The Philippine thyroid diseases study (PhilTiDeS): Prevalence of thyroid disorders among adults in the Philippines / Journal of the ASEAN Federation of Endocrine Societies

BACKGROUND:The national prevalence of goiters in the Philippines was 3.7% in 1987 and 6.7% in 1993. Since then, there has been no follow-up survey on goiter prevalence, nor has there been any national survey on the prevalence of abnormal thyroid dysfunction. The PhilTiDeS is a survey on the prevalence of both goiters and thyroid disorders in the Philippines.OBJECTIVES:To determine the prevalence of various categories of abnormal thyroid dysfunction among the Filipino non-pregnant adult population and to describe the prevalence of thyroid enlargement in the Philippines in relation to thyroid dysfunction status.MATERIALS AND METHODS:The PhilTiDes was a substudy of the 2008 National Nutrition and Health Survey (NNHeS), which covered all 17 regions and 80 provinces of the Philippines. It included all Filipino adults 20 years and older, who are non-pregnant and non-lactating. A standard questionnaire was used to collect data on previous diagnosis and current treatment for thyroid disorders, and neck examination by trained field personnel was done to assess the presence of goiter. Blood was extracted, processed and sent to an accredited laboratory for free T4 and TSH testing using micro-particle enzyme immunoassay.RESULTS: A total of 4897 persons had thyroid function tests. Of these, 417 (8.53%) had thyroid function abnormalities with the most common abnormality being subclinical hyperthyroidism occurring in 5.33%. The other categories had the following prevalence: true hyperthyroidism 0.61% ; true hypothyroidism 0.41%; and subclinical hypothyroidism 2.18%. Majority of the population 4480 (91.47%) had normal thyroid function tests. Of those with subclinical hyperthyroidism, 55% are females with mean age of 48 years (95% CI 45.9-50.1 years) compared with the volunteers with normal thyroid function who were younger (mean age of 43.1, 95% CI 42.5-43.6 years). Out of the 7,227 volunteers who responded to the survey and clinical examination, a total of 674 (8.9%) had goiters. Out of the 674 subjects with goiters, 379 had diffuse enlargement (56%) while the rest had nodular goiter (44%). Among the sub-population (n= 4897) who underwent thyroid function testing, 9% of those with normal thyroid function tests have goiters.CONCLUSION: The prevalence of thyroid function abnormalities in the Philippines is 8.53% with the greatest proportion of volunteers having subclinical thyroid disease. There is a low prevalence of both true or overt hyperthyroidism and hypothyroidism. In the larger survey, it was found that 8.9% of volunteers who were examined had goiters. The etiology of these goiters will need to be ascertained in future studies.

Prevalence and risk factors of gestational diabetes mellitus at the University of Santo Tomas Hospital

BACKGROUND: Gestational diabetes mellitus (GDM) has been as sociated with adverse maternal and fetal outcomes that extend beyond the postpartum period. Knowledge of its prevalence and risk factors can lead to possible preventive strategies.OBJECTIVE: To determine the prevalence and risk factors for GDM at the University of Santo Tomas Hospital-Clinical Division (USTH-CD).METHODS: A cross-sectional study was performed between January to December 2009 at the USTH-CD. Simple and multivariate logistic regressions were used to estimate the odds ratios with 95% confidence intervals, and to control for confounding variables.RESULTS: We reported the prevalence of GDM at USTH-CD to be 7.5%. The risk for GDM was significantly associated with increasing BMI (OR 1.54; 95% CI 1.06, 2.24), family history of diabetes (OR 6.27; 95% CI 2.63, 14.96) and hormonal contraceptive use (OR 8.48; 1.55, 46.52). Mothers with GDM were also at increased risk of delivering via cesarean section (OR 2.76; 95% CI 1.13, 6.72). The 1-minute APGAR score of infants born to mothers with GDM were also lower (OR 0.31; 95% CI 0.12, 0.83).CONCLUSION: Higher BMI, family history of diabetes and hormonal contraceptive use were strongly associated with GDM. Presence of GDM increases the risk of having cesarean deliveries and a poor fetal 1-minute APGAR score. The presence of these findings may be helpful in identifying those at risk for GDM who might benefit from heightened surveillance during pregnancy.

