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Thyroid disorders in India: An epidemiological perspective

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Unnikrishnan A G at Chellaram Diabetes Institute
Unnikrishnan A G
Usha V Menon
Usha V Menon
Usha V Menon
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Thyroid diseases are common worldwide. In India too, there is a significant burden of thyroid diseases. According to a projection from various studies on thyroid disease, it has been estimated that about 42 million people in India suffer from thyroid diseases. This review will focus on the epidemiology of five common thyroid diseases in India: (1) hypothyroidism, (2) hyperthyroidism, (3) goiter and iodine deficiency disorders, (4) Hashimoto's thyroiditis, and (5) thyroid cancer. This review will also briefly cover the exciting work that is in progress to ascertain the normal reference range of thyroid hormones in India, especially in pregnancy and children.
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Indian Journal of Endocrinology and Metabolism / 2011 / Vol 15 / Supplement 2
S78
Thyroid disorders in India: An epidemiological
perspective
Ambika Gopalakrishnan Unnikrishnan, Usha V. Menon
Department of Endocrinology, Amrita Institute of Medical Sciences, Cochin, Kerala, India
ABSTRACT
Thyroid diseases are common worldwide. In India too, there is a signicant burden of thyroid diseases. According to a projection from
various studies on thyroid disease, it has been estimated that about 42 million people in India suffer from thyroid diseases. This review
will focus on the epidemiology of ve common thyroid diseases in India: (1) hypothyroidism, (2) hyperthyroidism, (3) goiter and iodine
deciency disorders, (4) Hashimoto’s thyroiditis, and (5) thyroid cancer. This review will also briey cover the exciting work that is in
progress to ascertain the normal reference range of thyroid hormones in India, especially in pregnancy and children.
Key words: Hypothyroidism, India, thyroid
Review Article
Corresponding Author: Dr. A. G. Unnikrishnan, Department of Endocrinology, Amrita Institute of Medical Sciences, Cochin, Kerala, India.
E-mail: unnikrishnanag@gmail.com
Access this article online
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Website:
www.ijem.in
DOI:
10.4103/2230-8210.83329
IntRoductIon
Thyroid diseases are, arguably, among the commonest
endocrine disorders worldwide. India too, is no exception.
According to a projection from various studies on thyroid
disease, it has been estimated that about 42 million people
in India suffer from thyroid diseases.[1] Thyroid diseases
are different from other diseases in terms of their ease of
diagnosis, accessibility of medical treatment, and the relative
visibility that even a small swelling of the thyroid offers to
the treating physician. Early diagnosis and treatment remain
the cornerstone of management.
This article will focus on ve selected thyroid diseases
(hypothyroidism, hyperthyroidism, goiter/iodine deciency
disorders, Hashimoto’s thyroiditis, and thyroid cancer) and
will offer an insight into studies on their prevalence. This
review will also briey cover the exciting work that is in
progress to ascertain the normal reference range of thyroid
hormones in India, especially in pregnancy and children.
Rather than being an exhaustive, in-depth review, this article
will discuss selected studies from across the country and
the implications and perspectives these studies bring forth,
from an Indian context.
HypotHyRoIdIsm
Among the various varieties of hypothyroidism, congenital
hypothyroidism is probably the most important, as it
is requires an early diagnosis, which is usually followed
by appropriate therapy that can prevent the onset of
brain damage. Studies from Mumbai have suggested that
congenital hypothyroidism is common in India, the disease
occurring in 1 out of 2640 neonates, when compared with
the worldwide average value of 1 in 3800 subjects.[2] There is
often a delay in the diagnosis of congenital hypothyroidism
in the country. This delay is attributable to the lack of
awareness about the illness, as well as the lack of facilities
available or screening program in place to comprehensively
screen and test newborns for this illness.
