ABSTRACT
Background and Aim:
Recently, it has been revealed that most thyroid disorders occur among females and that the factors contributing to this are infertility and sex hormone imbalance. Other research studies showed both genders are equally affected. Therefore, this study aims to estimate the prevalence rate of thyroid disorder among young adults in the rural areas of Wardha district and correlate the results with demographic variables.
Materials and Methods:
A cross-sectional research design was used in this study. One thousand males and females were involved in the study. The Calbiotech Thyroxine Elisa kit was used to check the prevalence rate of thyroid disorder. Data were analysed using the Statistical Package for Social Sciences (SPSS) and released in 2016.
Results:
Among the rural villages of Wardha district, Seloo, Salod (Hirapur) and Kelzar were included in the study. It was found that in Seloo, 154 (49.04%) young adults had normal thyroid function, 105 (33.44%) had hyperthyroidism and 55 (17.52%) participants had hypothyroidism. Salod (Hirapur) showed 210 (47.95%) with normal thyroid function, 149 (34.02%) with hyperthyroidism and 79 (18.04%) with hypothyroidism. In Kelzar, there were 121 (48.79%) with normal thyroid function, 80 (32.26%) with hyperthyroidism and 47 (18.95%) with hypothyroidism.
Conclusion:
Prevalence of thyroid disorder revealed that majority of the thyroid problems were found among females in the rural areas of Wardha district. There are various problems in rural areas, such as lack of medical facilities and laboratory facilities to diagnose thyroid dysfunction early. It is recommended that health check-up camps be conducted in rural areas and health education be given to young adults about thyroid disorders and their prevention measures for promotion of health free from a thyroid disorder.
Keywords: Cross-sectional study, infertility, prevalence, sex hormones, thyroid disorder
Introduction
One of the largest glands in the body is the endocrine gland located at the front of the neck just over the trachea, which usually weighs 15–25 g in adults.[1] The hormones secreted by the thyroid are thyroxine (T4) and triiodothyronine (T3), which influence the body tissue’s basal metabolic process. They have a role in regulating the heart rate, bone and neural development; they are essential for the breakdown of glucose and stimulate lipolysis, reducing the cholesterol level in the blood.[2]
Thyroid-stimulating hormone (TSH) is secreted by the anterior pituitary gland, and its secretion is controlled by the hypothalamic thyrotrophic releasing hormone (TRH). To secrete the thyroid hormones, the gland needs iodine, a mineral obtained from food in an iodised form. Only a limited percentage of thyroid hormones is free to circulate after production.[3]
Hypothyroidism and hyperthyroidism are the two main categories of thyroid disorders, which are further divided into overt and subclinical variants.[4] The prevalence of thyroid disorder is mainly influenced by sex and age. Alteration in thyroid function is especially seen in women than men and in older adults compared to the younger age group. The prevalence rate of overt hyperthyroidism is 1.4% in women aged 60 and above. In men above 60 years of age, the incidence of hyperthyroidism is 0.13%.[5]
The current study intends to determine the prevalence of thyroid disorders among young adults in the rural areas of Wardha district.
Materials and Methods
Study setting and design
A cross-sectional study was conducted between March and July 2021 in Seloo, Salod (Hirapur) and Kelzar in a rural area of Wardha district. The general population of this area was selected for the research study. We went to each village and invited all young adults to participate in this research study.
Study population
A purposive sampling technique was used in this research study. This study enrolled 1000 males and females to participate in the study. Young adults aged 18–25 years who were present at the research areas and willing to give blood samples were included in the study after they gave informed consent.
Data collection
The most pivotal investigation approach is collecting sufficient data, so that the questions raised in the study can be answered using this data. For a detailed investigation, blood samples were collected. At the time of data collection, rapport was maintained with the participants. On the same day, a questionnaire was distributed and a thyroid assay was done to screen for the thyroid disorder. The Calbiotech Thyroxine Elisa kit was used for the thyroid assay.
Statistical analysis
Data were analysed using the Statistical Package for Social Sciences (SPSS) version 25. Demographic information was gathered through a questionnaire created by the study’s researchers. The Chi-square test was used to find the association of thyroid disorders with the demographic variables. P values <0.05 at a 95% confidence level were considered statistically significant.
Sample collection and laboratory analysis
Blood samples were taken from the study participants by venepuncture into a bare bulb by a trained phlebotomist, and the samples were placed in an airtight container and transported in a sealed bag. After the samples reached the laboratory, a thyroid assay was conducted using the Calbiotech Thyroxine Elisa kit to find the values of TSH, T3 and T4. The test results gave the thyroid function values in the kit and based on the kit values, we categorised the adults as those with hyperthyroidism, normal thyroid function and hypothyroidism.