Validation of the UST thyroid scoring index against ultrasensitive assays for thyroid-stimulating hormone and free thyroxine

BACKGROUND: Clinical manifestations of thyroid dysfunction are variable. The UST Scoring Index for thyroid disorders, formulated in the 1990s to evaluate thyroid functional status, was based on total thyroid hormone levels and thyroidal iodine uptake. However, with the advent of newer and more sensitive tests, the recommendations and practice now dictate the use of thyrotropin (TSH) and free thyroxine (FT4) levels in the confirmation of thyroid dysfunction.OBJECTIVE: To validate the UST Scoring Index for thyroid disorders using TSH and FT4.METHODS/RESULTS: The UST Clinical Scoring Index was administered to 170 patients presenting for thyroid-relatedcomplaints. Thyroid function tests were then requested (TSH and Free T4) and they were classified according to biochemical status. We obtained the following: 43 hyperthyroid, 102 euthyroid and 25 hypothyroid subjects. The mean TSH for the 3 groups were 0.08, 1.28, and 41.50 uIU/mL respectively (NV 0.27-3.75.) Mean FT4 levels were 36.18, 18.33, and 8.43 pM/L respectively (NV 10.3-25.0.) The most frequent findings in the biochemically hyperthyroid group were thyroid enlargement (88%), easy tiredness (74%), palpitations (70%), and nervousness (65%); in the euthyroid group, easy tiredness (62%), thyroid enlargement (54%), palpitations (53%), and irritability (49%); in the hypothyroid group, easy tiredness (64%), exertional dyspnea (52%), weight gain (44%), and constipation (44%.) The UST scoring index for thyroid disorders has a sensitivity of 67%, specificity of 84%, and accuracy rate of 80 %, with AUC of 0.850 on ROC analysis for the detection ofhyperthyroidism. For detecting hypothyroidism, it has a sensitivity of 40%, specificity of 92%, and asccuracy rate of 85%, with AUC 0.7553 on ROC analysis.CONCLUSION: The UST scoring index for thyroid disorders has good sensitivity, specificity and accuracy rate based on ROC when validated using TSH and FT4 for the detection of hyperthyroidism and hypothyroidism.

Clinical profile and etiology of hypopituitarism at the University of Santo Tomas hospital

OBJECTIVE: To establish data determining the etiology of hypopituitarism in the University of Santo Tomas Hospital (USTH) and to describe the clinical and biochemical profile of these patients.METHODOLOGY: A retrospective descriptive study in a tertiary hospital (USTH) involving patients diagnosed by clinical evaluation and biochemical tests to have hypopituitarism, admitted or seen at the outpatient department from January 2001 to December 2009 and whose charts were available for review. The clinical profile, manifestations and biochemical profile were defined and causes of hypopituitarism identified. Descriptive statistics were applied using percentages and frequency distribution.RESULTS: In the nine-year period (2001-2009), a total of 191 patients were recorded to have hypopituitarism but only 143 (75%) have adequate data available for review. Sixty one (43%) were males and 82 (51%) were females with mean age was 45±6 years. Hypopituitarism was found to be most prevalent in the fourth to fifth decade of life and clinical manifestations were noted with mean duration of 20±4 months. The most predominant documented pituitary hormone deficiency was gonadotrophic hormone (60%) manifesting prominently as decreased libido (82%). The most common target end organ hormone deficiency was secondary adrenal insufficiency (90%) and most prevalent etiology of hypopituitarism was pituitary tumors (40%). Sheehan's syndrome (8%) and tuberculosis (3%) were also noted as a cause of hypopituitarism.CONCLUSION: This study shows that the leading clinical manifestation and documented hormone deficiency of hypopituitarism is hypogonadism. Pituitary adenoma is the most common cause of hypopituitarism along with its treatment. Other causes not commonly seen in other countries but proved to be more prevalent here include Sheehan's syndrome and tuberculosis infection.