ABSTRACT
Background:Subclinical hypothyroidism (SCH) is a common endocrine disorder but spontaneous course of SCH in India is lacking. The aim of the study is to determine the spontaneous course of SCH and to identify the risk factors, which enhances the occurrence of overt hypothyroidism (OH).Method: This is a real world prospective observational study. 58 SCH were followed up six monthly for one year to determine the course of SCH.Results: After one year of follow up 11 (18.97%) patients progressed to OH. 37 (63.79%) remained in subclinical hypothyroid category. In 10 (17.29%) patients TSH (thyrotropin) normalized. Rate of progression (odds ratio: 4.58; 95% CI: 1.14, 18.28) was significantly more in anti-thyroid peroxidase (TPO) positive group as compared to anti-TPO negative group. Conclusions: This first data from India clearly shows that SCH has a variable course. Rate of progression to OH is high (18.97%) in Indian SCH patients. In a cohort of 58 patients followed for one year only the presence of anti-TPO antibody waspredictive of OH. The initial risk stratification can identify patients with SCH at greatest risk for progression to OH in which treatment is mandatory.
ABSTRACT
Introduction: Hypothyroidism is a common endocrine disorder characterized by decreased levels of thyroid hormones. Anti-thyroperoxidase antibody is produced in autoimmune thyroiditis which inhibits the synthesis of thyroid hormones. Aims & Objectives: The study was planned to explore the significance of anti-TPO antibody in hypothyroid patients. Materials and Methods: 150 newly diagnosed patients, age 20-60 years were enrolled for the study. Patients were divided on the basis of antiTPO levels as anti-TPO positive(n=87) anti-TPO negative (n=63).Thyroid hormones viz. serum triiodothyronine (T3), thyroxine (T4), free T3 (FT3), free T4 (FT4) and thyroid stimulating hormone (TSH) levels were compared between the two groups. Results: Mean serum TSH level was significantly higher in anti-TPO positive group. Mean serum T3 & T4 levels were comparable (P= NS) among the two groups whereas FT3 (P= 0.014) and FT4 (P= 0.003) were significantly lower in the anti-TPO positive group. Conclusion: Serum FT3 & FT4 represent the biologically active proportion of thyroid hormones. The present study suggests that lower FT3 & FT4 levels can better correlate with anti-TPO activity in patients of hypothyroidism
ABSTRACT
Background: Hashimoto’s thyroiditis, a well known condition affecting the thyroid gland is often under diagnosed due to its wide spectrum of clinical manifestations. As such it could present as a Multi Nodular Goitre, Diffuse Goitre or Solitary Nodule with features of Hypothyroidism, Hyperthyroidism or Euthyroid state. Materials and methods: Total 120 patients with Hashimoto’s Thyroiditis were studied with history, clinical signs and symptoms, recorded in the format and were subjected to hormonal assay, FNAC. Results: Out of 120 cases, 117 were females and 3 were males. All the 120 patients presented with complaint of swelling in the front of the neck, most of the patients presented within 6 months after noticing the swelling. Consistency of the gland was firm in all cases. 75 patients were Multi Nodular Goitre (62.5%), 42 were Diffuse Goitre (35%) and 3 were solitary nodule (2.5%). 57 patients were Hypothyroid (47.5%), 42 patients were Euthyroid (35%) and 21 patients were Hyperthyroid (17.5%). FNAC was positive in 111 patients (92.5%). Antibodies were positive in 105 patients (87.5%). 105 patients were treated conservatively and monitored regularly every 3 months. Conclusion: In Hashimoto’s thyroiditis, the hyperthyroid patients showed high positivity to Anti TPO Antibody, the hypothyroid patients were highly negative to Antibodies, and the Euthyroid patients responded well to Thyroxine therapy. Surgery was mostly required for patients presented with symptoms and signs of obstruction. Incidence of Lymphoma in patients with Hashimoto’s Thyroiditis was usually high.
ABSTRACT
Background & objectives: Several autoimmune disorders have been reported to be associated with autoimmune thyroiditis and may coexist with other organ-specific autoantibodies. The aim of the present study was to evaluate the presence of tissue transglutaminase (anti-TTG) and glutamic acid decarboxylase (anti-GAD) antibodies in patients suffering from autoimmune thyroiditis as diagnosed by anti-thyroid peroxidase (anti-TPO) antibodies, which may indicate high risk for developing celiac disease or type 1 diabetes mellitus. Methods: Five thousand children and 2800 adults were screening as part of a general health examination done on a voluntary basis in four different parts of Delhi. A total of 577 subjects positive for anti-TPO antibody constituted the cases. Equal number of age and sex matched anti-TPO antibody negative controls were randomly selected from the same cohort to form paired case control study. The cases and controls were further divided into two groups as follows: group-1 (children and adolescent <18 yr), group-2 (adults >18 yr). Serum samples of cases and controls were analysed for thyroid function test (FT3, FT4, and TSH), anti-TTG and anti-GAD antibodies. Results: A total of 1154 subjects (577 cases and 577 controls) were included in this study. Hypothyroidism was present in 40.2 per cent (232) cases compared to only 4.7 per cent (27) in controls (P<0.001). Anti-TTG and anti-GAD antibodies were present in 6.9 and 12.5 per cent subjects among cases compared to 3.5 per cent (P=0.015) and 4.3 per cent (P=0.001) in controls, respectively. Only anti-GAD antibody were significantly positive in cases among children and adolescents (P =0.0044) and adult (P=0.001) compared to controls. Levels of anti-TTG and anti-GAD antibodies increased with increasing titre of anti-TPO antibody. Interpretation & conclusions: Our findings showed high positivity of anti-GAD and anti-TTG antibodies among subjects with thyroid autoimmunity. It is, therefore, important to have high clinical index of suspicion for celiac disease or type 1 diabetes mellitus in patients with autoimmune thyroiditis.