Thyroid Research and Practice

EDITORIAL
Year
: 2020  |  Volume : 17  |  Issue : 3  |  Page : 99--100

Rising prevalence of Thyroid disorders in India - The time to act is now


Arun S Menon 
 HOD & Senior Consultant Endocrinologist, Department of Endocrinology, Lisie Hospital, Kochi, Kerala, India

Correspondence Address:
Dr. Arun S Menon
23, Vineyard Meadows, Eroor South - 682 036, Ernakulam, Kerala
India




How to cite this article:
Menon AS. Rising prevalence of Thyroid disorders in India - The time to act is now.Thyroid Res Pract 2020;17:99-100


How to cite this URL:
Menon AS. Rising prevalence of Thyroid disorders in India - The time to act is now. Thyroid Res Pract [serial online] 2020 [cited 2021 Oct 28 ];17:99-100
Available from: https://www.thetrp.net/text.asp?2020/17/3/99/307562


Full Text



Over the last decade, a number of regional surveys have pointed to the explosive rise of thyroid disorders in India.[1],[2] The reasons touted have varied from the rise in autoimmunity to rapid iodination and obesity. The commercialization and easy availability of thyroid function tests has led to a big industry growing around it without any clarity as to how to deal with a disorder that is fast rising to epidemic proportions. A lack of mechanistic studies has stalled our attempts to roll out programs to prevent the development of thyroid disorders as well as effective long-term management strategies.

Clinicians have been, for a while, aware of the rise in prevalence in children and younger individual, especially of subclinical hypothyroidism. This has mirrored the rise in obesity and metabolic syndrome during the same period in this age group. However, a lack of understanding of the epigenetics and pathophysiology has led us to follow the strategy of lifelong replacement while waiting for it to evolve into overt hypothyroidism. Similar challenges await us in the other extreme of age. Although studies from Europe and the US have pointed to the challenges of treating both subclinical hypothyroidism and hyperthyroidism, our approach has been muddled because of a lack of clinical supportive data from India.

Another issue that needs a closer look all over India is the increase in thyroid cancer.[3] Increased awareness and easy access to ultrasonography could be one of the main reasons for the sudden increase in detection rates. The treatments are costly and have put a burden on the already ailing health system. However, it is unclear whether following international guidelines is the way forward for a country with such a massive population.

Routine screening of thyroid function during early pregnancy is being practiced in most places,[4] although a uniform strategy is yet to evolve. Clear-cut normative data from the Indian population is lacking for us to differentiate borderline values from normal results. We have followed international guidelines for treatment, although the relevance is dubious with still uncertainties surrounding iodination status and normative data.

It is hence clear that there are many aspects of prevention, detection, and management of thyroid disorders that need clarity. Technological advances have put an unprecedented strain on the health system by identifying pathologies which may or may not be relevant in the long term. Thus, it is time for us as an organization to take a lead in bringing clarity to the issues mentioned above. The three areas that need immediate attention from ITS are updating medical practitioners about the impact of thyroid disorders in the community, educating our public about the relevance and importance of these disorders and devising practical cost-effective guidelines and treatment strategies.[5]

For this to happen, starting now, we have to embark on well-structured epidemiological studies in thyroid autoimmunity, hypothyroidism, and thyroid malignancy, which as we all know takes immense amount of time, expense, and patience. Indian Thyroid Society can take a lead along with premier institutes in India to shepherd the work in these areas. Educating the professionals and public will be another huge challenge which needs a structured policy emanating from the collective thoughts of experts in this field. For any meaningful work, significant funding from a governmental level will be required. The onus is on each one of us to convince the scientific community and health strategists about the impact of thyroid disorders on the health of the community.

References

1Unnikrishnan AG, Menon UV. Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab 2011;15:S78-81.
2Bagcchi S. Hypothyroidism in India: more to be done. Lancet Diabetes Endocrinol 2014;2:778.
3Veedu JS, Wang K, Lei F, Chen Q, Huang B, Mathew A. Trends in thyroid cancer incidence in India. J Clin Oncol 2018;36:15.
4Dhanwal DK, Bajaj S, Rajput R, Subramaniam KA, Chowdhury S, Bhandari R, et al. Prevalence of hypothyroidism in pregnancy: An epidemiological study from 11 cities in 9 states of India. Indian J Endocrinol Metab 2016;20:387-90.
5Marwaha RK, Tandon N, Ganie MA, Kanwar R, Sastry A, Garg MK, et al. Status of thyroid function in Indian adults: Two decades after universal salt iodization. J Assoc Physicians India 2012;60:32-6.