The epidemiology of thyroid diseases in the Arab world: A systematic review

The Association Between Estrogen-Containing Oral Contraceptive Pills and Hypothyroidism

Background: Hypothyroidism is an endocrine disorder that affects 10 times more females than males, with substantial health impacts. The role of estrogen-containing oral contraceptives (OCPs) in influencing thyroid function remains relatively underexplored. This study investigated the association between estrogen-containing OCP use and hypothyroidism in the female population in Qatar. Methods: We utilized data from the Qatar Biobank to conduct a cross-sectional study of 1001 female participants with a current or previous history of estrogen-containing OCP use. The thyroid function of the participants was evaluated via thyroid function test parameters (thyroid stimulating hormone (TSH) and free tetraiodothyronine (fT4)) as outcomes, and sex hormone-binding globulin (SHBG) levels as a proxy indicator of OCP use. We adjusted for confounders such as age, ethnicity, and type 2 diabetes mellitus status via multivariable logistic regression to determine the odds of hypothyroidism associated with SHBG levels. Results: Among the 1001 participants, 34 (3.4%) met the diagnostic criteria for hypothyroidism. Multinomial logistic regression revealed no increased odds of hypothyroidism at the 90th percentile cutoff for SHBG levels (OR 1.00, 95% CI 0.29-3.50). However, at the 95th percentile of SHBG values, there was 46% higher odds of hypothyroidism (OR 1.46, 95% CI 0.33-6.54) and an over tenfold increase at the 99th percentile (OR 10.07, 95% CI 1.94-52.45, p=0.006). Other variables, such as age, ethnicity, and diabetes status, were not associated with SHBG levels. Non-Qatari Arabs had higher odds of hypothyroidism compared with that of Qataris (OR 8.06, 95% CI 0.84-77.54, p value 0.071). Conclusion: This study offers evidence that SHBG levels can be used to indicate estrogen-containing OCP use. Furthermore, higher SHBG levels are associated with higher odds of hypothyroidism among OCP users, and the odds of hypothyroidism vary across different ethnicities. These findings highlight the need for further research to explore the mechanisms linking OCP use to thyroid dysfunction and to investigate other potential risk factors.

Prevalence of hypothyroidism among postmenopausal women in an urbanised village of northern India: A cross-sectional study

Introduction

Hypothyroidism is among the most prevalent endocrine disorders worldwide. Its risk increases with menopause. The prevalence of hypothyroidism among menopausal women in India is unknown, as conclusive data are scarce. The present study was conducted to find out the prevalence of hypothyroidism among menopausal women in Delhi, India, and study the socio-demographic factors associated with it.

Methods

This was a cross-sectional community-based study done among 282 menopausal women in an urbanised village in Delhi, India. Women with a previously known history of diagnosed thyroid disorders were also included in the study. Informed written consent was obtained from all participants. A socio-demographic profile was gathered by questionnaire and blood samples were collected and analysed for thyroid hormone levels.

Results

The mean age of study participants was 51.1 years. The prevalence of hypothyroidism among postmenopausal women was 27.3% (77) with 19.9% (56) previously diagnosed and 7.3% (21) diagnosed by the present study. Out of 56 previously diagnosed hypothyroid study participants, only 26 (46.4%) participants had thyroid hormones in a normal range. Age, socio-economic status and literacy status were found to be significantly associated with hypothyroidism.

Conclusion

About three postmenopausal women out of 10 were found to be hypothyroid. Nation-wide data were required to estimate the true burden of thyroid disorders in this population. The prevalence increased with age underscoring the need for further research to have conclusive evidence regarding this association. Hypothyroid women who are on treatment should undergo regular evaluation of thyroid hormones so that appropriate dose adjustments can be made for pharmacological therapies.

Evaluation of Age and Gender-Related Patterns in Clinical Features and Hematological Findings Among Hypothyroidism Patients in the Al-Jouf Region of Saudi Arabia: A Hospital-Based Study

BACKGROUND

The prevalence of hypothyroidism is high in Saudi Arabia and the contributing factors are iodine deficiency and lack of balanced nutrition. This study aims to correlate the gender, age, and presence of co-morbidities with the laboratory findings and clinical presentation.

