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SHORT COMMUNICATION
Year : 2018  |  Volume : 7  |  Issue : 2  |  Page : 94-96

Screening for thyroid disorders in medical undergraduate students


1 SVIMS - Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India
2 Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
3 Department of Endocrinology and Metabolism, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Web Publication26-Mar-2019

Correspondence Address:
P. V L. N Srinivasa Rao
Senior Professor and Head, Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCSR.JCSR_33_18

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  Abstract 


Background: Thyroid dysfunction can have a negative impact on cognitive functions in young girls in adolescent age group as well as affect their future development of infertility, reproductive dysfunction and poor pregnancy outcome.
Methods: Cross-sectional study of burden of thyroid disorders in 70 medical undergraduate students of 17-19 years age group studying in Sri Venkateswara Institute of Medical Sciences, Sri Padmavathi Medical College for Women, Tirupati.
Results: Among the 70 female subjects screened for thyroid disorders, a single subject was found to have subclinical hypothyroidism. The thyroid stimulating hormone (TSH) level of this subject was 8.1 mIU/L, which is considered to be mildly elevated from the normal range and the thyroxine levels were 89 ng/mL which is within the normal reference range. Her anti-TPO antibodies test results were negative.
Conclusions: Identification of subclinical hypothyroidism in asymptomatic young girls in adolescent age group can help in initiating treatment early.

Keywords: Adolescent girls, Screening, Subclinical hypothyroidism


How to cite this article:
Nikhita D, Srinivasa Rao PL, Suresh V. Screening for thyroid disorders in medical undergraduate students. J Clin Sci Res 2018;7:94-6

How to cite this URL:
Nikhita D, Srinivasa Rao PL, Suresh V. Screening for thyroid disorders in medical undergraduate students. J Clin Sci Res [serial online] 2018 [cited 2019 Sep 17];7:94-6. Available from: http://www.jcsr.co.in/text.asp?2018/7/2/94/254975




  Introduction Top


Thyroid disorders are one of the most common health issues in India.[1] The major cause of thyroid disorders is inhibition of triiodothyronine (T3) and thyroxine (T4) synthesis, and thus, the levels of thyroid-stimulating hormone (TSH) increase which are followed by hyperplastic enlargement of thyroid gland.[2] It is estimated that to produce normal quantities of T4, nearly 50 mg of ingested iodine in the form of iodides are required per year, i.e. about 1 mg/week.[3] India is currently in the phase of transition from iodine-deficient to iodine-sufficient state. Recent review of studies conducted in post-iodisation phase reveals a change in the thyroid status in the Indian population.[4],[5] Adolescence being the transitional phase of growth and development between childhood and adulthood is defined by the World Health Organization as any person between the age group of 10 and 19 years. Adolescents undergo hormonal changes which involve multiple physical, intellectual, personality and social developmental changes and are hence vulnerable both emotionally and physically.[6]

Thyroid dysfunction can have a negative impact on cognitive functions in young girls in adolescent age group as well as affect their future development of infertility, reproductive dysfunction and poor pregnancy outcome.[7] Thyroid function is usually downregulated during stressful conditions such as stress of work pressure, examinations, psychological stress and stresses due to trauma, surgery and various medical disorders.[8] Adolescent girls may present with pubertal goitre coinciding with the physiological growth of thyroid during puberty.[9] Patients with hypothyroidism present clinically with signs and symptoms suggestive of hypothyroidism, whereas patients with subclinical hypothyroidism do not manifest apparent signs and symptoms.[10] Identification in this stage of subclinical hypothyroidism when no clinical symptoms are present can help in initiating treatment early and thus prevent long-term morbidity associated with thyroid disorders. Hence, the present study was designed to screen adolescent medical undergraduate students for thyroid dysfunction and to study the common causes of thyroid dysfunction among them.


