PATTERN OF THYROID DISEASE IN ALKHARJ PROVINCE , SAUDI ARABIA

Dr. Mohamed Abdelrazik 1 , Waleed A. Okash 2 , Abdul Rahman M. Alenazi 2 , Faisal S. Alanazi 2 and Asma A. Alanzi 3 . 1. Assistant Professor of General Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Saudi Arabia. 2. Internship doctors, College of Medicine, Prince Sattam Bin Abdulaziz University, Saudi Arabia. 3. Internship doctor, College of Medicine, Hail University, Saudi Arabia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


(1), 2986-2998
2987 Thyroid gland is one of the imperative organ in human body and the encumbrance of thyroid disorders in the community is tremendous exceptionally in females . Thyroid diseases make numerous issues, even though most of them undergo medical or surgical management. Thyroid disorders are in general grouped and showed into two major classifications which are either because of diminished activity of the gland (hypothyroidism) or due to its over action (hyperthyroidism). The previous one is more common in older people (La Franchi, 1994& Griffith et al 1999. The epidemiology of thyroid disorders in iodine-sufficient areas deals mainly with thyroid autoimmune diseases and sporadic goiter (Elahi et al 2005). However in iodine deficient areas, other type of thyroid tumors and goiters are more common . The rate of Multi-nodular goiter is different as per the countries and seems to be generally dependant on the iodine status( Abu-Eshy et al 1994) The types of thyroid disease incorporate nontoxic goiter, Graves 'malady, Hashimoto's thyroiditis and thyroid neoplasm (Rallison et al.1991). There are two basic important thyroid gland autoimmune diseases which are Hashimoto thyroiditis and Graves disease. The first one is the most widely recognized reason for hypothyroidism, whilst the last one is the leading cause for hyperthyroidism (Rossi et al., 1985 There is a notable geographical reliance in thyroid disorders due to the various quantities of trophic iodine ingestion that happen in various geographic areas (Knudsen et al., 2000).The number of individuals in the community who have microscopic nodules, palpable goiter , and occult papillary carcinoma must be considered .
Risk factors of thyroid disorders include: Gender (thyroid disease are higher in women than in men), Diet rich in goitrogens or lacking in iodine , Family history, Pregnancy , Radiation to the neck and Smoking (Abdul Rahman et al 1997 ) The frequency and types of thyroid disorders were studied in Saudi Arabia by a few specialists (Al-Tameem, 1987;Koriesh et al., 1988;Abu-Eshy et al., 1994;Al-Zahrani et al., 2005). However little is thought about thyroid disorders studies in Alkharj province, so the present review was attempted study the types and causes of the disease among patients presented to the outpatient clinics of the University Hospital , Alkharj province, Saudi Arabia.

Patients and Methods:-
This is retrospective study included 203 patients with thyroid disorders presented to the outpatient clinics of Prince Sattam bin Abdul-Aziz University Hospital , and king Khalid hospital in Alkharj Saudi Arabia during the year 2014. They were diagnosed clinically to have thyroid dysfunction disease . That was reflected either by manifestation of hypothyroidism ,hyperthyroidism or enlargement of thyroid gland. Data was collected from admissions and outpatient medical records. The data contained causes risk factors ,social-demographic data and clinical presentation, The results had been noted and analyzed.

