Background: There is some "gray zone" of thyroid cytology, where the diagnostic efficacy declines sharply rendering it difficult to exactly categorize the lesion resulting in discrepancy. The aim of the study is to assess the accuracy of fine needle aspiration of the thyroid and critically evaluate the cytohistological discordant cases. Materials and Methods: A total of 447 patients with thyroid swelling were aspirated during a seven-year study period. Cases showing cytohistologic disparity were reevaluated for the detection of possible causes of failure. Results: In our study, cytohistologic concordance was achieved in 80.28% of the cases. Of the discordant cases, false positives accounted for 11.60% and false negatives for 9.8%. Suboptimal material and underdiagnosis of papillary carcinoma due to cystic degeneration were recognized as common pitfalls. Too much emphasis on cellularity and architectural pattern led to the erroneous false positive diagnoses. Conclusion: Strict adherence to adequacy criterion and meticulous examination of all the smears are of paramount importance in reducing discrepant cases.

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Aim: Hypothyroidism and metabolic syndrome are well-associated risk factors for atherogenic cardiovascular disease. Insulin resistance, being a common pathogenic mechanism in both, can cause a considerable overlap between hypothyroid and metabolic syndrome population. This cross-sectional study was intended to assess the thyroid function in patients with metabolic syndrome and to investigate the association between hypothyroidism and metabolic syndrome. Materials and Methods: One hundred patients with metabolic syndrome as per National Cholesterol Education Program-Adult Treatment Panel (NCEP ATP) III criteria and 50 controls (0 out of 5 criteria) attending the internal medicine outpatient clinic were included in the study. Patients were subjected to anthropometry, evaluation of vital parameters, and lipid and thyroid profile, along with other routine laboratory parameters. Students' "t" test, Chi-square test, linear regression, and multiple logistic regression models were used for statistical analysis. P value <0.05 was considered significant. Results: Body mass index, waist circumference, mean systolic pressure, diastolic pressure, fasting blood sugar, total cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, and thyroid stimulating hormone (TSH) were significantly higher, and free triiodothyronine (FT3), free thyroxine (FT4), and high density lipoprotein (HDL) cholesterol were significantly lower in the study group compared to the control group. In the metabolic syndrome group, 22 had subclinical hypothyroidism (22%), 4 were overtly hypothyroid (4%), and 74 were euthyroid (74%). Subclinical hypothyroidism was significantly associated with metabolic syndrome group (P = 0.032). There was significant linear association between TSH levels and total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol across the metabolic syndrome group in the linear regression model. Multiple logistic regression analysis recognized the association between body mass index with subclinical hypothyroidism (P = 0.006) in the metabolic syndrome group. Conclusion: It is concluded from this study that there is significant association between subclinical hypothyroidism and metabolic syndrome, and it highlights the importance of thyroid function tests in patients with metabolic syndrome.

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Maternal and fetal thyroid profiles differ throughout gestation. Due to many physiological changes during pregnancy, interpretation of thyroid function tests needs trimester specific reference intervals. American Thyroid Association strongly recommends to refer to population defined trimester-specific reference ranges with optimal iodine intake Though some studies have reported this reference range in South and a few in North, there has been no data from Central India yet. Aims and Objectives: To establish normative range of TSH in each trimester of pregnancy, To establish normative range of f T3 and f T4 in each trimester of pregnancy and to know the prevalence of subclinical hypothyroidism in normal pregnancies. Materials and Methods: in all 177 normal singleton pregnant women were screened and out of them 150 enrolled in the study(50 in each trimester). Their TSH, fT3, fT4 and urinary iodine was estimated. Observations and Results: The reference range of thyroid hormones for 1st trimester found in the present study are as follows: TSH: 0.24-4.17 (uIU/ml), fT3: 0.29-3 .1 (ng/100 ml), fT4: 01-2.2 (ng/100 ml). For 2 ^nd trimester: the reference range for TSH , fT3 and fT4 are 0.78-5.67 (uIU/ml) , 0.27-3.34(ng/100 ml) ,and 0.45-2.24 (ng/100 ml) respectively. For 3 ^rd trimester, the reference range for TSH , fT3 and fT4 are 0.47-5.78 (uIU/ml), 0.24-3.61(ng/100 ml) and 0.47-5.1 (ng/100 ml). Prevalence of subclinical hypothyroidism was found to be 4% in first and second trimesters and 8% in third trimester. No case was seen with clinical hypothyroidism. Conclusion: This study states the range of thyroid hormones in all 3 trimesters of pregnancy. The prevalence of subclinical hypothyroidism was found out to be 4% in first and second trimesters each and 8% in third trimester.

