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Prevalence, risks, and comorbidity of thyroid dysfunction: a cross-sectional epidemiological study

Abstract

Background

Worldwide, the incidence of individuals with thyroid dysfunction is increasing and represents approximately 30–40% of the patients seen in an endocrine clinic. The undiagnosed thyroid dysfunction may adversely affect the metabolic control and add more risk to already predisposing cardiovascular risk factors. Thus, the objective of the present study was to assess the prevalence of undiagnosed thyroid dysfunction and its association with other comorbidities.

Patients and methods

A cross-sectional study was conducted on 430 patients who attended the outpatient clinic of Diabetes and Endocrinology, the Internal Medicine Department, Zagazig University Hospitals. All patients underwent clinical and laboratory evaluations. A total of 304 patients had normal thyroid function (euthyroid) and 126 patients had thyroid dysfunction, who were stratified into one of the following groups based on the reference of the normal thyroid function test result: hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, and subclinical hypothyroidism. Thyroid-stimulating hormone and free thyroxine were used as the screening tests to diagnose thyroid dysfunction.

Results

Our results show the prevalence of thyroid dysfunction was 29.3%. Among thyroid dysfunction groups, the prevalence of subclinical hypothyroidism was 44.4%, hypothyroidism was 20.6%, hyperthyroidism was 19.2%, and subclinical hyperthyroidism was 15.8%. The prevalence of overall thyroid dysfunction among studied patients with type 2 diabetes mellitus was 27.6%, whereas in type 1 diabetes mellitus, the prevalence of overall thyroid dysfunction was 38.7%. Patients with subclinical hypothyroidism and hypothyroidism had a high prevalence of hypertension compared with those with subclinical hyperthyroidism and clinical hyperthyroidism. Approximately 8% of studied pregnant female patients had subclinical hypothyroidism. Among the 15% of female patients in the postpartum period who had thyroid dysfunction, 10% had clinical hypothyroidism and 5% had clinical hyperthyroidism. Among postmenopausal women, 20% had thyroid dysfunction (12% had subclinical hypothyroidism and 8% had clinical hypothyroidism).

Conclusion

The most frequently undiagnosed thyroid dysfunction was subclinical hypothyroidism. Thyroid dysfunction was common in certain age groups: reproductive age and postmenopausal as well as in patients with diabetes mellitus and hypertension; thus, screening for thyroid disease among those groups of patients should be routinely performed.

References

  1. 1

    Tsegaye B, Ergete W. Histopathologic pattern of thyroid disease. East Afr Med J 2003; 80:525–528.

    CAS  PubMed  Google Scholar 

  2. 2

    Rodondi N, Aujesky D, Vittinghoff E, Cornuz J, Bauer DC. Subclinical hypothyroidism and the risk of coronary heart disease: a meta-analysis. Am J Med 2006; 119:541–551.

    Article  Google Scholar 

  3. 3

    Volzke H, Ludemann J, Robinson DM, Spieker KW, Schwahn C, Kramer A, et al. The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 2003; 13:803–810.

    Article  Google Scholar 

  4. 4

    Fatourechi V. Subclinical hypothyroidism: an update for primary care physicians. Mayo Clin Proc 2009; 84:65–71.

    Article  Google Scholar 

  5. 5

    Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med 2000; 160:526–534.

    CAS  Article  Google Scholar 

  6. 6

    Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003; 13:3–126.

    PubMed  Google Scholar 

  7. 7

    Blum MR, Bauer DC, Collet TH, Fink HA, Cappola AR, da Costa BR, et al. Subclinical thyroid dysfunction and fracture risk: a meta-analysis. JAMA 2015; 313:2055–2065.

    Article  Google Scholar 

  8. 8

    Rodondi N, den Elzen WP, Bauer DC, Cappola AR, Razvi S, Walsh JP, et al. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 2010; 304:1365–1374.

    CAS  Article  Google Scholar 

  9. 9

    Ladenson PW, Singer PA, Ain KB, Bagchi N, Bigos ST, Levy EG, et al. American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med 2000; 160:1573–1575.

