European Journal of Cardiovascular Medicine

Hypothyroidism is one of the most common endocrine disorders globally, caused by deficient production or action of thyroid hormones that regulate metabolism, growth, and energy balance1. It manifests as primary, secondary, or subclinical disease, with primary hypothyroidism accounting for nearly 99% of cases2.  In India, hypothyroidism continues to be a major public-health problem. Although universal salt iodization reduced goiter prevalence, subclinical hypothyroidism has emerged as the most frequent thyroid dysfunction, affecting 3–15% of adults, predominantly women and the elderly3. Regional variation is considerable. A hospital-based study from Srinagar reported thyroid disorders in 40.3% of subjects, with 33% subclinical and 5% overt hypothyroidism, the majority being women of reproductive age4. Cold climate, iodine imbalance, and autoimmune predisposition are possible contributors.

Clinical features include fatigue, weight gain, dry skin, constipation, cold intolerance, menstrual irregularities, and anaemia. Laboratory confirmation is by elevated TSH with low or normal T4/T35. Subclinical disease shows raised TSH with normal hormones and may progress to overt hypothyroidism if untreated6. The Indian Thyroid Society Consensus (2022) recommends early detection and levothyroxine therapy in symptomatic adults or those with TSH > 10 mIU/L to prevent cardiovascular and metabolic complications3.

Data from tertiary centers exist, but studies from district hospitals of Jammu and Kashmir are scarce. Local environmental and dietary factors may influence disease expression. This study therefore aims to assess the clinical profile and biochemical patterns of hypothyroidism including age, gender, TSH/T4 levels, symptoms, anaemia, weight change, and menstrual irregularities among patients attending a district hospital in Jammu and Kashmir.

After obtaining clearance from the Institutional Ethics Committee and informed written consent from each participant, a detailed clinical evaluation was carried out. A pretested semi-structured proforma was used to record demographic details, presenting complaints, and examination findings. Particular emphasis was placed on the presence of fatigue, lethargy, weight gain, constipation, dry skin, cold intolerance, pallor, and menstrual irregularities in women. Each patient underwent a general and systemic examination to detect signs of anaemia, bradycardia, pedal oedema, or goitre. Height and weight were measured, and Body Mass Index (BMI) was calculated as weight in kilograms divided by height in metres squared7. Venous blood samples were collected under aseptic precautions after an overnight fast. Serum was separated and analyzed for thyroid-stimulating hormone (TSH) and thyroxine (T4) levels using a chemiluminescent immunoassay (CLIA) technique. The same method has been used in previous studies on thyroid dysfunction in Kashmir4. Haemoglobin concentration was measured using an automated haematology analyser. Anaemia was defined as a haemoglobin level below 12 g/dL in females and below 13 g/dL in males. The biological reference ranges followed for TSH and T4 were: TSH – 0.27 to 4.2 mIU/L, and T4 – 4.8 to 12.7 µg/dL. Based on these values, patients were classified into subclinical hypothyroidism, defined as elevated TSH with normal T4, and overt hypothyroidism, defined as elevated TSH with low T4 8. All data were entered and analysed using SPSS version 26.0. Continuous variables such as age, TSH, and T4 were expressed as mean ± standard deviation, while categorical variables such as gender, symptom frequency, anaemia, and menstrual irregularity were represented as proportions. Associations between categorical variables were assessed using the Chi-square test, and differences in mean biochemical values were evaluated using the independent t-test. A p-value of <0.05 was considered statistically significant.

A total of 500 patients with newly diagnosed hypothyroidism were included in the present study. Out of these, 370 (74%) were females and 130 (26%) were males, with a female-to-male ratio of 2.8:1. The mean age of the study population was 38.9 ± 11.6 years (range 18–70 years).

