Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
Home Print this page Email this page
Users Online: 937



 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 12  |  Issue : 2  |  Page : 62-66

Status of Thyroid disorders at Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, India


Department of Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences Sawangi (Meghe), Wardha, Maharashtra, India

Date of Web Publication8-May-2015

Correspondence Address:
Prashant S Adole
Department of Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences Sawangi (Meghe), Wardha 442 004, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-0354.153342

Rights and Permissions
  Abstract 

Background: Thyroid disorders are amongst the most common endocrine diseases in India. Numerous studies from various countries differ in their prevalence estimates for both hypothyroidism and hyperthyroidism. There is however a paucity of data from the rural areas. The present study was conducted to find out the prevalence of thyroid disorders among the people of Wardha district of Maharashtra. Materials and Methods: This is the observational, retrospective study conducted in Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha. In total, 1905 patients visiting to hospital and suspecting of thyroid disorders were screened for thyroid function. Thyrotrophin (TSH), free triiodothyronine (FT3), and free tetraiodothyronine (FT4) in human serum were quantitatively estimated by a microplate immunoenzymetric assay. Results: Of the 1905 total subjects in the age range 10-80 years, 35.7% had thyroid dysfunction and 64.3% had euthyroidism; 21.7% had hypothyroidism (6.9% clinical, 14.8% subclinical); 2.3% had hyperthyroidism (1.1% clinical and 1.2% subclinical), while 11.6% had mildly suppressed TSH with normal FT4. Conclusion: The prevalence of clinical (75%) and subclinical hypothyroidism (71%) and clinical (66%) and subclinical (70%) hyperthyroidism was high in the 21-50 year age group with decreasing trend towards end. Also, the prevalence of mildly suppressed TSH was high in the 21-50 year age groups, which is 65%. This means that major burden of thyroid disorders is on reproductive age groups. This problem must be addressed immediately to avoid deleterious effect of abnormal thyroid dysfunction on the patients as well as on their offspring.

Keywords: Hypothyroidism, subclinical hypothyroidism, thyroid function


How to cite this article:
Dhok AJ, Adole PS, Puppalwar PV, Agrawal U. Status of Thyroid disorders at Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, India . Thyroid Res Pract 2015;12:62-6

How to cite this URL:
Dhok AJ, Adole PS, Puppalwar PV, Agrawal U. Status of Thyroid disorders at Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, India . Thyroid Res Pract [serial online] 2015 [cited 2019 Nov 11];12:62-6. Available from: http://www.thetrp.net/text.asp?2015/12/2/62/153342


  Introduction Top


Thyroid disorders are amongst the most common endocrine diseases in India. [1] The prevalence of abnormal thyroid function continues to be debated. The prevalence and pattern of thyroid disorders depends on sex, age, and ethnic and geographical factors, and iodine intake, in particular. [2] The total burden of thyroid disorders in India is 42 million. This projection was based on recent nationwide studies on thyroid disorders among adolescents and young adults in the post-salt iodization phase. [1] Many studies conducted all over India had shown high prevalence of goiter. [3] A nationwide goiter survey revealed that out of 283 studied districts of 29 states and 4 Union Territories, 235 have prevalence of endemic goiter. [4]

Numerous studies from various countries differ in their prevalence estimates for both hypothyroidism and hyperthyroidism. Hypothyroidism is by far the most common thyroid disorder in the adult population and is more common in older women. Virtually all studies report higher prevalence rates for hypothyroidism in women and with advancing age with rates as high as 24% among women older than 60 years recruited from several senior citizens' centers and ambulatory clinics. [5] It is usually autoimmune in origin, presenting as either primary atrophic hypothyroidism or Hashimoto's thyroiditis. Hypothyroidism is 10 times more common in women than in men. [6] The prevalence of hyperthyroidism is also reported as more common in women than men. [7] There is however a paucity of data from the rural areas. We still lack information on thyroid dysfunction amongst peoples in Wardha region of Maharashtra. This study was designed to address this question.