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Background: Only few studies concerning thyroid status and intellectual evaluation in iron deficiency anemia, which is frequently seen in primary school children in Egypt. Aim: The present study was planned to investigate the effect of iron deficiency anemia on the thyroid functions and intellectual activity of young children in a primary school. Settings and Design: Cross-sectional controlled study. Patients and Methods: This study was carried out on 60 primary school children aged 6-12 year with iron deficiency anemia (Group 1) and 20 children as control (Group 2). Complete blood count, iron, total iron binding capacityferritin, thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroid hormones (FT4 and FT3), and intelligence quotient (IQ) were determined in all the children included in the study. Results: TT3 and TT4 values were statistically lower while TSH is significantly higher in the study group as compared to control (P < 0.001 for each). Patients with hemoglobin (HB) level < 10 > 7 g/dl had significantly lower levels of serum FT3 and FT4 (P < 0.01 for both) and significantly higher levels of serum TSH (P < 0.05) as compared to patients with HB level <7 g/dl. Serum ferritin was correlated negatively with TSH levels (r = −0.76, P < 0.001) while positively with TT4 (r = 0.69, P < 0.001) and TT3 (r = 0.84, P < 0.001) levels. A significant positive correlation was found between serum level of TT3 and transferrin saturation% (r = 0.78, P < 0.001). Total, as well as performance IQ were significantly lower in patients than controls with P <0.05 for each. Significant positive correlations were observed between both total and performance IQ and thyroid hormone levels and iron status parameters. Conclusion: Egyptian primary school children with iron deficiency anemia especially severe type are liable to develop subclinical hypothyroidism and intellectual dysfunction. A randomized, double-blind, controlled study is needed to address the question of whether subclinical hypothyroidism associated with iron deficiency anemia should be treated with oral iron only or iron and levothyroxine combination aiming to prevent the combined effects of both conditions on cognitive function of the brain. Moreover, more comprehensive studies are needed to elucidate if the effect of iron deficiency anemia on thyroid status is reversible or not.

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It is a known fact that thyroid malignancies are the most common of endocrine malignancies. Furthermore, differentiated thyroid malignancies including the papillary and follicular types are the most common among these malignancies of the thyroid. However, it is extremely uncommon to get a combination of two primary malignancies within the same thyroid gland. These combinations can be classified into collision tumors, mixed tumors, and composite tumors. Whenever such tumors have been described, they have almost always been combinations of papillary carcinoma and medullary carcinoma. Recently, a couple of cases of combinations of papillary and follicular carcinomas are being reported. It is difficult to completely explain the occurrence of such tumor types together in the same gland. Various theories have been proposed to explain this simultaneous occurrence such as the stem cell theory, collision theory, and the hostage theory. It is now accepted that these tumors should be considered more aggressive and having a higher risk of recurrence as compared to either of the tumors occurring independently. Treatment should be patient specific and is directed by the more aggressive of the tumors; however, no standardized protocols for diagnosis or treatment have evolved due to lack of significant information on their behavior.

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Chronic autoimmune thyroiditis is the most common cause of hypothyroidism worldwide. Sometimes, it is associated with a transient hyperthyroid phase. This hyperthyroid phase, called Hashitoxicosis (the term generally refers to a combination of thyrotoxicosis/hyperthyroidism in the setting of ongoing autoimmune thyroiditis), is self limiting, and lasts for a period of a few weeks to some months. During this time, classical symptoms of mild to moderate hyperthyroidism may co-exist with a diffuse, firm, painless goiter. Thyroid scintigraphy may show normal or a slightly increased uptake. Anti-thyroid antibodies are often positive, and ultrasound with Doppler is a useful test. A combination of clinical features, thyroid function tests, and appropriate radiology will help make the diagnosis. This mini review will touch upon the clinical aspects of Hashitoxicosis.

