Prevalence of previously undiagnosed hypothyroidism in patients with cholelithiasis in a tertiary care center, North-East India

Debabrata Singha; Naresh Manohar Pawar; Prabhu B. J.; Nitesh Kumar; Sankamithra Gopalarathnam

doi:10.18203/2349-2902.isj20170507

Authors

Debabrata Singha Department of General Surgery, Silchar Medical College and Hospital, Silchar, Assam, India
Naresh Manohar Pawar Department of General Surgery, Silchar Medical College and Hospital, Silchar, Assam, India http://orcid.org/0000-0001-9546-2184
Prabhu B. J. Department of Radio-diagnosis, Silchar Medical College and Hospital, Silchar, Assam, India
Nitesh Kumar Department of General Surgery, Silchar Medical College and Hospital, Silchar, Assam, India
Sankamithra Gopalarathnam Department of General Surgery, Silchar Medical College and Hospital, Silchar, Assam, India

DOI:

https://doi.org/10.18203/2349-2902.isj20170507

Keywords:

Cholelithiasis, Goitre, Hypothyroidism, Thyroid hormone assay

Abstract

Background: Earlier, the studies had an increased prevalence of previously diagnosed hypothyroidism in gallstone patient and recent studies also demonstrated low bile flow in hypothyroid subjects or the sphincter of oddi expresses thyroid hormone receptors and thyroxin has a direct prorelaxing effect on the sphincter. Iceberg of hypothyroidism was present in cholelithiasis patients. The objective of this study was to find out the prevalence of previously undiagnosed hypothyroidism in cholelithiasis patients.

Methods: A prospective study was conducted in the 500 consecutive patients with cholelithiasis between 1st October 2014 and 31st March 2016 to find relation between gallstone and hypothyroidism. Patients already diagnosed as hypothyroidism were excluded. In each patients, detailed history and clinical examination was done and sent for ultrasound of neck for goitre detection and laboratory Thyroid hormone assay (S-FT3, S-FT4 and S-TSH).

Results: A total of 2.2%, 5.0% and 6.6% (total 13.8%, 69 of 500) of the cholelithiasis patients were diagnosed to have clinical, subclinical and borderline subclinical hypothyroidism. In women older than 50 year, the prevalence of clinical and subclinical plus borderline-hypothyroidism was 6.8% and 25.6% (11.7%±13.9%) and clinical plus subclinical plus borderline-subclinical hypothyroidism was 32.4% in cholelithiasis patients.

Conclusions: Although a low prevalence of hypothyroidism was found in this study, but it is evident that subclinical and borderline subclinical hypothyroidism were significantly more common, compared with the clinical hypothyroidism and with increasing age there was increase in its prevalence, so we recommend that S-TSH level should be measured for every patient with cholelithiasis older than 50 years.

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References

Russel RCG. The gall bladder and bile ducts. In: Williams NS, Bulstrode CJK, Oconnell PD. Bailey and Love’s short practice of surgery, 25th edition. London, Edward Arnold Ltd. 2008:1119-20.

Yousif HH. Relationship between serum levels of TSH and cholesterol with types of gallstones. Iraqi Postgraduate Med J. 2011;10:7-12.

Bassi N, Aggio L, Ghiro S, Meggiato T, Mario DF, Favero DG. X-ray diffraction study of biliary calculi morphological and composition correlations of calculi. G Clin Med. 1990;71:331-5.

Kleiner O, Ramesh J, Huleihel M, Cohen B, Kantarovich K, Levi C, et al. A comparative study of gallstones from children and adults using FTIR spectroscopy and fluorescence microscopy. BMC Gastroenterology. 2002;2:3.

Cicala M, Hibib FI, Fiocca F, Pallotta N, Corazziari E. Increased sphincter of oddi basal pressure in patients affected by gallstone disease: a role of biliary stasis and colicky pain? Gut. 2001;48:414-7.

Inkinen J, Sand J, Nordback I. Association between common bile duct stones and treated hypothyroidism. Hepato Gastroenterology. 2001;47:919-21.

Vassilakis JS, Nicolopoulos N. Dissolution of gallstones following thyroxine administration. A case report. Hepato Gastroenterology. 1981;28:60-1.

Diehl AK. Epidemiology and natural history of gallstones disease. Gastroenterol Clin North Am. 1991;20:1-19.

Heaton KW, Braddon FE, Mountford RA, Hugnes AO, Emmett PM. Symptomatic and silent gallstones in the community. Gut. 1991;32:316-20.

Kartzar W, Mason RA, Kachele V. Prevalence of gallstones in sonographic surveys worldwide. J Clin Ultrasound. 1999;27:1-7.

George L, Jordan J. Choledocholelithiasis. Curr Prob I Surg. 1982;19:722-98.

Thistle JL. Pathophysiology of bile duct stone. World J Surg. 1998;22:1114-8.

Osenes M, Lootveit T, Larsen S, Aune S. Duodenal diverticula and their relationship to age, sex and biliary calculi. Scand J Gastroenterology. 1981;16:103-7.

Bergman F, Linden VW. Further studies on the influence of thyroxin on gallstones formation in hamsters. Acta Chir Scand. 1966;131:319-28.

Laukkarinen J, Sand J, Saaristo R, Salmi J, Turjanmaa V, Vehkalahti P, et al. Is bile flow reduced in patient with hypothyroidism? Surgery. 2003;133:288-93.

Woeber KA. Update on the management of hyperthyroidism and hypothyroidism. Arch Intern Med. 2000;160:1067-71.

Honore LH. A significant association between symptomatic cholesterol cholelithiasis and treated hypothyroidism in women. J Med. 1981;12:199-03.

Volzke H, Robinson DM, John U. Association between thyroid function and gallstone disease. World J Gastroenterol. 2005;11:5530-4.

Laukkarinen J, Kiudelis G, Lempinen M, Raty S, Pelli H, Sand J, et al. Increased prevalence of subclinical hypothyroidism in common bile duct stone patients. J Clin Endocrinol Metab. 2007;92:4260-4.