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Dr Shoeb Kaiser, Subhasis Neogi, Subhankar ChowdhuryDepartment:
An institution-based cross-sectional observation study was carried at the outpatient facility of the department of endocrinology and metabolism of IPGME&R, Kolkata, India during the period January 2020 to June 2020 to study the frequency of persistent symptoms in patients with subclinical and overt hypothyroidism after normalisation of thyroid stimulating hormone and also to determine the correlation of anti thyroid peroxidase antibody titre and final thyroid stimulating hormone with residual symptoms of hypothyroidism. The study involved 25 patients with overt hypothyroidism and 25 patients with subclinical hypothyroidism. Clinical evaluation, estimation of Billewicz score and measurement of serum thyroid stimulating hormone and free T4 were done before initiation of laevothyroxine and again after normalisation of thyroid stimulating hormone. Anti thyroid peroxidase antibody titre was also obtained.
After normalisation of thyroid stimulating hormone, 68% patients with overt hypothyroidism and 56% patients with subclinical hypothyroidism had residual symptoms. Although the anti thyroid peroxidase antibody levels were significantly higher in those with overt hypothyroidism as compared to those with subclinical hypothyroidism, the titre did not influence the final Billewicz score or residual symptoms. A positive correlation was found between final thyroid stimulating hormone and persistent symptoms, but it was not statistically significant (p = 0.222). Persistence of one or more symptoms of hypothyroidism despite normalisation of thyroid stimulating hormone with laevothyroxine, is a commonly encountered clinical problem. Anti thyroid peroxidase antibody titre and final thyroid stimulating hormone level did not have a statistically significant correlation with residual symptoms in this study.Keyword:
Billewicz score, overt hypothyroidism, subclinical hypothyroidism, antibody, thyroid peroxidase, laevothyroxine