Hypothyroidism ls a common endocrine disorder affecting vbrious organs including lungs. Putmonary ctysfunction in hypothyroid patients has been noted.

1. Original Article
PEFR and FEF25_7' in Female Hypothyroids and Their
Relationships with Serum TSH and FT, Levels
pervin Akterl, Shelina Begumz, Matia Ahmeds, Farzana Yesmin4,selina Akhtars, Tanzima Begumo
Abstract
Background: Hypothyroidism ls a common endocrine disorder affecting vbrious organs
including lungs. Putmonary ctysfunction in hypothyroid patients has been noted.
Objective: To observe PEFR and FEF2s-7sin hypothyroid female patients'
Methods: Ihis cross-se ctional study was carried out in the Department of Physiology'
BSMMU, Dhaka, from 1"t July 2008 to 30th June 2009 on 60 hypothyroid female patients of
30-50 years age (Group B). For comparison, 30 age and BMI matched apparently healthy
sublects (Group A) were also studied. Based on receiving treatment, hypothyroid patients
were divided into B, (untreated patients on their 1"t day of diagnosis) and B, (patients-
treated for at least 12-1 I months). They were selected from the Out Patient Deparlment of
Endocrinology, BSMMU, Dhaka. Serum TSH and FTotevels were measured by Microparticle
Enzyme lmmunoassay (MEtA) principle in AxSYM syslem. The PEFR and FEFru.ruof all the
subT'ects were measured by a digital MicroDL spirometer. Data were analyzed by one way
ANOVA test, tndependent sample t- test and Pearson's correlation coefficient test'
Resu/fs.. The mean percentage of predicted values of all the lung function variables in
healthy female subTecfs and treated hypothyroicts were within normal ranges. However, all
of them were significantly lower in untreated hypothyroids in comparison fo fhose of control
and treated hypothyroids. tn addition, all the ventilatory variables had negative correlation
with serum TSH tevel and positive correlation with serum FTo level and these relationships
were statisticalty significant in control (p<0.001) and treated hypothyroids (p<0.01).
Conclusion: This study reveats that PEFR and FEFrr-rumay be lower in untreated hypothyroid
female patients compared to control and treated hypothyroids and the deterioration may be
positivety correlated with serum FTn level and negatively correlated with serum TSH level.
Key words : PEFR, FEF2i.7s. Hypothyroidism
(J lJttara Adhunik Med Coll. 2013; 3(1) : 44-47).
Like other target organs, the lungs are also affected
i n hypothyroid ism. Mucopolysaccharide deposition in
the lungs may cause fibrosis and thickening of the
alveolar wall which may lead to decreased diffusing
capacity of the lung and cause loss of elastic tissue
and increase the work of breathing. These changes
may cause reduction in many ventilatory lung functions
which is mainly restrictive in patternls.
Several researchers reported that pulmonary functions
may decrease in hypothyroid female and after thyroid
hormone replacement these values may increase
significantly in these group of patients 3-7. lncidence
is greater in females than males ( ratio is 5-10:1)8.
Bangladesh is an iodine deficient area and thyroid
related diseases are common in our country'
lnternationally 2.2 billion people worldwide are at risk
for iodine deficiency disorder. lt is more prevalent in
lntroduction
Hypothyroidism is a common endocrine disorder
resulting from deficiency of thyroid hormones and
commonly manifests as slowing in physical and
mental activities which may be asymptomatic.
Majority of systemic effects are present due to
reduction in metabolic activity and deposition of
glycosaminoglycans in interstitial tissuesl.
1 . Departmeni of Physiology, Delta Medical College and Hospital
2. Department of Physiology, Bangabandhu Sheikh Mujib
Medical University (BSMMU).
