Clinical features of spontaneous hypothyroidism in one physician’s practice in Jamaica

OBJECTIVE To describe the clinical characteristics of patients with spontaneous hypothyroidism, the frequency of chronic autoimmune thyroiditis, and the thyroid autoantibody most often associated with this condition in a referral population in Jamaica. METHODS A retrospective study of all cases referred to the author's endocrinology practice from 1995 to 2005 with a diagnosis of spontaneous hypothyroidism was undertaken. The clinical history, examination findings, biochemical test results, thyroid autoimmune antibodies, and imaging data were reviewed. RESULTS Spontaneous primary hypothyroidism was correctly diagnosed in 53 subjects. Fifty of the patients were females and three were males. Mean age was 43.3 years (range 12-82 years); 24.4% of the patients had a family member with thyroid disease; 27.1% presented because of a goiter; and 54.2% because of symptoms suggestive of hypothyroidism. The thyroid was palpable in 56.3% and thyroid ultrasound was consistent with Hashimoto's thyroiditis on 64% of occasions. Only 8% of the patients had the atrophic variant of hypothyroidism. Antithyroid peroxidase and antithyroglobulin antibody were positive in 75.8% and 37.5% of patients, respectively. Chronic autoimmune thyroiditis was confirmed in 78.8% of cases. CONCLUSION In these cases in Jamaica, spontaneous hypothyroidism was predominantly a female disorder. Chronic autoimmune thyroiditis was the commonest cause, and antithyroid peroxidase antibody was the thyroid antibody most likely to be positive in this population.