A clinico-epidemiological analysis of subclinical hypothyroidism in a tertiary care health center

Background: Subclinical hypothyroidism (SCH) is defined by increase in serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) and free triiodothyronine (FT3) levels within normal range, coupled with absence of typical clinical symptoms. The present study was undertaken to analyse the SCH associated comorbidities, especially lipid disturbances, thyroid autoantibodies, etc.Methods: The present study was retrospective observational study, which was carried out at a tertiary health care center.Results: Out of the 100 patients, majority were in the age group 21 to 30 years (31 patients), followed by 26 patients in age group >51 years and least in age group 41 to 50 years. Prevalence showed female predilection, with female: male ratio of 1.9:1. Most common symptom reported was general fatigue, which was encountered in 40 patients, followed by weight gain, menstrual abnormalities, and constipation. 10 patients were asymptomatic. Serum TSH range in the patients was 5 to 21.1 µIU/l, while mean TSH was 10.9 µIU/l. 20 patients were found to have serum TSH>10.Conclusions: Despite high prevalence, detection rate of subclinical hypothyroidism is very low. Carrying out epidemiological study on national scale is need of the hour, as lack of typical clinical features makes the detection less likely and it has numerous complications, if untreated.

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Subclinical hypothyroidism

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.3252 ◽

2011 ◽

pp. 543-547

Author(s):

Jayne A. Franklyn

Keyword(s):

Thyroid Function ◽

Subclinical Hypothyroidism ◽

Expert Panel ◽

Elevated Serum ◽

Thyroid Stimulating Hormone ◽

Free Thyroxine ◽

Thyroid Function Tests ◽

Free Triiodothyronine ◽

Function Tests ◽

Serum Tsh

Subclinical hypothyroidism is defined biochemically as the association of a raised serum thyroid-stimulating hormone (TSH) concentration with normal circulating concentrations of free thyroxine (T4) and free triiodothyronine (T3). The term subclinical hypothyroidism implies that patients should be asymptomatic, although symptoms are difficult to assess, especially in patients in whom thyroid function tests have been checked because of nonspecific complaints such as tiredness. An expert panel has recently classified individuals with subclinical hypothyroidism into two groups (1): (1) those with mildly elevated serum TSH (typically TSH in the range 4.5–10.0 mU/l) and (2) those with more marked TSH elevation (serum TSH >10.0 mU/l).

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Clinical Profile of Subclinical Hypothyroidism:A Retrospective Study

International Journal of Medical and Dental Sciences ◽

10.18311/ijmds/2017/18835 ◽

2017 ◽

Vol 6 (2) ◽

pp. 1475

Author(s):

Mallikarjuna Shetty ◽

Krishna Prasad Adiraju ◽

Nageswar Rao Modugu

Keyword(s):

Retrospective Study ◽

Subclinical Hypothyroidism ◽

Low Dose ◽

Clinical Symptoms ◽

Clinical Profile ◽

Common Symptom ◽

Number Of Patients ◽

Age Range ◽

Symptoms And Signs ◽

Serum Tsh

Background: Subclinical hypothyroidism occurs due to an under functioning thyroid gland and presents with varied symptoms and signs. Thyroid disorders are common in Indian population and the prevalence of subclinical hypothyroidism is high.Objective: This study intended to assess the clinical profile of patients presenting with subclinical hypothyroidism.Materials and Methods: This was a retrospective study that analyzed the medical records of adult patients diagnosed with subclinical hypothyroidism for a period of three years.Results: 71 patients within the age range of 18 years to 77 years were diagnosed with subclinical hypothyroidism. Among these 53 (75%) patients had various clinical symptoms. Body pains were the most common symptom (38 %) followed by weight gain(27%) and tiredness (20%). A significant number of patients were obese (25%). Enlarged thyroid(14%) and dyslipidemia (25%) were also recorded. 63 (75%) patients were initiated on low dose levothyroxine.Conclusion: Patients with subclinical hypothyroidism present with varied non-specific clinical symptoms. Treatment with low dose levothyroxine resulted in lowering of serum TSH to normal range and relief of symptoms.

