Prevalence of previously undiagnosed hypothyroidism in patients with cholelithiasis in a tertiary care center, North-East India

Abstract

Background: Earlier, the studies had an increased prevalence of previously diagnosed hypothyroidism in gallstone patient and recent studies also demonstrated low bile flow in hypothyroid subjects or the sphincter of oddi expresses thyroid hormone receptors and thyroxin has a direct prorelaxing effect on the sphincter. Iceberg of hypothyroidism was present in cholelithiasis patients. The objective of this study was to find out the prevalence of previously undiagnosed hypothyroidism in cholelithiasis patients.Methods: A prospective study was conducted in the 500 consecutive patients with cholelithiasis between 1st October 2014 and 31st March 2016 to find relation between gallstone and hypothyroidism. Patients already diagnosed as hypothyroidism were excluded. In each patients, detailed history and clinical examination was done and sent for ultrasound of neck for goitre detection and laboratory Thyroid hormone assay (S-FT3, S-FT4 and S-TSH).Results: A total of 2.2%, 5.0% and 6.6% (total 13.8%, 69 of 500) of the cholelithiasis patients were diagnosed to have clinical, subclinical and borderline subclinical hypothyroidism. In women older than 50 year, the prevalence of clinical and subclinical plus borderline-hypothyroidism was 6.8% and 25.6% (11.7%±13.9%) and clinical plus subclinical plus borderline-subclinical hypothyroidism was 32.4% in cholelithiasis patients.Conclusions: Although a low prevalence of hypothyroidism was found in this study, but it is evident that subclinical and borderline subclinical hypothyroidism were significantly more common, compared with the clinical hypothyroidism and with increasing age there was increase in its prevalence, so we recommend that S-TSH level should be measured for every patient with cholelithiasis older than 50 years.

The role of routine thyroid assay in the management of gallstones

“…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.…”

“…Along with the classical etiological factors causing gallstone, 5 several studies have shown a positive association between symptomatic thyroid dysfunction and biliary stone disease. 14,23,24 The various hypotheses that explain the connection between thyroid failure and gallstone formation are as follows. 15,19,25 1.…”

“…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.…”

A clinical study on prevalence of subclinical hypothyroidism in patients with cholelithiasis in a tertiary care center in South India

“…22 In a study by Singha et al the prevalence of previously undiagnosed thyroid disorder in the form of hypothyroidism was found in 13.2% patients, subclinical hypothyroidism was 5.0%, borderline subclinical hypothyroidism was 6.6% and clinical hypothyroidism was 2.2%. 23 There was high prevalence of subclinical hypothyroidism in our study.…”

Magnitude of hypothyroidism among patients of cholelithiasis in a tertiary care centre in rural West Bengal: a prospective study

“…The similar type of age group was detected in various literature likewise Nath et al (51-60 years); Singha et al (>40 years); Ghimire et al (>40 years). [28][29][30] The euthyroid patients were 41 (75.92%) and the hypothyroidism patients were 13 (24.08%) out of 54 patients in this study. The prevalence of hypothyroidism was 24.08% in the study.…”