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Published in: World Journal of Surgery 10/2009

01-10-2009

Prevalence of Hypothyroidism in Benign Breast Disorders and Effect of Thyroxine Replacement on the Clinical Outcome

Authors: Panchagan R. K. Bhargav, Anjali Mishra, Gaurav Agarwal, Amit Agarwal, Ashok Kumar Verma, Saroj Kanta Mishra

Published in: World Journal of Surgery | Issue 10/2009

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Abstract

Background

The aim of this study was to determine the prevalence of hypothyroidism in patients with benign breast disorders (BBD). We then asked if thyroxine replacement in hypothyroid patients has any impact on the clinical outcome of the BBD.

Methods

This prospective study included 201 women with BBD. None of the included patients had previously suspected hypothyroidism. Clinical, laboratory, and follow-up details of the patients were noted. Baseline serum thyroxine, thyroid-stimulating hormone (TSH), and prolactin estimation was done in all cases. Thyroid peroxidase antibody (TPOAb) estimation was done in hypothyroid patients and/or patients with a goiter. In addition to the standard conservative management protocol, hypothyroid patients were given thyroxine replacement therapy. Their response to treatment was assessed at 3-month intervals. The clinical outcomes of euthyroid and hypothyroid groups were compared.

Results

The mean age of the patients was 34 ± 8 years, and the mean length of follow-up was 13.0 ± 4.2 months. The overall prevalence of hypothyroidism was 23.2% (nipple discharge 37%, mastalgia 23%, lump/lumpiness 17.4%). The rate of hypothyroidism and the mean serum TSH concentration were significantly higher among patients with nipple discharge than among those with mastalgia (P = 0.001) or a lump (P = 0.01). In all, 39% of hypothyroid women had TSH concentrations >10 mIU/l, and 53% had an elevated TPOAb titer. BBD symptoms were alleviated in 83% of the hypothyroid patients with only thyroxine replacement. The final clinical outcomes of hypothyroid patients with nipple discharge and mastalgia were significantly better than that of their euthyroid counterparts (P = 0.028 and 0.001, respectively); no significant difference was noted in patients with lumpiness (P = 0.144).