  Materials and Methods Top


Population study

This is an observational retrospective study conducted in Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha. Patients visiting to hospital and suspecting of thyroid disorders were screened for thyroid function. All patients visiting the hospital from three years, i.e., 2010, 2011, and 2012 were included in this study.

Laboratory methods

The quantitative determination of thyrotrophin (TSH), free triiodothyronine (FT3), and free tetraiodothyronine (FT4) in human serum was estimated by a microplate immunoenzymetric assay using the reagent kit by Monobind, Lake forest, USA. [8],[9],[10],[11],[12] For estimation of the FT3 and FT4, competitive enzyme immunoassay was performed. Upon mixing the biotinylated antibody, reaction occurred between the biotin attached to the antibody and the steptavidin immobilized on the microwell. This affects the separation of the antibody bound fraction after decantation or aspiration. Upon mixing serum and enzyme-antigen conjugate, a competitive reaction occurs between the native antigen in serum and enzyme-antigen conjugate for a limited number of antibody-binding sites. The enzyme activity in the antibody-bound fraction, measured by reaction with luminol, was inversely proportional to the native antigen concentration.

For the measurement of TSH levels, the immobilization takes place during the assay at the surface of a microplate well through the interaction of streptavidin coated on the well and exogenously added biotinylated monoclonal anti-TSH antibody. The monoclonal biotinylated antibody (the enzyme-labeled antibody) and serum containing the native antigen are mixed. Upon mixing, reaction results between the native antigen and antibody without competition or steric hindrance to simultaneously form a soluble sandwich complex, the complex is deposited to the well through the high-affinity reaction of streptavidin and biotinylated antibody. After equilibrium is attained, the antibody-bound fraction is separated from the unbound antigen by decantation. The enzyme activity in the antibody-bound fraction is directly proportional to the native antigen concentration.

Data analysis

The laboratory's reference values were TSH (0.4-4.5 μIU/ml), FT4 (0.8-2.0 ng/dL), FT3 (1.5-4.1 pg/ml). Hypothyroidism was classified as clinical if TSH was ≥4.5 μIU/ml and FT4 was ≤0.620 ng/dL and subclinical if TSH was ≥4.5 μIU/ml and FT4 ≥0.620 ng/dL. Hyperthyroidism was classified as clinical if TSH was ≤0.1μIU/ml and FT4 was ≥1.705 ng/dL and subclinical if TSH was ≤ 0.1μIU/ml and FT4 ≤1.705 ng/dL. A TSH concentration of 0.1-0.4 μIU/ml was considered as mildly suppressed. [13]

Statistical analysis

Statistical analysis was done using Microsoft Office "Excel" with Windows 98 Operating System. For TSH, FT3, and FT4, we calculated the mean and standard deviation.


  Results Top


Of the 1905 total subjects in the age range 10-80 years, 35.7% had thyroid dysfunction and 64.3% were euthyroid [Figure 1]. About 21.7% had hypothyroidism (6.9% clinical, 14.8% subclinical), 2.3% had hyperthyroidism (1.1% clinical and 1.2% subclinical), while 11.6% had mildly suppressed TSH with normal FT4.
Figure 1: Prevalence of thyroid abnormalities found in adult subjects from AVBRH, Sawangi, Wardha

Click here to view


[Table 1] shows the distribution of patients based on their thyroid status in different age groups. Thyroid disorders were highest among patients aged 31-40 years old. With increase in age (> 50 years), the number of thyroid disorders decreased. [Table 2]a and 2b shows the differences between FT3, FT4, and TSH levels in the six study groups: Subclinical hypothyroidism, clinical hypothyroidism, subclinical hyperthyroidism, clinical hyperthyroidism, mildly suppressed TSH, and euthyroidism. Mean levels of all three hormones significantly differed between the groups (P <0.0001). The mean TSH level in the subclinical hypothyroid group was 14.79 ± 6.72 μIU/ml and subclinical hyper thyroid group 0.082 ± 0.012 μIU/ml. The mean TSH level in the clinical hypothyroid group was 77.15 ± 37.18 μIU/ml and clinical hyperthyroid group was 0.08 ± 0.021 μIU/ml. The cut-off values for subclinical hypothyroidism was TSH > 4.5 μIU/ml and FT4 ≥ 0.620 mg/dl. The cut-off values for subclinical hyperthyroidism was TSH ≤ 0.1 μIU/ml and FT4 ≤ 1.705 mg/dl. The mean TSH level in the mildly suppressed TSH group was 0.23 ± 0.02 μIU/ml.
Table 1: Distribution of patients based on their thyroid status in different age groups


