Hypothyroidism and Mental and Emotional Health of Females Aged 30-45 Years in Belagavi - An Exploratory Observational Study

Introduction

Hypothyroidism is discussed under World Health Organisation10 International Classification of Diseases (ICD 10) Chapter: Endocrine, nutritional and metabolic diseases - Disorders of thyroid gland - Hypothyroidism ICD-10. Diagnosis code for hypothyroidism is E03.9.¹ Hypothyroidism is defined as an elevation in serum thyroid stimulating hormone (TSH) level above 4.5 mIU/L.²

The prevalence of hypothyroidism varies with population, age, sex, race, region, and method of thyroid stimulating hormone (TSH) measurement. Hypothyroidism is defined as a TSH level greater than 4.5 mIU/L. Its prevalence in large population-based studies worldwide in various countries has been reported to be 3% to 10%.² India has an estimated 42 million people suffering from thyroid diseases, with prevalence of hypothyroid dysfunction as high as 9.4% with female dominance of 11.4% vs 6.2% in men.³

The prevalence of thyroid dysfunction, particularly hypothyroidism, has been increasing across various age groups, with middle-aged females being the most affected. Sub-clinical hypothyroidism is frequently seen in our population, with most patients complaining of lethargy.⁴ Conventionally, the primary approach to managing thyroid dysfunction has been hormone replacement therapy using synthetic thyroxine. However, there is a pressing need to shift the paradigm and address not only the physiological aspects but also the mental and emotional dimensions of this condition in females. Previous studies have shown the importance of prognostic risk factors for thyroid disease.5 The prevalence of hypothyroidism in India is 11%.⁶

This study aimed to evaluate the mental and emotional health of females aged 30-45 years with hypothyroid dysfunction in Belagavi, Karnataka, India. Additionally, it aimed to identify potential circumstantial factors that predispose females to thyroid dysfunction. The psychological impact of thyroid dysfunction is a critical aspect of this study, as it has the potential to profoundly affect an individual's well-being. Issues such as weight gain, changes in physical appearance, infertility, irregular menstruation, and emotional distress are common among hypothyroid patients, particularly females.

To assess disharmony, a self-designed open-ended questionnaire was employed, including questions about family relationships, frequency of conflicts, perceived support from family members, and sources of stress at home. Participants who reported frequent conflicts or lack of support were considered to be experiencing disharmony. In addition to the primary focus on hypothyroid dysfunction, the study also considered other factors such as age, parity, perimenstrual emotional states, and history of any other diseases. These factors were documented to provide a comprehensive understanding of the participants' health status. Associations between these factors and thyroid dysfunction were explored; causality was not conclusively established due to the exploratory nature of the study.

Early detection of thyroid dysfunction is vital to implement timely and effective measures that can prevent its progression. This not only ensures physical health but also has a positive impact on mental and emotional well-being. This study aligns with the noble purpose of serving the ailing sick by contributing to the comprehensive understanding of thyroid dysfunction and its associated mental and emotional challenges. The objectives of this study were to assess the mental and emotional health of females aged 30-45 years with hypothyroid dysfunction, to identify circumstantial factors that may predispose females to thyroid dysfunction and to explore the psychological impact of thyroid dysfunction, including its effects on physical appearance, self-esteem, and reproductive health.

Materials and Methods

This study adopted an exploratory observational approach with qualitative research methods. The research design involved purposive sampling of hypothyroid females aged between 30-45 years. Data collection included documenting age, parity, perimenstrual emotional states, and history of any other diseases. Due to the exploratory nature of the study, a cautious approach was taken when establishing causality between these factors and thyroid dysfunction. The analysis focused on identifying associations and highlighting potential correlations instead of establishing definitive causality.

Study Design: Qualitative

Type of Research: Exploratory observational

Sampling Technique: Purposive

Selection Criteria: Subclinical and clinical hypothyroid females

Materials Used in Study: Text notes from hypothyroid patients

Self-Designed Open-Ended Questionnaire: Assessing thyroid dysfunction and mental/emotional health in females (Aged 30-45 years).

Ethical Considerations: Given that the study was conducted within an institution where the author works, ethical guidelines were strictly followed to ensure impartiality and confidentiality. Participants were informed of the study's purpose, and informed consent was obtained.

Statistical Analysis: This study primarily employed qualitative data collection and analysis. Thematic analysis and content analysis were used to extract meaningful insights from the text notes.

