Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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On Sep 2018




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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help ones reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journalsNo manuscriptsNo authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2009 | Month : December | Volume : 3 | Issue : 6 | Page : 1853 - 1858

Subclinical Thyroid Disorders In Postmenopausal Women Of Iran

NIAFAR M, NAJAFIPOUR F, BAHRAMI A

*Endocrinology and Metabolism section, Department of Medicine, Imam Reza Hospital, Tabriz,(Iran).

Correspondence Address :
Akbar Aliasgarzadeh, Associated professor of medicine and endocrinology.Endocrinology and Metabolism section,Deptt of Medicine, Imam Reza Hospital,Tabriz University of Medical sciences,Tabriz, (Iran). Tele&Fax: + 98 -411-3357850
Email:asgharzadeha@tbzmed.ac.ir, asgharzadeha@gmail.com

Abstract

Objectives: The present Cross-sectional study was aimed to investigate the prevalence of subclinical thyroid disorders in postmenopausal women in a community on the northwest of Iran.
Methods: By using the records of the local household registry, a sample of 1000 subjects aged between 60 and 89 years (mean 64.5±5.4) were included in our survey. Tests of thyroid function including TSH concentration in all subjects and free T4 concentration, free T3 concentration and anti-microsomal antibodies in those with abnormal TSH were conducted.
Results: Eight hundred and seventy three (87.3) subjects were euthyroid, as indicated by their serum TSH concentrations. The overall prevalence of thyroid dysfunction in the samples was 12.7%. The prevalence of subclinical hypothyroidism and subclinical hyperthyroidism was 5.8% and 4.1%, respectively. High titers of anti-microsomal antibodies were found in 60.6% of the patients with high TSH levels.
Conclusion: The prevalence of abnormal biochemical thyroid function reported here is substantial and confirms previous reports from other populations. We found that the prevalence of thyroid dysfunction is high in the elderly female population of East Azerbaijan. The results from this study provide the baseline information to settle public health plans and to track the changes.

Keywords

Anti-microsomal antibody, subclinical hypothyroidism, subclinical hyperthyroidism, postmenopausal women

Introduction
The advent of automated sensitive assays for thyroid hormones and thyroid-stimulating hormone (TSH) and the increasingly widespread use of such tests have led to a substantial increase in the identification of mild thyroid dysfunction, especially in elderly patients. Previous studies on the prevalence of thyroid disease in Iran and other countries have included patients of all ages (1),(2),(3),(4),(5),(6),(7),(8) and have reached differing conclusions. Most of these studies have examined only a small number of elderly patients; furthermore, recent developments in tests of thyroid function mean that previously undetected biochemical abnormalities may become evident.

The potential consequences of subclinical hypothyroidism are much less well established and although elevated TSH levels in the elderly have been recently suggested to confer a mortality advantage (9), most of the literature refers to adverse consequences such as the possibility of cardiac dysfunction or adverse cardiac end points (including atherosclerotic disease and cardiovascular mortality) (10), elevation in total and low-density lipoprotein cholesterol (11), systemic or neuropsychiatric symptoms (12) and progression to overt symptomatic hypothyroidism (13).

Approximately 4% of community-based patients per year, who are found to have subclinical hypothyroidism, are estimated to progress to overt hypothyroidism [13, 14]. Subclinical hyperthyroidism may also be associated with adverse cardiac end points [15, 16] including atrial fibrillation (17), cardiac dysfunction, systemic and circulatory disease mortality (18), neuropsychiatric symptoms (19), (20), reduced bone mineral density and fractures (23), (24).
The evidence supporting the progression of subclinical hyperthyroidism to overt hyperthyroidism lacks consensus, as the available studies tend to be small, with study populations having significant heterogeneity (14), (23),(24),(25),(26).