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Transient high thyroid stimulating hormone and hypothyroidism incidence during follow up of subclinical hypothyroidism

Endocrine Regulations ◽

10.2478/enr-2021-0022 ◽

2021 ◽

Vol 55 (4) ◽

pp. 204-214

Author(s):

Munir Abu-Helalah ◽

Hussam Ahmad Alshraideh ◽

Sameeh Abdulkareem Al-Sarayreh ◽

AbdelFattah Al-Hader

Keyword(s):

Subclinical Hypothyroidism ◽

Screening Program ◽

Thyroid Stimulating Hormone ◽

Overt Hypothyroidism ◽

Thyroid Peroxidase ◽

Free Triiodothyronine ◽

High Prevalence ◽

Levothyroxine Replacement ◽

Stimulating Hormone

Abstract Objectives. Given the high prevalence of subclinical hypothyroidism (SCH), defined as high thyroid stimulating hormone (TSH) and normal free thyroxine (FT4), and uncertainty on treatment, one of the major challenges in clinical practice is whether to initiate the treatment for SCH or to keep the patients under surveillance. There is no published study that has identified predictors of short-term changes in thyroid status amongst patients with mild elevation of TSH (4.5–10 mIU/L). Subjects and Results. A cohort study was conducted on patients with SCH detected through a general population screening program, who were followed for six months. This project identified factors predicting progression to hypothyroid status, persistent SCH and transient cases. A total of 656 participants joined the study (431 controls and 225 were patients with SCH). A part of participants (12.2%) developed biochemical hypothyroidism during the follow-up, while 73.8% of the subjects became euthyroid and the remained ones (13.4%) stayed in the SCH status. The incidence of overt hypothyroidism for participants with TSH above 6.9 mIU/L was 36.7%, with incidence of 42.3% for females. Anti-thyroid peroxidase antibodies (TPO) positivity is an important predictor of development of hypothyroidism; however, it could be also positive due to transient thyroiditis. Conclusions. It can be concluded that females with TSH above 6.9 mIU/L, particularly those with free triiodothyronine (FT3) and FT4 in the lower half of the reference range, are more likely to develop biochemical hypothyroidism. Therefore, it is recommended to give them a trial of levothyroxine replacement. It is also recommended to repeat TSH after six months for male subjects and participants with baseline TSH equal or less than 6.9 mIU/L.

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Homeopathic Treatment of Subclinical Hypothyroidism—A Series of 19 Cases

Homeopathy ◽

10.1055/s-0041-1734028 ◽

2021 ◽

Author(s):

Luiz Carlos Esteves Grelle ◽

Luiz Antonio Bastos Camacho

Keyword(s):

Subclinical Hypothyroidism ◽

Clinical Importance ◽

Clinical Problem ◽

Thyroid Stimulating Hormone ◽

Exclusion Criteria ◽

The Mean ◽

Common Clinical Problem ◽

Prompt Diagnosis ◽

Serum Tsh ◽

Tsh Levels

Abstract Background Subclinical hypothyroidism (SCH) is a common clinical problem. Controversy surrounds the definition, clinical importance, and need for prompt diagnosis and treatment of the mild form of SCH. Aim The aim of the study was to analyze the evolution of serum thyroid stimulating hormone (TSH) levels after a therapeutic homeopathic intervention in women older than 40 years with SCH. Methods This study is a retrospective series of 19 cases of SCH, with serum TSH levels between 5 and 10 mIU/L, treated exclusively with homeopathic medicines prescribed on an individualized basis. Results Nineteen patients were included according to the inclusion and exclusion criteria. Their mean age was 56 years, they were followed for a mean duration of 69 months, the mean number of serum TSH level measurements was 18, and the intervention was successful for 13 patients. Conclusion The homeopathic therapeutic intervention was successful in 68% of the patients, with serum TSH levels back within the normal range (0.5–5.0 mIU/L).

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Thyroid Function Changes and Pubertal Progress in Females: A Longitudinal Study in Iodine-Sufficient Areas of East China

Frontiers in Endocrinology ◽

10.3389/fendo.2021.653680 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yingying Wang ◽

Dandan He ◽

Chaowei Fu ◽

Xiaolian Dong ◽

Feng Jiang ◽

...

