|Year : 2014 | Volume
| Issue : 2 | Page : 55-59
Spectrum of thyroid disorders: A retrospective study at a medical college hospital
Jimmy Antony, TM Celine, Michale Chacko
Department of Community Medicine, Malankara Orthodox Syrian Church Medical College, Kolenchery, Ernakulam, Kerala, India
|Date of Web Publication||31-Mar-2014|
Department of Community Medicine, Malankara Orthodox Syrian Church Medical College, Kolenchery, Ernakulam - 682 311, Kerala
Source of Support: None, Conflict of Interest: None
Background: The spectrum of thyroid disease varies from underactive thyroidism (hypo) to overactive (hyper) thyroidism. It is a common endocrine disease reported worldwide and leads to major consequences of the human body, if left untreated. Aim: The aim is to exhibit the spectrum of thyroid disorders based on age and sex during the period of study in the hospital. Settings and Design: This study was conducted in a teaching and medical college hospital in Kerala State during a time period of five years from April 2005 to March 2010. Materials and Methods: The medical records department follow the guidelines of World Health Organization-International Classification of Diseases (WHO-ICD)-10 for classification of diseases and collected data were analysed by Statistical Package for the Social Sciences software (SPSS) package. Statistical Analysis: 'Z' test applied for finding out the comparison of proportions. Results: Out of 1088 thyroid cases, 152 (14%) were males and 936 (86%) were females. In males and females, the highest proportion of cases was reported in 40-60 years, which accounted for 58 cases (38.2%) and 386 cases (41.2%), respectively. The age group <20 years only shows significant difference between male and female (P = 0.02). The most commonly observed type of thyroid disorder is non-toxic multinodular goiter (E04.2), which is 528 (48.5%). In females, the most common type of thyroid disorder is non-toxic multi nodular goitre (E04.2) and in males it is hypothyroidism, unspecified (E03.9) is 45 29.6%. Conclusion: Public awareness regarding the thyroid disorder is important especially among the females and untreated thyroid disease can produce serious consequences to the health.
Keywords: Age, sex, thyroid disorders, year
|How to cite this article:|
Antony J, Celine T M, Chacko M. Spectrum of thyroid disorders: A retrospective study at a medical college hospital. Thyroid Res Pract 2014;11:55-9
|How to cite this URL:|
Antony J, Celine T M, Chacko M. Spectrum of thyroid disorders: A retrospective study at a medical college hospital. Thyroid Res Pract [serial online] 2014 [cited 2020 Jun 5];11:55-9. Available from: http://www.thetrp.net/text.asp?2014/11/2/55/129725
| Introduction|| |
Thyroid disorders are the common glandular disorders of the endocrine system.  Thyroid gland produces two key metabolic hormones such as thyroxine T4 and tri-iodo thyrosine T3.  These thyroid hormones regulate metabolism rate, growth, and development. These two hormones are under the control of thyroid stimulating hormone TSH), which is produced by the anterior pituitary gland and stimulate hormone production of the thyroid gland. Thyroid gland also secretes the hormone calcitonin which is involved in calcium metabolism. The thyroid uses the iodine for producing these hormones and the mineral iodine is mainly derived from sea foods or in the form of iodized salt. The spectrum of thyroid disorders range from underactive hypo to overactive thyroidism hyper. Almost one third of the world's population live in areas of iodine deficiency.  Even though it affects the entire population, more cases are reported from South-east Asia, Latin America and Central Africa.  A recently released report  shows that 300 million people in the world are suffering from this endocrine problem and 42 million of these diseased are residing in India.  It is different from other diseases in terms of its ease of diagnosis, the relative visibility in the neck region and accessibility of medical treatment. 
| Materials and Methods|| |
This is a hospital based retrospective study of five years. The medical records department follow the guidelines of WHO-ICD 10 for classification of diseases. Data on disorders of thyroid gland (E00-E07) collected from the medical records department with the permission of institutional ethical committee. The collected data was analyzed using SPSS package. The 'z' test was applied to find out the difference in proportions.
| Result|| |
Out of 1088 thyroid cases reported during the study period in the medical college hospital, 152 (14%) were males and 936 (86%) were females. Of these 1088 cases, 104 (9.55%) were in >20 years, 418 (38.41%) were in 20-40 years, 444 (40.80%) were in 40-60 years, 114 (10.47%) were in 60-80 years and 8 (0.75%) were in 80 years and above. In males the highest proportion of 58 (38.2%) cases were reported in 40-60 years and is followed by 20-40 years with 48 cases (31.6%). In the females also, highest proportion of 386 (41.2%) cases was in 40-60 years, followed by 20-40 years with 370 (39.5%) cases. The age group <20 years only shows significant difference between male and female (P = 0.02). Age and sex wise distribution of thyroid disorders are given in the [Table 1].
