Misconceptions, lack of awareness, and iodine deficiency have led to rise in Thyroid disorders in India

According to doctors and health experts, despite the high prevalence of Thyroid functional disorders and diseases, there is still a lack of awareness among people in India. As most of the symptoms related to thyroid disorders are non-specific, people often ignore them.

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“You have put on so much weight, you need to get a thyroid test!” This is an often-heard phrase that we come across in our day-to-day life. But are we really aware of this small organ? Thyroid diseases are among the most common endocrine disorders worldwide. India too is no exception. According to a study published in the Indian Journal of Endocrinology and Metabolism, it has been estimated that about 42 million people in India suffer from thyroid diseases. Over the last decade, numerous studies have revealed that there has been an explosive rise in thyroid disorders in India. According to experts, this increase in thyroid diseases varies from autoimmunity to rapid iodination and obesity.

According to a study published in Thyroid Research and Practice, there has been an increase in cases of thyroid cancer in recent years. However, the study suggests that easy access to ultrasonography could be one of the main reasons for the sudden increase in detection rates. Meanwhile, there is a lack of well-structured epidemiological studies on thyroid autoimmunity, hypothyroidism, and thyroid malignancy. The study also revealed that there are many aspects of prevention, detection, and management of thyroid disorders that need clarity and technological advancement has somehow put an “unprecedented strain on the health system by identifying pathologies which may or may not be relevant in the long term.”

“Thyroid diseases have been on the rise in India over the past decade, according to several regional surveys. Hypothyroidism, the most common among thyroid disease is frequent in India, with a prevalence rate of 10-11 percent, which is one of the highest worldwide. Hyperthyroidism, or excessive thyroid activity, is a relatively uncommon condition. Thyroid problems have a wide range of symptoms, making it challenging to detect thyroid dysfunction. Thyroid screening is the most reliable method for detecting thyroid problems early,” Dr. Srinivasa P Munigoti, Consultant Endocrinologist, Fortis Hospitals, Bannergatta Road, Bengaluru told Financial

What is thyroid and its role in the human body?

The thyroid or thyroid gland is a butterfly-shaped endocrine gland located in the neck of the human body. The Thyroid gland is responsible for secreting hormones like triiodothyronine (T3) and thyroxine (T4), and a peptide hormone, calcitonin. According to doctors, the hormones secreted by the Thyroid influence the metabolic rate and protein synthesis, and in children, growth, and development. A healthy thyroid helps in maintaining the rate and strength of the heartbeat. Moreover, thyroid hormones play a particularly crucial role in brain maturation during fetal development and the first few years of postnatal life. Additionally, sexual function, including libido and the maintenance of a normal menstrual cycle, are also influenced by thyroid hormones.

Common disorders of Thyroid

According to doctors and health experts, there are five common thyroid functional disorders and diseases in India: Hypothyroidism, hyperthyroidism, goiter and iodine deficiency disorders, Hashimoto’s thyroiditis, and thyroid cancer. When excessive production of the thyroid hormones occurs, it often leads to a condition called hyperthyroidism. Another condition, known as Hypothyroidism is usually caused due to an underactive thyroid gland. According to a study published in Lancet, the prevalence of hypothyroidism in India is 11 percent, compared with only 2 percent in the UK and 4·6 percent in the USA.

“Hypothyroidism caused by iodine deficiency and autoimmunity, Thyrotoxicosis caused by autoimmunity or due to destructive thyroiditis, and rarely thyroid carcinomas are the causes of thyroid disorders in India. Most of the conditions are treatable except for some rare carcinomas like anaplastic carcinoma of the thyroid,” Dr. Raman Boddula, Consultant Endocrinologist, Yashoda Hospitals Hyderabad told Financial

Several experts point out that the reason behind the higher mean thyroid-stimulating hormone concentration and range in India as compared to western countries is possibly linked to long-standing iodine deficiency in the country, which has only been partly corrected over the past two decades. Goitre, a condition in which the thyroid gland becomes enlarged, can be caused due to a large number of causes, including iodine deficiency, autoimmune diseases like Graves’ disease, and Hashimoto’s thyroiditis, infection, inflammation, and infiltrative diseases such as sarcoidosis and amyloidosis. However, sometimes no cause can be found, a state often called “simple goitre”.

“When people ignore or neglect potential symptoms of thyrotoxicosis, they may develop arrhythmias, heart failure, osteoporosis, pyrexia of unknown origin, and rarely thyroid storm and if symptoms of hypothyroidism are neglected, then they may develop menstrual irregularities and infertility and miscarriages in women and rarely pericardial effusion and myxedema coma. In children having congenital hypothyroidism cretinism can occur if treatment is delayed. If carcinomas are neglected metastasis will develop to local and distant sites,” Dr. Boddula told Financial

Dr. Munigotti explained that Hypothyroidism is widespread in India, and is commonly understood to be caused by autoimmunity leading to the under-production of thyroid hormone. It is easily treatable with thyroid hormone tablets.

He also stated that according to recent demographic research, roughly 12 percent of adults have a palpable thyroid gland described as ‘goitre’. “In locations where iodine is abundant, autoimmune thyroid disease is probably more common than iodine shortage as a cause of goitre. Most Goiters are benign and non-cancerous, he added. However, Dr. Munigotti emphasised that all these conditions are easily treatable after a correct diagnosis.

Symptoms and signs related to Thyroid abnormalities that one must not ignore

According to doctors and health experts, despite the high prevalence of Thyroid functional disorders and diseases, there is still a lack of awareness among people in India. As most of the symptoms related to thyroid disorders are non-specific people, often ignore them.

“Changes in weight, changes in bowel movements, menstrual abnormalities, increase in the size of thyroid swelling, palpitations, breathlessness, stridor or dysphagia in case of goitre and redness and painful protrusion of eyeballs with difficulty in vision are the symptoms one must not ignore in thyroid disorders,” Dr. Boddula explained.