The reference range for TSH was 0.37–5.1 μIU/ml. The intermediate precision for T3 was 5.50% for a mean of 1.56 μIU/ml, and analytical sensitivity was 0.2 ng/ml. The reference range for T3 was 0.8–2.0 ng/ml. The intermediate precision for T4 was 7.32% for a mean of 119.5 nmol/l. The functional sensitivity was 6.43 nmol/l, and the reference range for T4 was 60–160 nmol/l.
Results
This section deals with the distribution of participants, along with the percentage of young adults, according to their demographic characteristics. This was obtained to describe the sample characteristics, including age, gender, village name, educational status, family history and so on [Table 1].
Table 1.
Demographic characteristics of young adults
| Demographic variable | No. of participants (n=1000) | Percentage |
|---|---|---|
| Age (years) | ||
| 18-21 | 458 | 45.80 |
| 22-25 | 542 | 54.20 |
| Gender | ||
| Male | 456 | 45.60 |
| Female | 544 | 54.40 |
| Village name | ||
| Seloo | 314 | 31.40 |
| Salod (Hirapur) | 438 | 43.80 |
| Kelzar | 248 | 24.80 |
| Education status | ||
| Primary education | 442 | 44.20 |
| Secondary education | 267 | 26.70 |
| Higher secondary education | 80 | 8 |
| Graduate | 211 | 21.10 |
| Family history | ||
| Yes | 456 | 45.60 |
| No | 544 | 54.40 |
| Have you already been diagnosed with a thyroid disorder? | ||
| Yes | 268 | 26.80 |
| No | 732 | 73.20 |
The mean score was 1.934 ± 0.747 for the prevalence of thyroid disorder. Of the 314 participants from Seloo, 154 (49.04%) young adults had normal thyroid function, 105 (33.44%) had hyperthyroidism and 55 (17.52%) participants showed hypothyroidism [Table 2].
Table 2.
Prevalence of thyroid disorder in selected villages of Wardha district
| City | No. of participants (n=1000) | Hyperthyroidism (%) | Normal thyroid function (%) | Hypothyroidism (%) | Mean±SD |
|---|---|---|---|---|---|
| Seloo | 314 | 105 (33.44%) | 154 (49.04%) | 55 (17.52%) | 1.934±0.747 |
| Salod (Hirapur) | 438 | 149 (34.02%) | 210 (47.95%) | 79 (18.04%) | |
| Kelzar | 248 | 80 (32.26%) | 121 (48.79%) | 47 (18.95%) |
SD=standard deviation
Of the 438 participants from Salod (Hirapur), 210 (47.95%) had normal thyroid function, 149 (34.02%) had hyperthyroidism and 79 (18.04%) had hypothyroidism.
Of the 248 participants from Kelzar, 121 (48.79%) had normal thyroid function, 80 (32.26%) had hyperthyroidism and 47 (18.95%) had hypothyroidism [Figure 1].
Figure 1.
Bar chart showing the prevalence of thyroid disorder in selected villages of Wardha district
The mean thyroid disorder among the young adults diagnosed with hyperthyroidism and hypothyroidism showed a statistically significant association (P < 0.001) with age, gender, educational status and family history of thyroid disorder. There was no significant association with the pre-existing thyroid disorder status [Table 3].
Table 3.
