Reproductive health Problems Associated with Thyroid
Indian Journal of Public Health Research & Development, April-June 2018, Vol.9, No. 2 65 probably may be a consequence of the myth that people
residing in coastal areas eat plenty of sea foods and hence do not develop iodine deficiency disorders.13
This study was therefore done among university female students with thyroid disorders in this settings to assess their reproductive health problems. This would help the cause to implement suitable remedial measures among the affected in future.
MATeRIAlS ANd MeThOd
This cross sectional study was done in a private medical, dental and nursing college in February 2014.
The Institutional Ethics Committee gave ethical clearance for this study. Informed consent was taken in writing from participants after explaining to them the nature and purpose of this study.
The minimum required sample size was calculated as 349 at 95% confidence level, 20% relative precision and assuming the proportion of female college students with thyroid disorders as 21.6% 14 as reported in a previous study.
Using convenience sampling method, a total of 510 participants took part in this study. Students who were known case of polycystic ovarian syndrome (PCOS), Cushing’s syndrome and who were not consenting were excluded from this study.
Questions on socio-demographic information, presence and type of thyroid disorders and dietary habits of participants were part of the questionnaire. Questions to assess emotional problems like feeling moody or easy fatigability over previous 2 weeks, questions on difficulty in maintaining ideal body weight and in controlling excess weight and of menstrual problems,
over the past 6 months were also part of the questionnaire designed in a 7 point Likert scale. Content validation of the questionnaire was done by experts before the study began. It was then pretested in a group of 10 students before its use in the study.
Stadiometer was used to record height to the nearest 0.1 cm and a standard weighing scale was used to record weight to the nearest 0.5 kilograms. Body Mass Index (BMI) was categorized based on Asian classification.
Data was entered and analyzed using SPSS Inc.
Illinois, USA version 17.0. Pearson Chi-square test was used for analysis of association between variables. P value
≤ 0.05 was taken as cut off for statistical significance.
FINdINgS
Of the total 510 participants, 39 were known case of PCOS and hence were excluded from this study. A total of five incompletely filled forms received were also excluded from analysis. The mean age of the remaining 466 participants was 20.4+1.5 years. The participants comprised of MBBS students 294(63.1%), BDS 93(20%) and 79(16.9%) nursing students. Majority were non vegetarians 357(76.6%) and were from urban areas 414(88.8%). As many as 25(5.4%) had thyroid disorders and all these were cases of hypothyroidism.
(Table 1) Mean age of the participants who were known cases of hypothyroidism was 20.36+1.7 years. The mean age at menarche was 12.8±1.7 years among those with hypothyroidism compared to 12.8+1.3 years among others (t=0.015, P=0.988).
There was no association of age (P=0.67), type of diet (P=0.681) and place of residence (P=0.891) with hypothyroid status among participants. (Table 1)
Table 1: distribution of socio demographic and other risk factors of hypothyroidism among participants.
Characteristics Hypothyroidism present (%) Hypothyroidism absent (%) Total Age (years)
18 2(6.9) 27(93.1) 29
19 7(6.1) 107(93.9) 114
20 5(4) 119(96) 124
21 8(7.4) 100(92.6) 108
≥22 3(3.3) 88(96.7) 91
X2 = 2.36, p=0.67
66 Indian Journal of Public Health Research & Development, April-June 2018, Vol.9, No. 2 Contd…
Type of diet
Vegetarian 5(4.6) 104(95.4) 109
Non vegetarian 20(5.6) 337(94.4) 357
X2 = 0.169, p=0.681 Place of residence
Urban 22(5.3) 392(94.7) 414
Rural 3(5.8) 49(94.2) 52
X2 = 0.019, p=0.891
Total 25 441 466
Difficulty in maintaining ideal body weight was reported by 15(60%) and trouble in controlling excess weight by 12(48%) participants with hypothyroidism over the past six months. These problems were significantly associated with hypothyroidism. (Table 2)
Table 2: Association between presence of hypothyroidism with symptoms like tiredness and problems with weight control among participants (n = 466).