    CAS  Article  Google Scholar 

  10. 10

    Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18:499–502.

    CAS  Article  Google Scholar 

  11. 11

    Usha Menon V, Sundaram KR, Unnikrishnan AG, Jayakumar RV, Nair V, Kumar H. High prevalence of undetected thyroid disorders in an iodine-sufficient adult south Indian population. J Indian Med Assoc 2009; 107:72–77.

    CAS  PubMed  Google Scholar 

  12. 12

    Lamfon HA. Thyroid disorders in Makkah, Saudi Arabia. Ozean J Appl Sci 2008; 1:52–58.

    Google Scholar 

  13. 13

    Nouh AM, Eshnaf I, Basher MA. Prevalence of thyroid dysfunction and its effect on serum lipid profiles in a Murzok, Libya Population. Thyroid Sci 2008; 3:1–6.

    Google Scholar 

  14. 14

    Ghawil M, Tonutti E, Abusrewil S, Visentini D, Hadeed I, Miotti V, Tenore A. Autoimmune thyroid disease in Libyan children and young adults with type 1 diabetes mellitus. Eur J Pediatr 2011; 170:983–987.

    Article  Google Scholar 

  15. 15

    Marwaha RK, Tandon N, Gupta N, Karak AK, Verma K, Kochupillai N. Residual goiter in the postiodization phase: iodine status, thiocyanate exposure, and autoimmunity. Clin Endocrinol (Oxf) 2003; 59:672–681.

    CAS  Article  Google Scholar 

  16. 16

    Yang F, Teng W, Shan Z, Guan H, Li Y, Jin Y, et al. Epidemiological survey on the relationship between different iodine intakes and the prevalence of hyperthyroidism. Eur J Endocrinol 2002; 146:613–618.

    CAS  Article  Google Scholar 

  17. 17

    Golden SH, Robinson KA, Saldanha I, Anton B, Ladenson PW. Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J Clin Endocrinol Metab 2009; 94:1853–1878.

    CAS  Article  Google Scholar 

  18. 18

    Vanderpump MP, Tunbridge WM. Epidemiology and prevention of clinical and subclinical hypothyroidism. Thyroid 2002; 12:839–847.

    Article  Google Scholar 

  19. 19

    Parle JV, Franklyn JA, Cross KW, Jones SC, Sheppard MC. Prevalence and follow-up of abnormal thyrotrophin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol (Oxf) 1991; 34:3477–3483.

    Google Scholar 

  20. 20

    Cooper DS, Halpern R, Wood LC, Levin AA, Ridgway EC. L-thyroxine therapy in subclinical hypothyroidism: a double-blind, placebo-controlled trial. Ann Intern Med 1984; 101:18–24

    CAS  Article  Google Scholar 

  21. 21

    Biondi B, Fazio S, Carella C, Sabatini D, Amato G, Cittadini A, et al. Control of adrenergic overactivity by beta-blockade improves the quality of life in patients receiving long term suppressive therapy with levothyroxine. J Clin Endocrinol Metab 1994; 78:1028–1033.

    CAS  PubMed  Google Scholar 

  22. 22

    Akbar DH, Ahmed MM, Al-Mughales J. Thyroid dysfunction and thyroid autoimmunity in Saudi type 2 diabetics. Acta Diabetol 2006; 43:14–18.

    CAS  Article  Google Scholar 

  23. 23

    Radaideh AR, Nusier MK, Amari FL, Bateiha AE, El-Khateeb MS, Naser AS, Ajlouni KM. Thyroid dysfunction in patients with type 2 diabetes mellitus in Jordan. Saudi Med J 2004; 25:1046–1050.

    PubMed  Google Scholar 

  24. 24

    Chubb SA, Davis WA, Davis TM. Interactions among thyroid function, insulin sensitivity, and serum lipid concentrations: The Fremantle diabetes study. J Clin Endocrinol Metab 2005; 90:5317–5320.

    CAS  Article  Google Scholar 

  25. 25

    Raboudi N, Arem R, Jones RH, Chap Z, Pena J, Chou J, et al. Fasting and postabsorptive hepatic glucose and insulin metabolism in hyperthyroidism. Am J Physiol 1989; 256:E159–E166.