The present study included a total of 500 patients diagnosed with hypothyroidism, comprising 130 males (26%) and 370 females (74%), giving a female-to-male ratio of approximately 2.8:1. The distribution across various age groups revealed that the majority of patients belonged to the 30–39-year age group (33%), followed by 18–29 years (26.4%) and 40–49 years (23.8%). A smaller proportion of patients were in the 50–59-year (11.6%) and ≥60-year (5.2%) categories. Among males, the highest prevalence of hypothyroidism was noted in the 30–39-year age group (28.46%), followed by 40–49 years (24.62%) and 18–29 years (21.53%), showing that male patients were most frequently affected in early to middle adulthood. Among females, however, the highest frequency was observed in the 30–39-year age group (34.59%), followed by 18–29 years (28.11%) and 40–49 years (23.52%), indicating that women of reproductive and perimenopausal age constituted the major burden of disease.

The biochemical evaluation of all 500 patients revealed a mean serum TSH level of 12.86 ± 7.42 mIU/L, with values ranging from 5.1 to 45.6 mIU/L, and a mean serum T4 level of 6.15 ± 2.21 µg/dL, with a range of 2.4 to 11.8 µg/dL. The findings indicate that a majority of patients exhibited elevated TSH levels beyond the normal upper limit (4.2 mIU/L), confirming biochemical hypothyroidism. The wide range of TSH values demonstrates variability in disease severity, with some patients presenting with mild (subclinical) elevations and others showing markedly high values consistent with overt hypothyroidism.

Among the 500 patients included in the present study, 322 (64.4%) were diagnosed with subclinical hypothyroidism, while 178 (35.6%) had overt hypothyroidism. This demonstrates that subclinical hypothyroidism constituted nearly two-thirds of all cases, indicating that a substantial proportion of patients presented in the early or mild biochemical stage of thyroid dysfunction. The predominance of subclinical disease suggests that a large number of patients were detected through routine thyroid function testing before the onset of advanced symptoms. This reflects increasing awareness and early diagnostic evaluation at the district hospital level.

In the present study, the clinical presentation of hypothyroidism was dominated by symptoms related to reduced metabolic activity and generalised slowing of physiological functions. The most frequently reported symptom was fatigue or lethargy, present in 392 patients (78.4%), followed closely by weight gain in 355 patients (71%) and dry skin in 312 patients (62.4%). These three symptoms together formed the most characteristic triad of hypothyroidism in this cohort. Constipation was the next most common complaint, seen in 51.2% of cases, followed by cold intolerance in 44.2%, indicating impaired thermoregulation as a common feature. Hair loss and facial puffiness were observed in 42.8% and 41.6% of patients respectively, both representing typical dermatological and myxoedematous changes associated with thyroid hormone deficiency. Less frequent but still notable manifestations included hoarseness of voice in 23.4%, depression or irritability in 19%, and dyspnoea on exertion in 15.2% of cases. The presence of neuropsychiatric and respiratory symptoms suggests that prolonged or untreated hypothyroidism may have multi-systemic impact.

The association between anaemia, body mass index (BMI), and the type of hypothyroidism was assessed among the 500 study participants. Anaemia was present in a total of 137 patients (27.4%). When stratified according to type of hypothyroidism, 21.1% of patients with subclinical disease and 38.8% of those with overt hypothyroidism were anaemic. This difference was found to be statistically significant (p = 0.002), indicating that anaemia is significantly more common in patients with overt hypothyroidism compared to those with subclinical disease. Among patients with normal haemoglobin levels, 78.9% belonged to the subclinical group, while only 61.2% were in the overt category, further reinforcing the inverse relationship between thyroid hormone levels and haemoglobin concentration. Regarding nutritional status, 202 patients (40.4%) were classified as overweight (BMI 25–29.9 kg/m²), and 111 patients (22.2%) were obese (BMI ≥ 30 kg/m²). Overweight was more frequent among subclinical hypothyroid patients (42.9%) compared to overt cases (36.0%), though this difference was not statistically significant (p = 0.16). However, obesity showed a significant association with disease severity, being present in 29.2% of overt cases versus 18.3% of subclinical cases (p = 0.03).

