Contributing Factors related to hypothyroidism / hyperthyroidism for adult patient at Bagdad Teaching Hospitals

Objective (s):To assess of contributing factors related to hypothyroidism/ hyperthyroidism for adult patients, and to find out the relationship between some demographic characteristic (age, gender, level of education ) with contributing factors.
Methodology: A descriptive study was conducted at the outpatient consultation in Bagdad teaching hospitals the period between October 2014 to May 2015in order to assess the contributing factors related to Hypothyroidism / Hyperthyroidism for adult patient at Bagdad Teaching Hospitals .A random sample consisted of (50) patients from suffering hypothyroidism and (50) patients from suffering hyperthyroidism who were systematically admitted to the outpatient consultation were selected one by one. A questionnaire was constructed for the purpose of the study, which is comprised of three parts that include: (1) Sociodemographic Characteristics data (2) The past medical history for patient and family (3) Assessment of contributing factors related to diet , psychological factors, social factors and medication. Content validity of the questionnaire was determine through a panel of (14) experts. Reliability and validity of questionnaire was determined through test re-test (r= 0.861) of pilot study. Data was collected by the researcher who interviewed those patients and filled out the constructed questionnaire form. Data were analyzed by using descriptive statistical approach (frequency, percentage and mean of score) and inferential statistical approach (stander deviation and correlation coefficient).
Results: The study findings indicated that there is highly significant difference between Women and man the incidence of thyroid disease (hypothyroidism and hyperthyroidism) more than female. It is aged between (28-37) years old for hypothyroidism patient s and (48-57) years old for hyperthyroidism patients, the most of study sample primary graduates and urban setting. Our results also show that there are significant difference between history of thyroid disease patient and non-history of thyroid disease patients. 
Conclusion: past history of thyroid disease raises the risk to develop hypothyroidism and hyperthyroidism disease and barely sufficient income for hypothyroidism and sufficient income for hyperthyroidism patients.
Recommendations: The study recommends that the further research aimed at early detection hypothyroidism and hyperthyroidism and education program to help and understand the thyroid disease and find ways to reduce the risk of future thyroid problems and life style habit.


Conclusion:
Conclusion from the study that past history of thyroid disease raises the risk to develop hypothyroidism and hyperthyroidism disease and barely sufficient income for hypothyroidism and sufficient income for hyperthyroidism patients.

Recommendations:
The study recommends that the further research aimed at early detection hypothyroidism and hyperthyroidism and education program to help and understand the thyroid disease and find ways to reduce the risk of future thyroid problems and life style habit.Keyword: Contributing factors, Hypothyroidism, Hyperthyroidism.

INTRODUCTION:
Worldwide about one billion individuals are estimated to be iodine deficient; however, it is unknown how often this leads to hypothyroidism.In large population-based studies in Western countries with deficiency dietary iodine, 0.3-0.4% of the population have overt hypothyroidism.A larger proportion, 4.3-8.5%,has subclinical hypothyroidism (1) .Hypothyroidism and hyperthyroidism are the production of an imbalance of thyroid hormone.Hypothyroidism is simply insufficiency thyroid hormone and hyperthyroidism is too much.Either imbalance affects the metabolism in the body.Guyton (2000) says "hypothyroidism like hyperthyroidism is probably initiated by autoimmunity against the thyroid gland, but immunity that destructs the gland rather than stimulates it.The thyroid gland regulates the body's metabolism, heart rate, blood pressure, and body temperature, among other functions.Thyroid hormone maintains the rate at which your body uses fats and carbohydrates, burn calories, assist regulate body temperature, influence heart rate and helps in controlling the production of protein.Sometimes the thyroid can produce too much hormones or insufficiency (2) .Women are most probability to develop hypothyroidism than men.In population-based studies, women were seven times more likely than men to have TSH levels over 10 mU/l (3) .Many risk factors predispose women and man to hypothyroidism and hyperthyroidism, including autoimmune thyroid disease (AITD), type (1) diabetes mellitus, other endocrine deficiencies, Down syndrome, thalassemia major, thyroid ablation and who are treated with pituitary surgery or irradiation, head and neck irradiation, treatment of growth hormone deficiency, cytotoxic therapy, lithium, interferon α, interferon β, and therapeutic monoclonal antibodies.Patients with a family or client history of thyroid disease, goiter, history of spontaneous abortion in women, Positive thyroid peroxidase antibody, origin from areas of endemic iodine deficiency, Previous thyroid disease or surgery, or any symptoms suggesting at higher risk for hypothyroidism and hyperthyroidism (4) .