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Objective: The thyroid gland is essential for metabolism and normal function of body cells, including the liver cells. It helps in the development and maturation of the hepatocytes and other body cells and tissues. This study investigated the effect of altered thyroid state on liver function. Materials and Methods: Rats were randomized into three groups: control, hypothyroid, and hyperthyroid rats. Results: Thyroid dysfunction led to lysis of the hepatocytes. Hypothyroidism caused significant (P < 0.05) reduction of body weight gain, serum total protein, albumin, direct bilirubin, transaminases, and gamma glutamyl transferase. Hyperthyroidism led to significant (P < 0.05) body weight loss. Hypothyroidism and hyperthyroidism were associated with significant (P < 0.05) increase in liver weight and diameter. Conclusion: This study reveals that although hyperthyroid state is not associated with altered liver function, hypothyroidism caused hepatic dysfunction. We therefore suggest that liver function indices should be monitored in altered thyroid states, especially in hypothyroidism.

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Thyroid ectopia is a dysgenesis of thyroid gland. A series of seventeen patients with ectopic thyroid tissue and dyshormonogenesis is presented here. Patient data were reviewed retrospectively for this descriptive study. At presentation, age of the patients ranged from 2 months to 50 years (mean age -13.7 yr). Male to female ratio is 1: 7.5. Hypothyroidism is present in 94.1% cases whereas 5.88% (one case) cases have thyrotoxicosis. Though dyshormonogenesis was the main reason for reference of these cases to our department, a variety of other symptoms like dysphagia (5.88%), obstructive sleep apnea (5.88%), swelling in the neck (17.6%), slow growth were also present (5.88%). Other than thyroid replacement therapy for hypothyroidism and radioactive iodine therapy for thyrotoxicosis, surgical removal was advised in two cases of persisting obstructive symptoms.

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Objectives: This paper describes the prevalence of hypothyroidism, in young children and adolescents, aged less than 18 years, with type 1 diabetes mellitus, in northern India. Materials and Methods: Seventy patients (23 female, 47 male) were screened for hypothyroidism, using serum TSH, as part of a detailed assessment of the clinical profile of children and adolescents with type 1 diabetes in an endocrine centre located in Haryana, northern India. Results: Seven girls were found to have hypothyroidism of varying degree, and two boys had subclinical hypothyroidism. Conclusion: Thus, hypothyroidism is found to be a frequent association with type 1 diabetes mellitus in northern India.

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Context: Nigella sativa, (black cumin seeds) compounds display a remarkable array of biochemical, immunological, and pharmacological actions, including bronchodilatory, antibacterial, hypotensive, immunopotentiating, hypoglycemic, and antitumor activity. Aims : The aim of the present study was to evaluate effects of Nigella sativa L. ethanolic extract (NSE) on the thyroid function test in normal and alloxan-induced diabetic Wistar albino rats. Settings and Design: Experimental study. Materials and Methods: Alloxan monohydrate was injected intraperitoneally at single dose of 150 mg/kg body weight to induce diabetes. Twenty Wistar albino rats were divided into four groups: NSE-treated normal, diabetic, NSE-treated diabetic, and control. NSE was administered daily orally by gavage at a dose of 1 g/kg body weight for 14 days. Serum concentration of TSH, T ₄ , T ₃ were measured by radioimmunoassay on day 7 ^th and 14 ^th . Statistical Analysis Used: Data are expressed as the mean ± S.E.M. For statistical analysis, ANOVA was used. Results: NSE induced a significant increase in the T ₃ serum concentration on both day 7 ^th and 14 ^th in the diabetic rats and increase T ₄ serum concentration on day 14 ^th in the normal rats. Conclusions: The results revealed that daily oral administration of Nigella sativa L. ethanolic extract (1 g/kg Bwt.) for 14 days significantly increased the serum concentration of T ₄ in the normal Wistar albino rats. On the other hand the results revealed that treatment returned the serum concentration of T ₃ to the normal level in the Alloxan-induced diabetic rats. Further work is suggested for evaluating the effect of Nigella sativa L. on the serum concentration of thyroid hormones to elucidate the possible mode of action.

