Advertisement

World Journal of Surgery

, Volume 33, Issue 10, pp 2087–2093 | Cite as

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

  • Panchagan R. K. Bhargav
  • Anjali MishraEmail author
  • Gaurav Agarwal
  • Amit Agarwal
  • Ashok Kumar Verma
  • Saroj Kanta Mishra
Article

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.

Keywords

Hypothyroidism Goiter Thyroid Dysfunction Subclinical Hypothyroidism Nipple Discharge 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Barton MB, Elmore JG, Fletcher SW (1999) Breast symptoms among women enrolled in a health maintenance organization: frequency, evaluation, and outcome. Ann Intern Med 130:651–657PubMedGoogle Scholar
  2. 2.
    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 75:83–86PubMedGoogle Scholar
  3. 3.
    Goehring C, Morabia A (1997) Epidemiology of benign breast disease, with special attention to histologic types. Epidemiol Rev 19:310–327PubMedGoogle Scholar
  4. 4.
    Peters F, Schuth W, Scheurich B et al (1984) Serum prolactin levels in patients with fibrocystic breast disease. Obstet Gynecol 64:381–385PubMedGoogle Scholar
  5. 5.
    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 56:500–502PubMedCrossRefGoogle Scholar
  6. 6.
    Minton JP, Abou-Issa H (1989) Nonendocrine theories of the etiology of benign breast disease. World J Surg 13:680–684PubMedCrossRefGoogle Scholar
  7. 7.
    Adamopoulos DA, Vassilaros S, Kapolla N et al (1986) Thyroid disease in patients with benign and malignant mastopathy. Cancer 57:125–128PubMedCrossRefGoogle Scholar
  8. 8.
    Giustarini E, Pinchera A, Fierabracci P et al (2006) Thyroid autoimmunity in patients with malignant and benign breast diseases before surgery. Eur J Endocrinol 154:645–649PubMedCrossRefGoogle Scholar
  9. 9.
    Venturi S (2001) Is there a role for iodine in breast diseases? Breast 10:379–382PubMedCrossRefGoogle Scholar
  10. 10.
    Ghent WR, Eskin BA, Low DA et al (1993) Iodine replacement in fibrocystic disease of the breast. Can J Surg 36:453–460PubMedGoogle Scholar
  11. 11.
    Estes NC (1981) Mastodynia due to fibrocystic disease of the breast controlled with thyroid hormone. Am J Surg 42:764–766CrossRefGoogle Scholar
  12. 12.
    Goodson WH, Moore DH (2002) Overall clinical breast examination as a factor in delayed diagnosis of breast cancer. Arch Surg 137:1152–1156PubMedCrossRefGoogle Scholar
  13. 13.
    Surks MI, Ortiz E, Daniels GH et al (2004) Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 291:228–238PubMedCrossRefGoogle Scholar
  14. 14.
    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 71–83Google Scholar
  15. 15.
    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 502Google Scholar
  16. 16.
    Saraiva PP, Figueiredo NB, Padovani CR et al (2005) Profile of thyroid hormones in breast cancer patients. Braz J Med Biol Res 38:761–765PubMedCrossRefGoogle Scholar
  17. 17.
    Shering SG, Zbar AP, Moriarty M et al (1996) Thyroid disorders and breast cancer. Eur J Cancer Prev 5:504–506PubMedGoogle Scholar
  18. 18.
    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 103:1122–1128PubMedCrossRefGoogle Scholar
  19. 19.
    Rao VR, Lakshmi A, Sadhnani MD (2008) Prevalence of hypothyroidism in recurrent pregnancy loss in first trimester. Indian J Med Sci 62:359–363Google Scholar
  20. 20.
    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 106:240–242PubMedGoogle Scholar
  21. 21.
    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 13:3–126PubMedCrossRefGoogle Scholar
  22. 22.
    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 8:457–469PubMedGoogle Scholar
  23. 23.
    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) 43:55–68CrossRefGoogle Scholar
  24. 24.
    Wilson GR, Curry RW (2005) Subclinical thyroid disease. Am Fam Physician 72:1517–1524PubMedGoogle Scholar
  25. 25.
    Arrigo T, Wasniewska M, Crisafulli G et al (2008) Subclinical hypothyroidism: the state of the art. J Endocrinol Invest 31:79–84PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2009

Authors and Affiliations

  • Panchagan R. K. Bhargav
    • 1
  • Anjali Mishra
    • 1
    Email author
  • Gaurav Agarwal
    • 1
  • Amit Agarwal
    • 1
  • Ashok Kumar Verma
    • 1
  • Saroj Kanta Mishra
    • 1
  1. 1.Department of Endocrine SurgerySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

Personalised recommendations