In childhood too, hypothyroidism can occur. In a clinic-
based study from Mumbai, out of 800 children with thyroid
disease, 79% had hypothyroidism. Common causes of
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Indian Journal of Endocrinology and Metabolism / 2011 / Vol 15 / Supplement 2 S79
hypothyroidism in these children were thyroid dysgenesis,
dyshormonogenesis, and thyroiditis.[2]
Among adult people in India, the prevalence of
hypothyroidism has been recently studied. In this
population-based study done in Cochin on 971 adult
subjects, the prevalence of hypothyroidism was 3.9%.[3] The
prevalence of subclinical hypothyroidism was also high in
this study, the value being 9.4%. In women, the prevalence
was higher, at 11.4%, when compared with men, in whom
the prevalence was 6.2%. The prevalence of subclinical
hypothyroidism increased with age. About 53% of subjects
with subclinical hypothyroidism were positive for anti-TPO
antibodies. This was a population-based study, which used
cluster sampling strategy.[3] In this study, Urinary Iodine
Status was studied in 954 subjects from the same population
sampled, and the median value was 211 µg/l; this suggested
that this population was iodine sufcient.
HypeRtHyRoIdIsm
The prevalence of hyperthyroidism has been studied in
several studies. In an epidemiological study from Cochin,
subclinical and overt hyperthyroidism were present in
1.6% and 1.3% of subjects participating in a community
survey.[3] In a hospital-based study of women from
Pondicherry, subclinical and overt hyperthyroidism were
present in 0.6% and 1.2% of subjects.[4] More than a third
of community-detected hyperthyroid cases have positive
anti-TPO antibodies, and about 39% of these subjects have
a goiter[3] [Figure 1].
GoIteR and IodIne defIcIency
Recent population studies have shown that about 12% of
adults have a palpable goiter.[3] Autoimmune thyroid disease
is probably commoner than iodine deciency as a cause
of goiter in areas that are now iodine sufcient. However,
given that iodine deciency is a problem in India, the
importance of iodine deciency cannot be underestimated
in the Indian context.
The link between endemic goiter and iodine deciency has
been researched in India by several eminent researchers,
and this has led to the publication of several important
reports.[5-7] Critical research has resulted in endemic goiter
being reported from all over the country and not just from
the Himalayan and Sub-Himalayan regions.[1] Researchers
from New Delhi had shown that this was linked to
iodine deciency and that this resulted in decompensated
hypothyroidism in many cases.[1] This led to landmark
studies which showed that iodine deciency was associated
with hypothyroidism in neonates, setting the scene for the
now legendary salt iodization program supported by the
Government of India.[1] Subsequent to this program, it
was shown that in selected regions of Uttar Pradesh, the
prevalence of congenital hypothyroidism had come down
from 100/1000 to 18/1000.[1] Several landmark studies have
been carried out in the area of iodine deciency disorders
in the country.[5-7]
In the postiodization phase, what happens to the prevalence
of goiter? This very important question was answered in
an elegantly conducted study.[8] About 14,762 children from
all over India were studied for the following characteristics:
goiter prevalence, urinary iodine and thiocyanate excretion,
functional status of the thyroid, as well as serological and
cytopathological markers for thyroid autoimmunity. About
23% of subjects had a goiter. A signicantly higher level of
median urinary thiocyanate (USCN) excretion was noted
in goitrous subjects (0.75 mg/dl) when compared with
controls (0.64 mg/dl; P < 0.001). The authors suggested
that despite iodization, the prevalence of goiter has not
dramatically declined.[8] The researchers noted that thyroid
autoimmunity could only partly explain the goiter and
concluded that the role of goitrogens is an area that
deserves further study.
autoImmune tHyRoIdItIs In IndIa
Population studies have suggested that about 16.7% of adult
subjects have anti-thyroid peroxidase (TPO) antibodies and
about 12.1% have anti-thyroglobulin (TG) antibodies.
In this same study of 971 subjects, when subjects with
abnormal thyroid function were excluded, the prevalence
of anti-TPO and anti-TG antibodies was 9.5% and 8.5%.[3]
In a landmark study of Hashimoto’s thyroiditis in
India, 6283 schoolgirls from all over the country were
Unnikrishnan and Menon: Thyroid disorders in India
Figure 1: Prevalence of thyroid function abnormalities found in 971 adult
subjects form a community study from Kerala, South India.[3]
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Indian Journal of Endocrinology and Metabolism / 2011 / Vol 15 / Supplement 2
S80
screened.[9] Among them, 1810 schoolgirls had a goiter.