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Autoimmune polyendocrine syndrome II (APS II) is defined as Primary adrenal insufficiency with Autoimmune hypothyroidism and/or Type 1 Diabetes. Hypothyroidism is commonly diagnosed but adrenal insufficiency often gets missed out. Levothyroxine replacement before glucocorticoid replacement in a patient APS II can lead to precipitation of adrenal crisis. We report a case of Autoimmune polyendocrine syndrome type II (Schmidt syndrome) who presented to us in adrenal crisis after having started on Levothyroxine without glucocorticoid replacement.

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Subclinical hypothyroidism (SH), defined as an elevated serum TSH level, but normal serum Free T4 and T3 levels, is a common laboratory finding, but its clinical significance remains uncertain and controversial. This brief review will summarize the definition, epidemiology, current data related to the effects of SH on cardiovascular risk and in pregnancy, and clinical guidelines on therapy.

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Introduction: Iodine is an essential micronutrient with an RDA of 100-150 μg for normal human growth and mental development. Iodine deficiency disorder (IDD) refers to complex clinical and subclinical disorder caused mainly due to inadequate intake of food with sufficient iodine . Aims and Objectives: The objective was to find out the prevalence of goiter in primary school children; to determine median urinary iodine concentration; to assess the level of iodine in salt samples at household. Materials and Methods: A 30-cluster survey was done in Jamnagar district in primary school children (6-12 years). A total of 70 children from first to seventh standards (35 boys and 35 girls) and 20 children from the community in each cluster were included. Total 2792 children were taken for the total goiter examination by population proportion to size in each cluster with informed consent. A total of 360 children were tested for the median urinary concentration and 750 salt samples were tested on the spot with a test kit from the households of the study population. Results: The total goiter rate was 4.83% among primary school children aged 6-12 years with no significant difference between age and sex. As the age increased the goiter prevalence also increased but the difference was not statistically significant (P > 0.05). The median urinary iodine excretion level of the district was found 80 mcg/l. It was observed that 81.9% salt samples had more than 15 ppm (as recommended) iodine content. Conclusion: The goiter prevalence is less in the study district but low median urinary iodine excretion and use of insufficient iodized salt at households describe the inadequacy in efforts to eliminate IDDs in the district.

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Background: Fine needle aspiration cytology (FNAC) is the commonly used test for diagnosis of thyroid nodules. FNAC is a cost-effective procedure that provides specific diagnosis rapidly with minimal complications. Based on the cytology findings, patients can be subjected to surgery only in cases of malignancy, thereby decreasing the rate of surgery and its consequent complications. The purpose of our study was to find the diagnostic accuracy of FNAC in thyroid lesions and to compare it with histopathology. Materials and Methods: A retrospective hospital-based study was conducted at Department of Pathology in a tertiary care institute and associated hospital of Bhopal. Data were collected from the records of FNAC and histopathology of thyroid lesions, done in last 4 years duration. Analysis was done by entering data in SPSS software, and Chi-square test was applied to find statistical significance. Results: FNAC was done on 234 patients in 4 years duration. The most common thyroid lesions were benign [221 (94.4%)], followed by malignant only [6 (2.6%)], indeterminate [3 (1.3%)], and inadequate [4 (1.7%)]. Out of 221 (94.4%) benign thyroid lesions, 33% were simple colloid goiter, 27.6% goiter with cystic changes, 16.28% nodular colloid goiter, 10.41% lymphocytic thyroiditis, 4.53% thyroglossal cyst, 4.07% colloid goiter with hemorrhage, 0.9% were follicular adenoma, and others formed 3.17%. Out of six (2.6%) malignant thyroid lesions, three were papillary carcinoma and the other three were follicular neoplasm. Conclusions: The cytological criterion for the diagnosis of thyroid lesions as benign and malignant by FNAC is a highly reliable method for the diagnosis. FNAC showed sensitivity, specificity, and diagnostic accuracy of 100% in the diagnosis of malignant lesions like papillary carcinoma as well as thyroglossal cyst and abscess.

