The Indian Thyroid Society (ITS) has launched three guidelines for the management of thyroid dysfunction in pregnancy, dyslipidemia and depression at the 10th Annual Conference 'ITSCON - 2013'. These guidelines are for managing thyroid dysfunction in pregnancy to safeguard mother and child health, and for patients of depression and dyslipidemia to reduce the co-morbidities associated with thyroid disorders.

Thyroid disorders in India are characterized by a high prevalence (approximately 11 percent of adult population), minimal diagnosis, low awareness and low involvement of doctors in treatment.

The guidelines were developed by Elsevier, a global provider of scientific, technical and medical information, and endorsed by the ITS, Endocrine Society of India [ESI], Federation of Obstetric and Gynecological Societies of India [FOGSI] and The Association of Physicians of India [API]. Abbott provided the financial assistance for the development of these guidelines.

On the launch of the ITS Guidelines, Dr RV Jayakumar, president, Indian Thyroid Society, professor of Endocrinology, AIMS, Cochin said, "Conditions such as depression, cardiovascular disorders, high cholesterol, obesity, osteoporosis, infertility and miscarriages are linked to thyroid disorders and these are on the rise in India. The three independent guidelines for the screening and management of thyroid dysfunction will support the medical fraternity in diagnosis and treatment. Timely diagnosis of thyroid disorders in pregnant women is important for a healthy pregnancy and a healthy child. In addition, the guidelines for dyslipidemia and depression offer recommendations to minimize the risk of arising complications."

Dr Mala Dharmalingam, professor and HOD of Endocrinology, MS Ramaiah Medical College and Hospital, Bangalore says, "Thyroid hormone is very important for normal functioning of the body processes. However, low production of the hormone leads to hypothyroidism indicated by fatigue, weight gain, cold chills, dry skin, heavy menstrual periods, constipation, slowed thinking, brittle nails, swelling in arms and legs and hair loss. Ignoring these symptoms can develop into serious medical conditions like heart disease, and mental health issues. Through these guidelines we can create awareness amongst the general public about symptoms related to thyroid disorders and the complications that can arise if not diagnosed and treated in time."

The Thyroid Dysfunction and Pregnancy Guidelines recommend the following:

• For the screening for hypothyroidism in pregnant women at the 1st antenatal visit by measuring TSH levels.
• If overt hypothyroidism is diagnosed then expectant mothers should be treated with a full replacement dose of thyroxine to normalize thyroid function as rapidly as possible. It is also important to understand that; thyroid dysfunction by itself is not an indication for termination of pregnancy. 
• Overt hypothyroidism is associated with the risk of cardio vascular disease as it causes increased levels of LDL cholesterol and hypertension. It is therefore advised that doctors screen patients with dyslipidemia for abnormal thyroid levels and accordingly prescribe treatment.
• One of the co-morbidities associated with thyroid disorders is depression. It is important for doctors who are treating patients for depression to refer them to undergo a TSH test to detect hypothyroidism. This will help in correct diagnosis and treatment to prevent further damage.

Thyroid disorder is a medical condition that impairs the normal functioning of the thyroid gland causing abnormal production of hormones leading to hyperthyroidism or hypothyroidism. Multiple factors such as hereditary, environment and diet can trigger thyroid dysfunction. Thyroid disorders are commonly diagnosed between 20-40 years and research has shown that women are more commonly detected with thyroid disorders than men.

Speaking of thyroid disorders in women during pregnancy, Dr Hema Divakar, president, Federation of Obstetric and Gynaecological Societies of India [FOGSI], Bangalore said, "Hypothyroidism is emerging as one of the most common endocrine problem during pregnancy and often goes undetected. It increases the risk of miscarriage, stillbirth, premature birth and placental abnormalities that adversely affects the overall development of the fetus. In the best interest of the mother and baby, we encourage regular screening for thyroid disorders amongst pregnant women. The guidelines recommend screening at the 1st antenatal visit by measuring TSH levels."

Often symptoms such as anxiety, mood swings and poor concentration are ignored as signs of stress. These could have been triggered due to abnormal levels of thyroid hormone which can push people into depression.

According to Dr Sarita Bajaj, president, Endocrine Society of India (ESI), Allahabad, "Thyroid hormones have a tremendous effect on body processes and can even impact cognitive function. There is little awareness that depression is a co-morbidity associated with hypothyroidism. All patients with depression should preferably be screened for thyroid function tests and be appropriately treated with thyroxine as judged by the physician."

Hypothyroidism also leads to a co-morbid condition called dyslipidemia indicated with an increase in serum total cholesterol, low-density lipoprotein (LDL), apolipoprotein B, lipoprotein (a) levels, and possibly triglyceride levels. Dyslipidemia puts a patient at an increased risk for developing cardiovascular diseases, atherosclerosis and coronary artery disease.

The chairman organizing committee Dr KM Prasanna Kumar confirmed that close to 500 eminent speakers and key opinion leaders from across India were present at the ITSCON-2013 conference. The speakers highlighted various disorders arising from thyroid dysfunctions, the importance of timely screening and recommended treatment to prevent further complications.

Till 2012, Indian Thyroid Society had screened close to 12 lakh women for thyroid disorders at various diagnostic and education camps throughout India.