RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
|a) |RESUME OF THE INTENDED WORK |
| |1. |Need for the study: |
| | | Postmenopause, is the period of time after menopause which is diagnosed retrospectively as twelve consecutive months of |
| | |amenorrhoea [1]. |
| | |Thyroid dysfunctions are more common in postmenopausal women[2,5]. They predominantly have subclinical thyroid dysfunctions, followed by |
| | |overt thyroid dysfunctions (Hypothyroidism > Hyperthyroidism) [4, 6, 7]. |
| | |Thyroid hormones are known to regulate lipid metabolism, therefore any thyroid dysfunction will cause dyslipidemia [3, 8, 11]. |
| | |Many menopausal symptoms are similar to symptoms of thyroid dysfunctions like fatigue, weight gain, hot flushes, palpitations, mood |
| | |disturbances, cold intolerance etc. There is likelihood of these symptoms being misinterpreted as menopausal symptoms and thyroid |
| | |dysfunctions may be undetected, which will lead to health hazards like dyslipidemia, which increases the risk of hypertension, ischemic |
| | |heart disease etc and complications of thyroid dysfunctions [9, 10]. |
| | |In practice regular screening of postmenopausal women for thyroid dysfunction is not done. Therefore this study is necessary to stress the |
| | |importance of regular screening for timely detection and prevention of further complications, associated with thyroid dysfunctions in |
| | |postmenopausal women [9, 10]. |
| |2. |REVIEW OF LITERATURE |
| | | Age related thyroid dysfunction is common and it is mainly seen in elderly women [2]. |
| | |Pearce E N in his publication also states that thyroid dysfunction is common among women over the age of 50 [5]. |
| | |Dima L Diab, in his study observed that hypothyroidism is common among older women and that subclinical hypothyroidism is more prevalent |
| | |than overt hypothyroidism [7]. |
| | |Robin P Peeters in his publications states that the prevalence of hyperthyroidism in the elderly is increased with frequency ranging form |
| | |0.5-3% in population older than 60 years of age. The prevalence of subclinical hyperthyroidism may be upto 6.3% in elderly being more |
| | |frequent in females [6]. |
| | |Schindler A E in his publications gives the incidence of thyroid disease in postmenopausal women as follows-clinical thyroid disease about |
| | |2.4% subclinical thyroid disease about 23.2%. Among the group of subclinical thyroid disease 73.8% are hypothyroid and 26.2% are |
| | |hyperthyroid [4]. |
| | |C V Rizos et al., in their study state that thyroid hormones regulate a wide variety of metabolic functions and that thyroid function |
| | |significantly affects lipoprotein metabolism [8]. |
| | |Hypothyroidism is associated with elevated plasma LDL cholesterol levels due primarily to a reduction in hepatic LDL receptor function and |
| | |delayed clearance of LDL, these patients also have increased levels of IDL and some patients also have triglyceridemia [3]. |
| | |Dr Pradeep Sharma in his journal also states that hypothyroidism causes dyslipidemia[11]. |
| | |Sulabh Avinassh Joshi et al., in their study state that menopause is a state of estrogen deficiency and is characterized by appearance of |
| | |variety of menopausal symptoms llike lethargy, hot flushes, anxiety, tremors etc. Many of these symptoms are similar to symptoms of thyroid|
| | |dysfunction. There is likelihood of symptoms of thyroid dysfunction in this age group being misinterpreted as menopausal symptoms and |
| | |thyroid dysfunction remaining undetected and untreated which can lead to health hazards like dyslipidemia, atherosclerosis and heart |
| | |disease [9]. |
| | |Jandee Lee and Woong Youn Chung have shown in their study that subclinical hypothyroidism was associated with modestly increased |
| | |cardiovascular risks of coronary heart disease and total mortality [10]. |
| | |A 2004 consensus committee comprised of representatives of The American Thyroid Association, The Endocrine Society and The American |
