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Hypothyroidism may exacerbate diabetes, hypertension-related complications

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On World Thyroid Day, May 25th, Dr Srirupa Das, Director, Medical Affairs, Abbott India reviews the burden of hypothyroidism in India and explains to Viveka Roychowdhury how timely detection and treatment of this condition might prevent related complications from occurring

What is the incidence and disease burden of hypothyroidism in India? How do these figures compare to the rest of the world?

Hypothyroidism, also called underactive thyroid, is when thyroid gland does not produce enough thyroid hormone. The initial symptoms are difficult to notice, and include fatigue, weight gain and feeling cold. Though the condition may progress slowly, if left untreated, hypothyroidism can lead to various health consequences.1 Thus, the condition can contribute significantly to the non-communicable disease burden in the country.

Studies show that the prevalence of hypothyroidism in developed countries is about 4–5 per cent whereas in India its 10 per cent.2 Even if we do not take into consideration that rural areas of India may under-report this condition, rates in India are more than double developed countries.

Why is early diagnosis critical?

Diagnosing hypothyroidism is challenging. The same symptoms of thyroid disorder are also common in other diseases. An analysis of newly diagnosed patients in India shows that fatigue is the most common symptom, followed by weight gain with poor appetite, poor memory and concentration, constipation, shortness of breath and feeling cold.3 If you consider that almost everyone has experienced one of these symptoms at some point without having a thyroid disorder, you can see how easy it is to ignore symptoms. Moreover, the symptoms may not be severe enough or recur noticeably to prompt a patient to consult a doctor.

Nonetheless, hypothyroidism needs to be taken seriously because the condition can progress and cause impairment in health-related quality of life.4 Patients with hypothyroidism show a greater propensity for comorbidities and complications as compared to the general population. There are evidences which suggest hypothyroidism may exacerbate diabetes- and hypertension-related complications.4 Moreover, pre-menopausal women with thyroid frequently report menstrual abnormalities such as menorrhagia, irregular cycle and inter-menstrual bleeding.5 Early diagnosis allows us to treat and manage the condition in a timely manner, which helps in improving health-related quality of life and might prevent related complications from occurring.

What are the treatment and management strategies?

Treatment of choice for hypothyroidism is thyroxine sodium, a once-a-day oral medication, which should only be taken in consultation with your doctor.

Conventionally, hypothyroid patients are advised to take thyroxine sodium tablet on an empty stomach half an hour before breakfast to prevent impairment of absorption by food. Monitoring thyroid function during therapy involves measuring TSH. It is recommended that the TSH is measured 6–8 weeks after initiation of, or a change in thyroxine sodium dose. Once the patient is on a stable dose of thyroxine sodium, annual monitoring of TSH is recommended.

Given the link between hypothyroidism and diabetes / hypertension in India, what are the latest insights on screening in the Indian population?

Screening can help ensure early detection and thus better management of hypothyroidism, before it leads to serious cardiovascular and neurological complications. Data shows high prevalence of hypothyroidism in Indian patients with Type 2 diabetes (26.9 per cent) and hypertension (31.2 per cent).5 There are evidences which suggest hypothyroidism may exacerbate diabetes- and hypertension-related complications.5 Moreover, data from India’s largest registry of newly diagnosed hypothyroidism patients shows that more than 70 per cent of patients were women, 86 per cent resided in urban areas, 65 per cent were in the age group of 18-45 years and more than 75 per cent were in upper or upper-middle socio-economic classes.3 While such trends are only indicative, we can consider them and increase focus on screening for young and middle aged women.

What difference has screening and early diagnosis made in other countries?

Screening for thyroid dysfunction allows early detection and appropriate treatment. Although universal screening for thyroid dysfunction in asymptomatic non-pregnant adults is not recommended, international guidelines from the American Thyroid Association and American Association of Clinical Endocrinologists recommends aggressive case finding in those with autoimmune diseases, family history of thyroid diseases, those with a history of neck radiation to the thyroid gland, patients with psychiatric disorders, dyslipidemia, hypertension. Diagnosing hypothyroidism in these patients early in the course of disease has helped to manage the condition better.

1 Indian J Endocrinol Metab. 2011 Jul; 15(Suppl2): S78–S81.

2 Indian J Endocrinol Metab. 2013 Jul-Aug; 17(4): 647–652.

3 Indian J Endocrinol Metab. 2017 Mar-Apr; 21(2): 302–307.

4 JAMA. 2018;320(13):1349–1359.

4 Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2019:12 369–376

5 Endocr Rev. 2010;31(5):702-755

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