METHODOLOGY

A cross-sectional study was done in the hospitals of the Al-Jouf region. The files of the patients diagnosed with hypothyroidism from the last two years were retrieved by non-probability consecutive sampling technique. IBM SPSS Statistics for Windows, Version 23, (Released 2015; IBM Corp., Armonk, New York, United States) was used for data entry and analysis. Descriptive statistics were presented as frequencies and proportions (for qualitative variables) and mean and standard deviation (SD) (for continuous data). Associated factors were identified through a chi-square test. A p-value less than 0.05 was considered statistically significant.

RESULTS

Most of the patients were females within the age group of 36 to 50 years. Significant differences were observed between male and female patients with respect to the FT4 levels, hemoglobin (Hb) levels, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) values, and RBC counts (p-values of <0.001, <0.001, <0.001, <0.001, <0.001 and <0.001, respectively). However, no significant differences were observed between male and female patients in the TSH levels and hematocrit values. Most of the patients were euthyroid (77.24%). The pattern of thyroid function status did not show significant differences with respect to the gender of participants and the different age groups (p-values of 0.447 and 0.775, respectively). The most common co-morbidities observed were diabetes and hypertension. No significant association between the co-morbidities and the pattern of thyroid function status was observed. The most common symptoms were epigastric pain, fatigue, constipation, drowsiness, altered bowel habits, and weight gain.

CONCLUSION

This hospital-based study provides valuable insights into some epidemiological characteristics, clinical features, and hematological findings in hypothyroidism patients of the Al-Jouf region. Significant differences were observed between male and female patients with respect to the FT4 levels, Hb levels, MCV, MCH, MCHC values, and RBC counts. The findings strengthen the existing knowledge base and emphasize the importance of timely detection and management of hypothyroidism in this population. Implementation of salt iodination programs and a timely evaluation of the hematological parameters is recommended. Further research is warranted to delve into the hidden mechanisms and long-term ramifications of hematological changes associated with hypothyroidism.

Thyroid dysfunction and mortality in cardiovascular hospitalized patients

Background

Thyroid dysfunction (TD) is associated with increased cardiovascular morbidity and mortality. Early detection may influence the clinical management.

Objective

To determine the prevalence, predictors, and prognostic value of TD among hospitalized cardiac patients.

Methods

A retrospective analysis of a 12-year database consisting of nonselectively adult patients admitted to a Cardiology Department and who were all screened for serum thyroid-stimulation-hormone (TSH) levels . Statistical analysis of demographic and clinical characteristics, mortality and length of hospital stay (LOS) was performed.

Results

A total of 14369 patients were included in the study; mean age was 67 years, 38.3% females. 1465 patients (10.2%) had TD. The most frequent type of TD was mildly elevated TSH (5.4%) followed by mildly reduced TSH (2.1%), markedly elevated TSH (1.5%), and markedly reduced TSH (1.2%). Female gender, history of hypothyroidism, heart failure, atrial fibrillation, renal failure and amiodarone use were significantly associated with TD. During follow-up 2975 (20.7%) patients died. There was increased mortality in the mildly reduced TSH subgroup (hazard ratio [HR] =1.44), markedly elevated TSH subgroup (HR=1.40) and mildly elevated TSH subgroup (HR=1.27). LOS was longer for patients with TD; the longest stay was observed in the markedly elevated TSH subgroup (odds ratio=1.69).

Conclusion

The prevalence of TD in hospitalized cardiac patients is 10.2%. TD is associated with an increased mortality rate and LOS. Consequently, routine screening for thyroid function in this population is advisable, particularly for selected high-risk subgroups. Future studies are needed to determine whether optimizing thyroid function can improve survival in these patients.

Hypothyroidism Among College Students and Its Association With Academic Performance: A Cross-Sectional Study

BACKGROUND

Little is known about the impact of hypothyroidism and its contribution to learning difficulties and academic performance in college-age students.