Among them 764 subjects underwent a ne needle aspiration
cytology, and of these subjects, 58 (7.5%) had evidence of
juvenile autoimmune thyroiditis (the term included both
Hashimoto’s thyroiditis and focal lymphocytic thyroiditis).
Among ne needle aspiration cytology-conrmed cases
of juvenile autoimmune thyroiditis, subclinical and overt
hypothyroidism were seen in 15% and 6.5%, respectively.[9]
tHyRoId canceR and IndIa
The Indian Council of Medical Research established
the National Cancer Registry Program, and the NCRP
has collected the data of more than 3,00,000 cancer
patients between the periods 1984 and 1993.[10] Among
these patients, the NCRP noted 5614 cases of thyroid
cancer, and this included 3617 females and 2007 males.
The six centers involved in the studies were at Mumbai,
Delhi, Thiruvananthapuram, Dibrugarh, Chandigarh, and
Chennai. Among them, Thiruvananthapuram had the
highest relative frequency of cases of thyroid cancer among
all cancer cases enrolled in the hospital registry, 1.99%
among males and 5.71% among females. The nationwide
relative frequency of thyroid cancer among all the cancer
cases was 0.1%–0.2%. The age-adjusted incidence rates of
thyroid cancer per 100,000 are about 1 for males and 1.8 for
females as per the Mumbai Cancer Registry, which covered
a population of 9.81 million subjects. The histological
types of thyroid cancer were studied in a Hospital Cancer
Registry of 1185 “new cases” of thyroid cancer.[11] The
commonest cancer type was papillary, followed by follicular
cancer, and the results are summarized in Figure 2.
RefeRence RanGes of tHyRoId functIon
In pReGnancy and cHIldRen
In the past 2 years, exciting work has been carried out
to understand the thyroid in pregnancy and childhood
in India.[12-14] In the rst article, Marwaha et al indicate
the normal reference ranges of FT4, FT3, and TSH in
pregnant women, and used the 5th and 85th percentile to
dene the reference ranges in the disease-free subjects.
The authors report that the trimester-wise values in the
rst, second, and third trimesters were FT(3) (1.92–5.86,
3.2–5.73, and 3.3–5.18 pM/l), FT(4) (12–19.45, 9.48–19.58,
and 11.32–17.7 pM/l), and TSH (0.6–5.0, 0.44–5.78, and
0.74–5.7 IU/ml), respectively.[12] With regard to iodine
deciency during pregnancy, a hospital-based study from
Kolkata has suggested that pregnant women from their
center were iodine sufcient.[13]
In a large epidemiological study of 24,685 students from
all over India published in 2010, the authors attempted to
dene normative data on thyroid hormone levels in healthy
school children.[14] Among them, the authors calculated
the reference ranges from the 5343 subjects. In a separate
publication in 2008, the same authors studied normative
thyroid hormone ranges in 5122 school children, after
excluding children who had a personal or family history
of thyroid disease, used thyroid medications, had a goiter,
and had hypoechogenicity/nodularity on ultrasound or
positivity for serum anti-TPO antibodies.[15] The authors
reported that for TSH, the 97th percentile was in the range
6.01–8.4 mIU/l for boys and 5.28–8.04 mIU/l for girls.[15]
This, as the authors themselves suggest, offers a compelling
argument against lowering the reference range of TSH in
this population.
communIty-Based ultRasound studIes
In IndIa
Interesting work is in progress to ascertain the predictors
of thyroid gland size in an Indian population. In a study
of 1002 children from Gujarat, the authors note that the
prevalence of goiter was very high (80%) when assessed by
ultrasound. This was also a population with a high prevalence
of malnutrition (82% subjects were underweight). In this
population, the authors note that thyroid size was related to
several anthropometric parameters. However, it is not clear
whether these results are applicable to the general Indian
population.[16] In the state of Gujarat, the same group had
reported that iodine deciency continues to be a problem,
as more than 20% of the population had a very low median
urinary iodine of <50 µg/l.[17] In the same population, the
Figure 2: Histological type distribution of 1185 “new cases” of thyroid cancer.
