First cross-sectional, multi-city study carried out in India related to thyroid dysfunction  

Posted online: Friday, Dec 20, 2013 at 0000 hrs
New Delhi : Abbott India announced today the New Delhi results from a study assessing the prevalence of hypothyroidism in India that was published in the July 2013 issue of the Indian Journal of Endocrinology and Metabolism. 

The Thyroid Epidemiological Study team was led by Dr. A. G Unnikrishnan, Principal Investigator and CEO and Endocrinologist, Chellaram Diabetes Institute, Pune; Dr. Raj Kumar Lalwani, New Delhi Investigator and 

Consultant Physician – PG Medical Centre, Malviya Nagar, New Delhi; and other researchers [1]. This study initiated by Abbott is India’s first cross-sectional multi-city study to quantify prevalence of thyroid dysfunctions in the post iodization phase in New Delhi, Kolkata, Chennai, Bangalore, Goa, Mumbai, Hyderabad and Ahmedabad. 

Key Findings from the Study: 

Hypothyroidism is highly prevalent amongst the surveyed population across India with one out of ten people being diagnosed with the condition. 

Hypothyroidism was found to be a common form of thyroid dysfunction affecting 10.95% of the study population in India. The older population (above the age of 35 years) seemed to be at higher risk of hypothyroidism than the younger population (13.11% vs. 7.53%). 

Of the 5360 people screened for thyroid disorders in India, more than one fourth (26.79%) were from Delhi. Delhi formed the biggest sample size for the nationwide study. Over 11% of the study population from Delhi reported hypothyroidism and one third of them were not aware of their disease. 

Women were three times more likely to be affected by hypothyroidism than men (15.86% vs. 5.02%), especially those in the 46-54age group.   

Hypertension (20.4%) and diabetes mellitus (16.2%) were the other common diseases observed in the study population. 

Undetected cases from study population are significantly higher in Delhi (3.97%) as compared to other major cities like Mumbai (2.86%) and Chennai (2.09%) 

Approximately 22% of the study population in Delhi had anti-thyroid peroxidase antibodies [TPO] positivity, an established autoimmune marker pointing toward a steady risk of thyroid disorders. 

About 9.61% of the study population from Delhi had mild thyroid failure; these cases may progress to hypothyroidism in future. 

Dr. A. G Unnikrishnan, Principal Investigator of the study and CEO and Endocrinologist, Chellaram Diabetes Institute, Pune says “The study assessed the nationwide prevalence of thyroid disorder, particularly hypothyroidism, in adults residing in various cities that represent diverse geographic origin, occupation, socio-economic status and food habits. Many patients were diagnosed with hypothyroidism for the first time during the study. Screening for thyroid disorders is therefore essential for early detection, treatment and management of the disease. Since women are more affected than men, it poses major health issues to women. Tiredness, weight gain, hair loss, menstrual irregularities, decreased fertility and depression are symptoms that are observed in women with hypothyroidism.” 

Dr. Raj Kumar Lalwani, New Delhi Investigator and Consultant Physician – PG Medical Centre, Malviya Nagar, New Delhi says, “Over 11% of the study population was diagnosed of hypothyroidism and one third of hypothyroid cases were not aware of their disease. Undetected cases are significantly higher in Delhi (3.97%) as compared to other major cities like Mumbai (2.86%) and Chennai (2.09%). About 9.61% of population from Delhi had mild thyroid failure; these cases may progress to hypothyroidism in future. Approximately 22% of the study population tested positive for anti-TPO antibodies putting them at a higher risk of developing thyroid disorder in the future.” 

Globally, thyroid disorders continue to be common yet one of the most under-diagnosed and neglected chronic health conditions. These disorders impair normal functioning of the thyroid gland causing abnormal production of hormones leading to hyperthyroidism or hypothyroidism. The prevalence of hypothyroidism in the developed world is estimated to be about 4-5%. [2] 

If left untreated, hypothyroidism can cause elevated cholesterol levels, an increase in blood pressure, an increased rate of cardiovascular complications, decreased fertility, and depression; and in pregnant women, placental abnormalities and increased risks for the baby’s well-being. These symptoms are often confused with other disorders, thus making thyroid disorders one of the most underdiagnosed disorders in India. Like diabetes, there is no permanent cure for most forms of thyroid disorders, but with medication and precise treatment, thyroid disorders can be controlled and patients can live normal lives.

Rehan A. Khan, Managing Director, Abbott India, said “The city-specific epidemiological study has helped get a true picture of the evolving profile of thyroid disorders in the post iodization phase in India. By partnering with various stakeholders, Abbott is seeking to advance understanding, increase awareness and support proper diagnosis of thyroid disorders in our country.” 

About the Thyroid Epidemiological Study 

The study assessed the nationwide prevalence of thyroid disorder, particularly hypothyroidism, in adults residing in various cities that represent diverse geographic origin, occupation, socio-economic status and food habits. 

All men or women (residing in that area for at least 5 years) aged 18 years or over, were invited to participate in a general health checkup. More than 5,000 participants took part, giving a target population that constituted 0.01% of the total population of the eight cities, according to 2001 national census data.  Willing participants signed a written informed consent. Participants were excluded if they were pregnant, or had any acute or chronic systemic illnesses as judged by the study investigator. 

The study was approved by a Central Ethics Committee (CEC) and carried out in accordance with the approved protocol, principles of Declaration of Helsinki and Good Clinical Practices. It was registered with the Clinical Trials Registry India (registration no: CTRI/2011/11/002180). 

Thyroid abnormalities were diagnosed by measuring the status of thyroid hormones - serum FT3, FT4 and thyroid stimulating hormone [TSH]. 

Hypothyroidism, commonly categorized under the cluster of iodine deficiency disorders (IDDs), is a common health issue in India, as it is worldwide. Since the time India adopted the universal salt iodization program in 1983, there has been a decline in goiter prevalence in several parts of the country which were endemic in the pre-iodization period. With a majority of households (83.2% urban and 66.1% rural) now consuming adequate iodized salt, India is supposedly undergoing a transition from iodine deficiency to sufficiency state (WHO 2004).[4,5,6] A recent review of studies conducted in the post-iodization phase gives some indication of the corresponding change in the thyroid status of the Indian population, and thyroid disorders seem to be increasing despite India being an iodine sufficient country now.