Keyword(s):

Linear Regression ◽

Multiple Linear Regression ◽

Thyroid Function ◽

Pubertal Development ◽

Thyroid Stimulating Hormone ◽

East China ◽

Regression Analyses ◽

Free Triiodothyronine ◽

Serum Tsh

BackgroundThe onset of puberty is influenced by thyroid function, and thyroid hormones (THs) fluctuate substantially during the period of pubertal development. However, it needs to be further clarified how THs change at specific puberty stages and how it influences pubertal development in girls. So far, longitudinal data from China are scarce.MethodsA cohort study was conducted among girls during puberty in iodine-sufficient regions of East China between 2017 to 2019. Serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were determined for each participant. Thyroid homeostasis structure parameters (THSPs), including the ratio of FT4 to FT3 (FT4/FT3), Jostel’s TSH index (TSHI), and thyroid feedback quantile-based index (TFQI), were calculated. Puberty category scores (PCS), calculated based on the Puberty Development Scale (PDS), was used to assess the stage of puberty. Girls were grouped into three categories according to PCS changes (△PCS) and six categories according puberty stage (BPFP: pre-pubertal at both baseline and follow-up; BPFL: pre-pubertal at baseline and late-pubertal at follow-up, respectively; BPFT: pre-pubertal at baseline and post-pubertal at follow-up, respectively; BLFL: late-pubertal at both baseline and follow-up; BLFT: late-pubertal at baseline and post-pubertal at follow-up, respectively; BTFT: post-pubertal at both baseline and follow-up). Multiple linear regression analyses were used to evaluate the associations of THs changes with pubertal progress.ResultsThe levels of serum TSH and FT3 decreased while serum FT4 increased during the study period (P<0.001). In multiple linear regression analyses, after adjustment for covariables, FT3 decreased by an additional 0.24 pmol/L (95% CI: -0.47 to -0.01) in the higher △PCS group than the lower △PCS group. Compared with the BLFL group, the BPFT group showed an additional decline in FT3 (β= -0.39 pmol/L, 95%CI: -0.73 to -0.04), the BTFT group showed a lower decline in TSH (β=0.50 mU/L, 95% CI: 0.21 to 0.80) and a lower decline in TSHI (β=0.24, 95%CI: 0.06 to 0.41), respectively. There was no association of △FT4 or △TFQI with △PCS or the puberty pattern.ConclusionsSerum TSH and FT3 decreased while serum FT4 increased among girls during puberty. Both the initial stage and the velocity of pubertal development were related to thyroid hormone fluctuations.

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Study of Fasting Lipid Profile in Patients with Subclinical Hypothyroidism in a Tertiary Care Hospital in Bangladesh

Faridpur Medical College Journal ◽

10.3329/fmcj.v16i1.55731 ◽

2021 ◽

Vol 16 (1) ◽

pp. 17-20

Author(s):

Mohammad Afjal Hossain ◽

- Atiquzzaman ◽

Mirza Sharifuzzaman ◽

Farzana Amin ◽

Lutful Kabir ◽

...

Keyword(s):