| | |Association of Clinical Endocrinologists recommended that aggressive case finding is appropriate in women over age 60 [10]. |
| |3. |Objectives of the study: |
| | |To study the prevalence of thyroid dysfunction in postmenopausal women. |
| | | |
| | |To study the effects of thyroid dysfunction on lipid profile. |
|b) |Materials and Methods: |
| |1. |Source of Data: |
| | |Asymptomatic postmenopausal women who will be attending the outpatient and inpatient of Medicine department in Navodaya Medical College |
| | |Hospital And Research Centre, Raichur. |
| |2. |Methods of collection of Data : |
| | |Method of study: Data will be collected using a pretested performa meeting the objectives of the study. Detailed history and necessary |
| | |investigations will be undertaken. The purpose of the study will be explained to the patient and informed consent obtained. Minimum of 100 |
| | |patients are selected randomly who will fulfill the inclusion and exclusion criteria. Relevant history including symptoms and signs at |
| | |presentation, past medical history, drug history and examination findings will be noted. |
| | |Type of Study: Hospital Based Crossectional study. |
| | |Period of Study: 1 year study period |
| | |Inclusion Criteria: |
| | |Postmenopausal women attending outpatient and inpatient of Medicine Department. |
| | |Exclusion Criteria: |
| | | |
| | |Known cases of diabetes mellitus, Thyroid dysfunction, Hypertension, Chronic kidney disease. |
| | |Patients on Hormone replacement therapy |
| | |Diagnosed cases of Ovarian and uterine malignancy |
| | |Patients on drugs like iodide, amiodarone, salicylates, propranolol, octreotide, phenytoin, lithium, glucocorticoid, amphetamine, |
| | |aminoglutethemide, somatostatins. |
| |3. |Does your study require any investigation intervation to be conducted on patient or other human or animals. |
| | |Yes |
| | | |
| | |Routine Investigations |
| | |Complete blood count |
| | |Blood urea |
| | |Serum creatinine |
| | |Urine analysis |
| | |FBS, PPBS |
| | |ECG |
| | |Chest X ray PA view |
| | |USG abdomenopelvis |
| | | |
| | |Special investigations |
| | |Thyroid profile – TSH, Free T4. |
| | |Lipid profile – Total cholesterol, Triglycerides, LDL cholesterol, HDL cholesterol. |
|c) |LIST OF REFERENCES |
| |Serdar E. Bulun and Eli Y. Adashi, Physiology and Pathology of Female Reproductive Axis, page no. 596, William’s textbook of Endocrinology, 11th |
| |edition, New Delhi, Saunders and Elsevier, 2008 |
| |Steven W. J. Lamberts, Endocrinology and Aging, pg no. 1185, William’s textbook of Endocrinology, 11th edition, New Delhi, Saunders and Elsevier, 2008|
| | |
| |Daniel J.Rader, Helen H Hobber, Disorders of Lipoprotein Metabolism, Harrisson’s Principles of Internal Medicine, volume 2, pg no.3155, New Delhi, Mc |
| |Graw Hill, 2012 |
| |Schindler AE, Thyroid function and postmenopause, Gynecol Endocrinol; 17(1):79-85, 2003 |
| |Pearce EN, Thyroid dysfunction in perimenopausal and postmenopausal women, National Centre for Biotechnology Information (NCBI) US, 13(1): 8-13, |
| |PubMed, 2007 |
| |Robin P. Peeters, Thyroid hormones and aging, HORMONES, 7(1): 28-35, 2008 |
| |Dima L Diab, MD, Current Screening and Management of Hypothyroidism, Menopause management, 2010 |
| |C.V.Rizos et al., Effects of Thyroid Dysfunction on Lipid Profile, The Open Cardiovascular Medicine Journal, Volume 5, 2011 |
| |Sulabha Avinash Joshi et al., Screening of Peri and postmenopausal women for Hypothyroidism, Journal of South Asian Federation of Obstetrics & |
| |Gynecology, 3(1): 14-16; Jaypee, Maharashtra; 2011 |
| |Jandee Lee & Woong Youn Chung, Subclinical Hypothyroidism; Natural History, Long Term Clinical Effects and Treatment, Current Topics in Hypothyroidism|
| |with Focus on Development, InTech Journals, 2013 |
| |Dr. Pradeep Sharma et al., Hypothyroidism causing dyslipidemia in both subclinical and overt hypothyroidism, Indian Journal of Basic and Applied |
| |Medical Research, Issue-7, Volume-2, P. 779-788; 2013 |
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