Is the clinic pathological profile of hypothyroidism gradually changing: a comparative study from North India

Background: Thyroid dysfunction has been subject of academical and therapeutically interest not only to the endocrinologist but also to the disciplines of medicine. Statistical data and studies on hypothyroidism are scanty, clinical picture is varied, investigations are usually not available at all levels and therefore to enlarge clinical profile of hypothyroidism minimal base line investigation, clinical approach and effects of replacement therapy and complications are to be studied.Methods: Observational cross-sectional study conducted among patients with hypothyroidism registered at the Air Force Central Medical Establishment (AFCME) New Delhi.Results: Among 50 patients with hypothyroidism were enrolled in this study during the study period. Idiopathic hypothyroidism was present in 98% patients while only one patient (2%) had Hashimotto’s thyroiditis. Generalized weakness was the commonest presenting symptom followed by lethargy and anorexia. Thyroid swelling was diffuse in nature with no predilection to right or left lobe enlargement. Hypertension (40%) and ischemic heart diseases (36%) were the most common comorbid condition. Mean serum TSH was elevated while serum T3 and T4 values were reduced. Antithyroid antibody titre was positive in more than seventy percentage of patients. X-ray among patients revealed cardiomegaly in ten patients (20%), pulmonary Koch’s in (4%) of patient and in rest of patients x-ray chest PA view was normal. ECG changes showed low voltage on electrocardiogram in (20%) of patients and sinus bradycardia in (24%) of patients. Most of the patients were put on replacement therapy (L. thyroxine) in dose of 1.6 - 1.7 mcg/kg/day.Conclusions: Hypothyroidism as a clinical entity is common between 4th and 6th decade of life and seen more among females. Though etiology remained unknown in majority of the patients, weakness, and lethargy were the common clinical presentation.

Encefalopatía asociada a enfermedad tiroídea, un diagnóstico a tener en mente / Encephalopathy associated with thyroid disease, a diagnosis to take into account

Mujer de 54 años con antecedentes de Hipertensión arterial e Hipotiroidismo. Historia de aproximadamente 3 meses de evolución caracterizado al inicio por ánimo bajo, cambios en el comportamiento con aparición progresiva de conductas extraña, ideas delirantes y alucinaciones visuales y auditivas, junto con disminución en requerimientos de hormonas tiroídeas hasta la suspensión. Consulta en varios centros donde se cataloga como Trastorno depresivo severo con síntomas psicóticos, Síndrome confusional, Síndrome Psicótico. En este contexto se pesquisa Hipertiroidismo con títulos elevados de Anticuerpos Antitiroídeos e inicia tratamiento con Metimazol y Betabloqueo. Tras extenso estudio que descartan causas infecciosas, neoplásicas y autoinmunes; se inicia tratamiento con pulsos de Metilprednisolona con excelente y rápida respuesta clínica, la cual mantiene durante el curso del seguimiento con dosis decrecientes de corticoides.

A 54-year-old woman with a history of arterial hypertension and hypothyroidism. History of approximately 3 months of evolution characterized at the beginning by low mood, changes in behavior with progressive appearance of bizarre behaviors, delusional ideas and visual and auditory hallucinations. Consultation in several centers where it is classified as severe Depressive disorder with psychotic symptoms, Confusional syndrome, Psychotic syndrome. Hyperthyroidism is investigated with high titers of Antithyroid Antibodies and initiates treatment with Methimazole and Betablock. After extensive study that ruled out infectious, neoplastic and autoimmune causes; Treatment with Methylprednisolone pulses is initiated with excellent and rapid clinical response, which is maintained during the course of follow-up with decreasing doses of corticosteroid.

Clinical, biochemical & cytomorphologic study on Hashimoto’s thyroiditis.

Background & objectives: Despite, the extensive salt iodization programmes implemented in India, the prevalence of goiter has not reduced much in our country. The most frequent cause of hypothyroidism and goiter in iodine sufficient areas is Hashimoto’s thyroiditis (HT). This study records the clinical presentation, biochemical status, ultrasonographic picture and cytological appearance of this disease in a coastal endemic zone for goiter. Methods: Case records of patients with cytological diagnosis of HT were studied in detail, with reference to their symptoms, presence of goiter, thyroid function status, antibody levels and ultrasound picture. Detailed cytological study was conducted in selected patients. Results: A total of 144 patients with cytological proven HT/lymphocytic thyroiditis were studied. Ninety per cent of the patients were females and most of them presented within five years of onset of symptoms. Sixty eight per cent patients had diffuse goiter, 69 per cent were clinically euthyroid and 46 per cent were biochemically mildly hypothyroid. Antibody levels were elevated in 92.3 per cent cases. In majority of patients the sonographic picture showed heterogeneous echotexture with increased vascularity. Cytological changes were characteristic. Interpretation & conclusions: our study showed predominance of females in the study population in 21-40 yr age group with diffuse goiter. We suggest that in an endemic zone for goiter, all women of the child bearing age should be screened for HT.

Subclinical Hypothyroidism During Pregnancy: A Clinical Review.

