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+ : @ a)RESUME OF THE INTENDED WORK1.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 REFERENCESSerdar E. Bulun and Eli Y. Adashi, Physiology and Pathology of Female Reproductive Axis, page no. 596, Williams textbook of Endocrinology, 11th edition, New Delhi, Saunders and Elsevier, 2008
Steven W. J. Lamberts, Endocrinology and Aging, pg no. 1185, Williams textbook of Endocrinology, 11th edition, New Delhi, Saunders and Elsevier, 2008
Daniel J.Rader, Helen H Hobber, Disorders of Lipoprotein Metabolism, Harrissons 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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