Effects of Thyroid Profile Changes on the Biochemical Makers of Bone, Liver and Renal Function in Non Pregnant Women of Khyber Pakhtunkhawa, Pakistan

Abstract

This hospital based cross sectional study was conducted from 01 March 2014 to 31 March 2015 in Khyber Teaching Hospital (KTH), a tertiary care hospital in Khyber Pakhtunkhawa (KP) province of Northern Pakistan. The study group comprises of 259 non pregnant women in the age group of 18-75 years. Informed consent was sought from each patient and all human dignity was respected throughout the study period in accordance with the international norms involving human as an experimental subjects. 5 mL of fresh venous blood (fasting sample) was taken from each patient. It was divided into two portions- one portion was used for the determination of thyroid profile markers by Elisa methods and the other portion was used for the determination of serum alkaline phosphatase, calcium, Zinc, urea, creatinine, SGPT and SGOT level on autoanalyser (Erbamannhein chemistry autoanalyser, Germany) by using Erba kits and Standard protocols. After the determination of thyroid profile status, patients having normal thyroid profile (n=54, TSH≤6.0, normal T3 and T4 levels) were taken as controls. While the hypothyroid patients (n=96) and hyperthyroid group (n=109) constituted the study group. The patients in the hypothyroid groups were further sub divided into Sub clinically hypothyroid (Sh) (n=48) and Overtly hypothyroid (Oh) (n=48). Similarly the patients in hyperthyroid groups were also subdivided into Overtly Hyperthyroid (OH) (n=58) and Sub clinically Hyperthyroid (SH) (n=51). Purposive sampling method was employed for the collection of the relevant data. The total no of patients who met the purpose of the study were 259. The data about age, BMI and all the required biochemical parameters for each patient was collected on a well-designed data entry form. The data so obtained was statistically analyzed using SPSS for windows 21.0 software and Microsoft Excel. Values were reported as mean ± standard error of mean. Pearson’s correlation of the data was also carried out to look for association between variables. A, p value of < 0.05 was considered to be significant. The mean age of patients in the control group (N) was 42.15 ± 1.86 years, 46±1.38 years for Overtly hypothyroid (Oh), 45.97±1.93 years for Sub clinically hypothyroid (Sh), 49.74±1.62 years for Overtly Hyperthyroid (OH) and 48.94±1.87 years for the Sub clinically Hyperthyroid (SH).The control group were 54, of which 61.11% (33) were Menopausal (M, age below 45 years), 18.52% (10) were Early Post-Menopausal (EPM, age 45-50 years) and 20.37% (11) were Late Post-Menopausal (LPM, age above 50 years). The %age of M, EPM and LPM in the Oh (48) and Sh (48) group were, 54.16%(26), 12.5%(06), 33.83%(16) and 45.83%(22), 22.92% (11), 31.25%(15) respectively. Similarly the %age of M, EPM and LPM in the OH (58) and SH(51) were 34.48% (20), 27.58%(16), 37.93%(22)and43.14%(22), 07.84%(04), 49.07%(25) respectively. The mean serum level of TSH was found to be lowest in OH group (0.17±0.01µIU/ mL) and highest in the Oh group (25.89±2.86µIU/ mL). Serum T3 level was highest in OH group (2.37±0.01ng/mL) and lowest in Oh group (0.94±0.09ng/mL). Highest serum T4 level was found for OH group (12.07±0.46µg/ dL) and lowest in Oh group (4.30±0.28µg/ dL). Mean serum creatinine was highest in N group (1.47±1.25 mg/dL) as compared to OH (1.29±0.01 mg/dL) and SH group (1.34±0.15 mg/dL). Serum Urea level was found elevated in OH (35.35±1.75 mg/dL) and SH (32.98±1.63 mg/dL) as compared to N group (32.60±1.22 mg/dL). Serum creatinine showed positive relation with TSH, in all the study groups, negative relation with T3 in the N group and OH and positive in SH group. Serum creatinine showed a significant positive correlation with TSH in the OH group (p= 0.05). Serum creatinine showed a significant negative correlation with T3 in the N group (p= 0.05). No significant correlation with T4 was found either for creatinine or Urea in any of the study groups. A minor decrease in the serum creatinin level in the Oh (1.10mg/dL) and Sh group (1.18 mg/dL) was found as compared to N group (1.47mg/ dL). Serum urea was found to be slightly decreased in the Sh group (23.22 mg/dL) as compared to N group (32.60mg/dl) and Oh group (30.11mg/dL). A very significant positive correlation was found between Serum creatinine and T3 in the Sh group (p= 0.005) and significant negative correlation with T3 in the N group (p= 0.05). Urea was significantly negatively correlated with TSH in Sh group (p= 0.05). Mean Serum Calcium was highest in OH group (9.80±0.90 mg/dL) and lowest in Oh group (8.95±0.10 mg/ dL). Serum total alkaline phosphatase was found to be maximum in N group (159±7.61 U/L) and minimum in Sh group (128±6.42 U/L). There were no significant differences in the Serum Zinc level of all the diseased groups. Calcium showed significant positive correlation with TSH in Oh (p=0.01) and OH (p=0.04). Serum Calcium was significantly negatively correlated with T3 in OH (p=0.01). Serum alkaline phosphatase was significantly negatively related with T4 in OH (p=0.01). Serum Zn showed a very significant positive correlation with T3 in SH (p=0.02). Significance differences were found in the SGPT and SGOT level in all the five groups. SGPT level was found to be 33.14±2.98 in OH, 29.50±1.69 in SH group as compared to 29.69±3.28 IU/L in N group. SGOT level was 33.70±5.12 IU/L in N group, 30.68±2.7 in OH group and 30.38±2.6 IU/L in SH group. Avery significant positive correlation was found between SGOT and TSH in the N group (p =0.002). Avery significant positive correlation was also found between BMI and T3 in N group and OH group (p =0.01). SGPT level was found to be 24.35±1.11 IU/L in the Oh, 16.85±0.55 IU/L in Sh as compared to 29.69±3.28 IU/L in N group. SGOT level was 33.70±5.12 IU/L in N group 23.65±1.22 IU/L in Oh group and 17.86±0.98 IU/L in Sh group respectively. SGOT was none significantly negatively correlated with TSH in the Oh and Sh groups. No significant correlation was found between SGPT and thyroid profile markers (TSH, T3 and T4) in any of the study groups. In conclusions, thyroidal dysfunction is a common problem in northern Pakistan affecting women folks more as compared to other gender due to poverty, lack of education, social taboos and lack of health facilities in rural areas. More over there is a lack of adequate amount of iodine in drinking water and iodized salt due to lack of strict quality control. There is a complex interaction between thyroid kidney, liver and bone turnover markers. It was concluded from this study that bones desorption occurs at higher rate in hyperthyroid patients and bone turnover is increased in favor of desorption. Opposite changes are observed in hypothyroid women. Also hyperthyroidism may affect renal function in the long run if left untreated, while hypothyroidism may not affect renal functions in non-pregnant women. It was also concluded from this study that SGOT is directly affected by the change in the serum level of TSH in the normal individual (N). Serum T3 directly affected BMI in N and OH groups. It was also found that hypothyroidism may decrease while Hyperthyroidism may increase the rate of synthesis of liver enzymes. Due to this complex inter play between these vital organs of the body and thyroid hormone, multi system approach should be adopted in the diagnosis of clinical conditions affecting either organs.