CLINICAL PRESENTATION OF HYPOTHYROIDISM: A CASE CONTROL ANALYSIS

Irfan M. Khurram, Kiran S. Choudhry, Khan Muhammad, Najmul Islam

Abstract


Background: Hypothyroidism is a common endocrinological disorder. Its clinical presentation is variable but well established. However, clinical features vary significantly among different populations owing to their climate, education status and awareness about the disease. This study is designed to evaluate the difference in clinical presentation of our population from already available literature. Methods: In this study we have compared the symptoms and signs of hypothyroid and euthyroid patients coming to a diagnostic centre (PINUM, Faisalabad) from January to July 1999. Of the 1594 patients coming to the centre, 394 were included in the study and were examined. After the laboratory investigations, 109 were identified as the cases of hypothyroidism, the rest were declared as euthyroid and selected as controls. We compared the 21 common signs and symptoms of hypothyroidism in our patients. Results: Lethargy was the commonest symptom and facial oedema was the most prevalent sign in our population. Old age is reported to be a risk factor for hypothyroidism but in this study we could not find a rising trend with increasing age (odds ratio 1.15, p-value 0.71). We also compared the clinical presentation of our patients with the available literature. It was also proved that the signs elicited by the physicians were more reliable and specific for the identification of hypothyroidism. Conclusion: Thus, the presentation of hypothyroidism is non-specific and high degree of suspicion is required for its early diagnosis.

KEY WORDS: Hypothyroidism, Age Groups, Signs and Symptoms, Case-Control Studies.


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References


Helfand M, Crapo L. Screening for thyroid disease. Ann Intern Med 1990;112(11):840-849.

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 Endocrinology (Oxf) 1977 Dec;7(6):481-93.

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(3): 247-50.

Sawin CT, Castelli WP, Hershman JM, McNamara P, Bacharach P. The aging thyroid: Thyroid deficiency in the Framingham study. Arch Intern Med 1985;145(8):1386-88.

Bonar BD, McColgan B, Smith DF, Darke C, Guttridge MG, Williams H, et al. Hypothyroidism and aging: the Rosses’ survey. Thyroid 2000; 10(9): 821-7.

Desai MP. Disorders of thyroid gland in India. Indian J Pediatr 1997; 64(1):11-20.

Doeker B, Reinehr T, Andler W. Autoimmune thyroiditis in the children and adolescents: clinical and laboratory findings in 34 patients. Klin Padiatrie 2000; 212(3):103-107.

Chiu AC, Sherman SI. Clinical manifestations and differential diagnosis of hypothyroidism. In: Falk SA, ed. Thyroid disease: Endocrinology, Surgery, Nuclear Medicine, and Radiotherapy. 2nd ed. Philadelphia, Lippincott-Raven, 1997, pp379.

Smith TJ, Balin RS, Gorman CA. Connective tissue, glycosaminoglycans and diseases of the thyroid. Endocr Rev 1989; 10(3): 366-391.

Schectman JM, Kallenberg GA, Shumacher RJ, Hirsch RP. Yield of hypothyroidism in symptomatic primary care patients. Arch Intern Med 1989; 149(4): 861-864.

Billewicz WZ, Chapman RS, Crooks J, Day ME, Gossage J, Wayne E, et al. Statistical methods applied to diagnosis of hypothyroidism. Q J Med 1969; 38 (150): 255-266

Utiger RD. Hypothyroidism. In: Degroot LJ eds. Endocrionolgy. 3rd ed. Philadelphia, W.B. Sanders Company, 1995, pp 752-768.

Freinkel R, Freinkel N. Hair growth and alopecia in hypothyroidism. Arch Dermatol 1972; 106(3): 349-352.

Yamamoto K, Saito K, Takai T, Naito M, Yoshida S. Visual field defects and pituitary enlargement in primary hypothyroidism. J Clin Endocrinol Metab 1983; 57(2): 283-87.

Lerman J, Means JH. The gastric secretion in exopthalmic goiter and myxoedema. J Clin Invest 1932;11:167.

Degroot LJ, Larsen PR, Hennemann G. Eds: Adult hypothyroidism. In: The thyroid and its diseases. 6th ed. New York, Churchill Livingstone, 1996. pp 323-370.

Watanakunakorn C, Hodges RH, Evans TC. Myxedema: a study of 400 cases. Arch Intern Med 1965; 116: 183-190.


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