The prevalence of thyroid dysfunction in U.K is high in the elderly population (13.8%), especially in elderly women (17.9%) (24). Estimates of the prevalence of subclinical thyroid dysfunction in elderly populations differ substantially and vary according to ethnic groups, dietary iodine intake and the prevalence of antithyroid antibodies (27),(28),(29),(30). The prevalence of subclinical hypothyroidism has been estimated in European and American populations of elderly ambulatory participants, to vary 5-fold from 1.4% in rural Sweden (31) to 7.8% in the Framingham Heart Study (25). Subclinical hypothyroidism appears to be more common in females (7–18%) than in males (2–15%) [27, 30, 33] and the Whickham survey (British survey of adults of all ages) demonstrated an increasing prevalence with age in women, reaching 18% in those aged 74 yrs and older, as compared to a relatively stable 2–5% in males regardless of age (34).

Because of the high prevalence of thyroid dysfunction in patients over 60 years of age, the American Association of Clinical Endocrinologists (AACE) has recommended screening for this disorder in older women (34).

Iran is now not an iodine deficiency area, but thyroid dysfunction is one of the major health issues in our country (35). The prevalence of thyroid dysfunction in elderly women in the community has neither been documented nor established in recent years. The aim of this community-based survey was to investigate the prevalence of thyroid dysfunction in elderly women aged 60 yrs or older.

Material and Methods

Subjects And Methods
The subjects of this study were enrolled as participants of a community-based survey which was carried out from August 2007 to April 2008 in Tabriz, the capital city of East Azerbaijan, a north-western province of Iran. A sample of 1150 subjects was drawn by using a simple random method from a sampling frame constructed from the records of the mentioned local household registry. The selected subjects were approached either directly or by letter after the exclusion of nonresponse subjects; finally, 1000 (89.6%) subjects were included in our study. The design of this research was approved by the Research Ethics Committee of Tabriz University (Medical Sciences). Personal details on past and present thyroid disorders were obtained by a questionnaire and a general physical examination. The recently prescribed drugs were noted. Following written consent, a blood sample was taken. Fasting blood samples were drawn from the ante cubital vein. Sera were separated after 10 minutes of clotting at room temperature and 10 minutes of centrifugation at 3000rpm. Serum samples were stored at -20 °C prior to their analysis. Tests of thyroid function including those to check TSH concentration in all subjects, free T4 concentration, free T3 concentration and levels of anti-microsomal antibodies, were conducted in patients with abnormal TSH. Serum FT4 and FT3 levels were measured in the same specimens for which tests for the measurement of TSH levels were done. Patients with a clear biochemical evidence of thyrotoxicosis or hypothyroidism (most of whom had symptoms of thyroid dysfunction) were then treated appropriately.

Assays
Sera TSH, FreeT4, FreeT3 and anti-microsomal antibody levels were measured using a fully automated chemiluminescent immunoassay (Liaison, DiaSorin, Saluggia VC, Italy). The coefficients of variation percent were 7.9, 6.2 and 8.3 for TSH, FT4, and FT3, respectively.

The laboratory reference range was 0.3 to 4.5 mU/L for TSH, 0.8 to 1.9 ng/dl for free T4 and 2.2 to 4.2 pg/ml for free T3.

Statistical Analysis
Analyses were undertaken using SPSS (version 14). The results are summarized using Mean ± SD & N (%). Chi square, Fisher Exact test and Pearson correlation coefficients were calculated to evaluate the association between variables. A probability of <0/05 was considered to be statistically significant. Adjustment to normal distribution was tested by the Kolmogorov – Smirnov test.

Results

The overall serum TSH levels were 1.77 ± 0.94 mU/liter. Eight hundred and seventy three (87.3) subjects were euthyroid, as indicated by their serum TSH concentrations. One hundred and twenty seven (12.7) subjects had either high or low TSH levels. Seventy-three of them had high TSH and 54 had low TSH values. Prevalence of individuals with low, normal, and high TSH values are given in (Table/Fig 1) with regards to different age strata (60-64, 65-69, 70-74, 75-79, and 80+). There was no correlation between age strata and TSH levels (χ2 =6.87, df = 8, P = 0.55).