OBJECTIVE

The objective is toassess the frequency of hypothyroidism and its associations with academic performance in college-age students.

METHODS

A cross-sectional study included 395 students studying across various Jeddah universities and selected by non-probability convenient sampling. Students self-answered the survey using Google Forms. The survey included demographic data, thyroid data, academic achievement as measured by overall grade point average (GPA), and student persistence as measured by academic failure and delay.

RESULTS

Three hundred ninety-five students were included, their median age was 23 years (17-33), 96 were males (24.3%) and 299 were females (75.7%). Their median GPA was 4 (2.76-4). Thirty-two students (8.1%) had been treated for hypothyroidism and eight students (25.8%) were non-compliant with therapy. Odds of hypothyroidism increased among females (OR 3.33, 95% CI: 0.99-10.78, p=0.048), older age (OR 2.60, 95% CI: 1.33-5.77, p=0.009), those with a positive family history of thyroid illnesses (OR 5.49, 95% CI: 2.30-13.07, p<0.001), and those with academic failure (OR 3.31, 95% CI: 1.43-7.30, p=0.003) and academic delay (OR 2.83, 95% CI: 1.14-7.05, p=0.020). There was no significant association between hypothyroidism and GPA (OR 2.42, 95% CI: 0.83-7.77, P=0.092).

CONCLUSION

Hypothyroidism was prevalent among college students (8%), especially among older females. Hypothyroidism was associated with difficult student persistence, but this association did not reflect on their overall academic achievement. Incompliance with thyroid replacement therapy may be a common issue among hypothyroid patients. Further studies should focus on specific tests of the cognitive function of different learning domains and the role of treatment.

Association between different metabolic phenotypes and the development of hypothyroidism: 9 years follow-up of Tehran thyroid study

PURPOSE

The association between metabolic phenotypes and thyroid function has not yet been established; therefore, this study examined whether different metabolic phenotypes are associated with the development of hypothyroidism.

METHODS

Study participants were selected from the Tehran Thyroid Study (TTS). A total of 3338 euthyroid adults were included and categorized into four obesity phenotype groups: metabolically healthy normal weight (MHNW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy obese (MUO). The participants were assessed at baseline and during three follow-up studies at three-year intervals. Multiple logistic regression analysis was used to examine the relationship between metabolic phenotypes and the development of hypothyroidism.

RESULTS

In the total population, the chi-square test was only significant (P=0.008) in 3^rd year with a higher prevalence of hypothyroidism in the MUNW phenotype, followed by MHO, MUO, and MHNW. Moreover, in the 3^rd and 9^th years of follow-up, hypothyroidism was more prevalent in MUO only in male subjects (P=0.002 and 0.035, respectively). In the unadjusted model, the MHO phenotype increased the odds of hypothyroidism compared with the MHNW phenotype (OR=1.51; 95% CI=1.04, 2.18; P-value=0.031). After adjusting for confounding factors, the odds of hypothyroidism were higher in the MUNW (OR=1.86; 95% CI=1.17, 2.96; P-value=0.008), MHO (OR=1.71; 95% CI=1.09, 2.67; P-value=0.018), and MUO (OR=1.64; 95% CI=1.03, 2.62; P-value=0.036) phenotypes than in the MHNW group. The MUNW phenotype increased the risk of hypothyroidism compared to MHNW, only in males. However, in females, the MHO phenotype increased the risk of hypothyroidism compared to MHNW.

CONCLUSION

Both obesity and metabolic abnormalities are associated with hyperthyroidism. Healthy metabolic and weight maintenance were associated with a lower risk of hypothyroidism in males and females.

The prevalence of thyroid dysfunction in Jordan: a national population-based survey

BACKGROUND

The objectives of this study are to assess the prevalence of clinical and subclinical hypo- and hyperthyroidism and their associated factors among Jordanian adults.