Out of the total 370 female patients included in the study, 222 women (60.0%) reported regular menstrual cycles, whereas 148 women (40.0%) presented with abnormal menstrual patterns. Among those with menstrual irregularities, oligomenorrhoea was the most frequently observed abnormality, seen in 72 patients (19.5%), followed by menorrhagia in 54 patients (14.6%) and amenorrhoea in 22 patients (5.9%). When analysed according to the type of hypothyroidism, menstrual abnormalities were considerably more common in patients with overt hypothyroidism (54.5%) compared to those with subclinical hypothyroidism (31.9%). This difference was found to be statistically significant (p = 0.001), indicating a strong association between the severity of thyroid hormone deficiency and menstrual disturbances. In subclinical hypothyroidism, mild forms such as oligomenorrhoea were predominant, whereas in overt disease, both menorrhagia and amenorrhoea were relatively more frequent. This progression suggests that as hypothyroidism advances, the hypothalamic–pituitary–ovarian axis becomes increasingly impaired, leading to more profound menstrual dysfunction. Overall, these findings confirm that menstrual irregularities are common in female hypothyroid patients, affecting nearly two out of every five women in this study, and their frequency and severity correlate directly with the degree of thyroid hormone deficiency.

The adaptation process for new complete denture wearers The present descriptive cross-sectional study was conducted among 500 patients with newly diagnosed hypothyroidism to evaluate their clinical and biochemical characteristics and to correlate disease type with various systemic manifestations. The findings were compared with previous regional and national studies to place the results in perspective.

In the current study, hypothyroidism showed a clear female preponderance, with 74% females and 26% males, yielding a female-to-male ratio of 2.8:1. The majority of cases were between 30 and 49 years of age (59.4%), and the mean age was 38.9 ± 11.6 years. This finding is consistent with the study of Jain HK et al., (2022)9 who reported 71.7% female prevalence and a mean age of 40.2 years among hypothyroid patients. Similarly, Umesh Babu MG and Joshi KP (2021)10 observed that 74.5% of their study population were females, with the most affected age group between 29–39 years. Jailkhani R et al., (2015)4 also found that 81.2% of hypothyroid cases in Srinagar were women, most of whom were of reproductive age. The predominance of females across studies can be attributed to the greater susceptibility of women to autoimmune thyroid disorders and hormonal influences on thyroid physiology. The concentration of cases in the middle-aged group emphasizes that hypothyroidism peaks during active reproductive years, reflecting both physiological vulnerability and increased screening in this demographic.

In the present study, the mean serum TSH level was 12.86 ± 7.42 mIU/L, and the mean serum T4 was 6.15 ± 2.21 µg/dL, with 64.4% of patients exhibiting subclinical hypothyroidism and 35.6% showing overt hypothyroidism. These proportions are comparable to those reported by Jain HK et al., (2022)9 where subclinical hypothyroidism accounted for 65% of all cases and overt disease for 35%. Umesh Babu MG and Joshi KP (2021)10 documented a similar trend, with subclinical cases comprising 60% and overt hypothyroidism 40% of patients. Likewise, Jailkhani R et al., (2015)4 reported a 33% prevalence of subclinical and 5% of overt hypothyroidism among Kashmiri adults. This concordance supports the notion that subclinical hypothyroidism constitutes the major burden of thyroid disease in India. The wide variation in TSH levels and normal-to-low T4 range observed in our study reflects the transition between subclinical and overt stages, highlighting the need for early detection to prevent progression.

The most common clinical manifestations in the present study were fatigue (78.4%), weight gain (71%), and dry skin (62.4%), followed by constipation (51.2%), cold intolerance (44.2%), and hair loss (42.8%). These findings are closely aligned with the results of Jain HK et al., (2022)9 who observed weakness (85.8%), weight gain (69.2%), and facial puffiness (47.1%) as predominant symptoms. Umesh Babu MG and Joshi KP (2021)10 reported weight gain, hair loss, lethargy, and cold intolerance as the leading symptoms in their study. Similarly, the Srinagar-based study by Jailkhani R et al., (2015)4 confirmed a high prevalence of nonspecific symptoms such as fatigue and dry skin, which are often the first indicators of thyroid dysfunction in the local population. The overall pattern of symptoms in our cohort mirrors the classical presentation of hypothyroidism described in Indian literature, though subtle variations likely reflect regional climatic and nutritional differences.