Figure based on a table published by Gangadharan et al.[11] Anaplastic,
Cancer Not-Otherwise Specied and No histology proof-cases, together,
accounted for 223 cases in this survey
Unnikrishnan and Menon: Thyroid disorders in India
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Indian Journal of Endocrinology and Metabolism / 2011 / Vol 15 / Supplement 2 S81
prevalence of hypothyroidism has been reported to be
about 7%.[17] The use of ultrasound in population studies
of thyroid gland size is an exciting new area for research
in the eld of thyroid epidemiology.[18-20]
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4. Abraham R, Murugan VS, Pukazhvanthen P, Sen SK. Thyroid
Disorders In Women of Puducherry. Indian J Clin Biochem
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5. Karmarkar MG, Deo MG, Kochupillai N, Ramalingaswami V.
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6. Sooch SS, Deo MG, Karmarkar MG, Kochupillai N, Ramachandran
K, Ramalingaswami V. Prevention of endemic goitre with iodized salt.
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7. Pandav CS, Karmarkar MG, Kochupillai N. Recommended levels of
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N. Residual goitre in the postiodization phase: Iodine status,
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RS, Sastry A, Singh S. Establishment of reference range for thyroid
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Bhowmick K. Iodine deficiency disorder among pregnant women
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et al. Reference range of thyroid hormones in normal Indian school-
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SC. Study of biochemical prevalence indicators for the assessment
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R, et al. Ultrasound evaluation of thyroid size: A large nationwide
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Cite this article as: Unnikrishnan AG, Menon UV. Thyroid disorders in India:
An epidemiological perspective. Indian J Endocr Metab 2011;15:S78-81.
Source of Support: Nil, Conict of Interest: None declared.
Unnikrishnan and Menon: Thyroid disorders in India
[Downloaded free from http://www.ijem.in on Wednesday, September 28, 2016, IP: 151.250.101.64]
... In India, it has been estimated that about 42 million people suffer from thyroid diseases [7]. The study conducted by Deshmukh P Y et al concluded that the prevalence of subclinical hypothyroidism was 18% [8][9][10]. ...
... The extremely evident connection is the increased BMI and insulin resistance widespread to both the situations. Increase in BMI is an important part of this condition and is found in a substantial proportion (54-68%) of these cases [9]. ...
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... In India, it has been estimated that about 42 million people suffer from thyroid diseases [7]. The study conducted by Deshmukh P Y et al concluded that the prevalence of subclinical hypothyroidism was 18% [8][9][10]. ...
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Full-text available
  • Jun 2025
Introduction: Thyroid disorders are the most common endocrine disorders affecting the Indian population and as well the World's population next to Diabetes Mellitus. As per various reports published, around 300 million people in the world are suffering from thyroid disorders. In India it is estimated that around 42 million people are affected from thyroid disorders. Objectives of the study: the objectives of the study include to measure the levels of anti-TPO antibodies and anti-Tg antibodies in euthyroid subjects and to measure and compare the levels of TSH, FT3 and FT4 in patients with elevated anti-TPO antibodies and elevated anti-Tg antibodies during their follow-up visits. Methodology: 280 subjects satisfied the inclusion criteria out of 180 subjects, at baseline we noted down TSH, FT3, FT4, anti-TPO antibodies and anti-Tg antibodies values and all these patients were instructed to come for follow-up at 6 months and 1 year for TSH, FT3, FT4, anti-TPO antibodies and anti-Tg antibodies testing. During the follow-up visits, random blood sample of 5 mL was drawn into plain tubes (red stoppered) and subjected to centrifugation for separation of serum and used for estimation of TSH, FT3, FT4, and antibody testing using fully automated chemiluminiscence immunoassay analyzer. A total of 216 subjects came for the follow up thyroid biomarker tests. Further we divided these 216 subjects into two groups. Out of 216 subjects, 154 belong to Group A1 and 24 belong to Group A2. Group A1: Euthyroid at baseline with elevated either of the antibody (Anti-TPO or Anti-Tg) indicating autoimmune thyroiditis but converted to subclinical/overt hypothyroidism in follow-up visit. Group A2: Euthyroid at baseline with elevated either of the antibody (Anti-TPO or Anti-Tg) indicating autoimmune thyroiditis but converted to subclinical/overt