Conclusions

All women with BBD should be screened for hypothyroidism because the prevalence of hypothyroidism is high among this group and correction of hypothyroidism results in significant clinical improvement of BBD in most of these patients.
Literature
1.
go back to reference Barton MB, Elmore JG, Fletcher SW (1999) Breast symptoms among women enrolled in a health maintenance organization: frequency, evaluation, and outcome. Ann Intern Med 130:651–657PubMed Barton MB, Elmore JG, Fletcher SW (1999) Breast symptoms among women enrolled in a health maintenance organization: frequency, evaluation, and outcome. Ann Intern Med 130:651–657PubMed
2.
go back to reference Dawson C, Armstrong MW, Michaels J et al (1993) Breast disease and the general surgeon. II. Effect of audit on the referral of patients with breast problems. Ann R Coll Surg Engl 75:83–86PubMed Dawson C, Armstrong MW, Michaels J et al (1993) Breast disease and the general surgeon. II. Effect of audit on the referral of patients with breast problems. Ann R Coll Surg Engl 75:83–86PubMed
3.
go back to reference Goehring C, Morabia A (1997) Epidemiology of benign breast disease, with special attention to histologic types. Epidemiol Rev 19:310–327PubMed Goehring C, Morabia A (1997) Epidemiology of benign breast disease, with special attention to histologic types. Epidemiol Rev 19:310–327PubMed
4.
go back to reference Peters F, Schuth W, Scheurich B et al (1984) Serum prolactin levels in patients with fibrocystic breast disease. Obstet Gynecol 64:381–385PubMed Peters F, Schuth W, Scheurich B et al (1984) Serum prolactin levels in patients with fibrocystic breast disease. Obstet Gynecol 64:381–385PubMed
5.
go back to reference Watt-Boolsen S, Eskildsen PC, Blaehr H (1985) Release of prolactin, thyrotropin, and growth hormone in women with cyclical mastalgia and fibrocystic disease of the breast. Cancer 56:500–502PubMedCrossRef Watt-Boolsen S, Eskildsen PC, Blaehr H (1985) Release of prolactin, thyrotropin, and growth hormone in women with cyclical mastalgia and fibrocystic disease of the breast. Cancer 56:500–502PubMedCrossRef
6.
go back to reference Minton JP, Abou-Issa H (1989) Nonendocrine theories of the etiology of benign breast disease. World J Surg 13:680–684PubMedCrossRef Minton JP, Abou-Issa H (1989) Nonendocrine theories of the etiology of benign breast disease. World J Surg 13:680–684PubMedCrossRef
7.
go back to reference Adamopoulos DA, Vassilaros S, Kapolla N et al (1986) Thyroid disease in patients with benign and malignant mastopathy. Cancer 57:125–128PubMedCrossRef Adamopoulos DA, Vassilaros S, Kapolla N et al (1986) Thyroid disease in patients with benign and malignant mastopathy. Cancer 57:125–128PubMedCrossRef
8.
go back to reference Giustarini E, Pinchera A, Fierabracci P et al (2006) Thyroid autoimmunity in patients with malignant and benign breast diseases before surgery. Eur J Endocrinol 154:645–649PubMedCrossRef Giustarini E, Pinchera A, Fierabracci P et al (2006) Thyroid autoimmunity in patients with malignant and benign breast diseases before surgery. Eur J Endocrinol 154:645–649PubMedCrossRef
10.
go back to reference Ghent WR, Eskin BA, Low DA et al (1993) Iodine replacement in fibrocystic disease of the breast. Can J Surg 36:453–460PubMed Ghent WR, Eskin BA, Low DA et al (1993) Iodine replacement in fibrocystic disease of the breast. Can J Surg 36:453–460PubMed
11.
go back to reference Estes NC (1981) Mastodynia due to fibrocystic disease of the breast controlled with thyroid hormone. Am J Surg 42:764–766CrossRef Estes NC (1981) Mastodynia due to fibrocystic disease of the breast controlled with thyroid hormone. Am J Surg 42:764–766CrossRef
12.
go back to reference Goodson WH, Moore DH (2002) Overall clinical breast examination as a factor in delayed diagnosis of breast cancer. Arch Surg 137:1152–1156PubMedCrossRef Goodson WH, Moore DH (2002) Overall clinical breast examination as a factor in delayed diagnosis of breast cancer. Arch Surg 137:1152–1156PubMedCrossRef
13.
go back to reference Surks MI, Ortiz E, Daniels GH et al (2004) Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 291:228–238PubMedCrossRef Surks MI, Ortiz E, Daniels GH et al (2004) Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 291:228–238PubMedCrossRef
14.
go back to reference Mansel RE, Fenn NJ, Davies EL (1998) Benign breast disease and its management. In: Johnson CD, Taylor I (eds) Recent advances in surgery, vol 21. Churchill Livingstone, Edinburgh, pp 71–83 Mansel RE, Fenn NJ, Davies EL (1998) Benign breast disease and its management. In: Johnson CD, Taylor I (eds) Recent advances in surgery, vol 21. Churchill Livingstone, Edinburgh, pp 71–83
