A Cross Sectional study on Subclinical Hypothyroidism in Elderly Females above the Age of Fifty Years

Ramkumar, S (2013) A Cross Sectional study on Subclinical Hypothyroidism in Elderly Females above the Age of Fifty Years. Masters thesis, Chengalpattu Medical College, Chengalpattu.


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INTRODUCTION The term subclinical hypothyroidism was originally used to describe the patient with a low- normal free T4 but a slightly elevated serum TSH level. Other terms for this condition are mild hypothyroidism early thyroid failure, preclinical hypothyroidism, and decreased thyroid reserve. The TSH elevation in such patients is modest, with values typically between 4 and 15 mU/L, although patients with a TSH above 10 mU/L more often have a reduced free T4 and may have some hypothyroid symptoms. The definition of this syndrome depends significantly on the reference range for a normal TSH concentration. This syndrome is most often seen in patients with early Hashimoto's disease and is a common phenomenon, occurring in 7% to 10% of older women. The common etiology of this disease are not sufficiently treated cases of hypothyroidism and disease of the gland caused by autoimmunity. The existence of antibodies against the gland point out the existence of autoimmune disease of the gland. Other etiologies for this disease are those cases of hyperthyroidism who have undergone therapy in the past, those who have undergone radiation treatment to the neck in the past and also undergone therapy like with cytokines, therapy with iodine, therapy with lithium, with drugs like amiodarone and also the thyroiditis which develops after delivery which has got a hypothyroid period. Subclinical hypothyroidism is very commonly encountered in the community showing a prevalence rate of three to eight percent where previously no disease of the thyroid has been shown to occur. There is a rise seen in the prevalence as the age progresses and also more case is seen in females. Also prevalence of subclinical hypothyroidism is more in females than in males and also in older people than in younger people because of the fact that the prevalence of thyroglobulin and thyroid peroxidase (microsomal) antibodies is higher in females and in older people. Subjects due to subclinical hypothyroidism show an increased rate at which they convert into clinical hypothyroidism about 2.6 % every year in cases when the thyroperoxidase have antibodies against them not present and 4.3 percent if they have it [6]. However it has been shown that some people do not manifest clinical hypothyroidism while others return to normal level. A thyroid stimulating hormone value more than 10 mIU/L mostly manifest clinical hypothyroidism while value below 6 mIU/L less frequently manifest. It has been shown in one of the trials in both males and females above fifty five years and followed up for a mean period of thirty two months, the thyroid stimulating hormone values returned to normal in fifty two percent of subjects who had the hormone below 10 mIU/L. Even though it has been agreed that hypothyroidism results in increase in the cholesterol levels in the patient there by causing atherosclerosis[8], it has been found out from various studies that the correlation between increased lipids, atherosclerosis and subclinical hypothyroidism resulted in not so convincing outcome. While some studies showed that there are large number of hypercholesterolemic patients in SH while some other studies showed that SH patients develop only modest in the range of only 10% higher average in terms of total cholesterol than subjects not having the disease [9-22]. In the first Whickham study it was shown that the cholesterol levels did not show any association with regard to the increase in thyroid stimulating hormone after the researchers adjusted the subjects for age [11]. Also after that the Whickham survey showed that there is no relation between the increased thyroid stimulating hormone and increased probability of suffering from ischemic disease of the heart or abnormality in serum lipid levels [23]. Therefore it can be said that from the discussions above the relationship between subclinical hypothyroidism and cardiovascular disease remains controversial. However there was no difference between women with subclinical hypothyroidism and controls regarding hypertension and diabetes mellitus 21,24. This study was done to find out the prevalence of subclinical hypothyroidism and its relation to Hypertension, Diabetes and Ischemic heart disease among women above the age of 50 years attending medical outpatient clinic at Government Chengalpattu Medical College and Hospital. AIM OF THE STUDY : • To find out the prevalence of subclinical hypothyroidism among women above 50 years of age. • To study the relation between subclinical hypothyroidism and Hypertension, Diabetes and Ischemic Heart Disease in those patients. MATERIALS AND METHODS : Case selection : Women above 50 years of age attending Medical outpatient clinic of Chengalpattu medical college and hospital from January 2012 to june 2012 were studied. The sample consisted of a random selection of 100 women. Informed consent was obtained from all participants. All the participants were examined for thyroid function. Women with subclinical hypothyroidism (defined as TSH > 5.5

Item Type: Thesis (Masters)
Uncontrolled Keywords: Subclinical Hypothyroidism ; Elderly Females ; above the Age of Fifty Years ; Cross Sectional study.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 06 Mar 2018 02:10
Last Modified: 06 Mar 2018 02:14
URI: http://repository-tnmgrmu.ac.in/id/eprint/6010

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