hyperthyroidism in follow-up visit. Discussion: The primary objective of the current study was to showcase the early appearance of anti-TPO autoantibodies, prior to the onset of biochemical changes in thyroid hormones, TSH and FT4. Measuring anti-TPO along with TSH and FT4 benefits as a predictive marker in diagnosing euthyroid subjects who might be at risk for potential thyroid dysfunctions. Many individuals may not seek medical attention due to the gradual development of symptoms or due to nonspecific symptoms. The results of our study clearly indicate that anti-TPO antibodies do elevate in thyroid disorders prior to the onset of subclinical/overt hypothyroidism or hyperthyroidism. All these patients who presented with symptoms of thyroid disorders had been tested for thyroid profile parameters at 6 months follow up intervals. A significant number of subjects turned out to be subclinical/overt hypothyroid or hyperthyroid. Conclusion: The results of the present study showed that thyroid autoantibodies precede subclinical/overt hypothyroidism and hyperthyroidism. Hence, it is highly beneficial to consider testing for anti-TPO in conjunction with the primary thyroid markers, TSH and FT4, to prevent long-term morbidity by early therapeutic intervention.
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Evaluation of Osteopontin and Malondialdehyde Level and its Correlation with Iron Status in Hypothyroidism Patients: A Case-control Study
Article
Full-text available
  • Feb 2022
Introduction: Hypothyroidism is a clinical condition characterised by abnormally low thyroid hormone production. Hypothyroidism is associated with increased Malondialdehyde (MDA), Total Iron Binding Capacity (TIBC) and decreased Osteopontin (OPN), iron and ferritin level.
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Prevention of endemic goitre with iodized salt (Reprinted from Bull World Health Organization, vol 49, pg 307-312, 1973)
Article
Full-text available
  • May 2001
  • NATL MED J INDIA
The paper describes a study, carried out over 16 years, of the use of iodized salt for the control of endemic goitre in a valley of the Himalayan foothills. From 1956, salt was fortified with either potassium iodide or potassium iodate to provide an estimated daily intake of 200 mug per head. There was a progressive and significant decline in goitre prevalence, together with a return of the pattern of iodine metabolism to within normal limits. It is concluded that endemic goitre can be successfully controlled by iodization of domestic salt.
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Study of biochemical prevalence indicators for the assessment of iodine deficiency disorders in adults at field conditions in Gujarat (India)
Article
Full-text available
  • Feb 2001
  • ASIA PAC J CLIN NUTR
The main objective of this study was to assess the severity of iodine deficiency disorders (IDD) in the adult populations of the Baroda and Dang districts from Gujarat, western India using biochemical prevalence indicators of IDD. The other aim of this study was to establish a biochemical baseline for adequate iodine intake as a result of program evolution in the face of multiple confounding factors, like malnutrition and goitrogens responsible for goiter. A total of 959 adults (16–85 years) were studied from two districts (Baroda and Dang) and data was collected on dietary habits, anthropometric and biochemical parameters such as height, weight, urinary iodine (UI) and blood thyroid stimulating hormone (TSH). Drinking water and cooking salt were analyzed for iodine content. All subjects, irrespective of sex and district, showed median UI = 73 μg/L and mean blood TSH ± SD = 1.59 ± 2.4 mU/L. Seven per cent of the studied population had blood TSH values > 5 mU/L. Females in Baroda and males from Dang district were more affected by iodine deficiency as shown by a lower median UI. Mean TSH was significantly higher in women from both districts as compared to men (P = 0.001). The blood spots TSH values > 5 mU/L were seen in 20% of women from Dang. The normative accepted WHO values for UI and TSH for the severity of IDD as a significant health problem are not available for target population of adults. Urinary iodine normative limits and cut-offs are established for school-aged children. Blood spot TSH upper limit and cut-off values are available for neonate populations. The IDD has not been eliminated so far, as more than 20% of both male and female subjects had UI < 50 μg/L. Males were more malnourished than females in both districts (P < 0.05). Pearl millet from Baroda contained flavonoids like apigenin, vitexin and glycosyl-vitexin. Dang district water lacked in iodine content. Iodine deficiency disorder is a public health problem in Gujarat, with the Baroda district a new pocket of IDD. High amounts of dietary flavonoids in Baroda and Dang, malnutrition and an additional lack of iodine in Dang water account for IDD.
