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Background: Chronic kidney disease (CKD) is one of the vital health problems worldwide leading to increased global morbidity and mortality. Thyroid dysfunction including hypothyroidism, hyperthyroidism and non-thyroidal illness has been reported in CKD patients. This study was conducted to determine the prevalence of subclinical and overt hypothyroidism among chronic kidney disease patients. This study also tried to correlate thyroid function abnormalities with severity of renal failure.Method: In this observational and cross sectional study, 100 patients of CKD who were admitted in Department of Medicine, Rajendra institute of medical sciences, Ranchi were studied for thyroid function abnormalities. Result: This study found that glomerular filtration rate (GFR) is positively correlated with serum T3 and T4 level (i.e. with decreasing renal function both T3 and T4 levels decreased). Serum creatinine levels were negatively correlated with serum T3 and T4 level.Conclusions: From this study it was established that CKD is associated with thyroid dysfunction characterized by low serum fT3 and fT4 with high TSH in some cases.
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Background: A prospective clinical trial to evaluate the prevalence of thyroid disorder among pregnant women and obstetrical and fetal outcome was done in a tertiary health centre (RKDF Medical College and Research Centre, Bhopal) located in central India.Methods: This prospective study was carried out in antenatal women in their first trimester attending antenatal OPD in RKDF Medical College and Research Centre, Bhopal, Madhya Pradesh to know the prevalence of thyroid disorder and its association with pregnancy outcome.Results: In this study prevalence of thyroid disorder was 12.4%, subclinical hypothyroidism 7.2%, overt hypothyroidism 3.4%, subclinical hyperthyroidism 1.4%, overt hyperthyroidism 0.4%. Thyroid disorder is responsible for several obstetrical and fetal complication like pre-eclampsia, preterm delivery, abortion, IUGR and low birth weight.Conclusions: Thyroid disorder associated with poor obstetrical outcome and fetal complication. so timely diagnosis and treatment is required. Universal screening should be preferred over high-risk screening because of high prevalence of the disease in India.
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Background: Hypothyroidism is associated with maternal and fetal complications. This study aims to evaluate the prevalence, maternal and fetal outcome in hypothyroidism. Objective of this study was to determine whether thyroid function test can be recommended as a universal or selective screening in pregnancy.Methods: An analytical cross-sectional study with internal comparison carried out at Govt. Kilpauk Medical College & Hospital from September 2017 to July 2018 for antenatal mothers in third trimester. Serum TSH and freeT3, T4 in case of abnormal TSH were measured, grouped into subclinical and overt hypothyroidism and were treated with Levothyroxine. Six-week follow-up with TSH, pregnancy complications were observed.Results: 932 pregnant mothers were followed up. Prevalence of hypothyroidism was 10.5% (n = 98). Among the hypothyroid 62.24% (n = 61) had subclinical and 37.76% (n = 37) had overt hypothyroidism. The prevalence of anaemia was 35% in overt and 15% in subclinical hypothyroid group (p = 0.019). Preeclampsia is reported in 49% of overt and 16% of subclinical hypothyroid group (p = <0.001), statistically significant. Eclampsia was noted in 1 (1.64%) overt hypothyroid patient. Abruptio placenta was observed in 1 subclinical and 4 overt hypothyroid patients (5.1%). The incidence of preterm labour in this study subjects was 38% in overt and 20% in subclinical hypothyroid group (p = 0.048). The incidence of LBW fetus was 41% in overt hypothyroid and 21% in subclinical hypothyroid group (p = 0.041). The incidence of complication in this study was 41% in subclinical and 78% in overt hypothyroid group (p = <0.001).Conclusions: Early screening, adequate treatment and follow up will bring down maternal and fetal complications in hypothyroidism.
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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抯 level and test of thyroid function is available at subsided cost therefore it should be offered to all such patients.
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Background: Thyroid hormones can cause significant changes in renal function such as decrease in sodium re-absorption in the proximal tubules, impairment in the concentrating and diluting capacities of the distal tubules, a decrease in the urinary urate excretion and a decrease in the renal blood flow and glomerular filtration rate (GFR). This study was therefore planned to analyse the changes in biochemical markers of renal function in patients with subclinical and overt hypothyroidism and to correlate these values with the thyroid profile of the patients with an aim to determine whether thyroid dysfunction has deleterious effects on renal function.Methods: Study was conducted on 200 patients, in the age group of 20-70 years, in the Department of Medicine, in collaboration with Department of Biochemistry, GMC Jammu over a period of 6 months. After centrifugation, the serum was divided into 2 aliquots: one for renal function tests and the other for thyroid function tests.Results: Age wise, mean was found to be 33.2±9.3 years for euthyroid group and 42.8±8.7 years for hypothyroid group. Patients with both subclinical hypothyroidism and overt hypothyroidism showed statistically significant rise in TSH levels as compared to controls.Conclusions: It was seen that primary hypothyroidism is associated with a reversible elevation of serum creatinine in adults as well as children. It is believed that renal impairment with hypothyroidism is due to reduced cardiac output and increased systemic and renal vasoconstriction leading to reduced renal blood and plasma flow and decreased GFR.