Lipid Profile ◽

Subclinical Hypothyroidism ◽

Tertiary Care ◽

Thyroid Function Test ◽

Significant Negative Correlation ◽

Thyroid Stimulating Hormone ◽

Care Hospital ◽

Cross Sectional ◽

Metabolic Complications ◽

Normal Thyroid Function

Subclinical hypothyroidism (SCH) is a metabolic disorder with prevalence about 4-10% in general population. This study was conducted to observe the pattern of fasting lipid profile in SCH and to correlate the components of it with thyroid stimulating hormone and free thyroxin level. This cross sectional observational study included 31 newly diagnosed cases of SCH and 17 age and BMI matched healthy control subjects with normal thyroid function test. Fasting lipid profile was recorded and compared. TSH was significantly higher in SCH compared to controls (9.09±2.79 vs 2.31±0.92 μIU/ml; p=0.001). FT4 was comparable between the groups (1.17±0.18 vs 1.28±0.20 ng/dl; p=0.938). Significantly higher level of Total cholesterol and LDL-C were observed in SCH compared to controls (TC 194.77±29.70 vs 156.59±20.45 mg/dl; p=0.042 and LDL-C 124.81±27.85 mg/dl vs 88.59±18.41mg/dl; p=0.045 respectively). Triglycerides and HDL-C were comparable between the groups (TG 134.90±80.97 vs 118.12±49.14 mg/dl; p=0.171 and HDL-C 42.87±4.83 vs 44.47±5.66; p=0.633 respectively). TSH showed significant positive correlation with TC and LDL-C (r=0.591, p<0.001 and r=0.644, p<0.001 respectively), but not with TG or HDL-C (r=0.011, p=0.943 and r=0.115, p=0.435 respectively). FT4 only showed significant negative correlation with LDL-C (r=0.302; P=0.037) but not with TC, TG or HDL-C (TC: r=0.245, P=0.093; TG: r=0.121, p=0.411 and HDL-C: r=0.108, p=0.466 respectively). SCH is associated with raised TC and LDL-C. So patients with SCH are more vulnerable to develop future adverse cardio-metabolic complications. Faridpur Med. Coll. J. 2021;16(1):17-20

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A comparative study on outcomes of preprandial versus postprandial thyroid function test

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194945 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1662

Author(s):

Vasim Ismail Patel ◽

Akshay B. K.

Keyword(s):

Thyroid Function ◽

Subclinical Hypothyroidism ◽

Clinical Symptoms ◽

Thyroid Function Test ◽

Thyroid Stimulating Hormone ◽

Endocrine Gland ◽

Thyroid Function Tests ◽

Sample Collection ◽

Free T4 ◽

Group 2

Background: The thyroid is an endocrine gland. It secretes two hormones thyroxine (T4), triiodothyronine (T3). Hypothyroidism is a common condition encountered by a clinician. Subclinical hypothyroidism (SCH) defined as normal free thyroxine (T4) and elevated thyroid stimulating hormone (TSH), is primarily a biochemical diagnosis with or without clinical symptoms. Studies have observed that TSH levels vary at different times in a day. In practice not much importance is given to the timing of the sample collection (pre-prandial or post-prandial sate). SCH is diagnosed depending on TSH value. So the condition may be under or over diagnosed based on a single value. So we conducted this study to determine whether timing of sample collection had any significant relationship in the determination of levels of thyroid hormones.Methods: The study was carried on 114 patients who visited ENT department, NMCH between July 2018 and June 2019. Group-1 consisted of 38 normal patients. Group-2 consisted of 36 hypothyroidism patients GROUP-3 consisted of 40 subclinical hypothyroidism patients. Thyroid function tests (TSH and free T4) were done in fasting state and 2 hours postprandially. Results: TSH values were found to be significantly lowered after food in all the three groups. Free T4 values did not show any statistically significant alteration after food.Conclusions: There was a significant decline in TSH values postprandially. This might lead to inappropriate diagnosis and management of patients as cases of hypothyroidism, especially in cases of sub clinical hypothyroidism.

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Subclinical hyperthyroidism

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.3177 ◽

2011 ◽

pp. 461-465

Author(s):

Jayne A. Franklyn

Keyword(s):

Expert Panel ◽

Normal Values ◽

Thyroid Stimulating Hormone ◽

Subclinical Hyperthyroidism ◽

Free Triiodothyronine ◽

Biochemical Diagnosis ◽

Undetectable Serum ◽

Detectable Serum ◽

Serum Tsh ◽

Low Serum

Subclinical hyperthyroidism is defined biochemically as the association of a low serum thyroid-stimulating hormone (TSH) value with normal circulating concentrations of free thyroxine (T4) and free triiodothyronine (T3). The biochemical diagnosis of subclinical hyperthyroidism is dependent upon the use of sensitive assays for TSH able to distinguish normal values found in euthyroid people from reduced values, so our understanding of this topic has accumulated in recent years since such assays became widely available. An expert panel has recently classified patients with subclinical hyperthyroidism into two groups (1): (1) those with low but detectable serum TSH (0.1–0.4 mU/l) and (2) those with undetectable serum TSH (<0.1 mU/l) reflecting the fact that studies of this condition largely divide people into these categories and that the likely consequences reflect the biochemical severity of the condition.