Click here to view
Table 2:

Click here to view



  Discussion Top


The burden of thyroid disease in the general population is enormous. Thyroid disorders are the most common among all the endocrine diseases in India. Despite the coverage of National iodine deficiency diseases control Programme (NIDDCP) in India, iodine deficiency is still prevalent in many parts of India. There are still many districts in India where we are unaware of incidence of thyroid disorders. One such district in Maharashtra is Wardha. Thus, the present study was conducted to know the prevalence of thyroid disorders in Wardha district of Maharashtra.

The Wardha district in Maharashtra has heavy rainfall because of this frequent flooding is particularly likely to wash away thereby decreasing the iodine of the superficial layer (in which iodine is present) of the soil. Iodine deficiency in the soil is aggravated by soil erosion from deforestation. Further, an analysis of the soil characteristics of Wardha District indicates that one-fifth of the soil is classified as bardi, while four-fifths is accounted for by kanhar and madhyam that have relatively better levels of productive potential. However, kanhar and madhyam category soils have several inherent problems and deficiencies such as low level of availability of macro- and micronutrients, which further aggravates the iodine deficiency.

This survey included 1905 subjects who attended the Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha. Their ages ranged from 10-80 years. About 35.7% had thyroid dysfunction, and 11.5% were hypothyroid (6.9% clinical, 14.8% subclinical). In the study conducted at Pondicherry by Abraham et al., [13] 15.8% of study subjects had thyroid dysfunctions and 11.5% had hypothyroidism (2% overt and 9.5% subclinical). Also in the study carried out by Skaria et al., [14] 79.4% of subjects had thyroid dysfunctions: 59.37% had hypothyroidism, 7.3% had clinical hypothyroidism, and 12.6% had subclinical hypothyroidism. Lower prevalence of hypothyroidism found in present study may be due to ingestion of non-goitrogenic food in Wardha region. Skaria et al. [14] found high prevalence of hypothyroidism because of ingestion high goitrogenic food by people of Baster region of Chhattisgarh. We also found high prevalence of subclinical hypothyroidism and lower prevalence of clinical hypothyroidism in our study. These findings suggest that thyroid function test should be done by the people of Wardha region to exclude the diagnosis of hypothyroidism as they will not experience the signs and symptoms of it.

Hyperthyroidism was seen in 2.3% (overt 1.1% and Subclinical 1.2%) of the total subjects when the cut off value for TSH was <0.1 μIU/ml. In more recent surveys, Hoogendoorn et al. [15] have reported thyrotoxicosis in 1.2% subjects (overt 0.4%, subclinical 0.8%) and Hollowell et al. [16] in their (NHANES III) study have reported an incidence of 1.3% (overt 0.5% and subclinical 0.7%). This also indicates higher prevalence of clinical and subclinical hyperthyroidism in the present study.

The prevalence of clinical and subclinical hypothyroidism was high in the 21-50 year age group, which is 75% and 71%, respectively, with decreasing trend towards end. The prevalence of clinical and subclinical hyperthyroidism was high in the 21-50 year age group, which is 66% and 70%, respectively. Also, the prevalence of mildly suppressed TSH was high in the 21-50 year age groups, which is 65%. This means that major burden of thyroid disorders is on reproductive age groups. This indicates that thyroid disease should be considered during routine evaluation of this susceptible group and should be followed by appropriate detection and treatment. This problem must be addressed immediately to avoid deleterious effect of abnormal thyroid dysfunction on the patients as well as on their offspring. We hope to extend the study to a larger cross-section of men and women in this region keeping in mind environmental and etiological factors such as auto immunity, drugs, iodine, and non-thyroidal illness.


