Gall stones and hypothyroidism: a double jeopardy

Abstract

Background: Gall stones are one of the frequent biliary pathologies in the biliary system. Gall stones are deposition of bile pigments, cholesterol and calcium salts in the form of hard crystalline mass in the gall bladder. Saturation of bile in gall bladder, bile stasis due to sphincter of Oddi dysfunction, biliary sludge and change in chemical disproportion of bile are all risk factors for gall stone development. Thyroid disorders are also a very common endocrine pathology. On the Oddi sphincter, thyroid hormone receptors are present, and thyroxine has a strong relaxing effect on the sphincter. Hypothyroidism reduces the gall bladder contractility and causes lipid metabolism alteration which leads to biliary stasis. These promote the gall stone formation.Methods: A single centre cross-sectional study, was done among 86 patients diagnosed with cholelithiasis clinically and confirmed by ultrasonography. All patients were subjected to thyroid profile test, liver function test, fasting lipid profile test. Patients with a history of hypothyroidism were excluded from the study.Results: Among 86 study subjects, 29 (33.7%) of study subjects had hypothyroidism, out of which 21 (24.4%) had subclinical hypothyroidism, 8 (9.3%) had clinical hypothyroidism. Of the remaining subjects 4 (4.7%) were hyperthyroid and 53 (61.6%) were Euthyroid. A total of 24 subjects had dyslipidaemia of which (15) 62.5% had clinical and sub clinical hypothyroidism (p<0.001).Conclusions: In the evolution of Gall stones in hypothyroid patients, decreased liver cholesterol metabolism, decreased bile emptying and decreased Oddi relaxation sphincter play a role. In our study there was a strong association between hypothyroidism and gall stones. Hypothyroid patients also had abnormal total cholesterol, triglycerides and ALP levels.