3. Department of Physiology, Uttara Adhunik Medical College,
Uttara, Dhaka
4. Department of Physiology, Popular Medical College
5. Department of Physiology, Zainul Haque Sikder Womens
Medical College
6. Department of Pharmacology, Delia Medical College and
Hospital
Address for correspondence: Dr. Pervin Akter' Department
of Physiology, Delta Medical College and Hospital

2. PEFR and FEF 25-75 in Female Hypothyroids and Their Relationships with serum TSH and FTo Levels
elder population with 2ok lo as much as 20% of older
age group. The latest national survey showed that
aboullZoh of our population is suffering from thyroid
disorder and the numbers of hypothyroid patients in
our country are increasing day by daye. lt is surprising
that there is no age limitation for presentation of
hypothyroidism. Along with this it is also remarkable
that, many of the patients are diagnosed after
development of one or more complications'
Many studies on pulmonary functions in
hypoihyroidism have been done in other countries4-
7,10,13. With the best of our knowledge no data is
available in Bangladesh. Therefore, the present study
was conducted to observe some aspects of lung
functions in hypothyroid female patients to evaluate
their lung function status and also correlate it with
serum thyroid hormones.
Methods:
This cross sectional study was carried out in the
Department of Physiology, BSMMU, Dhaka, from
1"t July 2008 to 30th June 2009 on 60(sixty)
hypothyroid female patients of 30-50 yrs of age (Group
B). For comparison, 30 (thirty) age, BMI and
socioeconomic status matched apparently healthy
female subjects (Group A) were also studied. The
protocol of this study was approved by Departmental
Ethical Committee. Patients with serum TSH level
>5.01 mlUiL and serum FTo level <9.'14 pmol/L were
selected as hypothyroid. Based on receiving
treatment, hypothyroid patients were divided into B,'
(30 untreated patients on their 1"t day of diagnosis)
and B, (30 patients treated for at least 12-18 months)'
The pltients were selected from the Out Patient
Department (OPD) of Endocrinology (an unit of lnternal
Medicine) of BSMMU, Dhaka. Subjects with history
of any type of smoking, COPD, heart disease,
diabetes mellitus, hypertension, Chronic renal failure
were excluded from the study. After selection of the
subjects the purpose and procedure of the studywere
explained to each subjectwith a cordial attitude giving
emphasis on the benefits they would obtain from this
study. They were encouraged for their voluntary
participation and were also allowed to withdraw
themselves as soon as they need' All the subjects
were requested to attend at Department of Physiology,
BSMMU within 9 am (aftertaking breakfastatT am)
on the day of examination. Before examination an
informed written consentwas taken from each subject'
A detail personal, medical, family, socio economic,
Pervin Akter et al
occupational and drug history were taken and a
thorough physical examination was done which were
documented in a prefixed questionnaire. Height and
weight of the subjectwere measured for calculation
of BMl. Then after taking all the aseptic precaution, 5
ml of venous blood was collected at 9 am from the
subject for estimation of serum glucose, serum
creatinine, TSH and FTo level. Then the subjectwas
taken to the Respiratory Laboratory for pulmonary
function tests. The detailed'procedure of spirometric
examination was explained to the subject and PEFR
and FEFru-75 were measured by a digital MicroDL
Spiro metei manufactured by Clement Clarke
lnternational Ltd., Edinburgh Way, Harlow, Essex
CM202TT England. Data were analyzed by Oneway
ANOVAtest, lndependent sample t- test and Pearson's
correlation coefficient test, as applicable'
Results
The demographic variables of the study subjects are
presented in Table-|. All the groups were matched for
age and BMl.
Table I
Age and BMlin differentgroups (n=90)
37 .27! 6.20 24.50 !4.31A (n=30)
8.,(n=30)
B, (n=30)
(30-48) (16.38-34.6e)
38.0016.64 24.68t4-77
(30-50) (17.31-35.52)
37.83t5.93 25.91!4.57
(30-50) (17.84-35.08)
Statistical analYsis:
Groups p value
A vs B., vs Bra
A vs B.,b
A vs Brb
0.g02ns
0.660 ns
0.724ns
0.437 ns
0.B93ns
0.231ns
B. vs B.b 0.B07ns 0.312ns
,4,-
Data were expressed as mean + SD. Figures in parentheses
indicate ranges.
a = one way ANOVA, b = independent sample t - test'
BMI = Body Mass lndex.