    CAS  PubMed  Google Scholar 

  26. 26

    Smithson MJ. Screening for thyroid dysfunction in a community population of diabetic patients. Diabet Med 1998; 15:148–150.

    CAS  Article  Google Scholar 

  27. 27

    Perros P, McCrimmon RJ, Shaw G, Frier BM. Frequency of thyroid dysfunction in diabetic patients: value of annual screening. Diabet Med 1995; 12:622–627.

    CAS  Article  Google Scholar 

  28. 28

    Owen PJ, Sabit R, Lazarus JH. Thyroid disease and vascular function. Thyroid 2007; 17:519–524.

    CAS  Article  Google Scholar 

  29. 29

    Dhanwal DK, Bajaj S, Rajesh R, Subramaniam KAV, 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; 20:387–390.

    CAS  Article  Google Scholar 

  30. 30

    Klein RZ, Haddow JE, Faix JD, Brown RS, Hermos RJ, Pulkkinen A, Mitchell ML. Prevalence of thyroid deficiency in pregnant women. Clin Endocrinol 1991; 35:41–46.

    CAS  Article  Google Scholar 

  31. 31

    Mandel SJ, Cooper DS. The use of antithyroid drugs in pregnancy and lactation. J Clin Endocrinol Metab 2001; 86:2354–2359.

    CAS  Article  Google Scholar 

  32. 32

    Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011; 21:1081–1125.

    Article  Google Scholar 

  33. 33

    Shahbazian HB, Sarvghadi F, Azizi F. Prevalence and characteristics of postpartum thyroid dysfunction in Tehran. Eur J Endocrinol 2001; 145:397–401.

    CAS  Article  Google Scholar 

  34. 34

    Filippi U, Brizzolare R, Venuti D, Cesarone A, Maritati VA, Podesta M, et al. Prevalence of post-partum thyroiditis in Liguria (Italy): an observational study . J Endocrinol Invest 2008; 31:1068.

    Article  Google Scholar 

  35. 35

    Bensor I, Goulart AC, Loutufo PA, Menezes PR, Scazufac M. Prevalence of thyroid disorders among older people : results from the Paulo Ageing and Health Study. Cad Saude Publica 2011; 27:155–161

    Article  Google Scholar 

  36. 36

    Chakera AJ, Pearce SH, Vaidya B. Treatment for primary hypothyroidism: current approaches and future possibilities. Drug Des Devel Ther 2011; 6:1–11.

    PubMed  PubMed Central  Google Scholar 

  37. 37

    Bjùro T, Holmen J, Krueger E, Midthjell K, Hunstad K, Schreiner T, et al. Prevalence of thyroid disease, thyroid dysfunction in a large, unselected population: The Health Study of Nord-Trundelag (HUNT). Eur J Endocrinol 2000; 143:639–647.

    Article  Google Scholar 

  38. 38

    Kitahara CM, Platz EA, Ladenson PW, Mondul AM, Menke A, Berrington de González A. Body fatness and markers of thyroid function among U.S. men and women. PLoS ONE 2012; 7:e34979.

    CAS  Article  Google Scholar 

  39. 39

    Manji N, Carr-Smith JD, Boelaert K, Allahabadia A, Armitage M, Chatterjee VK, et al. Influences of age, gender, smoking, and family history on autoimmune thyroid disease phenotype. J Clin Endocrinol Metab 2006; 91:4873–4880.

    CAS  Article  Google Scholar 

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Correspondence to Nearmeen M. Rashad MD.

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Rashad, N.M., Samir, G.M. Prevalence, risks, and comorbidity of thyroid dysfunction: a cross-sectional epidemiological study. Egypt J Intern Med 31, 635–641 (2019). https://doi.org/10.4103/ejim.ejim_22_19

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Keywords

  • diabetes mellitus
  • hypertension
  • postmenopausal
  • postpartum
  • prevalence
  • thyroid dysfunction
  • thyroid-stimulating hormone