Seventy-three subjects (mean age 65.8 ± 6.9 years) had high serum TSH levels. Serum TSH values in this group ranged from 4.6 to104 mU/liter (mean serum TSH, 10.16± 10.30 mU/liter). Serum TSH values strongly correlated with FT4 levels in this group (r = – 0.50, n = 73, p = <0.0005) (Table/Fig 3). Fifteen subjects had serum FT4 levels below the normal range and 58 were within the normal range. The prevalence of overt hypothyroidism was 1.5% (mean serum TSH, 25.1 ± 2.55 mU/liter) and prevalence of subclinical hypothyroidism was 5.8%. The 54 subjects (mean age 64.5±5.1 years) had low serum TSH levels (range: 0.02 to 0.29 mU/liter; mean serum TSH, 0.067±0.045 mU/liter). Twelve subjects with low TSH (mean serum TSH, 0.06±0.04) had low FT4 levels. One subject had elevated serum FT3 levels with low TSH and normal FT4 levels; 41 subjects with low TSH levels had normal FT4 and FT3 levels. The prevalence of overt hyperthyroidism, subclinical hyperthyroidism and T3 toxicosis were 1.2%, 4.1%and 0.1%, respectively. The anti-microsomal antibody titer was measured in all patients with high TSH levels. A high titer of antibody was present in 60.8% of the patients with high TSH concentrations (88.8% of those with TSH concentrations over 10 mU/liter and in 51% of those with TSH over 4.5 mU/liter and less than or equal to10 mU/liter) Fisher Exact test showed that this difference was significant (χ2 =8.29, df = 1, P = 0.004).

Discussion

The present study has confirmed the markedly high prevalence of thyroid dysfunction in elderly women.

(Table/Fig 2) summarizes the data from previous similar studies. It is notable that each of these studies revealed a similar prevalence of elevated TSH values to that found in the present report, with the exception of Falkenberg et al.(1983)(31) and Chuang et al.(1998) (36) whose found that the prevalence of hypothyroidism was about 2 % and 3%, respectively. The low incidence of hypothyroidism in these two studies might be related to high iodine consumption in the subjects who were studied in Taiwan, as indicated by their high urinary iodine excretion and probably, the use of the low sensitivity TSH assay in the Falkenberg study.

Few studies have investigated the prevalence of TSH concentrations below the normal range, although Parle et al. (1991) (24) and Chuang et al. (1998) (36), by using a TSH assay with increased sensitivity, found a level of prevalence in their study, which was similar to our results (6.3%, 4.3% respectively).

In the current study, in subjects with high TSH levels, the TSH values were inversely related to the free T4 values. The results were compatible to the findings of other similar studies (24),(36),(37). It suggested that elevated TSH values directly reflected on impaired thyroid hormone production. Previous studies have shown that individuals with TSH values above 10 mU/liter could progress to overt hypothyroidism (24), (37), (38). Furthermore, the follow-up of subjects with high TSH values was important to diagnose the progression of their disease to overt thyroid failure. Nevertheless, the risk of progression to thyrotoxicosis in those with low TSH values appeared to be slight (24).

We found that serum TSH levels did not vary with age. This result was in agreement with other reports (8).

A high prevalence of thyroid autoantibodies (73.3%) was found in patients with overt hypothyroidism. This indicated that autoimmune disease was the major causes of hypothyroidism in elderly populations of Iranian women, in agreement with other studies (8), (36),(39).

In conclusion, we have shown that thyroid dysfunction is common in elderly women; it may often go undetected and may be associated with adverse health outcomes that can be avoided by the measurement of serum TSH levels. High titers of antithyroid antibodies were found in 60.6% of the patients with high TSH levels. This result indicates that autoimmune disease is still the major cause of hypothyroidism in aged people.

Acknowledgement

The authors have no conflicts of interest. The authors gratefully acknowledge the assistance of the following individuals: Dr.Ramin Heshmat (Statistician), Dr.morteza Ghojazade (Statistician),) and Dr.Shole Emami (staff of the Endocrine Laboratory).

