Endocrine Abstracts

Background: Hypothyroidism is a clinical state resulting from underproduction of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). Most cases are due to primary hypothyroidism, a failure of the thyroid gland to produce thyroid hormones. Primary hypothyroidism is defined as thyroid-stimulating hormone (TSH) concentrations above the reference range and free thyroxine concentrations below the reference range. Patients with hypothyroidism usually present with puffy eyes, cold intolerance, coarse hair, constipation, poor memory, slow thinking, muscle cramps, weak muscles, depression, dry skin, and hypersomnolence.

Aim: To study the clinical presentation of patients with primary hypothyroidism in rural India.

Materials and methods: This cross-sectional study was conducted in a hospital in rural India from March 2021 to December 2021. TSH, free T3 and free T4 levels were measured using venous blood in all patients with presented with signs-symptoms of hypothyroidism. Patients having biochemically confirmed primary hypothyroidism (elevated TSH, low free T3 and low free T4) were selected for the study. Proper history was taken from patients and their relatives to obtain the demographic and clinical data including hypothyroidism symptoms.

Results: 87 patients with primary hypothyroidism were included in the study among whom 75% were female, 45% aged between 25 to 50 years, 90% lived in rural and sub-urban areas. Hypertension was the most common (45%) co-morbid condition followed by obesity (29%), diabetes (23%), obstructive sleep apnoea (19%) and ischemic heart disease (15%). 31% patients presented with TSH more than 100. Puffiness of face was most common (65%) symptom followed by dry skin (52%), cold intolerance (42%), constipation (29%), muscle cramps (23%) and hypersomnolence (19%).

Conclusions: Primary hypothyroidism is one of most common and easily treatable endocrine disorder. Despite being potentially manageable, primary hypothyroidism is often undiagnosed and untreated. Timely diagnosis of primary hypothyroidism is utmost important. The medical and family history can be very helpful in identifying patients in whom thyroid dysfunction should be assessed. Gender, age, family or personal history of thyroid diseases, recent pregnancy, presence of autoimmune diseases, medications and radiation history should all be noted. Hypothyroidism is far more common in women, and the prevalence of mild hypothyroidism increases in the elderly. Patient education regarding signs and symptoms of hypothyroidism, regular screening with TSH, free T3 and free T4 are very crucial to diagnose this easily manageable endocrine disorder.