A Study of Prevalence of Hypothyroidism in Cholelithiasis

Abstract

BACKGROUNDFor decades, there has been discussion whether thyroid disorders could cause gallstone disease. Gallstone formation is a complex process involving various mechanisms affecting the flow of bile and bile content. Hypothyroid patients are found to have biliary stasis because of slowed emptying of bile from the biliary tract into the duodenum. This is attributed to the decreased pro-relaxing action of thyroxine on sphincter of Oddi in hypothyroid individuals. The hallmark laboratory investigation to detect hypothyroidism and also a sensitive indicator for diagnosing early thyroid dysfunction is serum TSH level. Serum TSH level is the most accurate indicator of thyroid function. This study attempts to know the prevalence of hypothyroidism in cholelithiasis. MATERIALS AND METHODSA cross-sectional study was done between April 2014 to September 2014. 50 patients diagnosed as cholelithiasis in Department of General Surgery, Government Royapettah Hospital, were included in the study. Full history, clinical examination, ultrasound abdomen and laboratory blood test for free T3, free T4 and TSH were done for every patient. Data was analysed statistically using SPSS version 19.0. RESULTSOut of 50 patients of cholelithiasis, 29 (58%) were females and 21 (42%) were males. Thyroid disorder in form of hypothyroidism was found in 19 (38%) patients. In that, 11 (22%) patients presented with subclinical hypothyroidism and 8 (16%) patients with clinical hypothyroidism. CONCLUSIONThere is an increase in prevalence of hypothyroidism in cholelithiasis in this study. The prevalence was more among >40 years age group. This increase in prevalence could have an effect on the diagnostic and therapeutic workup of cholelithiasis patients.

The role of routine thyroid assay in the management of gallstones

“…Among the cases, a higher prevalence of gallstone disease was seen after the age of 40years in both the genders. This was in concordance with studies by Subramani et al 15 who showed 60% of the patients presented with gallstones after 41years. The study by Vivek et al 17 showed that gallstone occurred in the age group of 50-60years.…”

“…they did not show any symptoms and had normal thyroid hormone levels. This was in correlation with studies by various studies 1,[13][14][15][16][17][18]22,24 showed an association between undiagnosed/subclinical hypothyroidism with gallstones. Singh BR 1 concluded that subclinical hypothyroidism was common in female patients belonging to the age group of 40-50years.…”

“…14,23,24 The various hypotheses that explain the connection between thyroid failure and gallstone formation are as follows. 15,19,25 1. Thyroid abnormality causes disturbance of lipid metabolism and change in bile composition, thus decreases bile flow into the duodenum.…”

“…S-TSH is the most sensitive marker for detecting thyroid failure. 15,16,22 As subclinical hypothyroidism is more prevalent, measuring the S-TSH levels should be made a routine investigation test along with the standard preoperative workup that includes LFT (liver function test) and USG.…”

“…Furthermore, the sphincter of Oddi has thyroid receptors and thyroxin has a direct pro-relaxing effect on the sphincter. [12][13][14][15][16][17][18][19][20] The identification of thyroid dysfunction in patients diagnosed with gallstones remains suboptimal and often missed, 21 thus delaying its management. Gall stone disorder has its surgical related morbidity and mortality 22 which can be avoided with a euthyroid state.…”