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Iodine deficiency disorder among pregnant women in a tertiary care hospital of Kolkata, India
Article
Full-text available
  • Jul 2010
  • Southeast Asian J Trop Med Publ Health
The present unicentric, hospital based, non-interventional, cross-sectional study was undertaken to assess the iodine status of pregnant women attending the antenatal clinic at a medical college in Kolkata, India, during the different trimesters of pregnancy and to compare their iodine status with those of age-matched non-pregnant control women. Assessment of the iodine status was based on urinary iodine excretion (UIE). Serum levels of free triiodithyronine (fT3), free thyroxine (fT4) and thyroid stimulating hormone (TSH) were assayed as an indirect measure of iodine status. A statistical comparison between the median values for UIE, TSH, fT4 and fT3 in pregnant women and non-pregnant controls revealed a significant difference between the median values for UIE (p < 0.0047), TSH (p < 0.00001) and fT4 (p < 0.001). UIE and fT4 were significantly lower and TSH was significantly higher in pregnant women than in non-pregnant controls. However, no significant difference in median values for fT3 concentration between the groups was seen (p = 0.4). Only 4 cases out of 200 pregnant women had an UIE of less than the lower cut-off value for UIE recommended by the WHO corresponding to optimal iodine intake. The results indicate most pregnant subjects attending the antenatal clinic at Medical College Kolkata, India, a tertiary care institution, did not suffer from significant iodine depletion. This may be ascribed to increased awareness of this condition and the accessibility of iodized salt among the study population.
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Ultrasound evaluation of thyroid size: A large nationwide study of schoolchildren in India
Article
Full-text available
  • Mar 2008
  • NATL MED J INDIA
Ultrasound assessment of thyroid volume is considered a more objective method than clinical palpation for the diagnosis of goitre. We used ultrasonography to establish normal reference cut-off points of thyroid volume in schoolchildren of different socioecomonic groups in India and compared the results with international norms. In a cross-sectional study, we clinically examined 27,250 children from the lower and higher socioeconomic strata (SES) from all over India to determine their goitre staging. A single sonologist, using ultrasonography, assessed the thyroid volume in a subset of 15,986 children (8463 from the lower and 7523 from the higher SES). Students were recruited from at least one school each representing the higher and the lower SES, from cities located in 5 zones of India. Children with known thyroid disorders were excluded from the study. Clinical evaluation revealed a mean goitre prevalence of 19.9% (23.2% in girls; 16.5% in boys; 17.1% in the higher SES; 23.5% in the lower SES). The thyroid volume as assessed by ultrasonography was significantly higher in children from the lower SES (mean 5.65 ml, SE 0.02) compared with those from the higher SES (mean 5.02 ml, SE 0.02) after adjusting for the imbalance in body surface area (p < 0.001). Using international norms (WHO 2004), the prevalence of goitre in various body surface area categories among children who had no goitre on clinical examination ranged from 48.2% to 75.1% for boys and 23.2% to 67.4% for girls. The striking discrepancy in the prevalence of goitre assessed by using clinical examination and ultrasound techniques suggests that the norms recommended by WHO based on ultrasound techniques are not appropriate for India.
