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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 14  |  Issue : 6  |  Page : 87-91

Profile of thyroid dysfunctions among the female population in a rural community of wardha district: A hospital-based study


Department of Community Medicine, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India

Date of Submission22-Mar-2019
Date of Decision10-Apr-2019
Date of Acceptance03-May-2019
Date of Web Publication30-Sep-2020

Correspondence Address:
Dr. Pramita A Muntode
Department of Community Medicine, Jawaharlal Nehru Medical College, DMIMS (DU) Sawangi (Meghe), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_231_19

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  Abstract 


Background: Thyroid disorders are among those chronic health conditions that are highly underdiagnosed and neglected. Hypothyroidism is by far the most common thyroid disorder in the adult population and is more common in older women. Thyroid hormone deficiency can result in mental retardation, stillbirths, and congenital anomalies, and this hypothyroidism can contribute to morbidities ranging from osteoporosis to cardiovascular and neuropsychiatry diseases in the population. The present study was conducted due to the paucity of data regarding the prevalence and patterns of thyroid disorders among women in and around Wardha district. Methodology: A cross-sectional descriptive study was conducted involving a sample size of 40 female participants admitted to Acharya Vinoba Bhave Rural Hospital, located at Wardha district in Maharashtra from June to August 2018, who were asked to respond to a Thyroid Assessment Questionnaire. The participants were categorized as euthyroid (normal thyroid-stimulating hormone [TSH]), hypothyroid (high TSH), and hyperthyroid (low TSH) based on serum thyroid hormone levels. Data were entered into MS Excel and were analyzed for the descriptive statistics. Results: Of the 40 female participants in the age range of 18–70 years, 35% had a hypothyroid gland, 30% had a hyperthyroid gland, 27.5% presented with thyroid nodules, and the remaining 7.5% presented with thyroid cancer. According to the laboratory results, 37.5% of the patients had TSH levels above or equal to 5 uIU/ml, of which 86% complained of unusual hair loss, 73% felt fatigued and had poor concentration, 46% claimed that they experienced palpitations as well as felt depressed, 46% complained of unusual weight gain, 26% complained of dry skin, 13% complained of feeling restless, and 6% had complaints of loose stools. About 30% of the total participants had TSH levels below or equal to 0.25 uIU/ml, 83% of which had complaints of weight loss and heat intolerance, 75% had complaints of unusual hair loss, 41% stated that they experienced slept more than usual, and 35% had complaints of constipation. Conclusion: The major thyroid burden is in between the ages of 30–59, with hypothyroidism being most common.

Keywords: Pattern, prevalence, symptoms, women


How to cite this article:
Jose AM, Muntode PA, Sharma S, Mathew SS, Nair RR, Solanki S. Profile of thyroid dysfunctions among the female population in a rural community of wardha district: A hospital-based study. J Datta Meghe Inst Med Sci Univ 2019;14, Suppl S2:87-91

How to cite this URL:
Jose AM, Muntode PA, Sharma S, Mathew SS, Nair RR, Solanki S. Profile of thyroid dysfunctions among the female population in a rural community of wardha district: A hospital-based study. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2022 Aug 11];14, Suppl S2:87-91. Available from: http://www.journaldmims.com/text.asp?2019/14/6/87/296817




  Introduction Top


In a developing and densely populated country such as India, communicable diseases have become a priority health concern due to their large contribution to the national disease burden, not falling far behind are the noncommunicable diseases such as diabetes mellitus, hypertension, and other cardiovascular diseases, easily shifting the focus away from thyroid disorders.

Thyroid disorder is a silent disease where the symptoms are subtle and can be often overlooked at the time of diagnosis; hence, it is essential to critically monitor it.

Any dysfunction of the thyroid has a profound impact on health and well-being.[1] Factors that influence could be an inability to access high-quality treatment and endocrinologists and others specialized with thyroid disorders, physician's ignorance in educating patients about such ailments, and the general lack of knowledge in the community.