We acknowledge and thank the reviewer of this article, Dr. Alireza Esteghamati (Associated Professor of medicine and endocrinology, University of Medical Sciences, Tehran) for his valuable contributions to manuscript revision.

We thank the East Azerbaijan Province Health Center and the patients who collaborated with this study.

This work was supported by Tabriz University of Medical Sciences (research deputy).

References

1.
Heydarian P, Azizi F. Thyroid dysfunction and autoantibodies 10 years after implementation of universal salt iodiation: Tehran thyroid study. Int J Endocrinol Metab 2002;4:229-41.
2.
Eggertsen R, Petersen K, Lundberg PA et al. Screening for thyroid disease in a primary care unit with a thyroid stimulating hormone assay with a low detection limit. BMJ. 1988; 297:1586-92.
3.
dos Remedios LV, Weber PM, Feldman R et al. Detecting unsuspected thyroid dysfunction by the free thyroxine index. Arch Intern Med. 1980; 140:1045-49.
4.
Konno N, Yuri K, Taguchi Het al. Screening for thyroid diseases in an iodine sufficient area with sensitive thyrotrophin assays, and serum thyroid autoantibody and urinary iodide determinations.Clin Endocrinol. 1993; 38:273-81.
5.
Okamura K, Ueda K, Sone Het al.A sensitive thyroid stimulating hormone assay for screening of thyroid functional disorder in elderly Japanese.J Am Geriatr Soc. 1989; 37:317-22.
6.
Kagedal B, Manson JC, Norr Aet al. Screening for thyroid disorders in middle-aged women by computer-assisted evaluation of a thyroid hormone panel. Scand J Clin Lab Invest. 1981; 41:403-8.
7.
Gordin A, Heinonen OP, Saarinen P et al. Serum-thyrotrophin in symptomless autoimmune thyroiditis. Lancet. 1972; 1:551-54.
8.
TunbridgeWM,Evered DC, Hall R et al. The spectrum of thyroid disease in a community: the Wickham survey. Clin Endocrinol (Oxf) 1977; 7:481–93
9.
Gussekloo J, van Exel E, de Craen AJ et al.Thyroid status, disability and cognitive function, and survival in old age. JAMA 2004; 292:2591–99
10.
Hak AE, Pols HAP, Visser TJ et al.Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam study. Ann Intern Med 2000; 132:270–78
11.
Danese MD, Ladenson PW, Meinert CL et al.Clinical review 115: effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: a quantitative review of the literature. J Clin Endocrinol Metab 2000; 85: 2993–3001
12.
Haggerty Jr JJ, Stern RA, Mason GA et al.Subclinical hypothyroidism: a modifiable risk factor for depression? Am J Psychiatry 1993; 150:508–10
13.
Vanderpump MP, Tunbridge WM, French JM et al.The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham survey. Clin Endocrinol (Oxf) 1995; 43:55–68
14.
Pirich C, Mullner M, Sinzinger H.Prevalence and relevance of thyroid dysfunction in 1922 cholesterol screening participants. J Clin Epidemiol 2000; 53: 623–29
15.
Rodondi N, Newman AB, Vittinghoff E et al. Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med 2005; 165:2460–66
16.
Walsh JP, Bremner AP, Bulsara MK et al.Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med 2005; 165:2467–72
17.
Cappola AR, Fried LP, Arnold AM et al.Thyroid status, cardiovascular risk, and mortality in older adults. JAMA 2006; 295:1033–41
18.
Parle JV, Maisonneuve P, Sheppard MC et al.Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet 2001; 358:861–65
19.
Bommer M, Eversmann T, Pickardt R et al. Psychopathological and neuropsychological symptoms in patients with subclinical and remitted hyperthyroidism. Klin Wochenschr 1990; 68:552–58
20.