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Prevention of endemic goitre with iodized salt
Article
Full-text available
  • Feb 1973
  • B WORLD HEALTH ORGAN
The paper describes a study, carried out over 16 years, of the use of iodized salt for the control of endemic goitre in a valley of the Himalayan foothills. From 1956, salt was fortified with either potassium iodide or potassium iodate to provide an estimated daily intake of 200 mug per head. There was a progressive and significant decline in goitre prevalence, together with a return of the pattern of iodine metabolism to within normal limits. It is concluded that endemic goitre can be successfully controlled by iodization of domestic salt.
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Thyroid disorders in women of Puducherry
Article
  • May 2009
Thyroid stimulating hormone (TSH), Free Thyroxine (FT(4)) and Free Triiodothyronine (FT(3)) were assayed in 505 women of this region. 60 women had previous history of thyroid disease. The remaining 445 women formed the "Disease free group". A "Reference group" was obtained by excluding women with previous and present history of thyroid dysfunction. Of the total 505 women examined 15.8% had thyroid dysfunction and 84.2% were euthyroid. 11.5% were hypothyroid (9.5% sub-clinical) and 1.8% hyperthyroid (1.2% clinical). The geometric mean TSH for the total population was 2.65 μIU/ml. It was significantly (p=0.025) lower in the reference population 2.17 μIU/ml. There was no significant difference in the FT(3) and FT(4) values between groups. 19% of women over 60 years had elevated TSH above 4.5 μIU/ml. The 2.5 and 97.5 percentiles of the reference population was 1.1-5.2 μIU/ml. 6.1% of women in the reference group had TSH levels above the reference intervals. Hypothyroidism particularly sub-clinical hypothyroidism is predominantly present amongst women in this iodine sufficient region. Evaluation of thyroid status could help in early detection and treatment.
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High prevelance of undetected thyroid disorders in an iodine sufficient Adult South Indian population
Article
  • Mar 2009
  • J Indian Med Assoc
India is in the transition phase from iodine deficiency to iodine sufficiency, and this is expected to change the thyroid status of the population. The thyroid status and auto-immune status of adult Indian population in the postiodisation phase is largelyunknown, and this study was conducted to answer this question. A cross-sectional population survey was conducted in two phases among the residents of urban coastal area of central Kerala. The initial phase included a house-to-house survey of 3069 adults (>18 years of age), selected by cluster sampling method. From the surveyed population, 986 subjects underwent further physical examination and biochemical evaluation for thyroid function, thyroid autoimmunity status and iodine status. The total prevalence of goitre was 12.2% and median urine iodine excretion was 211.4 mcg/l (mean 220.3 +/- 99.5 mcg/l) indicating iodine sufficiency. Thyroid function abnormalities were present in 19.6% of subjects. Subclinical hypothyroidism was present in 9.4%. Among the population with normal thyroid function, 9.5% and 8.5% respectively had positive anti-TPO and anti-TG antibodies. Among those with thyroid dysfunction, 46.3% had positive anti-TPO and 26.8% were anti-TG positive. A significant proportion of this iodine-sufficient adult population had thyroid disorders. Further studies are required to characterise the reasons for this high prevalence. Iodine deficiency as well as thyroid dysfunction should both be the focus of public health strategies in susceptible populations.
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Reference range of thyroid hormones in healthy school-age children: Country-wide data from India
Article
  • Apr 2009
This study was planned to obtain normative data of thyroid functions in school-age children from different regions of India. Students from 36 schools involving 13 states across four geographical zones of India were evaluated for goiter. Subjects who consented, underwent evaluation for serum FT3, FT4, TSH, anti-TPO antibodies and thyroid ultrasound. From this, a "reference population" was obtained by excluding those with personal or family history of thyroid disease, use of thyroid medications, goiter, hypoechogenicity or nodularity on ultrasound or positive anti-thyroid antibodies. Of 24,685 students clinically evaluated, 8665 formed part of the study. The reference population comprised 5343 subjects. The mean, median, 3rd and 97th percentiles of FT3, FT4 and TSH for each year (6-17 years) were obtained. This community based study in Indian school-age children provides reference intervals for thyroid hormones and evidence against narrowing the TSH reference range.
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