thyroid dysfunction and the relationship between thyrotropin levels and cardiovascular risk factors in residents of the coastal area of China. Exp Clin Cardiol. 2013;18(1):e16-e20.

9.         Thakur V. Subclinical hypothyroidism in India: an imperative risk for coronary artery disease (CAD). Metab Int J. 2018;6(6):401- 403.

 

Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

COPE guidelines for Reviewers

SCOPUS indexing: 2014, 2019 to 2021


Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

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A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
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A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
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A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
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
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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
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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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