Association of thyroid disorders with selected demographic variables
| Demographic variable | No of participants (n=1000) | Thyroid disorder | chi-square-value | P | ||
|---|---|---|---|---|---|---|
|
| ||||||
| Hyperthyroidism | Normal thyroid function | Hypothyroidism | ||||
| Age (years) | ||||||
| 18-21 | 458 | 145 | 211 | 102 | 9.91 | 0.007S |
| 22-25 | 542 | 189 | 274 | 79 | ||
| Gender | ||||||
| Male | 456 | 64 | 352 | 40 | 8.32 | 0.001S |
| Female | 544 | 270 | 274 | 0 | ||
| Education status | ||||||
| Primary education | 442 | 145 | 218 | 79 | 9.21 | 0.001S |
| Secondary education | 267 | 0 | 267 | 0 | ||
| Higher secondary education | 80 | 80 | 0 | 0 | ||
| Graduate | 211 | 109 | 0 | 102 | ||
| Family history | ||||||
| Yes | 456 | 64 | 211 | 181 | 7.65 | 0.012S |
| No | 544 | 270 | 485 | 181 | ||
| Have you been already diagnosed with a thyroid disorder? | ||||||
| Yes | 268 | 64 | 102 | 102 | 8.74 | 0.079NS |
| No | 732 | 270 | 383 | 79 | ||
NS=non-significant, S=significant
Discussion
This study investigated the prevalence of thyroid disorders among the young adult population in the rural areas of Wardha district. There are several findings from this study. The results showed difference in the prevalence rate according to the sex and age factor, which is in agreement with the previous studies.[6]
Regarding the women’s age, this period may reflect the childbearing age of women or already are pregnant women since the study did not ask for pregnancy. Approximately 1 in 10 women developed thyroid peroxidase antibodies (TPOAb) during the first trimester, and 16% of these women had hypothyroidism.[7]
The overall prevalence of thyroid dysfunction in this study was 24%. Twelve per cent of cases had hypothyroidism (10% subclinical, 2% overt). Similarly, hyperthyroidism was found in 12% of cases (7% subclinical, 5% overt). A cross-sectional survey performed in central Kerala found that the overall prevalence of thyroid function abnormalities was 19.6% of the population.[8,9]
The mean thyroid disorder among the young adults diagnosed with hyperthyroidism and hypothyroidism showed a statistically significant association (P < 0.001) with age, gender, educational status and family history of thyroid disorder. This is firmly to the study conducted by Wartofsky et al.,[10] who stated that the measurement of serum total T3 is less valuable and it may be within the normal range in most patients with hypothyroidism. Others reported that T3 has no role in diagnosing hypothyroidism since it declines much later than T4 or may even be normal.[11]
The result of this study is consistent with that of a recent research conducted in India which reported that the most common abnormality was an elevated TSH (hypothyroid), constituting 11% of the total patients, and 9.7% of them had the subclinical type.[8,9]
Recent survey data has noted the increased association between coronary event and morbidity rate due to thyroxine treatment in subclinical hypothyroid persons; this requires huge attention for drug monitoring.[11]
Regarding hyperthyroid cases, the incidence rate of subclinical and overt variants was higher in females than males, which is consistent with De Ruiter’s[12] study, which revealed that the annual incidence rate of hyperthyroidism in women ranges from 0.36 to 0.47 per 1000 females and in men ranges from 0.087 to 0.101 per 1000 males.
The incidence rate of thyroid disorders in our study was significant in females. However, in other countries, most thyroid patients (about 90% in Singapore) suffer from hyperthyroidism than hypothyroidism (only 10%).[13]
There was a significant association between thyroid dysfunction and increased risk of arterial fibrillation, heart failure, dementia and mortality rate in older people. Cappola et al.[14] studied the correlation of these diseases with thyroid function in older people who had low TSH and high free thyroxine (FT4).
These adverse outcomes of thyroid dysfunction could be disastrous; therefore, we propose introducing thyroid function test (TFT) as one of the screening tests for every woman, especially in the reproductive age and during pregnancy. Pop et al. revealed that abnormally low maternal serum free thyroxine concentrations at 12 weeks of gestation were significantly associated with impaired neural development in infants at 10 months.[15]
Haddow et al. revealed that infants born to lactating mothers with high TSH levels during pregnancy had significantly lower intelligence quotient scores than the controls born to euthyroid mothers.[16]
In addition, the American Thyroid Association recommends that women at age 35 should undergo screening every 5 years and women over age 50 should seek medical care and all geriatric care upon hospital admission.[11]
The intake of iodine salt is less among the rural population studied in Wardha district. This explains the prevalence of hypothyroidism, as iodine represents an essential ion for stimulating thyroid hormone production.
Limitation of the study
There were a few limitations in the study. The study did not include radiological examination of the thyroid by ultrasound. If it had been included, it would have helped us better understand many issues related to thyroid disorders.
Conclusion
It can be concluded from this study that thyroid disorders are one of the common disorders that affect a wide range of population, and they affect females more than males and younger women more than older ones. Moreover, the prevalence of thyroid disorders in this study revealed that majority of the thyroid problems were shown by females in the rural areas of Wardha district. There are various problems in rural areas, such as lack of medical facilities and laboratory facilities to diagnose thyroid dysfunction early. It is recommended that health check-up camps be conducted in rural areas and health education be given to young adults about thyroid disorders and their prevention measures for promotion of health free from a thyroid disorder.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Ethical approval
Consent for the study was taken from each participant after explanation of the concept and purpose of the study. Ethical approval was taken from the ethical committee of Datta Meghe Institute of Medical Sciences (DMIMS) (DU)/IEC/Dec-2020/4214.
Data and materials availability
All data associated with this study are present in the paper.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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