title: Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India.
abstract: BACKGROUND
  Hypothyroidism is believed to be a common health issue in India, as it is worldwide. However, there is a paucity of data on the prevalence of hypothyroidism in adult population of India.
  
  
  METHODS
  A cross-sectional, multi-centre, epidemiological study was conducted in eight major cities (Bangalore, Chennai, Delhi, Goa, Mumbai, Hyderabad, Ahmedabad and Kolkata) of India to study the prevalence of hypothyroidism among adult population. Thyroid abnormalities were diagnosed on the basis of laboratory results (serum FT3, FT4 and Thyroid Stimulating Hormone [TSH]). Patients with history of hypothyroidism and receiving levothyroxine therapy or those with serum free T4 <0.89 ng/dl and TSH >5.50 μU/ml, were categorized as hypothyroid. The prevalence of self reported and undetected hypothyroidism, and anti-thyroid peroxidase (anti-TPO) antibody positivity was assessed.
  
  
  RESULTS
  A total of 5376 adult male or non-pregnant female participants ≥18 years of age were enrolled, of which 5360 (mean age: 46 ± 14.68 years; 53.70% females) were evaluated. The overall prevalence of hypothyroidism was 10.95% (n = 587, 95% CI, 10.11-11.78) of which 7.48% (n = 401) patients self reported the condition, whereas 3.47% (n = 186) were previously undetected. Inland cities showed a higher prevalence of hypothyroidism as compared to coastal cities. A significantly higher (P < 0.05) proportion of females vs. males (15.86% vs 5.02%) and older vs. younger (13.11% vs 7.53%), adults were diagnosed with hypothyroidism. Additionally, 8.02% (n = 430) patients were diagnosed to have subclinical hypothyroidism (normal serum free T4 and TSH >5.50 μIU/ml). Anti - TPO antibodies suggesting autoimmunity were detected in 21.85% (n = 1171) patients.
  
  
  CONCLUSIONS
  The prevalence of hypothyroidism was high, affecting approximately one in 10 adults in the study population. Female gender and older age were found to have significant association with hypothyroidism. Subclinical hypothyroidism and anti-TPO antibody positivity were the other common observations.
authors: Department of Endocrinology, Amrita Institute of Medical Sciences, Cochin, Kerala, India.
authors: Ambika Gopalakrishnan
authors: AG
authors: Unnikrishnan
authors: Sanjay
authors: S
authors: Kalra
authors: Rakesh Kumar
authors: RK
authors: Sahay
authors: Ganapathi
authors: G
authors: Bantwal
authors: Mathew
authors: M
authors: John
authors: Neeraj
authors: N
authors: Tewari
keywords: Anti-TPO positive; India; epidemiology; free T3; free T4; hypothyroidism; prevalence; subclinical hypothyroidism; undetected hypothyroidism
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