Results:-
The total number of patients presented to the endocrinology clinics in Prince Sattam bin Abdul-Aziz University Hospital and King Khalid Hospital was 1569.The patients complaining of different thyroid diseases were 203 (12.93%)   The stress (8.45%) , DM (21.13%) and iodine deficiency (12.68%) were the common risk factors, And graves' disease (14.08%) , Benign neoplasm (16.90%) and malignant neoplasm (8.45%) were the more frequent etiology in males. Furthermore the bad nutrition (29.55%) was the most risk factor , And the goiter (21.97%) and family history (15.15%) were the more frequent etiology in females.     Each patient of total ( 90) has more than one of these clinical manifestations.            Hypothyroidism results from deficient production of the thyroid hormone or defects in thyroid hormone receptor activity. The disorder may be acquired or congenital manifested at birth or delayed as a result of a variety of congenital defects. Congenital causes of hypothyroidism may be sporadic or familial (Ordookhani et al., 2005).
The current study revealed that out of 175 patients , 98 cases ( 27 male and 71 female ) was found to have hypothyroidism and 57 (26 male and 31 female) had hyperthyroidism. likewise , it was documented by many authors that hypothyroidism is more common in females while hyperthyroidism is more common in males (  Iodine deficiency was associated with hypothyroidism in females but it was common in males with hyperthyroidism. likewise high iodine deficiency was recorded in hypothyroidism females and hyperthyroidism males. Epidemiological studies has shown that pattern of thyroid dysfunction in a community is largely determined by iodine intake level (Knudsen et al. 2000). Kutras (2001) reported that iodine deficiency, thyroid autoimmunity, infection and previous irradiation are the common etiological factors of thyroid disorders In iodine deficient communities incidence of hypothyroidism is low while nontoxic goiter and hyperthyroidism due to toxic nodular goiter is common and increases with age. Like the results of the present study , high incidence of Hashimoto thyroidits was recorded in hypothyroidism males. Hanna and LaFranchi Goiter in the present study was found to be higher in males (60.7%) than in females (39.3%) . On the other hands Elhai et al (2005) reported an incidence of 60.6% in females. This may be due to the kind of their patients which were referred from a centre for nuclear medicine . On the contrarily one again, Al-Bouq et al. (2006) reported that the incidence of goiter was much less than that of ours (19.6%) in Medinah Munawarah, Saudi Arabia. A high incidence of goiter was also recorded in Gizan,Saudi Arabia (Sulimani et al. 1995), Bombay, India (Dodd and Samul ,1993) and Tunisia (El-May et al.1997). The appearance of goiter depends on many factors like sex, family history, iodine intake and thyroid autoimmunity. Low iodine intake enhances the TSH sensitivity and positive influence of growth factors involved in the physiological regulation of thyroid growth.
In Saudi Arabia thyroid cancer is the fourth most common cancer in all age and the second most common cancer in female ( National Cancer Registry ;1997).
The number of cases with malignant thyroid in the current study among cases admitted to the endocrinology clinic was 28 (12.9 % and 9.2 % in hypothyroidism and hyperthyroidism, respectively. It was reported that incidence of malignant thyroid varies from one geographical area to the other. It was recorded as 13% in Asir , Thyroid nodule presenting as either a solitary nodule or a multinodular goiter (Mazzaferri; 2004). Most of thyroid nodules are more common in women. One or more palpable thyroid nodules affect 4% of the adult population; most of these nodules are benign . Majority of solitary nodules of the thyroid proved to be localized, non-neoplastic conditions (Mazzaferri; 2004). Likewise, our results confirmed this fact as most of our patients with solitary nodules were found negative for malignancy.
In the present study, it was found that the cancer was more more frequent in males (75%) than females (25%). Similar results were obtained by (Hussein et al 2013). Considerable geographical variations were present in thyroid cancer incidence in Saudi Arabia. (Bazarbashi et al ; 2008).
In the present study, most of the patients with hyperthyroidism were complaining of palpitation (87.7%) and tremors (63.2%) About half of the case ( 49.1% ) had weight loss and (35.1%) had sweating .Others had exophthalmos , goiter , exophthalmos and irritability .Similarly symptoms recorded by (Michelageli et al ,200 ) were palpitation, tremors and weight loss each were over 50%. Other symptoms recorded included excessive sweating (45%), heat intolerance (31%), and nervousness (27%). On the hand, exophthalmos, tremors, and tachycardia ranked top on the list of clinical signs representing over 40% for each. However they added clinical manifestation that not included in the present work which were Proximal myopathy ( 8% ) and atrial fibrillation (4%) of patients. Graves' ophthalmopathy in their study was noted in 54% of their patients.

Conclusion:-
Thyroid disorders are common in Alkharj province especially in females .The pattern is more or less similar to that detected in other Saudi cities. Goiter and malignant thyroid are more common in males .