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Objective To observe the change of umbilical artery S/D value in the third trimester pregnant women with overt hypothyroidism(OH) or subclinical hypothyroidism(SCH).Methods We collect the data of 37-42 weeks pregnancy from January 2014 to December 2015.We devided them into OH group,SCH group and contral group.We compared the umbilical artery S/D value in these three groups and analyzed the relativity between S/D value and thyroid hormone.Results The S/D value was 2.46 ± 0.31 in OH group,2.48 ± 0.27 in SCH group and 2.32 ± 0.17 in control group.The differences were statistically significant between OH group and contral group (P =0.000),SCH group and contral group (P =0.000).There was no statistically significant between OH group and SCH group (P =0.907).The proportion of cases number during different S/D value range in these three groups had difference (P =0.000).The S/D value was positively correlated to TSH in OH group (r =0.186,P =0.037) and SCH group (r =0.146,P =0.015).There was no correlation between FT3 and S/D value(P ＞ 0.05) or FT4 and S/D value(P ＞ 0.05) in both OH and SCH group.There was no correlation between thyroid hormone and S/D value in the contral group either.Conclusion Both OH and SCH can effect umbilical artery S/D value in the third trimester pregnancy.
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Background: Since metabolic syndrome (MetS) and thyroid dysfunction (TD) are both characterized by a cluster of common abnormalities, it is possible that patients suffering from both disease entities might have compounded risk. This study was aimed to evaluate the pattern of TD in subjects with MetS and its relationship with components of the MetS. Methods: One hundred cases defined according to the International Diabetic Federation (IDF) criteria were evaluated for vital parameters, lipid and thyroid profile, along with other routine laboratory parameters. Results: There was a significant association of various metabolic syndrome parameters viz. body mass index(BMI), systolic blood pressure (SBP),diastolic blood pressure (DBP), total cholesterol(TC), triglycerides (TG) and fasting blood sugar(FBS) with TD (P<0.05). It was found that BMI, waist circumference (WC), SBP, total cholesterol (TC), triglyceride (TG) and FBS had significant (P<0.05) positive linear correlation whereas age and high density lipoprotein (HDL) had non-significant (P>0.05) negative correlation with thyroid stimulating hormone (TSH) levels. Conclusion: The prevalence of TD in patients with MetS was high; while subjects with SCH and elderly females were at increased risk.
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Background: Thyroid disorders constitute one of the most common endocrine disorders seen in pregnancy. Maternal thyroid function changes during pregnancy and inadequate adaptation to these changes results in thyroid dysfunction. Aim: A prospective and comparative clinical study to know prevalence of thyroid disorder in pregnancy and pregnancy outcome was done. Materials and methods: This study was carried out in pregnant women during 1st trimester who attended antenatal clinic of maternity hospital to know the prevalence of thyroid disorders in pregnant women living in and around and also to know the outcome of pregnancy in women suffering from thyroid disorders. Results: In this study, prevalence of thyroid disorder was 11.6% with 95% CI of 9.64 to 13.54 which was high when compared to other regions in India and in other parts of Asia. Subclinical hypothyroidism and Overt hypothyroidism was 6.4% and 2.8% respectively. Subclinical and Overt hyperthyroidism was 1.8% and 0.6% respectively. Subclinical hypothyroidism was more prevalent and hidden, leading to the poor obstetrical outcome and fetal complications. Rate of miscarriage was high in overt hyperthyroid patients. Conclusion: Due to the immense impact that the maternal thyroid disorder has on maternal and fetal outcome, prompt identification of thyroid disorders and timely initiation of treatment is essential. Thus, universal screening of pregnant women for thyroid disorder should be considered especially in a country like India where there is a high prevalence of undiagnosed thyroid disorder.
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Subclinical hypothyroidism (SCH) represents a mild or compensated form of primary hypothyroidism. The diagnosis of SCH is controversial, as its symptoms are non-specific and its biochemical diagnosis is arbitrary. The treatment of SCH was examined among non-pregnant adults, pregnant adults and children. In non-pregnant adults, treatment of SCH may prevent its progression to overt hypothyroidism, reduce the occurrence of coronary heart disease, and improve neuropsychiatric and musculoskeletal symptoms associated with hypothyroidism. These benefits are counteracted by cardiovascular, neuropsychiatric and musculoskeletal side effects. SCH is associated with adverse maternal and fetal outcomes that may improve with treatment. Treating SCH in children is safe and may improve growth. Importantly, the evidence in this field is largely from retrospective and prospective studies with design limitations, which precludes a conclusive recommendation for the treatment of SCH.
