Abstract
Objective: Thyroid disorders are known to influence lipid metabolism and are common in dyslipidemic patients. Overt and subclinical hypothyroidism have an adverse effect on the serum lipid profile that may predispose to the development of atherosclerotic disease. Our objective to conduct this study is to find out prevalence of lipid profile abnormalities in newly diagnosed case of hypothyroidism in Janakpur, Nepal.
Methods:
This study was conducted at provincial hospital Janakpur and Madanta Research Clinic Pvt.Ltd. Janakpur from December 2020-2021. This was a cross-sectional study of patients presented with symptoms and signs suggestive of hypothyroidism. Diagnostic algorithms were based on 2013 guidelines from European Thyroid Association. Subclinical hypothyroidism was defined as an elevated thyrotropin (TSH) concentration with normal serum level of thyroxine(fT4). Patients below 85 years old presented with symptoms and signs of hypothyroidism, who had given written consent were included in study. Those with current prescription of levothyroxine, anti-thyroid drugs, amiodarone and who had history of thyroid surgery or receipt of radioactive iodine within previous 12 month or having history of recent hospital admission for myocardial infarction and other terminal illness were excluded from study. Data were analyzed using IBM SPSS 25.
Results:
A total of 697 patients were enrolled in this study out of which 582(84.94%) were female and 105(15.1%) were male. Among them 58.97% of cases were from age group between 20 to 40 years. Symptoms like constipation (86.4%), tingling/numbness (85.5%), weight gain (85.5%), edema (85.5%), palpitation (85.5%), lethargy (85.5%) and easy fatigability (85.5%) were overall common clinical presentation documented. Overall mean TSH value(29.5mU/L) was significantly higher among age group 70 to 80 year followed by mean TSH value of 12.03021mU/L among age group 30 to 40 year. Symptoms like lethargy, easy fatigability, edema, tingling/numbness, weight gain, palpitation and constipation showing relatively high mean TSH value of around 7mU/L. TSH was normal in 529(75.9%) of cases, mildly increase in 121(17.4%) of cases and severely increased in 47(6.7%) of cases. Overall, 24.1% of cased were having TSH more than 4mU/L. Prevalence of subclinical hypothyroidism as calculated in this study was 12.3 percent whereas prevalence among group with TSH value more than 4mU/L was 45.83 percent. Overall, 6.7 percent of cases were having THS value more than 10mU/L. Mean cholesterol levels among group with TSH value less than 4, 4-10 and more than 10 were 180.35mg/dl, 241.22mg/dl and 355.32mg/dl respectively. Likewise, mean HDL level among groups with TSH value less than 4, 4-10 and more than 10 were 48.25mg/dl, 43.21mg/dl and 36.79mg/dl respectively. Mean LDL level among same TSH groups were 109.60mg/dl, 137.53mg/dl and 178.34mg/dl respectively. Mean TG level among same groups found to be 175.66mg/dl, 332.89mg/dl and 682.35mg/dl respectively. Mean cholesterol, LDL and TG were significantly higher among those with relatively higher TSH value (p < 0.0001). When calculating mean among patients with TSH more and less than 10mIU/L, mean cholesterol, mean HDL, mean LDL and mean TG values in group with TSH less than 10mIU/L were 191.68mg/dl, 47.31mg/dl, 114.8mg/dl and 204.95mg/dl respectively where in groups with TSH more than 10mU/L were 335.32mg/dl, 36.19mg/dl, 178.34mg/dl and 682.55mg/dl respectively (p < 0.0001).
Conclusions: Hypothyroidism is associated with dyslipidemia, so biochemical screening for thyroid dysfunction is recommended in all patients with dyslipidemia and regular lipid screening is mandatory in patient with hypothyroidism.