Traditionally, overt hypothyroidism cases during pregnancy have been treated due to its adverse effect on fetus as well as on mother. Evidences are now available for the need of treatment of subclinical hypothyroidism (SCH) during pregnancy. SCH is the commonest form of hypothyroidism in pregnancy and is usually due to progressive thyroid destruction due to autoimmune thyroid disease. The prevalence and incidence of SCH is found to be more in South Asia than other parts of the world. This review revealed that screening should be mandatory followed by identification of antithyroid antibody positive cases because they require treatment with oral levothyroxine.

The Diagnosis of Hashimoto Thyroiditis: A Report of 45 Cases / 中国医师杂志

Objective To investigate the clinical manifestation and diagnosis of Hashimoto thyroiditis (HT). Methods 45 HT patients diagnosed by fine needle aspiration cytology (FNAC) were enrolled in this study. Their medical history, clinical parameters, data of laboratory examination, colour doppler ultrasonic image and FNAC were analyzed. Results This disease was more common in women than in men, and most of cases occurred during 35～50 years old. Almost all cases had the symptoms of thyromegaly and laryngopharynx malaise. The patients had normal thyroid function, hypothyroidism or hyperthyroidism. The levels of both antithyroid globulin antibody and antithyroid microsome antibody increased in 39 cases. The ultrasonic imaging features of thyroid were such as following: diffusive nonhomogenous hypoecho pattern in 19 cases, numerous hypoecho micronodes in 15 cases, hyperecho micronodes in 3 cases, and hyperecho bandlike echo pattern with swelling of neck lymph nodes in 8 cases. Conclusion Diagnosis of HD should put emphasis on a complete medical history, physical examination and necessary laboratory tests. Antithyroid auto-antibody assay and thyroid ultrasonic examination were very important for diagnosis of HD, and FNAC may be indispensable in suspected cases.

Influence of Antithyroid Antibodies in Euthyroid Women on the Outcome of Superovulatin with Intrauterine Insemination / 대한산부인과학회잡지

The present study was designed to investigate if antithyroid antibodies(ATA) could affect the pregnancy outcome in euthyroid women undergoing superovulation with intrauterine insemination(IUI). From January 1995 to September 1996, 18 euthyrouid women with ATA who undersent superovulation with IUI were suudied. Thirty-two euthyroid women without ATA who underwent superovulation with IVI were served as control. Thyroid peroxidase antibody (TPOA) and thyroglobulin antibody(TGA) were assayed using radio ligand assay kits as ATA. All patient included in the study and the control groups had only ovulatory factor in infertility or had suffered from unexplained infertility. The infertile patients with ovulatory factor were resistant to clomiphene citrate(CC) or had previously failed to conceive despite 3 ovulatory cycles using CC. Long protocol of gonadotropin-releasing hormone agonist(GnRH-a) was used for superovulation in all patients. There were no significant differences between the study and the control groups in patient characteristics such as age, infertility duration and hormonal profil. There were also no significant differences between two groups with respect to the clinicalresponse to superovulation. The clinical pregnancy rate per cycle was significantly lower in the study group at 23.5%(8/34) compared with 44.4%(24/54) in the control group.l The biochemical pregnancy rate per cycle was significantly higher in the study group at 17.6%(6/34) compared with 3.7%(2/54) in the control group. The miscarriage rate seemed to be higher in the study group than in the control group(37.5% vs 8.3%), but the difference was not statistically significant. In the study group, both TPOA and TGA titers were higher in the miscarriage group than in the ongoing or delivery group, although statistical significance was not found. This study suggests that ATA in euthyroid women could be associated with the poor pregnancy outcome in superovulation with IUI cycles and ATA may serve as possible marker for reproductive failure.

Influence of Antithyroid Antibodies in Euthyroid Women on the Outcome of Superovulatin with Intrauterine Insemination / 대한산부인과학회잡지

The present study was designed to investigate if antithyroid antibodies(ATA) could affect the pregnancy outcome in euthyroid women undergoing superovulation with intrauterine insemination(IUI). From January 1995 to September 1996, 18 euthyrouid women with ATA who undersent superovulation with IUI were suudied. Thirty-two euthyroid women without ATA who underwent superovulation with IVI were served as control. Thyroid peroxidase antibody (TPOA) and thyroglobulin antibody(TGA) were assayed using radio ligand assay kits as ATA. All patient included in the study and the control groups had only ovulatory factor in infertility or had suffered from unexplained infertility. The infertile patients with ovulatory factor were resistant to clomiphene citrate(CC) or had previously failed to conceive despite 3 ovulatory cycles using CC. Long protocol of gonadotropin-releasing hormone agonist(GnRH-a) was used for superovulation in all patients. There were no significant differences between the study and the control groups in patient characteristics such as age, infertility duration and hormonal profil. There were also no significant differences between two groups with respect to the clinicalresponse to superovulation. The clinical pregnancy rate per cycle was significantly lower in the study group at 23.5%(8/34) compared with 44.4%(24/54) in the control group.l The biochemical pregnancy rate per cycle was significantly higher in the study group at 17.6%(6/34) compared with 3.7%(2/54) in the control group. The miscarriage rate seemed to be higher in the study group than in the control group(37.5% vs 8.3%), but the difference was not statistically significant. In the study group, both TPOA and TGA titers were higher in the miscarriage group than in the ongoing or delivery group, although statistical significance was not found. This study suggests that ATA in euthyroid women could be associated with the poor pregnancy outcome in superovulation with IUI cycles and ATA may serve as possible marker for reproductive failure.