METHODS

In a cross-sectional population-based survey, a representative sample that included 3753 Jordanian adults was selected from the 12 governorates that represent the three regions of the country, in the year 2017. Sociodemographic and clinical data were obtained and blood samples were collected from all participants. Thyroid stimulating hormone (TSH), free tri-iodothyronine (FT3), free thyroxine (FT4), thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) were measured to evaluate the thyroid function.

RESULTS

The overall prevalence of thyroid dysfunction was 11.9%. Around 76% of patients with thyroid dysfunction were previously undiagnosed. The prevalence of hypothyroidism and subclinical hypothyroidism was 3.1 and 5.3%, respectively. The prevalence of hyperthyroidism and subclinical hyperthyroidism was 1.0 and 2.5%, respectively. Female preponderance which was mainly related to hypothyroid disorders was evident. The prevalence of positive TPOAb and TgAb in the study population was 14.9 and 15.3%, respectively. The prevalence of detectable TPOAb and TgAb in the euthyroid participants was10.3 and 11.9%, respectively. Logistic regression analysis revealed that female sex, age ≥ 50 years and the presence of TgAb and TPOAb were strongly associated with hypothyroidism. Hyperthyroidism was significantly associated with the presence of TPOAb and age ≥ 50 years.

CONCLUSION

The prevalence of unrecognized thyroid dysfunction is high among Jordanians. A public health policy of screening high risk groups particularly those ≥50 years of age is recommended.

Clinical, Laboratory, and Ultrasound Related Diagnoses of Thyroid Disorders: Using a Family Medicine Center Data to Assess Thyroiditis and Thyroid Nodules in the Eastern Province of Saudi Arabia

Introduction/Objectives:

The prevalence of thyroid disorders is high in Saudi Arabia. Among the disorders, goiter and thyroiditis are the most common and have unique ultrasound (US) features, underscoring the need for US screening for thyroid pathologies. This study aimed to determine the prevalence of thyroiditis and thyroid nodules in patients attending the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University.

Methods:

This registry-based cross-sectional study analyzed laboratory and US data from 240 patients who attended the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University from January 2020 to December 2021. Abnormalities of the thyroid gland were categorized according to laboratory and US data. Associations between different types of thyroid pathology and clinical and laboratory findings were assessed using appropriate statistical methods.

Results:

The majority of participants were Saudi women. The prevalence of thyroiditis in the study population was 43%. Approximately 25% of these patients had more than 1 nodule, and fine-needle aspiration biopsy showed that most nodules were benign. Most nodules were found in clinically euthyroid patients. Thyroiditis might be associated with abnormal thyroid function.

Conclusions:

Thyroiditis and thyroid nodules were common in our cohort. Vitamin D deficiency, other autoimmune diseases, and a family history of thyroid disorders were associated with thyroiditis and thyroid nodules. US is useful for identifying the type of thyroid disease.

Evaluation of medication adherence among patients with chronic diseases in Saudi Arabia

BACKGROUND

Medication adherence in chronic diseases patients is a worldwide concern. Not achieving the goal of treatments because of non-adherence will lead to more complications and eventually may lead to death. In Saudi Arabia, we have insufficient data for interpretation. Hence, this study aims to have a better perspective at the number of the non-adherent patients with chronic diseases to their medications and its associated factors.

MATERIAL AND METHOD

Cross-sectional quantitative study was conducted among chronic diseases patients living in Saudi Arabia throughout social media and hospital visits from August 2018 to April 2019. A three-section questionnaire consists of patient's health, medications and adherence characteristics. Adherence to Refills and Medication Scale (ARMS) was used to identify the level of adherence among chronic diseases patients. Univariate descriptive statistics and independent sample t-test with one-way ANOVA were used as bivariate analysis. Finally, significant predictors of medical adherence with adjusted coefficient were determined by multivariable linear regression.

RESULTS

A total of 385 patients were included in the analysis for the current study. Overall, 96.62% (n = 372) were non-adherent to their medications according to ARMS scale. Multiple linear regression model found types of co-morbidities, medication dosage form and dosage regimen to be independent predictors of medical adherence.