  Conclusion Top


The people of Wardha district are exposing to heavy rainfall, frequent flooding leading to loss of iodine in superficial layer of soil. Moreover, the soil constituent in this region is also unfavorable for iodine. Prevalence of thyroid disorders was high among the people of reproductive age groups. This problem should be addressed immediately by appropriate detection and early treatment to avoid deleterious effects on patients and their offspring.


  Acknowledgment Top


I take the opportunity to thank EDP department and central clinical laboratory, AVBRH, Sawangi, Wardha.

 
  References Top

1.
Kochupillai N. Clinical endocrinology in India. Curr Sci 2000;79:1061-67.  Back to cited text no. 1
    
2.
Delang F. The Disorders induced by iodine deficiency. Thyroid 1994;4:107-28.  Back to cited text no. 2
    
3.
Unnikrishnan AG, Menon UV. Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab 2011;15:S78-81.  Back to cited text no. 3
    
4.
NIHFW. National iodine deficiency disorders control Programme. National Health Programme Series 5. New Delhi: National Institute of Health and Family Welfare; 2003. p. 99.  Back to cited text no. 4
    
5.
Sawin CT, Chopra D, Azizi F, Mannix JE, Bacharach P. The aging thyroid: Increased prevalence of elevated serum thyrotropin levels in the elderly. JAMA 1979;242:247-50.  Back to cited text no. 5
    
6.
Vanderpump MP, Turnbridge WM. Epidemiology and prevention of clinical and subclinical hypothyroidism. Thyroid 2002;12:839-47.  Back to cited text no. 6
    
7.
Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, et al. The spectrum of thyroid disease in a community: The Whickham survey. Clin Endocrino (Oxf) 1977;7:481-93.  Back to cited text no. 7
    
8.
Gharib H, Ryan RJ, Mayberry WE, Hockert T. Radioimmunoassay for triiodothyronine (T3): I. Affinity and specificity of antibody for T3. J Clin Endocrinol Metab 1971;33:509-16.  Back to cited text no. 8
    
9.
Chopra IJ, Ho RS, Lam R. An improved radioimmunoassay of triiodothyronine in human serum. J Lab Clin Med 1972;80:729-39.  Back to cited text no. 9
    
10.
Sterling L. Diagnosis and treatment of thyroid diseases. Cleveland: CRC Press, 1975. p. 9-51.  Back to cited text no. 10
    
11.
Barker SB. Determination of protein bound iodine. J Biol Chem 1948;173:175-24.  Back to cited text no. 11
    
12.
Young DS, Pestaner LC, Gilberman V. Effects of drugs on clinical laboratory tests. Clin Chem 1975;21:1-432D.  Back to cited text no. 12
    
13.
Abraham R, Srinivasa Murugan V, Pukazhvanthen P, Sen SK. Thyroid disorders in women of Puducherry. Indian J Clin Biochem 2009;24:52-9.  Back to cited text no. 13
    
14.
14 Skaria LK, Sarkar PD, Agnihitram G, Thakur AS, Pamidamarri G. Thyroid dysfunction in tribal women of Baster region of Chattisgharh, India. Thyroid Sci 2011;6:1-5.  Back to cited text no. 14
    
15.
Hoogendoorn EH, Hermus AR, de Vegt F, Ross HA, Verbeek Al, Kiemeney LA, et al. Thyroid function and prevalence of antithyroperoxidase antibodies in a population with borderline sufficient iodine intake: Influences of age and sex. Clin Chem 2006;52:104-11.  Back to cited text no. 15
    
16.
Hollowel JG, Staehling NW, Flanders DW, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T4 and thyroid antibodies in the United States population (1988 - 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-99.  Back to cited text no. 16
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Results
Discussion
Conclusion
Acknowledgment
Materials and Me...
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed1984    
    Printed60    
    Emailed0    
    PDF Downloaded211    
    Comments [Add]    

Recommend this journal