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Background: The spectrum of thyroid disease varies from underactive thyroidism (hypo) to overactive (hyper) thyroidism. It is a common endocrine disease reported worldwide and leads to major consequences of the human body, if left untreated. Aim: The aim is to exhibit the spectrum of thyroid disorders based on age and sex during the period of study in the hospital. Settings and Design: This study was conducted in a teaching and medical college hospital in Kerala State during a time period of five years from April 2005 to March 2010. Materials and Methods: The medical records department follow the guidelines of World Health Organization-International Classification of Diseases (WHO-ICD)-10 for classification of diseases and collected data were analysed by Statistical Package for the Social Sciences software (SPSS) package. Statistical Analysis: 'Z' test applied for finding out the comparison of proportions. Results: Out of 1088 thyroid cases, 152 (14%) were males and 936 (86%) were females. In males and females, the highest proportion of cases was reported in 40-60 years, which accounted for 58 cases (38.2%) and 386 cases (41.2%), respectively. The age group <20 years only shows significant difference between male and female (P = 0.02). The most commonly observed type of thyroid disorder is non-toxic multinodular goiter (E04.2), which is 528 (48.5%). In females, the most common type of thyroid disorder is non-toxic multi nodular goitre (E04.2) and in males it is hypothyroidism, unspecified (E03.9) is 45 29.6%. Conclusion: Public awareness regarding the thyroid disorder is important especially among the females and untreated thyroid disease can produce serious consequences to the health.

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Introduction: Hypocalcemia is an important and common complication following thyroid surgery with reports varying from 0.5% to 75%. Despite being self-limiting in most patients, symptomatic hypocalcemia is of particular concern because of a delay in its manifestation and the consequent need for prolonged patient hospitalization or re-admission. Aim of the Work: The aim of this study is to evaluate the clinical usefulness of oral calcium and vitamin D administration after total thyroidectomy in the prevention of post-operative hypocalcemia. Materials and Methods: Fifty patients who underwent total thyroidectomy for non-toxic goiters were randomly assigned to routinely receive or not receive oral calcium (1.5 g/d) and vitamin D (0.5 μg/d) for 4 weeks. Hypocalcemic symptoms and signs and total serum calcium levels were monitored and compared between the 2 groups. Results: The incidence of symptomatic and laboratory hypocalcemia was lower in the treatment group receiving the supplement than in the control group not receiving the supplement: 6 of 25 patients (24%) versus 11of 25 (44%). The hypocalcemic symptoms were minimal in the treatment group but more severe in the control group not receiving the supplement. Serum calcium levels decreased in both groups after surgery but were less in the treatment group. Conclusion: Routine administration of a supplement containing oral calcium and vitamin D may be effective in reducing the incidence and severity of hypocalcemia after total thyroidectomy.

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Background: Preventable thyroid dysfunction has remained a neglected entity worldwide. Excess fluoride consumption over years leads to irreversible thyroid dysfunction. Materials and Methods: Subjects (N = 275) with thyroid dysfunction were recruited from medicine and endocrinology OPDs/wards and were thoroughly examined. The source and type of water consumed by these subjects was asked and sampled for fluoride analysis. Results: A majority (75%) of the subjects were females. Hypothyroidism including subclinical hypothyroidism was the major underlying dysfunction. Majority of the afflicted (53%) consumed ground water as their predominant drinking water source. Fluoride content was well above acceptable limits of potability (1mg/L) in ground water and this correlated positively with elevated serum thyroid stimulating hormone (TSH) and negatively with free T3 levels in blood. The correlation was statistically significant (P < 0.05). Conclusion: Excess of fluoride in drinking water was the plausible cause of hypothyroidism in study individuals. Fluoridation of water for prevention of dental caries is a policy that can be amended for the sake of this larger picture. Thyroid diseases deserve recognition as non-communicable diseases (NCDs) of public health importance.