Difficulty in maintaining ideal body weight in the past 6 months
hypothyroidism All of the time (%)
Most of the time
(%)
A good bit of the time
(%)
Some of the time
(%)
A little of the time
(%)
hardly any of the time
(%)
None of the time
(%) Total
Present 4(16) 3(12) 6(24) 2(8) 3(12) 4(16) 3(12) 25
Absent 32(7.3) 34(7.7) 28(6.3) 56(12.7) 47(10.7) 72(16.3) 172(39) 441 X2 = 18.1, P = 0.006 Trouble controlling excess weight in the past 6
months
Present 4(16) 2(8) 6(24) 0(0) 7(28) 1(4) 5(20) 25
Absent 14(3.2) 36(8.2) 27(6.1) 49(11.1) 55(12.5) 57(12.9) 203(46) 441 X2 = 32.9, P<0.001 Feeling easily tired in the past two weeks
Present 2(8) 2(8) 5(20) 4(16) 8(32) 2(8) 2(8) 25
Absent 19(4.3) 21(4.8) 72(16.3) 82(18.6) 92(20.9) 80(18.1) 75(17) 441 X2 = 5.4, P=0.492 Late menstrual periods and irregular menstrual periods over previous 6 months were reported by 10(40%) and 9(36%) hypothyroid cases respectively and these symptoms were also significantly associated with hypothyroidism among participants. (Table 3)
Table 3: Association between presence of hypothyroidism with various menstrual symptoms and mood changes among participants (n = 466).
Feeling moody in the past two weeks hypothyroidism A severe
problem (%)
A major problem
(%)
Moderate problem
(%)
Some problem
(%)
A little problem
(%)
hardly any problem
(%)
problem No
(%) Total
Present 2(8) 2(8) 4(16) 6(24) 4(16) 5(20) 2(8) 25
Absent 18(4.1) 34(7.7) 75(17) 88(20) 102(23.1) 66(15) 58(13.2) 441 X2 = 2.5, p = 0.872
Indian Journal of Public Health Research & Development, April-June 2018, Vol.9, No. 2 67 Contd…
In relation to your previous menstrual periods having late menstrual period in the past 6 months
Present 3(12) 0(0) 3(12) 4(16) 5(20) 2(8) 8(32) 25
Absent 10(2.3) 18(4.1) 34(7.7) 42(9.5) 55(12.5) 90(20.4) 192(43.5) 441 X2 = 14.2, p=0.027 In relation to your previous menstrual periods having irregular
menstrual period in the past 6 months
Present 4(16) 2(8) 1(4) 2(8) 7(28) 4(16) 5(20) 25
Absent 12(2.7) 25(5.7) 34(7.7) 39(8.8) 49(11.1) 77(17.5) 205(46.5) 441 X2 = 22.2, p = 0.001 Overweight and obesity was significantly more among hypothyroid participants compared to others (p=0.045).
(Table 4)
Table 4: Association between hypothyroid status and body mass index of participants.
hypothyroid status Under weight (%) Normal (%) Overweight/ Obesity (%) Total
Present 0(0) 17(68) 8(32) 25
Absent 59(13.4) 306(69.4) 76(17.2) 441
Total 59 323 84 466
X2 = 6.21, p=0.045
dISCuSSION
The proportion of diagnosed cases with hypothyroidism in this study was 5.4%. This was less compared to proportion of female university students with thyroid gland enlargement reported as 21.6% in a study done in Yerevan, Armenia.14
In a study done in Delhi, India among school girls aged between 6 to 18 years, 20.2% had hypothyroidism.15 The prevalence of hypothyroidism in women in reproductive age group has been found to range from 2% to 30% in other studies.16-18 Hypothyroidism was observed in 11.5% to 19.1% among women of all age group in previous studies.1,19 From these observations it is evident that females form a high risk group for developing thyroid disorders.
In this study, late menstrual periods and irregular menstrual periods was significantly seen among hypothyroid participants compared to euthyroid participants which was similar to the observations of Krassas GE.20 Menstrual irregularities was reported by more than one-third of hypothyroid cases in this study in comparison to 23.4%20 and 68%21 reported in other studies. The other issues like difficulty in weight control
experienced by majority of hypothyroid cases in this study indicates that in future they are highly prone to develop reproductive health problems associated with obesity.
CONCluSION
This study observed that overweight and menstrual problems were associated with hypothyroidism among female students of various university colleges in the present settings. Therefore implementation of suitable remedial measures along with educational programs for awareness generation of long term consequences on reproductive outcomes due to hypothyroidism needs to be done in the settings.
limitations: This is the first study done on this aspect among female university students in this settings.
However since it is an institution based study and not a community based one, the findings may be representing only the tip of iceberg, and the magnitude of the real problem in the community could be much more than that actually observed in this study. There is also a possibility of undiagnosed cases of thyroid disorders among the comparison group in this study.
68 Indian Journal of Public Health Research & Development, April-June 2018, Vol.9, No. 2 Conflict of Interest: None declared
Source of Support: Nil
ethical Clearance: Obtained from Institutional Ethics Committee of Kasturba Medical College, Mangalore.
Source of Funding: None
Conflict of Interest: None declared
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