  Material and Methods Top


The study was conducted after obtaining the Institutional Ethics Committee approval and written informed consent from all the participants. Sample size calculation was done using the formula: N = 4pq/d2, where P = prevalence of the disease; q = (1 − p); d = precision of the estimate. The sample size obtained was n = 70.

Undergraduate medical students of Sri Venkateswara Institute of Medical Sciences (SVIMS), Sri Padmavathi Medical College for Women (SPMCW), Tirupati, Andhra Pradesh, in the age group 17–19 years were screened for inclusion in the study. These students hailed from diverse geographical regions of Andhra Pradesh and Telangana states with sixty students (86%) residing in hostel accommodation provided by the SVIMS, SPMCW and the remaining ten students (14%) were day scholars hailing from Tirupati.

Written informed consent was obtained from all the study participants. Participants who were earlier diagnosed with thyroid dysfunction and receiving treatment were excluded from the study. The students were asked to fill a questionnaire recording details related to dietary habits, socioeconomic status, physical activity, menstrual history, family history of thyroid and drug history. In all of them, a thorough physical examination was carried out. The body mass index (BMI, kg/m2) was calculated using the formula weight (kg)/[height (m)]2.

Sample collection

Two mL of venous blood sample was collected from all the participants following an overnight fast (10–12 h). The sample was transferred into a plain vial. The blood was allowed to clot for 15 min. Serum was separated by centrifugation at 2000 rotations/min and analysed for T3, T4 and TSH on Beckman Coulter access 2 autoanalyser (Chaska, Minnesota, USA) by chemiluminescence immunoassay method.

Statistical analysis

All study details were recorded in a proforma, and data were entered into Microsoft Excel Redmond, WA, USA. Data are expressed as mean ± standard deviation for continuous variables and as frequency (number [%]) for categorical variables. All statistical analyses were performed using Microsoft Excel (Microsoft, Redmond, WA USA).


  Results Top


Descriptive statistics of the study participants is shown in [Table 1]. Thyroid profile in the study participants is shown in [Table 2]. Proportion of participants with normal and elevated TSH values is shown in [Table 3].
Table 1: Demographic and clinical data of the participants studied

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Table 2: Thyroid profile of the participants studied

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Table 3: Proportion of participants with normal and elevated thyroid-stimulating hormone values

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Among the 70 female participants screened for thyroid disorders, a single participant was found to have subclinical hypothyroidism. This participant had a BMI of 23.6 kg/m2. Her T4 values were normal (89 ng/mL), but TSH values are found to be elevated (8.1 mlU/L). The participant who was detected with subclinical hypothyroidism hails from Vizianagaram but is residing in the college hostel for 2 years. It was observed that 12 of the participants (17.1%) in this study also hailing from the same place and also residing in the college hostel for 2 years were found to be euthyroid. The participant with subclinical hypothyroidism has been consuming the food prepared in the hostel where iodised salt is used in the preparation of food similar to other students and does not consume excess goitrogenic foods such as cabbage and cauliflower. The participant identified with subclinical hypothyroidism was advised to undergo antithyroid peroxidase (anti-TPO) antibodies test to rule out autoimmune thyroiditis. The anti-TPO antibodies test results were found to be negative. She received tablet thyronorm 25 μg for 6 months. Follow-up TSH level after 6 months reduced to 6.7 mIU/L. She is under regular follow-up in the endocrinology outpatient service.


  Discussion Top


In the present study (n = 70), subclinical hypothyroidism was detected in one student. In another study[1] from South India, abnormal TSH levels were reported in 12.5% of young females,[1] suggesting that a significant proportion of population may remain undetected as these subjects do not show any clinical symptoms. If untreated the subclinical hypothyroidism may progress to overt hypothyroidism, which affects the work performance and quality of life.