Meanwhile, Dr. Munigotti highlighted that an underactive thyroid can cause everything from infertility to a life-threatening slowing of essential physiological functions if left untreated.

Some of the symptoms include:

● Palpitations and faster heart beating
● excessive sweating
● Blurred vision
● Swelling under the eyes
● Shivers and chills
● Increased appetite or weight loss
● Diarrhea and more frequent bowel movements
● Thin, warm and moist skin
● Menstrual changes
● Sleep issues.
● Swelling and enlargement of the neck
● Hair fall and hair thinning
● Muscle pain

What are the common misconceptions about thyroid disorders?

The lack of awareness about thyroid diseases has led to some deep-rooted misconceptions about the organ and the diseases associated with it.

“All thyroid disorders are heritable and all thyroid swellings need surgery and strict dietary restrictions are needed for control of thyroid disorders are some of the common misconceptions about thyroid disorder,” Dr. Boddula pointed out.

There is another persistent misconception that Thyroid disorder only affect women. However, endocrinlogists maintain that such disorders can affect men too.

“There is Thyroid issues impact only women. Although thyroid disease is more common amongst women, it is not exclusive to them and can affect men too,” Dr. Munigotti pointed out.

Another common myth is thyroid disease patients will be on medicine for the rest of their lives. Medication to treat thyroid disease depends on the diagnosis and the clinical context. So, it need not always be for life It’s fine to skip treatment if your symptoms aren’t troublesome. However, medical advice should not be ignored and it is not wise to skip tablets without your doctor’s advice, he added.

Dr. Munigotti also stressed that people tend to assume that they will “feel” if they have any thyroid issue.

“This isn’t case all the time and there are clinical situations like pregnancy where it is important to test your thyroid function despite having no clinical symptoms. Thyroid issues can be treated safely with over-the-counter supplements,” Dr. Munigotti explained.

Diagnosis and treatment of Thyroid disorders

Dr. Boddula explained that Blood investigations like thyroid profile,auto-antibodies measurement, serum thyroglobulin, serum calcitonin measurements and imaging like ultrasound and doppler of neck and thyroid scintigraphy and Fine needle aspiration and cytology and biopsy are the necessary modalities for diagnosis of thyroid disorders.

“Treatment involves supplementation of levothyroxine for hypothyroidism,starting antithyroid medications like propylthiouracil and carbimazole and radioiodine ablation or rarely thyroidectomy for hyperthyroidism and thyroidectomy with or without radioiodine ablation and chemotherapy for thyroid carcinomas,” Dr. Boddula said.

Meanwhile, Dr. Munigotti explained that if blood tests reveal hyperthyroidism, the doctor may prescribe one of the tests below to figure out why your thyroid is overactive:
● Radioiodine uptake test
● Thyroid scan
● Thyroid ultrasound

“Whereas an underactive thyroid is indicated by low or normal thyroid hormones and a high TSH. Your doctor may request another blood test involving autoimmunity to confirm the cause of under-functioning gland or hypothyroidism,” Dr. Munigotti said.

Dr. Munigotti stressed that the treatment technique will differ from person to person, depending on factors such as age, physical condition, the underlying cause of hyperthyroidism, personal preference, and the severity of the problem.

Few of the treatment options for hyperfunctioning gland include:
● Radioactive iodine
● Anti-thyroid medications
● Beta-blockers
● Thyroidectomy (Surgery)

“Whereas the under-functioning gland is simply treated by a thyroid hormone supplement given in form of a tablet,” he added.

Challenges of treating thyroid disorders in India

According to Dr. Boddula, the non-availability of standard laboratory facilities for doing thyroid profiles and auto-antibodies at affordable costs even at district levels and the non-availability of nuclear medicine departments even in teaching medical colleges to perform scintigraphy and radioiodine ablations are some challenges in treating thyroid disorders in India.

Moreover, Dr. Munigotti explained that although thyroid disorders are very simple to treat, it’s a challenge to ensure patients adhere to medical advice.

“For example – Hypothyroidism, the most common of thyroid diseases needs patients to take tablets on regular basis in long term despite patients feeling normal themselves making it easy to miss the tablets and not feel the difference for a few days,” Dr. Munigotti said.

Has COVID-19 affected managing thyroid disorders in India?

According to experts, due to the COVID-19 infection lockdowns patients suffering from various thyroid disorders could not come for regular outpatient ffollow-upsfor for titration of their medication. “Post-COVID-19 infection cases of post-viral thyroiditis causing transient thyrotoxicosis have increased in the community,” Dr. Boddula said.

Although there is no scientific proof to support COVID viral infection directly affecting thyroid function, patients missing doctor visits and ignoring thyroid symptoms due to fear of hospital visits had been a concern during the pandemic.

The golden rule for patients with thyroid disorders in India

Dr. Boddula emphasised that regular follow-up visits for fine titration of medication for thyroid disorders and following instructions like levothyroxine supplements are to be taken on an empty stomach and maintaining a 1-hour gap for intake of liquids or solids after consuming levothyroxine tablets are extremely important. Also, stopping the antithyroid drug and reporting to the treating physician immediately if the patient develops pharyngitis along with aphthous ulcers or icterus and serial monitoring of thyroid nodules with imaging for any cancerous changes are the crucial steps that can be taken up by patients with a thyroid disorder.

“Thyroid disorders are increasing in prevalence. They are easy to diagnose and treat but associated with severe complications if not treated properly. It is important to diagnose and treat thyroid disorders in pregnancy because they are associated with adverse consequences for both mother and child. It is important to spread the awareness about thyroid disorders to reduce the misconceptions in the general population,” he said.

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