Disorders of thyroid gland in India

Abstract

The profile of thyroid disorders encountered in pediatric and adolescent age groups in India is similar to that seen in most parts of the world except for the prevalence of iodine deficiency disorders in certain endemic regions of this country. Clinical presentation is most commonly for hypothyroidism and goiters and infrequently for hyperthyroidism. Of nearly 800 children referred for thyroid problems, 79% had hypothyroidism (goitrous as well as nongoitrous), 19% had euthyroid goiters and 2% had hyperthyroidism. Hypothyroidism was due to thyroid dysgenesis in 75% (aplasia/hypoplasia--50% and ectopic thyroid gland 25%), thyroiditis in nearly 5% and dyshormonogenes is in 20%. The incidence of congenital hypothyroidism in our experience of screening nearly 40,000 newborns is about 1 in 2,640, which is much higher than the worldwide average of 1 in 3,800. Diagnostic delay in hypothyroidism is common and is related to lack of awareness amongst primary healthy care practitioners and family physicians as well as the cost and availability of laboratory investigations. This delay, compounded with inadequate therapeutic surveillance is responsible for the poor outcome in affected children. High incidence of dyshormonogenesis, inherited as autosomal recessive trait also calls for genetic counselling and routine sibling examination. Our results of family studies on first degree relatives of children with thyroiditis revealed presence of antimicrosomal antibodies in 43% and thyroid disease in 26%. Many etiologic factors cause goiters which may be functionally euthyroid or hypothyroid with almost equal frequency in our series. In nearly 200 schools children surveyed for goiter prevalence, 8% in high socioeconomic groups and about 21% in the low income group, had goiters. Female predominance was marked. However, iodine deficiency was not the sole cause as revealed by dietary survey and urinary iodine estimations. Hyperthyroidism is infrequent, less severe and in our experience responded well to long-term administration of antithyroid drugs. A high index of clinical awareness and education of primary health workers will help a great deal in improving the ultimate outcome in children with thyroid disorders/hypothyroidism.

Clinical Profile of Subclinical Hypothyroidism:A Retrospective Study

“…Delayed diagnosis and treatment of hypothyroidism is common in India in spite of relatively high prevalence. [6] As progression of subclinical hypothyroidism to overt hypothyroidism occurs in a substantial number of subjects, [3] adequate thyroid supplementation in the presence of high serum TSH levels, antithyroid antibodies, enlarged thyroid gland and symptoms is justified.…”

Clinical Profile of Subclinical Hypothyroidism:A Retrospective Study

“…[4,5] Regional and hospital based studies in India have shown a prevalence ranging from 9% to26%. [6] The prevalence is higher in lower socioeconomic groups. [6] Studies from neighboring countries like Nepal have also reported a higher incidence.…”

“…[6] The prevalence is higher in lower socioeconomic groups. [6] Studies from neighboring countries like Nepal have also reported a higher incidence. [7] Serum TSH levels are sensitive and specific for screening thyroid dysfunctions.…”

Incidence and etiology of thyroid disorders in children

“…Deficiency of these hormones leads to irreparable damage to the growth and development, both physical as well as mental, of the child. 4,5 One of the main causes is congenital hypothyroidism, which is preventable. It is estimated to occur in 1 in 3000-4000 children in the world.…”

“…In India, this ratio is 1:2500. 4,5 Hypothyroidism ranges from an overt state of myxedema, end organ effects and multisystem failure to asymptomatic or subclinical condition with normal levels of thyroxine and triiodothyronine but mildly elevated levels of thyrotropin. [6][7][8][9] The prevalence of hypothyroid in the developed world is estimated to be about 4-5% while subclinical hypothyroidism is estimated to be about 4-15%.…”