Prevalence of hypothyroidism in benign breast disorders and effect of thyroxine replacement on the clinical outcome.
BACKGROUND
The aim of this study was to determine the prevalence of hypothyroidism in patients with benign breast disorders (BBD). We then asked if thyroxine replacement in hypothyroid patients has any impact on the clinical outcome of the BBD.


METHODS
This prospective study included 201 women with BBD. None of the included patients had previously suspected hypothyroidism. Clinical, laboratory, and follow-up details of the patients were noted. Baseline serum thyroxine, thyroid-stimulating hormone (TSH), and prolactin estimation was done in all cases. Thyroid peroxidase antibody (TPOAb) estimation was done in hypothyroid patients and/or patients with a goiter. In addition to the standard conservative management protocol, hypothyroid patients were given thyroxine replacement therapy. Their response to treatment was assessed at 3-month intervals. The clinical outcomes of euthyroid and hypothyroid groups were compared.


RESULTS
The mean age of the patients was 34 +/- 8 years, and the mean length of follow-up was 13.0 +/- 4.2 months. The overall prevalence of hypothyroidism was 23.2% (nipple discharge 37%, mastalgia 23%, lump/lumpiness 17.4%). The rate of hypothyroidism and the mean serum TSH concentration were significantly higher among patients with nipple discharge than among those with mastalgia (P = 0.001) or a lump (P = 0.01). In all, 39% of hypothyroid women had TSH concentrations >10 mIU/l, and 53% had an elevated TPOAb titer. BBD symptoms were alleviated in 83% of the hypothyroid patients with only thyroxine replacement. The final clinical outcomes of hypothyroid patients with nipple discharge and mastalgia were significantly better than that of their euthyroid counterparts (P = 0.028 and 0.001, respectively); no significant difference was noted in patients with lumpiness (P = 0.144).


CONCLUSIONS
All women with BBD should be screened for hypothyroidism because the prevalence of hypothyroidism is high among this group and correction of hypothyroidism results in significant clinical improvement of BBD in most of these patients.
Bhargav
Panchagan R K
PR
Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
Mishra
Anjali
A
Agarwal
Gaurav
G
Agarwal
Amit
A
Verma
Ashok Kumar
AK
Mishra
Saroj Kanta
SK
D000293:Adolescent; D000328:Adult; D001941:Breast Diseases / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013974:Thyroxine / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D013974:Thyroxine