Group A: Apparently healthy Euthyroids (control group)
Group B: HYPothYroid (studY grouP)
81 : Untreated
82 : Treated
ns =non significant(P >0.05)
45

3. J Uttara Adhunik Med. College
Serum TSH level was significantly (p<0'001) higher
and serum FTo levelwas significantly lower in group
B, than those of group B, andA. Butstatistically no
silnificant difference of these values were observed
between group B, andA which has shown in Tablell.
Table ll
Serum TSH and FTolevel in different groups (n=90)
Vol.03, No.01, January 2013
Again, all the parameters were negatively conelated
with serum TSH level ( Figure 1,2 ) and positive*y
correlated with serum FTo level ( Figure 4,5) and tlrcse
relationships were statistically significant only in group
A and Br.
r iF*
^fii*'.ilTRB'
A (n=30) 2.19!1.04
( 0.5-4.1)
B,(n=30) 38.16t30.51
(8.2-e0)
2.05x1.02
15.09!4.14
(10-23)
5.12!1.89
(1.5€.7)
15.0113.82
A vs B.b
A vs Brb
B, vs B.b 0.000*** 0.000***
12,,.
Data were expressed as mean + SD. Figures in
parentheses indicate ranges.
a = one way ANOVA, b = independent sample t - test'
TSH = Thyroid stimulating hormone, FTo= Thyroxine (fr'ee form)'
*** = p<0.001
ns = non significant( p > 0'05)
The mean percentage of predicted values of both PEFR
and FEFrr-rs were significantly (p<0.001) lower in
group B.,1hin those of A and Br. But statistically no
significaht differences of these values were observed
between groupAand B, which has shown in Table lll'
Table lll
Mean percentage of predicted values of PEFR and
F EF 2s-7s i n d iffere nt grou ps (n=90)
Groups PEFR (%) FEF25-7'(%)
B,(n=30) 64.00119.98 70'40t14.72
B^(n=30) 78.70x9.54 86.10110.06
/ , | |
Statistical analysis:
Br(n=30)
(0.47- 4.0) (e.5-22),.
Statistical analysis:
Groups p value
A vs B., vs B, a 0.000*** 0.000**"
0.000***
0.964ns
Groups P value
0.000"**
0.000***
0.284ns
0.000***
Data were exPressed as Mean t
parentheses indicate ranges.
a = one way ANOVA, b = independent sample -t test'
***
= p.0.001 ns= non significant( p>0.05)
Fig.-1: Correlation of
of PEFR with serum
(n=90)
percentage of Predicted value
TSH level in different grouqs
r SFlo
^5FE?1
.5F{B'
Fig.-2: Correlation of percentage of predicted value
of FEF ,u-ru with serum TSH level in different
groups (n=90)
0.000***
0.608ns
h
h
r(
cr
rT
M
r€
gl
1.
2.
J.
4.
5.
6.
Ad
oft
M
Group A(r = - 0. 755, P = 0. 000)
Group B., (r = - 0. 239, P = 9'2941
Group B, (r = - 0. 518, P =
g. gg31
0.000***
0.000*"*
0.520ns
0.000***
SD. Figures in
GroupA(r = - 0. 663, P = 0. 000)
Group 8., (r = - 0. 336, P = 0. 069)
Group B, (r = - 0. 534, P = 6' 962;

4. r!