Results

The study analyzed the mental and emotional health of hypothyroid patients through qualitative data collected from text notes provided by 50 participants. Among the participants, 43 subjects were teachers, seven were housemakers with family disharmony. About 38 participants were aged between 40-45 years, 11 were aged between 35-40 years and one was between 30- 35 years. The results of this study highlight the mental and emotional challenges faced by female hypothyroid patients. These difficulties encompass stress, anxiety, fatigue. Among the 50 participants, depression, sleep disorders were noted in 23 participants, while low self-esteem was noted in 33 participants. The study also underscores the potential impact of multitasking-induced stress on thyroid function, with a specific focus on teachers.

Mental and emotional difficulties faced by women in challenging multitasking circumstances included:

Stress and anxiety

Multiple roles and responsibilities, such as work, family, and personal life, led to chronic stress and anxiety. The constant pressure to perform can contribute to heightened stress levels.

Fatigue and exhaustion

Multitasking leads to physical and mental exhaustion. Women experience constant fatigue due to the demands of managing various tasks simultaneously.

Depression

Persistent feelings of inadequacy and the inability to cope with multiple responsibilities led to depressive symptoms by getting absorbed with no enthusiasm.

Sleep disorders

Women experience disrupted sleep patterns, and poorquality sleep due to racing thoughts and stress.

Low self-esteem

Balancing numerous responsibilities make them feel that they are not excelling in any particular area of their lives.

Detailed Information on Teachers

Out of 50 participants, 41 were teachers. Teachers face intense multitasking circumstances due to the demands of their profession, which contribute to thyroid dysfunction.

Workload and Pressure

Teachers often manage large classes, curriculum planning, grading, and student support. The pressure to meet educational standards and the emotional toll of dealing with diverse student needs can lead to stress and burnout.

Lack of Autonomy

Educational institutions have rigid guidelines and curricula, limiting teachers' autonomy. This lack of control contributes to feelings of frustration and helplessness.

Parent-Teacher Interactions

Interactions with parents, especially during challenging situations or parent-teacher conferences, are emotionally taxing and stressful.

Professional Expectations

Expectations for continuous professional development and adapting to new teaching methods are mentally demanding.

Discussion

In-depth analysis of the study findings emphasizes the interplay between mental and emotional difficulties and thyroid dysfunction. It addresses the potential pathways through which stress, anxiety, and other emotional factors impact thyroid function, including cortisol levels, immune system function, inflammation, and sleep disruption.

Impact on Thyroid Dysfunction

Chronic exposure to the mental and emotional difficulties mentioned above has a significant impact on thyroid function. Below are the factors responsible for:

Stress and cortisol levels: Prolonged stress activates the body's stress response, leading to the release of cortisol. Elevated cortisol levels disrupt the hypothalamic-pituitary-thyroid (HPT) axis, negatively affecting thyroid function.⁷ A recent study by Smith et al. (2021) supports this finding, demonstrating that high cortisol levels are associated with decreased thyroid function in middle-aged women.⁷

Immune system function: Chronic stress weakens the immune system, potentially triggering autoimmune thyroid conditions such as Hashimoto's thyroiditis.⁸ This finding is consistent with research by Jones et al. (2020), which indicates a strong correlation between chronic stress and the onset of autoimmune thyroid diseases.⁸

Inflammation: Emotional difficulties lead to systemic inflammation, which interferes with thyroid hormone production and regulation.⁵ Recent studies by Wang et al. (2022) have shown that inflammation markers are significantly higher in patients with thyroid dysfunction, further linking stress-related inflammation to thyroid issues.⁹

Sleep Disruption: Sleep disturbances associated with multitasking-induced mental and emotional difficulties disrupt the circadian rhythm and thyroid hormone secretion.¹⁰ According to a study by Lee et al. (2023), poor sleep quality is prevalent among women with hypothyroidism, exacerbating the condition.¹⁰

Conclusion

In conclusion, this study underscores the urgent need to consider the mental and emotional well-being of females, especially teachers with hypothyroid dysfunction. By detecting thyroid dysfunction early and addressing the associated mental and emotional challenges, we can significantly improve the overall quality of life of these individuals.

Recommendations

Based on the research outcomes, we recommend the following:

• Implementation of stress management workshops and programs, especially for multitasking individuals like teachers.
• Advocacy for flexible work policies and work-life balance in high-stress professions. 
• Development of educational initiatives to raise awareness about the link between multitasking-induced mental and emotional difficulties and thyroid dysfunction. 
• Promotion of support network for females facing similar challenges.
• Encouragement of regular thyroid screening, particularly for women in high-stress professions.
• Ensuring the availability of mental health support services for females experiencing mental and emotional difficulties, with a focus on preventing and managing thyroid dysfunction-related issues.
• These recommendations aim to address the specific challenges faced by females, particularly teachers, and their potential impact on thyroid health. Implementing such measures can contribute to improved overall well-being and thyroid function in this population.

Conflict of Interest

None