CONCLUSION

Medication adherence is alarmingly low among chronic disease patients in Saudi Arabia. There is a clear need for in-depth understanding for barriers. It is therefore important to conduct a qualitative study. What's known Medication adherence is a critical factor in treatment success. Low adherence to the medication is a common problem among chronic disease patients. Moreover, the majority of the studies in Saudi Arabia showed low adherence rate, and it focused in one single chronic disease only despite that patient may have more. What's new Most patients had more than one single chronic disease, so this study aims to take a snapshot to capture the adherence rate among patients who are suffering from chronic disease Saudi Arabia and its associated factors. This can help in understanding medication adherence behavior in clinical practice.

Factors Associated with Thyroid Disorders and Iodine Adequacy in Pregnant Saudi Women

Little is known about iodine adequacy and gestational thyroid disorders (GTDs) in Saudi Arabia. This study measured the rates of GTDs and iodine adequacy in 810 healthy Saudi women. Concentrations of serum thyroid hormones and 24-h urine iodine (24-h UIC), and GTDs were diagnosed according to the American Thyroid Association guidelines. Dietary and socioeconomic data to determine factors associated with GTDs and iodine insufficiency were collected. GTDs were detected in 265 women (32.7%) as follows: subclinical (SCH; 20.2%) and overt (OH; 5.8%) hypothyroidism, isolated hypothyroxinemia (ISH; 4.7%) and hyperthyroidism (2%). The SCH (109.2 μg/L; IQR: 77.2-149.7), OH (95.3 μg/L; IQR: 74.3-130.5) and ISH (107.3 μg/L; IQR: 65.5-133.1) groups had median 24-h UIC below the WHO recommended limit, whereas the euthyroid (191.4 μg/L; IQR: 170.03-219.8) and hyperthyroid (159.5 μg/L; IQR: 152.9-238.3) groups were iodine sufficient. Numbers of pregnancies, less education, not consuming iodized salt and not using iodine supplements increased risk of hypothyroidism and ISH. Contrariwise, interval ≥ 3 years from last pregnancy and higher 24-h UIC decreased odds of hypothyroidism and ISH. Moreover, dairy products and egg consumption were markedly lower in all GTD groups. Dairy products and seafood consumption correlated independently with 24-h UIC of the study participants, whereas consuming yogurt, eggs, redfish and shellfish protected against GTDs. In conclusion, GTDs appear to be prevalent in pregnant Saudi women and the hypothyroid and hypothyroxinemia groups had iodine insufficiency. However, consuming iodized salt, iodine supplements, dairy products, seafoods and eggs may protect against GTDs.

Effectiveness of hemi-thyroidectomy in relieving compressive symptoms in cases with large multi nodular goiter

Introduction and importance

This case series describe the efficacy of hemi-thyroidectomy to relieve the compressive symptoms of cases having large multi-nodular goiter with preservation of the thyroid gland function. It's considered as an education tool for surgeons to perform safe hemi thyroidectomy to patients indicated for total removal of the gland. Compressive symptoms like mild/severe dysphagia or dyspnea associated with both benign and malignant thyroid disease. Although total thyroidectomy is currently considered the standard of care, hemi thyroidectomy is another surgical option with more benefits.

Case presentation

This case series was performed in a tertiary university hospital in Riyadh, Saudi Arabia. It included 35 females and 3 males above the age of 18 (mean age 42 years). All the operations were elective hemi-thyroidectomies performed by one surgeon, during 2019. Patients were complaining of; Voice Change, Neck Swelling, Dysphagia, Chocking, SOB, and Orthopnea. 20 of them were medically free and 18 patients had multiple associated comorbidities.

Clinical findings and investigations

Demographic data, baseline co-morbidities, TSH levels prior to surgery, thyroid gland size, FNA results and pre-operative symptoms were recorded. In addition, compressive symptomatology outcomes from two weeks to two years were recorded. Thirty-two of them (84%) had their symptoms resolve completely and did not need a completion surgery. Out of the 6 who had persistent symptoms, only two needed a completion surgery. Furthermore, only 34.2% required thyroid hormone replacement, 31.6% were euthyroid and 2.6% were hypothyroid preoperatively.

