A prospective study to analyze the etiology, prevalence, clinical presentation, age and sex wise distribution of thyrotoxicosis among thyroid disorders in a tertiary care hospital

Manoj Kumar Nirmalanandan, Kavitha Jayanthi Balachandran


Background: Thyrotoxicosis is a clinical syndrome characterized by an excess of free thyroxine and triiodothyronine or both. One of the major and usual causes of thyrotoxicosis is Graves’ disease. Morbidity associated with the situation is very high and it demands early diagnosis and treatment. This can reduce the burden of the disease it imparts on the society. The aim of the study is to analyse the etiology, prevalence, clinical presentation, age, and sex-wise distribution of thyrotoxicosis among thyroid disorders presenting to Government Medical College, Thiruvananthapuram.

Methods: It is a prospective study undertaken in tertiary care and teaching hospital over a period of one year. 2401 patients admitted in the general ward with thyroid disorders were included in the study. Definite inclusion and exclusion criteria were followed. Relevant blood tests were done in all cases.

Results: On analysis of the data which were entered in excel format the prevalence of thyrotoxicosis was 2.5%. The majority of the study population was in the twenties and forties. Incidences in females were more mainly due to increased prevalence.

Conclusions: By studying the etiology, prevalence, clinical presentation, age, and sex-wise distribution of Thyrotoxicosis, the disease burden in the population can be understood and early diagnosis and proper treatment can be instituted. Our study prevalence was comparable with similar studies done in other institutions. 


Thyrotoxicosis, Prevalence, Graves’ disease, Age, Sex

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Unnikrishnan AG, Menon UV. Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab. 2011;15:78-81.

Kravets I. Hyperthyroidism: Diagnosis and Treatment. Am Fam Physician. 2016;93(5):363-70.

Gilbert J. Thyrotoxicosis: investigation and management. Clin Med. 2017;17(3):274-7.

Blick C, Nguyen M, Jialal I. Thyrotoxicosis. StatPearls. Available at: Accessed on: 20 May 2020.

Nygaard B. Hyperthyroidism (primary). BMJ Clin Evid. 2010. Available at: Accessed on: 20 May 2020.

Ching GW, Franklyn JA, Stallard TJ, Daykin J, Sheppard MC, Gammage MD. Cardiac hypertrophy as a result of long-term thyroxine therapy and thyrotoxicosis. Heart. 1996;75(4):363-8.

Chazenbalk GD, Pichurin P, Chen CR, Latrofa F, Johnstone AP, McLachlan SM, et al. Thyroid-stimulating autoantibodies in Graves disease preferentially recognize the free A subunit, not the thyrotropin holoreceptor. J Clin Invest. 2002;110(2):209-17.

Muehlberg T, Gilbert JA, Rao PV, McGregor AM, Banga JP. Dynamics of thyroid-stimulating and -blocking antibodies to the thyrotropin receptor in a murine model of Graves’ disease. Endocrinology. 2004;145(4):1539-45.

Barsouk A, Peele KA, Kiljanski J, Stolarski C, Nebes V, Kennerdell JS, et al. Antibody-dependent cell-mediated cytotoxicity against orbital target cells in thyroid-associated ophthalmopathy and related disorders; close relationship between serum cytotoxic antibodies and parameters of eye muscle dysfunction. J Endocrinol Invest. 1996;19(6):334-41.

McLachlan SM, Rapoport B. Thyrotropin-blocking autoantibodies and thyroid-stimulating autoantibodies: potential mechanisms involved in the pendulum swinging from hypothyroidism to hyperthyroidism or vice versa. Thyroid Off J Am Thyroid Assoc. 2013;23(1):14-24.

Iagaru A, McDougall IR. Treatment of thyrotoxicosis. J Nucl Med. 2007;48(3):379-89.

Mumtaz M, Lin LS, Hui KC, Mohd Khir AS. Radioiodine I-131 for the therapy of Graves’ disease. Malays J Med Sci MJMS. 2009;16(1):25-33.

Livolsi V, Baloch Z. The pathology of hyperthyroidism. Front Endocrinol. 2018;9:737.

Bose A, Sharma N, Hemvani N, Chitnis DS. A hospital based prevalence study on thyroid disorders in Malwa region of central India. Int J Curr Microbiol App Sci. 2015;4(6):604-11.

Abraham R, Srinivasa MV, Pukazhvanthen P, Sen SK. Thyroid disorders in women of Puducherry. Indian J Clin Biochem. 2009;24(1):52-9.

Hoogendoorn EH, Hermus AR, de Vegt F, Ross HA, Verbeek ALM, Kiemeney LALM, et al. Thyroid function and prevalence of anti-thyroperoxidase antibodies in a population with borderline sufficient iodine intake: influences of age and sex. Clin Chem. 2006;52(1):104-11.

Velayutham K, Selvan SSA, Unnikrishnan AG. Prevalence of thyroid dysfunction among young females in a South Indian population. Indian J Endocrinol Metab. 2015;19(6):781-4.

Bjoro T, Holmen J, Krüger O, Midthjell K , Hunstad K, Schreiner T, et al. Prevalence of thyroid disease, thyroid dysfunction and thyroid peroxidase antibodies in a large, unselected population. The Health Study of Nord-Trùndelag (HUNT). Eur J Endocrinol. 2000;143(5):639-47.

Madariaga AG, Palacios SS, Grima FG, Galofré JC. The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab. 2014;99(3):923-31.

Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87(2):489-99.

Predicting relapse of Graves’ disease following treatment with antithyroid drugs. Available at: Accessed on: 21 May 2020.

Image graves ophthalmopathy. Available from: Accessed on: 22 May 2020.