Of 1088 cases the most commonly observed type of thyroid disorder is non-toxic multinodular goiter (E04.2), which is 528 (48.5%) cases and is followed by 197 cases of hypothyroidism, unspecified (E03.9) which is 18.1%. In the present study, there is no observed case of congenital iodine deficiency syndrome (E00), iodine deficiency related thyroid disorders and allied conditions (E01) and subclinical iodine deficiency hypothyroidism (E02). E03 or other hypothyroidism category constitutes 18.9% and among it the most common type is hypothyroidism, unspecified (E03.9) which is followed by 0.8% of congenital hypothyroidism without goiter (E03.1). E04 or the other types of non-toxic goiter category possess 753 cases (69.2%) and in this most common type is non-toxic multinodular goiter (E04.2), which is 528 (48.5%) cases followed by 193 cases (17.7%) of non-toxic single thyroid nodule (E04.1). The thyrotoxicosis or hyperthyroidism (E05) is 93 cases (8.5%) and in this category the most frequently observed type is thyrotoxicosis, unspecified (E05.9) which is 61 cases (5.6%) and is followed by 27 cases (2.5%) of thyrotoxicosis with toxic multinodular goiter (E05.2). Thyroiditis (E06) is 35 cases (3.2%) and the most common type of this category is thyroditis, unspecified (E06.9), which is 28 (2.6%) cases and is followed by 7 cases (0.6%) of autoimmune thyroditis (E06.3). The other disorders of thyroid (E07) is 0.1% and the most common and the only type found in this category are disorders of the thyroid, unspecified (E07.9) which is only one case (0.1%).
Age wise distribution of different type of thyroid disorders is given in [Table 2]. In the age group of <20 years, the most common type of thyroid disorder is hypothyroidism, unspecified (E03.9), which is 30 cases (28.8%) and is followed by non-toxic multinodular goiter (E04.2) which is 29 cases (27%). In the age groups of 20-40 years and 40-60 years the most frequently seen type is non-toxic multi nodular goiter (E 04.2) which is 214 (51.2%) in 20-40 years and 236 (53.2%) in 40-60 years, respectively. The second most common type of thyroid disorder in these age groups is non-toxic single thyroid nodule (E04.1) in both the age groups and these are 89 (21.3%) in 20-40 years and 76 (17.1%) in 40-60 years age group. In the 60-80 years, the commonly observed type is non-specific multi nodular goiter (E04.2) which is 46 (40.4%) and is followed by hypothyroidism, unspecified (E 03.9) which is 32 (28.1%). In 80 years and above (E 04.2), the most common type is non-toxic multinodular goiter 3 (37.5%) and is followed by (E05.9) thyrotoxicosis, unspecified, which is (25.2%).
|Table 2: Age wise distribution of different type of thyroid disorders (E03-E07)|
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Sex wise distribution of different type of thyroid disorders are given in [Table 3]. In females the most common type of thyroid disorder is non-toxic multinodular goiter (E 04.2) which is 487 (52%) cases and is followed by non-toxic single thyroid nodule (E04.1) which is 169 (18.1%) cases. In males, the most common type of thyroid disorder is hypothyroidism, unspecified (E03.9) which is 45 (29.6%) cases and is followed by non-toxic multinodular goiter (E04.2) which is 41 cases 27%. The thyroid disorders in the different age groups from 2005 to 2010 are given in the [Table 4] and sex wise fluctuating trend of the thyroid disorders from 2005 to 2010 has been represented in the [Figure 1].
|Table 4: Age wise distribution of thyroid disorders from April 2005 to March 2010|
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|Figure 1: Sex wise distribution of thyroid disorders from April 2005 to March 2010|
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| Discussion|| |
Studies show that the occurrences of thyroid disorders are not distinctive in different geographical areas, age groups and sex.  In the present study, thyroid disorders are higher in females compared to males and it is consistent with all the studies conducted in this regard in different parts of the world. In the present study, it is 152 14% in males and 936 86% in females. Oqbera AO et al.'s study on pattern of thyroid disorders in the South Western region of Nigeria  shows 5:1 ratio among males and females in the thyroid disorders. Sidibe'et al. in Sub-Saharan Africa  reveals that 94.2% females are affected by thyroid disorders, Mahato RV et al., in Nepal  reports that thyroid disorders is 83.27% in females compared to 16.73% in males. Afsheen Maqsood et al., in Karachi,  reports females are 85.5% and males report only in 11.5%. Rosemary Ikem et al., in their study on spectrum of thyroid disorder in Obafemi Awolowo University teaching hospital complex reveals 85.9% of thyroid disorders in females compared to 14.1% in males. However, this most common disorder of the endocrine system is increasing predominantly among women. 