Subject(s)
Adolescent , Child , Female , Humans , Male , Pregnancy , Biomarkers , Metabolism , Bone and Bones , Coronary Disease , Blood , Disease Progression , Goiter , Hypothyroidism , Blood , Diagnosis , Therapeutics , Migraine Disorders , Pregnancy Complications , Prospective Studies , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
Background: Overt hypothyroidism is an established risk factor for insulin resistance. In this study we find out whether this association exists between insulin resistance and subclinical hypothyroidism. Methods: Serum Insulin, Fasting blood sugar, Cholesterol were estimated in 60 clinically diagnosed patients of hypothyroidism these patients were divided in to two groups as group I, 30 overt hypothyroidism and group II, 30 subclinical hypothyroidism. Results were compared with a group of 30 normal subjects. To measure the level of insulin resistance using HOMA IR software. Results: In our study total cholesterol were significantly high in both overt hypothyroidism and sub clinical hypothyroidism as compared to euthyroid control group and serum TSH and serum insulin levels were positively correlated with total cholesterol levels in hypothyroidism patients. We also found that TSH levels were positively correlated with insulin and HOMA IR in patients with subclinical hypothyroidism. Conclusions: Hence it will be good practice to screen people for presence of subclinical hypothyroidism and insulin resistance for early detection and prolong the appearance of various fatal complications associated with insulin resistance in hypothyroidism.
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Aims: In conjunction with triglyceride (TG) and HDLc, changes in the Lp (a) level in hypothyroidism have shown variable results. In the present study we made an effort to evaluate the role of Lp(a) as cardiovascular risk factor in both subclinical(SH) and overt hypothyroidism(OH) along with its dependence with dyslipidemic changes found in both groups. Study Design: It was a cross sectional, observational, non interventional, hospital based study Place and Duration of the Study: The study period was one year spanning a duration from February 2014 to January 2015 in the Dept. of Biochemistry, Calcutta National Medical College, Kolkata. Methodology: We evaluated the changes in Lp(a) TG, HDLc and fT4 levels in 30 overt and 34 subclinical hypothyroid patients and compared them with 34 control subjects in a hospital based cross-sectional study. Data were compared for difference between mean values and obtaining dependence of Lp(a) on lipid parameters. Results: Mean values of Lp(a), TG, TC and LDLc were found to be increased most in the OH group followed by that in the SH patients, the difference between two groups being significant statistically (p < 0.001). In contrast, fT4 and HDLc showed decreased levels in both SH and OH groups with a significant difference between them. Results of multiple linear regression analysis revealed that changes in the Lp(a) levels showed significant positive and negative dependence on the TG (β = 0.377 for OH and 0.296 for SH), and fT4 (β= -0.699 for OH and -0.380 for SH) and HDLc (β= -0.341 for OH and -0.393 for SH) respectively. Conclusion: Dyslipidemic features are evident in patients with SH as well as in the OH group that play also an important predictive role on the changes in Lp(a), indicating that in addition to traditional dyslipidemia, nontraditional risk factors like Lp (a) play a major role in initiating cardiovascular adverse events even in the early stages of hypothyroidism (SH).
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Thyroid functions affect metabolic syndrome (MetS) parameters including blood pressure, fasting plasma glucose, serum triglycerides and HDL-Cholesterol. But the relationship between MetS and thyroid functions is yet to be identified clearly. Metabolic syndrome is a state in which most features of hypothyroidism can be seen. The aim of the present study was to investigate the frequency of MetS in hypothyroid patients. Thirty one patients with overt hypothyroidism, 32 patients with subclinical hypothyroidism (SCH) and 58 euthyroid controls were enrolled in this study. NCEP-ATP III criteria was used to diagnose metabolic syndrome. Majority of the participants were in the age group of 30-40 years. Body mass index and waist circumference, blood pressure, fasting plasma glucose and serum triglycerides were found to be higher in hypothyroid patients compared to that of euthyroid controls (p<0.001). On the other hand serum HDL-C was found to be significantly lower in hypothyroid patients compared to that of euthyroid controls (p<0.001). Prevalence of MetS was 82.5% in the hypothyroid group and 27.6% in eythyroid controls (p<0.001). No significant difference was found between SCH (81.3%) and overt hypothyroid (86.7%) groups in respect to prevalence of MetS (p<0.05). The findings of the study suggest a need to investigate the presence of hypothyroidism during the management of MetS patients.