Since it has been three decades after the start of universal salt iodisation programme in India, at present, India is considered to be in post-iodisation phase.[1],[4],[11] Despite implementation of the National Iodine Deficiency Diseases Control Programme, the thyroid disorders are found to be the most common endocrine disorders in India with iodine deficiency being the most common cause.[4],[12],[13]

Although the participant detected to have subclinical hypothyroidism consumes food prepared in the hostel, she was found to skip her breakfast or lunch frequently. The participant identified with subclinical hypothyroidism was advised to undergo anti-TPO antibodies test to rule out autoimmune thyroiditis which is one of the major causes of subclinical hypothyroidism. The anti-TPO antibodies test results were found to be negative, indicating that the present subclinical hypothyroidism is not due to an autoimmune thyroid disorder. The participant was observed to react too much to stressful situations, such as appearing for an examination or when questioned in the class indicating the presence of stress. Hence, as per the findings, the probable cause for the presentation of subclinical hypothyroidism in the present study may be primarily due to stress. The other cause which can be considered is probably inadequate daily iodine intake by the participant due to frequent skipping of meals.

Although the reported percentage of thyroid disorders in adolescent girls was less in the present study, it still is useful since it helps in early identification of subclinical hypothyroidism in asymptomatic young girls in adolescent age group which can help in initiating treatment early and prevent the important complications associated with thyroid disorders in future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Velayutham K, Selvan SS, Unnikrishnan AG. Prevalence of thyroid dysfunction among young females in a South Indian population. Indian J Endocrinol Metab 2015;19:781-4.  Back to cited text no. 1
    
2.
Kumar V, Abbas AK, Aster JG. The endocrine system. In: Anirban M, editor. Robbins and Cotran Pathologic basis of Disease. 9th ed. India: Elsevier; 2015. p. 1082-100.  Back to cited text no. 2
    
3.
Hall JE, Guyton AC. Thyroid metabolic hormones. In: Guyton and Hall Textbook of Medical Physiology. 12th ed. Philadelphia, PA, USA: Elsevier; 2011. p. 907.  Back to cited text no. 3
    
4.
Vir SC. Current status of iodine deficiency disorders (IDD) and strategy for its control in India. Indian J Pediatr 2002;69:589-96.  Back to cited text no. 4
    
5.
Unnikrishnan AG, Kalra S, Sahay RK, Bantwal G, John M, Tewari N, et al. Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India. Indian J Endocrinol Metab 2013;17:647-52.  Back to cited text no. 5
    
6.
World Health Organisation. Adolescent Development. Available from: http://www.who.int/maternal_child_adolescent/topics/adolescence/development/en/. [Last accessed on 2017 Jan 24].  Back to cited text no. 6
    
7.
Somashekar AR, Girish V, Rao C, Nandigudi SM. Correlation of cognitive performance and thyroid hormone levels in adolescents with subclinical hypothyroidism. Open J Pediatr 2014;4;169-75.  Back to cited text no. 7
    
8.
Ranabir S, Reetu K. Stress and hormones. Indian J Endocrinol Metab 2011;15:18-22.  Back to cited text no. 8
    
9.
Fleury Y, Van Melle G, Woringer V, Gaillard RC, Portmann L. Sex-dependent variations and timing of thyroid growth during puberty. J Clin Endocrinol Metab 2001;86:750-4.  Back to cited text no. 9
    
10.
Desai MP. Disorders of thyroid gland in India. Indian J Pediatr 1997;64:11-20.  Back to cited text no. 10
    
11.
Andersson M, Takkouche B, Egli I, Allen HE, de Benoist B. Current global iodine status and progress over the last decade towards the elimination of iodine deficiency. Bull World Health Organ 2005;83:518-25.  Back to cited text no. 11
    
12.
Kochupillai N. Clinical endocrinology in India. Curr Sci 2000;8:1061-7.  Back to cited text no. 12
    
13.
Wang C, Crapo LM. The epidemiology of thyroid disease and implications for screening. Endocrinol Metab Clin North Am 1997;26:189-218.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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