Objectives:Appropriate treatment of hypothyroidism requires accurate diagnosis. This registry aimed to study the disease profile and treatment paradigm in hypothyroid patients in India.Materials and Methods:We registered 1500 newly diagnosed, treatment-naïve, adult hypothyroid males and nonpregnant females across 33 centers and collected relevant data from medical records. The first analysis report on baseline data is presented here.Results:The mean age of the study population was 41.1 ± 14.01 years with a female to male ratio of 7:3. The most frequently reported symptoms and signs were fatigue (60.17%) and weight gain with poor appetite (36.22%). Menstrual abnormalities were reported in all women (n = 730) who had not attained menopause. Grades 1 and 2 goiter (as per the WHO) were observed in 15.41% and 3.27% patients, respectively. Comorbidities were reported in 545 patients (36.36%), type 2 diabetes mellitus being the most prevalent (13.54%) followed by hypertension (11.34%). Total serum thyroxine (T4) and thyroid-stimulating hormone (TSH) levels were assessed in 291 (19.47%) patients only. In majority of patients (81%), treatment was based on serum TSH levels alone. The dose of levothyroxine ranged from 12.5 to 375 mcg.Conclusions:Guidelines suggest a diagnosis of hypothyroidism based on TSH and T4 levels. However, most of the patients as observed in this registry received treatment with levothyroxine based on TSH levels alone, thus highlighting the need for awareness and scientific education among clinicians in India. The use of standard doses (100, 75, and 25 mcg) of levothyroxine may point toward empirical management practices.
Non-specific symptoms such as asthenia, anorexia, unintentional weight loss, nausea/vomiting particularly in the elderly population are often overlooked both by caretakers and physicians. Deteriorating general health and neuro-psychiatric symptoms are often attributed to depression in the elderly population. The most common electrolyte abnormality, hyponatremia is again more common in the elderly population. Often neglected chronic hyponatremia remains asymptomatic in many cases. Once hyponatremia is detected clinicians should establish a proper diagnosis before supplementation. Failure to diagnose such cases will lead to repeated hospitalization, poor quality of life, wastage of resources and even death. Isolated ACTH deficiency (IAD) is a rare disorder and potentially fatal. IAD can present rarely as hyponatremia and diagnosis can easily be missed if not suspected. IAD may not be as rare as earlier thought as more and more such cases are been reported. Here we report two cases of generalized weakness and nausea; they were repeatedly hospitalized and treated for hyponatremia and ultimately diagnosed as IAD in our hospital.
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