OBJECTIVES OF THE STUDY:
1. To assess contributing factors related to hypothyroidism / hyperthyroidism for adult patients.2. To find out the relationships between contributing factors related to hypothyroidism/ hyperthyroidism and adult patients' certain variables such as (age, gender, educational level).

METHODOLOGY:
A descriptive study was carried out throughout the present study to assessment contributing factors related tohypothyroidism/hyperthyroidism for adult patients who attended the outpatient consultation of Baghdad Teaching Hospital.The study was carried out during the period extended from the ofOctober28 th 2014 to May15 th 2015.The sample consisted of (100) patients divided two group (50) patients hypothyroidism and (50)patients hyperthyroidism.These patients were attending out patient's consultation of Baghdad Teaching Hospitals(Al-Yarmouk Teaching Hospital, Baghdad Teaching Hospital, AL.KindlyTeaching Hospital and Medical CityKazimain (peace be upon them).A questionnaire-interview format was designed and developed by the researcher for the purpose of the study; such development was employed through the available literature, clinical background and interview with patients who hypothyroidism/hyperthyroidism.All the items were measured on scale of (3) indicates that the always 1, sometimes 2, never 3.Diet domain; daily 1, Weekly 2, monthly 3 for hyperthyroidism, daily 3, Weekly 2, monthly 1 for hypothyroidism.The questionnaire consisted of (3) parts.Part I: Demographic Information Sheet.Part II : historical information satisfactory to the patient and family.Part III: Contributing factors domain which include diet, Psychological domain (anxiety &depression), social and Medication domain.Rating scale was used to rate the frequency and extension of the problems.The content validity of the instrument was established through a panel of ( 14) experts.Test-retest reliability was determined through a computation of Pearson Correlations for the scales.Coefficients for the (43) items of contributing factors of hypothyroidism and hyperthyroidism were (r= 0.861) for the total score of contributing factors.The data were collected by using the questionnaire structured format through interview technique.Each patient was interviewed personally by the researcher.Throughout each interview explanation of the study was held up with patient in order to accept participation.Each interview took approximately from (20-30) minute and initiated at the waiting room.Data were collected between 8.30 am to 1.30 pm.The determination was conducted during the period from January 13 th to April 5 th 2015.The data were analyzed through descriptive data analysis and inferential data analysis the data were analyzed through the use of Statistical Package of Social Sciences (SPSS) version 16.0.Table (1) revealed that 96% of the study samples were females for hypothyroidism and 84% of them were females for hyperthyroidism, more age (28-37 )years old for hypothyroidism and more age( 48-57) years old for hyperthyroidism, high percentage of them were primary graduated for both groups, hypothyroidism 30% and hyperthyroidism 32% , 70% of them were equal to housewife for hypothyroidism and hyperthyroidism ,(88%) study sample from urban setting for hypothyroidism and 92% from urban setting for hyperthyroidism,38% have barely sufficient income for hypothyroidism and 52% have sufficient income for hyperthyroidism.Table (4) shows that the mean of score are high on items3 rd (5,7), 4 th (2,5,6,7),moderate and low on the remaining items.Table (5) shows that the mean of score are high on items (1 st (1,5,9,10),2 nd (13,14),moderate and low on the remaining items.Table (7) show that there is week negative relationship between contributing factors with gender (r=-.162-), and there is positive moderate relationship between contributing factors with level of education(r=.144),there is relationship between contributing factors with age(r=.028).Table (8) show that there is week negative relationship between contributing factors and gender(r= -.113-), and relationship between contributing factors and{age(r=-.041-),level of education(r=.055).