Interventions and outcome

Hemi thyroidectomy was chosen to avoid the risk of hormone replacement, and hypocalcemia. Our results revealed that compressive symptoms were effectively relieved in the majority of our patients. Only 2 patients had to undergo completion thyroidectomy due to compressive symptoms with no perioperative or postoperative complications.

Relevance and impact

We would recommend hemi thyroidectomy for cases of large multi nodular goiter due to its positive implication on patient outcome particularly if the patient refuse hormonal replacement.

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Compressive symptoms were effectively relieved in the majority of our patients.

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Only 2 patients had to undergo completion thyroidectomy due to compressive symptoms.

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No perioperative or postoperative complications were witnessed during the primary or completion surgery.

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The main drawback with hemithyroidectomy is recurrence.

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Nevertheless, most recurrences post thyroid surgery are asymptomatic and are diagnosed on ultrasonography.

Spectrum and Prevalence of Thyroid Diseases at a Tertiary Referral Hospital in Mogadishu, Somalia: A Retrospective Study of 976 Cases

BACKGROUND

Thyroid disorder is one of the most common noncommunicable diseases worldwide and neglected public health issues in Somalia. The aim of the study thus was to investigate the thyroid disorders in patients attending to the largest tertiary referral hospital in Somalia.

METHODS

This retrospective study was conducted on patients admitted to the internal department of Somalia Mogadishu-Turkey Education and Research Hospital, Somali, between January 2017 and December 2019. Patients who were tested for thyroid function tests and had complete data were included. Patients with incomplete data and currently treated for any thyroid disorder were excluded from the study. Abstracted data including patients' sociodemographic characteristics, thyroid function tests, and histopathological findings were retrieved from the hospital database system.

RESULTS

A total of 976 patients with thyroid disorders were enrolled, of whom 66.6% (n = 650) were female and 33.4% (n = 326) were male. The mean age of the patients was 47 ± 18.5 years. The majority of the patients were reported in the 31-50 (35.9%) age range. The most reported thyroid function disorders were 58.8% euthyroid sick syndrome followed by 15.4% hypothyroidism, 12.5% subclinical hypothyroidism, 7.6% hyperthyroidism, and 5.7% subclinical hyperthyroidism. The distribution of comorbidity indicated that 13.4% had diabetes mellitus, 10.4% had HIV, 4.9% had malaria, and 4.5% had HIV and malaria coinfection. Thyroid malignancies were detached in 22 (2.2%) patients including eleven papillary thyroid cancer, nine patients had follicular thyroid cancer, and two patients had differentiated thyroid cancer.

CONCLUSIONS

Euthyroid sick syndrome was the most common type of thyroid disease in our setup. Hypothyroidism is the second most common, followed by subclinical hypothyroidism. Papillary thyroid cancer was the predominant histology among thyroid malignancies, followed by follicular thyroid cancer. This study revealed that thyroid diseases emerge as an important endocrine disorder encountered in Somali, necessitating a major public health response.

Potential causes of male and female infertility in Qatar

A steady decline in the fertility rate has been observed in Qatar during the past fifty years. Therefore, infertility is considered a national priority in Qatar, a pronatalist society. This review article summarises the potential causes of infertility that are particularly prevalent in the Qatari population. The high rate of consanguinity leading to genetic abnormalities, the high incidence of metabolic disease, environmental contamination due to the rapid urbanization and oil and natural gas extraction procedures are discussed. In addition, the particular lifestyle of the Qatari population and the influence of religion and culture on sexual and reproductive behavior in an Arab/Islamic society are considered. The active response of the state of Qatar in implementing ways to mitigate the effects of these factors to protect fertility are also presented.