As depicted in [Table 1], the highest number of cases is reported in 40-60 years followed by 20-40 years. It is 40.80% in 40-60 years and 38.41% in 20-40 years. In males the most affected in the age group of 40-60 years is 38.2% followed by 31.6% in 20-40 years. In females, this trend is repeating where 41.2% is reported in 40-60 years which is followed by 39.5% in the 20-40 age groups. Rosemary Ikem et al., reveals high affected group of thyroid disorders are in 40-60 years of age. Afsheen Maqsood et al., reports that in males, it is higher in above the age of 40 years and in females it is above the age of 30 years. Pradip Kumar et al., in their study on thyroid-stimulating hormone measurement in Kolkata, reports high thyroid disorders in 36-45 years age group.
As shown in [Table 2], the most common type of thyroid disorder that occurs in the present study, is non-toxic multinodular goiter (E04.2), which is 48.5% and it is followed by hypothyroidism, unspecified (E03.9) of 18.1%. Non-toxic multi-nodular goiter is one of the common presentations of various thyroid diseases. It is common in the developing and developed countries especially in the areas where intake of iodine in their diet is low.  Heather Hofflich reports that  one third to one half of people over the age of fifty in the United States of America have one or more nodules in their thyroid. While previous studies reveals the low risk of malignancy in multinodular goiter compared to single nodular goiter, recent studies seriously contradicted this belief and reveals possibility of malignancy in multinodular goiter.  But Giuffrida D et al.,  reveals that there is no difference between single and multinodular goiter in the occurrence of malignancy. Frates et al., reveals same prevalence of cancer in multinodular goiter and in single nodular goiter, which is 15%. Belfiore A et al.,  from Italy also support the theory that there is no difference in the occurrence of thyroid cancer in multi and single nodular goiter. A Frilling et al.,  reveals that its causation is multi-factorial and probably differs from patient to patient and the factors such as natural goitrogens, iodine intake, malnutrition and genetic factors strongly contribute to the development of nodular thyroid enlargement.
The second most common type of thyroid disorder in the present study is hypothyroidism. It is the most common functional disorder of thyroid gland and is an important public health issue especially in the iodine deficient area. Iodine deficiency is the main cause for hypothyroidism and results in the varying degrees of mental retardation problems in millions of people who reside there.  Shamon M reveals  that 8.9% people were hypothyroid while only 1.1% were hyperthyroid in America and Bjoro et al.,  reveal 9.3% hypothyroidism in UK. Devika T et al.,  reports 13.2% hypothyroidism in an Indian study which was conducted in New Delhi, 25.7% hypothyroidism in a Kolkata study conducted by Pradip Kumar S et al., and R V Mahato et al., reveal it is 11.6% in Nepal.  In a Cochin based study by Usha Menon et al., reports 3.9% hypothroism in adults and Desai MP reports 79% of hypothyroidism in the North Indian study and 11.5% hypothyroidism in another Indian study by Abraham R et al.,  According to Mrqusee et al., the main causes for hypothyroidism include iodine deficiency, autoimmune thyroid disease and thyroablative therapy. It raises the level of total cholesterol, LDL and triples the risk of developing hypertension especially in pregnant women and increases the risk of miscarriage and causes impaired mental performance to the children born to untreated women of this thyroid disorder.  Abalovich M et al., reveal that 20% incidence of perinatal mortality and congenital malformation are due to this thyroid disorder. According to him, untreated hypothyroidism leads to behavioral impairment and eventually dementia and depression.
In the present study, the most common type of disorder in males is hypothyroidism (29.6%) and is followed by non-toxic multinodular goiter (27%). In females, hypothyroidism is 16.2%. Bjoro et al., reveal that  it is comparatively higher in women (9.3%) than men (1.3%). In a Norway study, it is 4.8% in females and 0.9% in males. The present study shows that the most common thyroid disorder in females is non-toxic multinodular goiter (E04.2) is 52% and is followed by non-toxic single thyroid nodule (E04.1%) which is 18.1%.
| Conclusion|| |
In the present study, more cases are reported in females compared to males and highest number of cases is reported in 40 to 60 age groups which are followed by 20 to 40 age groups. None of the cases of congenital iodine deficiency syndrome (E00), iodine deficiency related thyroid disorders and allied conditions (E01) and subclinical iodine deficiency hypothyroidism (E02) are reported in this study. The most common type is non-toxic multi nodular goiter and recent studies prove that it has high risk of malignancy. The second common type is hypothyroidism, unspecified which is very common in the iodine deficient areas. The untreated thyroid disease can produce serious consequences to the body especially cardio vascular diseases. So improved public awareness and understanding of thyroid disorders is essential among patients and their families to cope with the thyroid illness.
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[Table 1], [Table 2], [Table 3], [Table 4]