It is estimated that a world prevalence of thyroid alterations is 5%, more common in women than in men.[2]

In the post iodization era, a study was conducted to analyze the thyroid hormone levels among adult nonpregnant women of Jharkhand region, which is traditionally known to be an iodine-deficient area. This is the first study in Jharkhand on the nonpregnant adult female population that is getting iodine sufficient foods in an iodine-deficient region. The study showed a high prevalence of thyroid disorders in the study group. Hypothyroidism, predominantly subclinical hypothyroidism, is prevalent among women in this region.[1]

The extent of thyroid disorders depends on sex, age, ethnic and geographical factors, and particularly on the iodine intake.[3] India had started with iodized salt campaign in the 1950s when the classical study of Professor V. Ramalingaswamy et al., in Kangra Valley of Himachal Pradesh established iodine deficiency as the causative factor for endemic goiter and consuming salt iodized with potassium iodate as the most economic and easiest means of its prevention and control in a population. In 1992, the National Goiter Control Programme was renamed as National Iodine Deficiency Disorder Control Programme. This led to the WHO declaring in 2004, India as “Optimum Iodine Nutrition.”[2] Yet, the thyroid disorders are still prevalent. Thyroid hormone deficiency can result in mental retardation, stillbirths, and congenital anomalies, and this hypothyroidism can contribute to morbidities ranging from osteoporosis to cardiovascular and neuropsychiatry disease in the population.

The use of symptoms for the screening of patients with thyroid disorders has deteriorated considering the recent trend of asymptomatic patients.

The paucity of the data regarding the prevalence and patterns of thyroid disorders in and around Wardha has inspired this study which is being carried out in Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi.


  Methodology Top


Study design

This was a cross-sectional descriptive study.

Study setting

This study was conducted at AVBRH, located at Wardha district in Maharashtra.

Study participants

Female participants between 18 years to 70 years attended the Surgery, Medicine, OBGY, and ENT Outpatient Department.

Sample size

Forty participants suspected of thyroid disorders based on the presence of swelling over the neck were screened for thyroid function in the hospital laboratory after obtaining consent from them.

The hospital had registered 44 patients during the period of 3 months (October–December 2017) last year. Records of these patients were derived from the Hospital Medical Records Department. On the basis of hospital outpatient department registration turnover for thyroid nodule/goiter, a 10% exclusion criterion was applied to estimate the sample size, which came as 39 (rounded up to 40).

Hence, the final sample size was decided to be 40.

Data collection tool

The questionnaire – Thyroid Assessment Questionnaire – has inquiries on symptomatology, gynecological or obstetrical problems, family history, past history of thyroid disease, and treatment if any. The participants were administered this prestructured preformed Thyroid Assessment Questionnaire in the local language: Marathi and Hindi.

The participants were categorized as euthyroid (normal thyroid-stimulating hormone [TSH]), hypothyroid (high TSH), and hyperthyroid (low TSH) based on serum thyroid hormone levels.

Inclusion criteria

  1. Female participants
  2. Age between 18 and 70 years
  3. Not critically/severely ill
  4. Willing to participate.


Exclusion criteria

  1. Males
  2. Below 18 years and above 70 years of age
  3. Critically and severely ill
  4. Unwilling to participate.


Ethical approval

The study protocol was submitted to the Institutional Ethical Committee for approval prior to data collection. Eligible participants were explained the purpose of the study and consent was obtained in the local language. Written informed consent was obtained from all the study participants.

Sociodemographic factors, educational status and level, occupation, menstrual history, and family history of similar diseases were recorded. The questionnaire had inquiries on symptomatology, gynecological and obstetrical problems, family history, past history of thyroid disease, and treatment received if any.

Data analysis

Data were entered into MS Excel and were analyzed for the descriptive statistics.


  Results Top


Our study focused on the thyroid profile of 40 patients who visited the AVBRH, a tertiary care center, in Central India.