15.
go back to reference Delange F, Bastiani S, Benmiloud M (1986) Definitions of endemic goiter and cretinism, classification of goiter size and the severity of endemias, and survey techniques. In: Dunn JT, Pretell EA, Daza CH et al (eds) Towards the eradication of endemic goiter, cretinism, and iodine deficiency. Pan American Health Organization, Washington, DC, p 502 Delange F, Bastiani S, Benmiloud M (1986) Definitions of endemic goiter and cretinism, classification of goiter size and the severity of endemias, and survey techniques. In: Dunn JT, Pretell EA, Daza CH et al (eds) Towards the eradication of endemic goiter, cretinism, and iodine deficiency. Pan American Health Organization, Washington, DC, p 502
16.
go back to reference Saraiva PP, Figueiredo NB, Padovani CR et al (2005) Profile of thyroid hormones in breast cancer patients. Braz J Med Biol Res 38:761–765PubMedCrossRef Saraiva PP, Figueiredo NB, Padovani CR et al (2005) Profile of thyroid hormones in breast cancer patients. Braz J Med Biol Res 38:761–765PubMedCrossRef
17.
go back to reference Shering SG, Zbar AP, Moriarty M et al (1996) Thyroid disorders and breast cancer. Eur J Cancer Prev 5:504–506PubMed Shering SG, Zbar AP, Moriarty M et al (1996) Thyroid disorders and breast cancer. Eur J Cancer Prev 5:504–506PubMed
18.
go back to reference Cristofanilli M, Yamamura Y, Kau SW et al (2005) Thyroid hormone and breast carcinoma: primary hypothyroidism is associated with a reduced incidence of primary breast carcinoma. Cancer 103:1122–1128PubMedCrossRef Cristofanilli M, Yamamura Y, Kau SW et al (2005) Thyroid hormone and breast carcinoma: primary hypothyroidism is associated with a reduced incidence of primary breast carcinoma. Cancer 103:1122–1128PubMedCrossRef
19.
go back to reference Rao VR, Lakshmi A, Sadhnani MD (2008) Prevalence of hypothyroidism in recurrent pregnancy loss in first trimester. Indian J Med Sci 62:359–363 Rao VR, Lakshmi A, Sadhnani MD (2008) Prevalence of hypothyroidism in recurrent pregnancy loss in first trimester. Indian J Med Sci 62:359–363
20.
go back to reference Gupta S, Saha PK, Mukhopadhyay A (2008) Prevalence of hypothyroidism and importance of cholesterol estimation in patients suffering from major depressive disorder. J Indian Med Assoc 106:240–242PubMed Gupta S, Saha PK, Mukhopadhyay A (2008) Prevalence of hypothyroidism and importance of cholesterol estimation in patients suffering from major depressive disorder. J Indian Med Assoc 106:240–242PubMed
21.
go back to reference Baloch Z, Carayon P, Conte-Devolx B et al (2003) Guidelines committee, national academy of clinical biochemistry: laboratory medicine practice guidelines—laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 13:3–126PubMedCrossRef Baloch Z, Carayon P, Conte-Devolx B et al (2003) Guidelines committee, national academy of clinical biochemistry: laboratory medicine practice guidelines—laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 13:3–126PubMedCrossRef
22.
go back to reference Baskin HJ, Cobin RH, Duick DS et al (2002) American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract 8:457–469PubMed Baskin HJ, Cobin RH, Duick DS et al (2002) American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract 8:457–469PubMed
23.
go back to reference Vanderpump MP, Tunbridge WH, French JM (1995) The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham survey. Clin Endocrinol (Oxf) 43:55–68CrossRef Vanderpump MP, Tunbridge WH, French JM (1995) The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham survey. Clin Endocrinol (Oxf) 43:55–68CrossRef
24.
go back to reference Wilson GR, Curry RW (2005) Subclinical thyroid disease. Am Fam Physician 72:1517–1524PubMed Wilson GR, Curry RW (2005) Subclinical thyroid disease. Am Fam Physician 72:1517–1524PubMed
25.
go back to reference Arrigo T, Wasniewska M, Crisafulli G et al (2008) Subclinical hypothyroidism: the state of the art. J Endocrinol Invest 31:79–84PubMed Arrigo T, Wasniewska M, Crisafulli G et al (2008) Subclinical hypothyroidism: the state of the art. J Endocrinol Invest 31:79–84PubMed
Metadata
Title
Prevalence of Hypothyroidism in Benign Breast Disorders and Effect of Thyroxine Replacement on the Clinical Outcome
Authors
Panchagan R. K. Bhargav
Anjali Mishra
Gaurav Agarwal
Amit Agarwal
Ashok Kumar Verma
Saroj Kanta Mishra
Publication date
01-10-2009
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 10/2009
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-009-0143-y

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