Probing the underlying causes of thyrotoxicosis and its applied significance: a comprehensive evaluation

Abstract

OBJECTIVE: To determine the significance of etiological basis of thyrotoxicosis in guiding optimal treatment selection and its correlation with age and the presence of goiter. METHODS: This cross-sectional study was conducted at MTI-Hayatabad Medical Complex in Peshawar, Pakistan, from December 2022 to May 2023. Utilizing nonprobability-consecutive sampling, we enrolled 119 participants, focusing on individuals presenting with thyrotoxicosis confirmed by thyroid function tests (TFTs). Those already undergoing treatment for hyperthyroidism were also included. Essential diagnostic assessments, such as radioiodine scans, erythrocyte sedimentation rate (ESR), and thyroid receptor stimulating antibody tests, were performed as needed. Patients with chronic renal disease, chronic liver disease, and pregnant and lactating women were excluded. RESULTS: The mean age of participants was 40.39±13.65 years, with 84.03% having TSH <0.1 mIU/L. Elevated ESR (74.17±33.62 mm/1st hour) was noted in thyroiditis. Females constituted 72.3%. Overt hyperthyroidism (51.3%) and Graves’ disease (50.4%) were prevalent. Inappropriately treated cases were 19.3%. Graves’ disease patients with Thyroid receptor stimulating antibodies showed 88% positivity. Treatment modalities included anti-thyroid drugs (43.7%), radioactive iodine therapy (28.6%), conservative (12.6%), and surgery (10.1%). Thyroid dysfunction was most prevalent in the age range of 31-40 years (32.7%). Goiter was absent in 44.5% of participants. Notably, 17.6% had apathetic hyperthyroidism. CONCLUSION: This research emphasizes the vital understanding of thyroid dysfunctions in Pakistan, revealing Graves' disease as the primary cause of overt hyperthyroidism. Females, particularly aged 31-40, exhibit higher susceptibility. Emphasizing the importance of accurate diagnosis, this study highlights the prevalence of inappropriate prior treatments in thyrotoxicosis cases.

Keywords

• thyroid gland
• thyroid hormones
• etiological factor
• hyperthyroidism
• thyrotoxicosis
• graves disease
• thyroxine
• overt hyperthyroidism
• receptors, thyrotropin