Of the 40 female participants in the age range 18–70 years, 35% had a hyperthyroid gland, 30% had a hypothyroid gland, 27.5% presented with thyroid nodules, and the remaining 7.5% presented with thyroid cancer [Table 1] and [Figure 1].
Table 1: Distribution of women diagnosed with a thyroid disease

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Figure 1: Distribution of women diagnosed with thyroid disorders between the ages of 18–70 years

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The highest prevalence is seen in the age group of 40–49 years, amounting to 30% of the total participant population and the least prevalence is seen in the age groups 20-29 and 60-69 [Table 2].
Table 2: Distribution of patients into various age groups

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[Figure 2] shows that among the participant population, 70% of the patients were premenopausal and the remaining 30% were postmenopausal.
Figure 2: Distribution of thyroid patients into premenopausal and postmenopausal

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[Table 3] shows that according to the laboratory results, 37.5% of the patients had TSH levels above or equal to 5 uIU/ml, of which 86% complained of unusual hair loss, 73% feel fatigued and have poor concentration, 46% claimed that they experienced palpitations as well as feel depressed, 46% complained of unusual weight gain, 26% complained of dry skin, 13% complained of feeling restless, and 6% had complaints of loose stools.
Table 3: Symptoms experienced by patients with thyroid-stimulating hormone level above or equal to 5 uIU/ml (n=5)

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[Table 4] depicts that 30% of the total participants had TSH levels below or equal to 0.25 uIU/ml, 83% of which had complaints of weight loss and heat intolerance, 75% had complaints of unusual hair loss, 41% stated that they experienced a pattern of sleeping excessively, and 35% had complaints of constipation.
Table 4: Symptoms experienced by patients with thyroid-stimulating hormone level below or equal to 0.1 uIU/ml (n=2)

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[Table 5] depicts the percentage of patients that experienced the symptoms commonly encountered by patients suffering from thyroid dysfunction. About 92.5% had stated that with the onset of the disease, they felt easily fatigue. 82.5% had said that they have poor concentration after the onset of the disease, whereas 80% had said that they had unusual hair loss.
Table 5: Distribution of patients according to symptoms

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About 77.5% stated that they had difficulty tolerating cold. Nearly 65% had said that they felt depressed up until they began treatment, and 60% had said that they were subjected to persistent pain at the front of the neck or at the neck swelling. About 57% had complaints of palpitations with the onset of the disease. Nearly 50% had complaints of patterns of excessive sleeping and 35% had complaints of hand tremors.

[Table 6] shows that among the 70%, all the participants had complaints of excessive bleeding and 21% had complaints of irregular menstrual cycles.
Table 6: Distribution of women according to symptoms before menopause

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Regarding their treatment, 20% stated that they were on thyroid hormone therapy in the past, whereas 40% stated that they were on thyroid hormone therapy at present and 7.5% have started to undergoing surgery for their thyroid lesions [Table 7].
Table 7: Distribution of women according to treatment for a thyroid disease in the past

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About 20% of the total participant population were hypertensive [Table 8], whereas 5% had a cardiac complication.
Table 8: Distribution of women according to medical problems

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Nearly 15% of the total participant population [Table 9][4] has said that they had a family member diagnosed with hyperthyroid and 12.5% have said that they had a family member who was previously diagnosed with thyroid nodules.
Table 9: Distribution of women according to family members with diagnosed thyroid disease

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Observation:

Normal range of the TSH was 0.25–5 uIU/ml (above 5 uIU/ml – hypothyroid and below 0.25 uIU/ml – hyperthyroid).

  • T3: 0.6–1.81 ng/ml
  • T4: 3.2–12.6ug/dl
  • FT3: 2.3–4.2 pg/ml
  • FT4: 0.89–1.76 ng/dl.