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Introduction: Hypothyroidism is a common functional disorder of the thyroid gland. Despite extensive research, data on this subject are lacking from the northeastern part of India, which falls in the Sub-Himalayan goitrogenic belt. Therefore, we decided to study the profile of hypothyroidism in Assam, a northeastern state with the following objectives: to determine the prevalence of hypothyroidism and to describe the various modes of clinical presentation. Materials and Methods: The study was conducted at a clinic-cum-radioimmunoassay laboratory in Guwahati, Assam, from January to November 2011. Two thousand and four hundred fifty-six patients referred to our center from different parts of Assam were evaluated clinically and their thyroid profile was estimated. Antithyroid peroxidase (TPO) antibody was estimated in 1950 patients. Results: The prevalence of overt hypothyroidism was 10.9% (n = 267) and that of subclinical hypothyroidism was 13.1% (n = 321). Male:female ratio was 1:3. Among the cases of overt hypothyroidism, 247 (92.51%) were adult hypothyroids, 15 (5.62%) juvenile hypothyroids, and 5 (1.87%) cretins. The common presenting features of hypothyroidism were weakness (98%), lethargy (95%), dry and coarse skin (87%), and body ache (85%). Uncommon modes of presentation were pleural and pericardial effusion, low body weight, frequent motions, and palpitations. Postthyroidectomy and drug-induced hypothyroidism accounted for 2.38% cases each and postpartum hypothyroidism for 3.74% cases. Thirteen percent cases presented with goiter. The prevalence of anti-TPO antibody in the study population was 8.41%. Conclusion: Hypothyroidsm is no longer a rarity, and Assam is no exception to this phenomenon. A population-based epidemiological study of thyroid disorders in Northeast India is an urgent need.

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Background: Levothyroxine sodium is widely prescribed to treat primary hypothyroidism. Conventionally, levothyroxine is asked to be taken in the morning on an empty stomach. A pilot study showed that levothyroxine intake at bedtime significantly decreased thyrotropin levels and increased free thyroxine (fT) and total triiodothyronine levels. Till date, no large randomized trial investigating the best time of levothyroxine intake, including quality-of-life evaluation has been performed. Materials and Methods: The primary objective of this study was to compare the serum thyroid stimulating hormone and fT₄level between patients taking evening dose of levothyroxine with patients taking morning dose. The secondary objectives were to compare lipid profile between patients of the two groups. Results: A total of 147 patients were recruited and randomized into either of the study groups (73 in Group A and 72 in Group B). A total of 58 patients in Group A and 57 patients in Group B were considered for statistical evaluation. There was no statistical difference in achievement of euthyroidism and improvement of thyroid profile between the two groups. Changes in values of total cholesterol, triglyceride, low-density lipoprotein (LDL), very LDL and high-density lipoprotein were not significantly different between the groups. Conclusions: Levothyroxine taken at bedtime improved thyroid hormone level. Serum lipid levels showed no significant changes with bedtime versus morning intake. Clinicians may consider prescribing levothyroxine at bedtime as an alternative to the conventional morning dose.

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Introduction: Thyroid disorders are among the common endocrine disorders in pregnant women. It is now well established that not only overt but subclinical thyroid dysfunction can also have adverse effects on fetal and maternal outcome. Maternal hypothyroidism during pregnancy raises serious concern about long-lasting psycho-neurologic consequences for the progeny, due to the risk of insuf-ficient placental transfer of maternal thyroid hormones to the developing fetus during the first half of gestation. To validate the need of antenatal screening for maternal thyroid dysfunction this study was undertaken to know the prevalence of thyroid dysfunction among pregnant women in Central India. Materials and Methods: In this ongoing study so far 73 patients in the first trimester of pregnancy have been recruited from Matru Seva Sangh Hospital. Detailed history and examination were done. Serum thyroid-stimulating hormone (TSH) estimation was done by the immunoradiometric assay method. Results: Out of 73 patients, 30 (41%) had TSH less than 2 mIU/ml, 35 out of 73 (47.95%) had TSH between 2 mIU/ml and 4 mIU/ml. The TSH value of more than or equal to 4 mIU/ml was seen in 8/73 (10.96%). Two patients also had gestational diabetes. TSH levels were more than 2 in both. Conclusions: Prevalence of hypothyroidism is more than 10%. As per recommendations all patients with TSH levels more than 2 should be evaluated for free T4 and thyroid antibody estimation. Screening for thyroid dysfunction should be done early in pregnancy. Looking at the high percentage of abnormal TSH in pregnancies, universal screening should be considered.

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Hypothyroidism is a chronic disease which needs active patient participation for optimal management. Compliance with suggested therapy is necessary in order to achieve euthyroid health. It is surprising, however, that this aspect of thyroid management has not been highlighted in detail in thyroidology literature. This brief communication discusses concerns of physicians as well as patients with hypothyroidism. It lists drug-related, patient-related, and physician-related factors which may impact compliance and suggests simple methods of improving concordance with therapy. The paper calls for acceptance of a patient-centered approach to the management of hypothyroidism.

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