PEFR and FEF 2s_75
in Female Hypothyroids and Their Relationships with serum TSH and FTo Levels
Ar o
^l
{r
o.loo s.oo 1o.oo 15.00 2o.oo 25.00
Fig.-3: Correlation of percentaEe of predicted
vaiue of PEFR with serum FTr level in different
groups (n=90)
r +4EJA
^[fff'.+EEE'
Discussion
ln the present study, the lung function parameters in
healthy subjects were almost similar to the findings
reported by the various investigators from different
Pervin Akter et al
countries 5'6'10 as well as in our country11'12' No
abnormal pulmonary tests were detected in them'
Serum TSH levelwas significantly higher and serum
FTo level was significantly lower in untreated
hypothyroids than those of control and treated
hypothyroids. However, statistically no significant
difference in TSH and FTolevelwas observed between
control and treated hypothyroid patients'
The mean percentageof prqdicted values of both PEFR
and FEFru-rs were significantly lower in untreated
hypothyroidsLompared to treated patients and healthy
control and the observation was similar to other
findings 3, 5,6. 3u1 no significant difference of these
values were observed between treated hypothyroids
and control and this findings were in agreementwith
several investigators from d ifferent cou ntries4' 1 0' 1 3'
All the observed spirometricvariables were negatively
correlated with serum TSH level and positively
correlated with serum FTolevel. These relationships
were statistically significant in treated hypothyroids
and control but non significant in untreated
hypothyroids. These observations were in partial
agreement with those of Cakmak at. al (2007)'
Various mechanisms have been proposed for these
observed changes in spirometric lung functions in
hypothyroidism. lt was suggested that respiratory
muscle such as diaphragmatic weakness in
hypothyroidism may be due to decreased phrenic nerve
conduction velocity which may lead to prolonged
phrenic nerve conduction time' ltwas also suggested
that hypothyroidism is also associated with poor
skeletal muscle strength and quality which may
decreases the respiratory muscle endurance and may
reduce the maximalvoluntary ventilation in hypothyroid
patientsl3.
ln addition, in hypothyroidism, reduced surfactant
phospholipid, phosphatidylglycerol and phosphatidic
acid along with increase in surface active lipids
phosphatidylserine and phosphatidylinositol in alveolar
epithelium may decrease alveolar septation and
reduce lung compliance and surfactant adsorptionlt
18. Moreover, mucopoiysaccharide deposition in the
lungs may causefibrosis and thickening of the alveolar
wall with loss of elastic tissue and may increase the
work of breathing. All these changes may reduce
ventilatory lung function=1e'20' 11*25 also suggested
that suggested t in hypothyroidism there is also
alteration in the distribution of type of fibers i'e'
47
r hT*
^
Efsr"
o F,'5f"
Group A(r = + 0.748, P = 0.000)
Group B., (r = + 0.247,P = 0.189)
Group B, (r = + 0.583, P = 0'001)
o.bo s.bo tti.oo 15.00 2o.oo 25.00
Fig.-4: Correlation of percentage of predicted value
of FEFru -ru with serum FT, level in different
groups (n=90)

5. t
J Uttara Adhunik Med. College
decrease in type 1 and increase in type llD fibers of
diaphragm which may+ significantly reduce the
strength of the diaphragm and may decrease the
lung function2o.
ln this study, decreased percentageof predicted values
of PEFE and FEFru-ru in untreated hypothyroid
patients in comparison to the control subjects and
treated hypothyroids are most likely due to decreased
thyroid hormone level which may cause respiratory
muscle weakness and reduction in contractile
strength. This low thyroid hormone level may also
decrease lung elastic tissue and increase the work of
breathing. This is further supported by negative
correlation of PEFE and FEFru-ru with serum TSH
level and positive correlation of these ventilatory
variables with serum FTo level.
Conclusion:
This study reveals that, hypothyroidism may cause
decrease in ventilatory lung functions and the
deterioration may be positively correlated with serum
FTo level and negatively correlated with serum
TSH level.
Acknowledgement:
Authors of this article are thankful to the authority of
Department of Endocrinology (an unit of lnternal
Medicine), Bangabandhu Sheikh Mujib Medical
University (BSMMU) for their nice cooperation during
sample collection.
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