DISCUSSION
Through the course of the data analysis of the presentstudy,the finding showed that the majority of the study samples for both group , hypothyroidism (96%) females ,(32%) were (28-37) years old and hyperthyroidism (48%) females , (28%) were (48-57) years old.This finding agree with other researcher who stated that Hyperthyroidism attacked approximately (2%) of female in UK, and this rate was (10) times to attack female.Graves' disease contributed to approximately (60% -80%) of hyperthyroidism patients This number achieved (10) times higher in women, where highest onset risk happen at age from (40 -60) years old (5) .
Seventy percent ofboth the study samples group are housewife as occupation and Thirty eight percent are barely sufficient for hypothyroidism and sufficient for hyperthyroidism as monthly income.
The finding of the study sample shows that highest percentages (94%) don't smoking for hypothyroidism and (90%) don't have hyperthyroidism.
This finding disagrees with other researcher who reported that there was relationship between smoking and hyperthyroid (the participation were nonsmoking (25%), While(75%) were smokers) (6) .
Regarding residence, majority (88%) of the study was urban for hypothyroidism and (92%) of the study were urban for hyperthyroidism.This finding were in good agreement with that obtain by other researcher which reported that the finding of participants had (19%) participants from urban areas, (81%) participants from rural areas (7) .
The finding of the study sample shows that (44%) of the patient had family history for hypothyroidismand48% of patients had family history of hyperthyroidism.This findings can be supported by another study the findings who reported that there was no significant difference between those who had history of thyroid problem in their family and those who did not have history of thyroid problem in their family in cases as well as in control group (8) .
Our finding about psychological domain are similar to those reported that of the other researcher who stated there was predominance of Major depressive disorder 24.2%, followed by anxiety disorders (23%).The p-value of the comparison between the case and the control patients is 0.0001 which is highly significant (9) .
The mean of score of social domain in table (3) for hypothyroidism patients are high on item (Are increasing problems during menstrual cycle days?)and item (Prefer to stay at home away from the eyes of the people).The mean of score is moderate item(Do take advantage of your free time?) , item(Feel anxiety when you stay at home) and low on the remaining items.This finding agrees with other researcher which reported that the patients of thyroid disease were significantly more anxious and perceived higher social support from family when compared with the control group (10) .
The mean of score of medication domain in table (4) for hypothyroidism patients are high on item(Iron and product) ,item(Anti-thyroid drugs) ,item(Cardiovascular drugs) and item (Diuretic drugs) .The mean of score is moderate item(Antacids drugs), item(Contraceptive drugs) and item(Sedatives and opiates).
These result were similar to those result obtained by other researcher who stated that many different drugs affect thyroid function.Most of these medication act at the level of the thyroid in patients with normal thyroid function, or at the level of thyroid hormone absorption or metabolism in patients requiring exogenous levothyroxine (11) .
The mean of score of diet domain in table (5) for hyperthyroidism patients are high on item(Meat (liver)) ,item (Butter), item(pineapple) and Green pepper.The mean of score is moderate & low on the remaining items.
This finding is supported other researcher who reported that iodine concentration in aquatic products, poultry products, vegetables, meat and poultry was relatively high.As patients with hyperthyroidism or subclinical hyperthyroidism were not allowed to take iodine or foods with high iodine content by recommendation of their doctors, participants with a known history of hyperthyroidism or subclinical hyperthyroidism are excluded (12) .
The mean of score of medication domain in table (6) for hyperthyroidism patients is high on item (Cortisone drugs), and item(Steroids drugs) .The mean of score is moderate item(Sedatives and opiates) , item(Anti-thyroid drugs) and item(Cardiovascular drugs).
This finding is supported by another study done who reported that shows Betaadrenergic blockers were the most frequently prescribed concomitant drugs with 24% of the subclinical hyperthyroid group, and 10.1% of the subclinical hypothyroid group taking this medication (13) .
The findings of the study sample hypothyroidism patients indicated that there is weak negative relationship between contributing factors with gender (r=-.162-),and there is weak positive relationship between contributing factors with level of education(r=.144), there is no relationship between contributing factors with age(r=.028).Table (7)  The findings of the study sample hyperthyroidism patients indicated there is weak negative relationship between contributing factors and gender(r= -.113-), and relationship between contributing factors and{age(r=-.041-),level of education(r=.055).Table (8)

CONCLUSIONS
Our data indicate that the contributing factors domains of patients with hypothyroidism and hyperthyroidismis moderate decline in all domains expect medication domain is high of contributing factors domains.

RECOMMENDATION:
Based on the results and conclusions of the present study; the researcher recommends the following: 1-These results suggest the identification of early detection hypothyroidism and hyperthyroidism for adult patient.2-Education program for patient and family to help and understand the thyroid disease and find ways to reduce the risk of future thyroid problems.

Table ( 2
) shows that 44% of patients had family history of hypothyroidism and 48% of patients had family history of hyperthyroidism.

Table ( 3
)shows that the mean of score are high on items (1 st (5,9),2 nd (14), moderate and low on the remaining items.