Association between subclinical hypothyroidism and metabolic disorders: A retrospective chart review study in an emerging university hospital

Background

Subclinical hypothyroidism is defined as an increase in serum levels of Thyroid Stimulating Hormone (TSH) above the normal range, without alteration of total T4 concentrations that is reported to have association with various metabolic conditions. The study aimed to investigate any association between subclinical hypothyroidism and metabolic disorders in Al Kharj city.

Methods

This is a cross‐sectional study that included review of patients’ charts from prince Sattam bin Abdul‐Aziz University, Al Kharj, Saudi Arabia, from August 1 to November 30, 2016. Data were analyzed with SPSS version 21. Descriptive statistics were obtained as frequencies. Pearson chi‐square analysis was used to assess any differences between disease status and study variables. P‐value < 0.05 was considered significant.

Results

The mean age was 30.65 ± 13.3 with a female predominance. The average BMI was 29.5 ± 7.71; 46 (11.5%) had hypertension, 52 (46.8%) had diabetes, 173 (44%) had anemia, and 192 (56%) had vitamin D deficiency. Due to increased TSH levels, male gender had higher prevalence of subclinical hypothyroidism with P‐value < 0.001 and 0.011, respectively.

Conclusion

Subclinical hypothyroidism is a significant topic worldwide whose prevalence is rising. In this study, we could not find any significant association between subclinical hypothyroidism and metabolic disorder. Further longitudinal studies with large sample size are needed to study this association.

Anthropometric Parameters and Thyroid Morphology in a Sample of Overweight and Obese Syrian Women

Objective: Obesity and thyroid nodules are very common. Many studies have reported that weight gain is a new risk factor for goiters and thyroid nodules. In this study, the authors aimed to evaluate thyroid morphology in obese women and tried to link thyroid morphology with anthropometric parameters. Design: A cross-sectional study was conducted between January 2017 and January 2018. Overweight and obese Syrian females, aged >35 years, without past or recent thyroid complaints, and living in the southern region of Syria were included in the study. Weight, height, and hip and waist circumference were measured to calculate anthropometric parameters. Thyroid volume and prevalence of thyroid nodules were compared among BMI groups as defined by World Health Organization classifications. Body Surface Area (BSA), waist circumference (WC), waist:hip ratio, and waist-to-height ratio (WtHR) were compared between nodule groups. Results: A total of 140 overweight and obese females, with a mean age of aged 53±7 years were studied. Mean thyroid volume was 12.4±7.4 mL, with the highest volume identified in the Obesity Class III group (14.9±10.9 mL). Significant positive correlations were found between thyroid volume and weight, BMI, WC, BSA, and WtHR (p<0.05). Thyroid nodule prevalence was 84.3%, and 22.0% of the nodules were fine needle aspiration indicated. Weight and BSA were positively correlated with thyroid nodules (p<0.05), while BMI was not. Conclusion: Thyroid volume was positively correlated with increased weight, BMI, WC, BSA, and WtHR in Syrian females. Positive correlations were found between weight, BSA, and thyroid nodules after age and thyroid stimulating hormone were excluded.

Global epidemiology of hyperthyroidism and hypothyroidism

Thyroid hormones are essential for growth, neuronal development, reproduction and regulation of energy metabolism. Hypothyroidism and hyperthyroidism are common conditions with potentially devastating health consequences that affect all populations worldwide. Iodine nutrition is a key determinant of thyroid disease risk; however, other factors, such as ageing, smoking status, genetic susceptibility, ethnicity, endocrine disruptors and the advent of novel therapeutics, including immune checkpoint inhibitors, also influence thyroid disease epidemiology. In the developed world, the prevalence of undiagnosed thyroid disease is likely falling owing to widespread thyroid function testing and relatively low thresholds for treatment initiation. However, continued vigilance against iodine deficiency remains essential in developed countries, particularly in Europe. In this report, we review the global incidence and prevalence of hyperthyroidism and hypothyroidism, highlighting geographical differences and the effect of environmental factors, such as iodine supplementation, on these data. We also highlight the pressing need for detailed epidemiological surveys of thyroid dysfunction and iodine status in developing countries.