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Effects of thyroid hormone and depression on common components of central obesity

Journal of International Medical Research ◽

10.1177/0300060519851624 ◽

2019 ◽

Vol 47 (7) ◽

pp. 3040-3049 ◽

Cited By ~ 1

Author(s):

Fu-Man Du ◽

Hong-Yu Kuang ◽

Bin-Hong Duan ◽

Da-Na Liu ◽

Xin-Yang Yu

Keyword(s):

Central Obesity ◽

Low Density Lipoprotein ◽

Fasting Blood Glucose ◽

Density Lipoprotein ◽

Epidemiological Studies ◽

Thyroid Stimulating Hormone ◽

Model Assessment ◽

Free Triiodothyronine ◽

Serum Tsh ◽

Tsh Levels

Objective We investigated the prevalence of abnormal thyroid function and depression in centrally obese participants, and to analyze the relationship of thyroid hormones and depression with components of central obesity. Methods We randomly selected 858 centrally obese participants and 500 non-obese controls in this study. For all participants, we measured serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), body mass index (BMI), waist–hip ratio (WHR), fasting blood glucose and insulin, homeostasis model assessment of insulin resistance (HOMA-IR), lipid concentrations, and blood pressure. Depression was assessed using the Center for Epidemiological Studies-Depression (CES-D) scale. Results Centrally obese participants had a higher prevalence of hypothyroidism and depression than non-obese controls. Serum FT4 levels negatively correlated with BMI and serum TSH levels and positively correlated with BMI, WHR, total triglycerides (TG), total cholesterol (TC), and low density lipoprotein cholesterol (LDL-C). After excluding participants with hypothyroidism and hyperthyroidism, serum FT4 levels showed negative correlation and serum TSH levels showed positive correlation with BMI in the remaining centrally obese participants. CES-D scores positively correlated with BMI. Conclusion We found high prevalences of hypothyroidism and depression among centrally obese participants. FT4 and TSH are important in weight regulation. Depression positively correlated with obesity.

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Correlation of Hormonal Profile and Lipid Levels with Female Adult Acne in a Tertiary Care Center of Nepal

Journal of Nepal Health Research Council ◽

10.3126/jnhrc.v16i2.20315 ◽

2018 ◽

Vol 16 (2) ◽

pp. 222-227 ◽

Cited By ~ 2

Author(s):

Smriti Shrestha

Keyword(s):

Lipid Profile ◽

Clinical Symptoms ◽

Care Center ◽

Tertiary Care ◽

Thyroid Stimulating Hormone ◽

Bivariate Analysis ◽

Female Adult ◽

Chi Square ◽

Chi Square Test ◽

Relationship Of

Background: Acne beyond 25 years of age is frequently associated with hormonal derangement in women. Hormonal association provides the impetus for hormonal therapy as well as underpins the need for blood investigations in this population. Hence, we aim to estimate the presence of hormonal derangement and lipid alteration in female adult acne.Methods: A prospective, observational study was conducted in Dhulikhel Hospital from July 2015 to February 2016. Females older than 25 years with acne were taken in the study after informed consent. Total 100 patients were enrolled aftersample sizeestimation. Hormonal paneland lipid profile were measured. Hormones tested were androgens, C-peptide and thyroid stimulating hormone. Data analysis was done with SPSS-23. Bivariate analysis was done by chi-square test for categorical data.Results: In this study, majority of patients were younger than 30 years (70.5%) and perioral area most commonly involved. Hormonal alteration was seen in 37.2% patients, among which 17.9% had hyperandrogenism, 15.4% had abnormal thyroid level and 10.3% had high C-peptides respectively. Lipid profile was altered in 15.4% patients. Hormonal alteration had significant association with irregular menstruation (P<0.05) but not acne severity.Conclusions: We observed hormonal alteration frequently in females with adult acne, which comprised of various hormonal parameters including hyperandrogenism. Hormonal alteration reflects deranged metabolic milieu and we suggestthat wide hormonal panel should be done in female adult acne. Relationship of hormones with menstrual irregularity but not with acne severity, suggest that clinical symptoms should lead hormonal investigations in all grades of acne.

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