de Escobar GM, Obrego´n MJ, del Rey FE.Is neuropsychological development related to maternal hypothyroidism or to maternal hypothyroxinemia? J Clin Endocrinol Metab 2000; 85:3975–87
21.
Faber J, Galloe AM. Changes in bone mass during prolonged subclinical hyperthyroidism due to l-thyroxine treatment: a meta-analysis. Eur J Endocrinol 1994; 130:350–56
22.
Bauer DC, Browner WS, Cauley JA et al.Factors associated with appendicular bone mass in older women. The Study of Osteoporotic Fractures Research Group. Ann Intern Med 1993; 118:657–65
23.
Tenerz A, Forberg R, Jansson R.Is a more active attitude warranted in patients with subclinical thyrotoxicosis? J Intern Med 1990; 228:229–33
24.
Parle JV, Franklyn JA, Cross KW et al.Prevalence and follow-up of abnormal thyrotropin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol (Oxf) 1991; 34:77–83
25.
Sawin CT.Thyroid dysfunction in older persons. Adv Intern Med 1992; 37: 223–48
26.
Stott DJ, McLellan AR, Finlayson J et al.Elderly patients with suppressed serum TSH but normal free thyroid hormone levels usually have mild thyroid overactivity and are at increased risk of developing overt hyperthyroidism.Q J Med 1991;78:77–84
27.
Samuels MH.Subclinical thyroid disease in the elderly. Thyroid 1998;8: 803–13
28.
Surks MI, Ocampo E.Subclinical thyroid disease. Am J Med 1996;10092: 217–23
29.
Ayala AR, Wartofsky L.Minimallysymptomatic (subclinical) hypothyroidism . Endocrinologist 1997; 7:44–50
30.
Hollowell JG, Staehling NW, Flanders WD et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANESIII). J Clin Endocrinol Metab 2002; 87:489–499
31.
Falkenberg M, Kagedal B, Norr A. Screening of an elderly female population for hypo- and hyper-thyroidism by use of a thyroid hormone panel. Acta Med Scand1983; 214:361–65
32.
Sawin CT, Castelli WP, Hershman JM et al. The aging thyroid: thyroid deficiency in the Framingham study. Arch Intern Med 1985; 145:1386–88
33.
Canaris GJ, Manowitz NR, Mayor G et al. The Colorado thyroid disease prevalence study. Arch Intern Med 2000; 160:526–34
34.
Jacksonville.Clinical practice guidelines for the evaluation and treatment of hyperthyroidism and hypothyroidism.American Association of Clinical Endocrinologists1996.
35.
WHO Regional Office for the Eastern Mediterranean. Promotion of iodized salt in the Eastern Mediterranean, Middle East and North Africa. Report of an Intercountry Meeting. 2000 April 10-12, Dubai, United Arab Emirates. Cairo: WHO, 2000.
36.
Chia-Chang Chuang , Shan-Tair Wang , Pei-Wen Wang et al. Prevalence Study of Thyroid Dysfunction in the Elderly of Taiwan. Gerontology 1998; 44:162-67
37.
Mokshagundam SP, Barzel US.Thyroid disease in the elderly. Am Soc1993; 41:1361-1369
38.
Gordin A, Lamberg BA. Spontaneous hypothyroidism in symptomless autoimmune thyroiditis: A long-term follow-up study.Clin Endocrinol 1981; 15:537-543.
39.
Hollowell JG, Staehling NW, Flanders WD et al. Serum TSH, T(4), and thyroid antibodies in the United States Population (1988-1994): National Health and Nutrition Survey (NHANES III). J Clin Endocrinol Metab 2002; 87:489-499
40.
Nystrom E, Bengtsson C, Lindquist et al.Thyroid disease and high concentration of serum thyrotrophin in a population sample of women. Acta Medica Scandinavica 1981; 210, 39 -46.
41.
Sue Wilson, Parle JV, Lesley M. Roberts et al.Prevalence of Subclinical Thyroid Dysfunction and Its Relation to Socioeconomic Deprivation in the Elderly:A Community-Based Cross-Sectional Survey. J Clin Endocinol Metab 2006; 91(12):4809-16

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