In the present study, anaemia was observed in 27.4% of patients overall, with a significantly higher prevalence in overt hypothyroidism (38.8%) than in subclinical hypothyroidism (21.1%) (p = 0.002). This relationship between thyroid hormone deficiency and reduced haemoglobin levels has been well established. Jain HK et al., (2022)9 found anaemia in 23.7% of hypothyroid patients, closely approximating our data. Deshmukh V et al., (2013)11 also reported a significant association between low TSH levels and anaemia in subclinical and overt cases. Similarly, Umesh Babu MG and Joshi KP (2021)10 observed that 20.7% of female and 26% of male hypothyroid patients were anaemic. The higher frequency of anaemia in overt hypothyroidism can be explained by decreased erythropoietin synthesis, altered iron metabolism, and nutritional deficiencies resulting from reduced metabolic rate and gastrointestinal hypomotility.

Anaemia was observed in 27.4% of patients overall in this study, with a significantly higher prevalence in overt hypothyroidism (38.8%) than in subclinical hypothyroidism (21.1%) (p = 0.002). This relationship between thyroid hormone deficiency and reduced haemoglobin levels has been well established. Jain HK et al., (2022)9 found anaemia in 23.7% of hypothyroid patients, closely approximating our data. Deshmukh V et al., (2013)11 also reported a significant association between low TSH levels and anaemia in subclinical and overt cases. Similarly, Umesh Babu MG and Joshi KP (2021)10 observed that 20.7% of female and 26% of male hypothyroid patients were anaemic. The higher frequency of anaemia in overt hypothyroidism can be explained by decreased erythropoietin synthesis, altered iron metabolism, and nutritional deficiencies resulting from reduced metabolic rate and gastrointestinal hypomotility.

Out of 370 female participants, 148 (40%) reported menstrual disturbances, with oligomenorrhoea (19.5%) and menorrhagia (14.6%) being the most common. Menstrual abnormalities were significantly more frequent in overt hypothyroidism (54.5%) compared to subclinical cases (31.9%) (p = 0.001). These findings are consistent with the report by Umesh Babu MG and Joshi KP (2021)10, who found menstrual problems in over 50% of women with hypothyroidism. Jain HK et al., (2022)9 similarly documented menstrual irregularities in 45.4% of female patients. Furthermore, the consensus document on subclinical hypothyroidism highlights menstrual dysfunction as one of the earliest and most frequent reproductive manifestations of thyroid deficiency. The strong correlation between overt hypothyroidism and menstrual abnormalities can be attributed to disruption of the hypothalamic–pituitary–ovarian axis and altered gonadotropin release, leading to anovulatory cycles and variable bleeding patterns.

The present study highlights that hypothyroidism is a highly prevalent endocrine disorder in the local population of Jammu & Kashmir, with a marked female predominance and maximum occurrence in the 30–49-year age group. Most patients presented with subclinical hypothyroidism (64.4%), indicating that a substantial proportion were detected at an early biochemical stage before the development of severe symptoms. The predominant clinical features included fatigue, weight gain, dry skin, constipation, and cold intolerance, which remain the hallmark presentations of thyroid hormone deficiency. Anaemia and obesity were significantly associated with the severity of hypothyroidism, while menstrual irregularities affected nearly 40% of female patients, with a higher prevalence in overt disease, underscoring the hormonal and systemic consequences of thyroid dysfunction. These findings emphasize the importance of early screening for thyroid disorders, particularly among women of reproductive age and those presenting with unexplained weight changes, menstrual abnormalities, or fatigue. Early diagnosis and timely initiation of levothyroxine therapy can prevent progression to overt disease, reduce metabolic and reproductive morbidity, and improve quality of life. Regular community-based screening programs, combined with increased public and physician awareness, are essential to ensure early detection and effective management of hypothyroidism in this region.

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