  Discussion Top


An unfathomable fact is that many parts of India continue to suffer from thyroid disorders, and the district of Wardha is one among them. Patients who attended the medicine, gynecology and obstetrics ward, surgery ward, and ENT ward of AVBRH, Sawangi, were randomly selected on the basis of signs and symptoms which are associated with thyroid dysfunction.

In the present study, of 40 patients with a thyroid disorder, highest number was found to have hypothyroid which was most prevalent in the age groups of 20–29 and 60–69, this contrasts with the findings in the study conducted by Skaria et al. who found a prevalence of hypothyroidism in the age group of 30–39 years.

Thyroid disorders were found to be most prevalent in the age group of 40–49 years with 30% of the total participant population similar to the findings of Helfand et al.[5] who found that disorders are mainly found in women over 40 years of age. Other studies such as Bose et al. (19–45 years)[3] and Vanderpump et al. (34 years and above)[6] have reported similar age groups.

The percentage of hyperthyroidism was highest among the age groups of 40–49 and 50–59 years, this contrasts with the findings of Skaria et al.,[6] who found the prevalence of hyperthyroidism in the age groups of 30–39 and 10–19 years, and among those aged more than 40 years, the percentage decreased.[7],[8]

According to the laboratory results, 37.5% of the patients had TSH levels above or equal to 5 uIU/ml, of which maximum, i.e., 86%, had complaints of unusual hair loss and 73% felt fatigue and have poor concentration, 30% of the total participants had TSH levels below or equal to 0.25 uIU/ml, among whom 83% had complaints of weight loss and heat intolerance, and 75% had complaints of unusual hair loss. Regarding their treatment, 20% stated that they were on thyroid hormone therapy in the past. whereas 40% stated that they were on thyroid hormone therapy for their current treatment and 7.5% have already undergone thyroid surgeries. About 20% of the total participant population were hypertensive, whereas 5% had a cardiac complication. Nearly 15% of the total participant population has said that they had a family member diagnosed with hyperthyroid and 12.5% have said that they had a family member who was previously diagnosed with thyroid nodules.


  Conclusion Top


This study has shown that the major thyroid burden is in between the ages of 30–59 years, with hypothyroidism being most common. Thyroid disorders are among the most common endocrine disorders among females that have resulted in various health defects from menstrual cycle irregularities to placental abnormalities in the reproductive age as well as the vulnerability of postmenopausal women to potential cardiovascular complications.

The study findings reveal a desperate need to establish practices of routine screening to identify individuals who are susceptible to or distressed by thyroid disorders and thus be able to provide proper management and catch the ailment before it takes a dreadful turn.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chakrabarty BK, Mitra B, Shahbabu B, Hazra N, Singh S. Thyroid function status in Indian adult nonpregnant females in Ranchi India. Indian J Med Biochem 2017;21:25-9.  Back to cited text no. 1
    
2.
Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull 2011;99:39-51.  Back to cited text no. 2
    
3.
Bose A, Sharma N, Hemvani N, Chitnis DS. A hospital based prevalence study on thyroid disorders in Malwa region of central India. Int J Curr Microbiol Appl Sci 2015;4:604-11.  Back to cited text no. 3
    
4.
Skaria LK, Sarkar PD, Agnihotram G, Thakur AS, Pamidamarri G. Thyroid dysfunctions in tribal women of the Bastar region of Chattisgharh India. Thyroid Sci 2011;6:1-5.  Back to cited text no. 4
    
5.
Helfand M. Screening for thyroid disease. Ann Intern Med 1990;112:840-9.  Back to cited text no. 5
    
6.
Vanderpump MP, Tunbridge WM. Epidemiology and prevention of clinical and subclinical hypothyroidism. Thyroid 2002;12:839-47.  Back to cited text no. 6
    
7.
Helfand M. Screening for thyroid disease. Ann Intern Med 1990;112:840-9.  Back to cited text no. 7
    
8.
Vanderpump MP, Tunbridge WM. Epidemiology and prevention of clinical and subclinical hypothyroidism. Thyroid 2002;12:839-47.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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