dr kalpit ppt.pptx

Presented By :
Dr. Kalpit Kumar Sahoo
PG Student
Department of Surgery
PGIMS, Rohtak

CERTIFICATE OF SUPERVISOR
 This is to certify that facilities for the study on the subject of the thesis
“Prevalence of deranged thyroid function in different types of gall stone
disease” exist in this institute and will be provided to the candidate. I shall
guide the candidate (Dr. Kalpit Kumar Sahoo) in his study and shall see that
the data being included in the thesis is genuine and study is done by the
candidate himself.
Dr. Bhavinder K Arora
Professor
Pt. B.D. Sharma PGIMS, Rohtak
(SUPERVISOR)

ETHICAL JUSTIFICATION
 All the procedures mentioned in material and method section of present study plan are
standard procedures worldwide. No unethical tests or procedures will be employed
during this study. Hence this study is ethically justified. Also, the proposed study
“Prevalence of deranged thyroid function in different types of gall stone disease”
will be undertaken after getting informed consent from the enrolled patients.
Dr. Bhavinder K Arora
Professor
(SUPERVISOR)
Dr. Hans Raj Ranga
Senior Professor and Unit Head
Chairman PG Board of Studies in Surgery
Department of General Surgery
Dr. M G Vashist
Sr. Professor and Head
Department of General Surgery

DECLARATION BY THE POSTGRADUATE STUDENT
I hereby declare that:
 The study will be done as per Institutional protocol and guidelines.
 Study shall be initiated only after clearance from institutional ethical committee.
 Written, Informed consent of the patients/control (volunteers) will be obtained.
 In case of children and mentally handicapped both patients/control (volunteers) written informed consent of the
parents/care givers will be obtained.
 The probable risks involved in the study will be explained in full to the subjects/parents/care givers in their own
language.
 I will terminate the study at any stage, if I have probable cause to believe, in the exercise of the good faith,
skill and careful judgment required for me that continuation of the study/experiment is likely to result in
injury/disability/death to the subject.
 Disclosure:
 Financial/ funding None
 Conflict of interest None
 Association None
Date :
Signature of Candidate

INTRODUCTION
 Cholelithiasis is mentioned as one of the most commonly encountered biliary
pathology. Gallstones can be divided into three main types: cholesterol,
pigment (brown/black) or mixed stones. In the USA and Europe 80% are
cholesterol or mixed stones, whereas in Asia 80% are pigment stones.
Cholesterol, which is insoluble in water, is secreted from the canalicular
membrane in phospholipid vesicles. Whether cholesterol remains in solution
depends on the concentration of phospholipids and bile acids in the bile, and
on the type of phospholipid and bile acid. When bile is supersaturated with
cholesterol or bile acid concentrations are low, unstable unilamellar
phospholipid vesicles form, from which cholesterol crystals may nucleate, and
stones may form. The process of gallstone formation is complex and many
areas remain unclear. Obesity, high-caloric diets and certain medications (e.g.
oral contraceptives) can increase secretion of cholesterol and supersaturate the
bile, increasing the lithogenicity of bile.1 A very important factor in the
development of gall stones is the stasis of biliary products, which may be an
effect of stenosis of the sphincter of Oddi, dyskinesia or stricture of the bile
duct.2,3 The disease is frequently encountered in otherwise healthy young to
middle-aged people with a prevalence being around 11-36% on the autopsy
report. The highest incidence rates of cholelithiasis in the world are
21.5/100,000 in females in Delhi.4

 Thyroid illnesses are amongst the most commonly
encountered endocrine abnormality, only second to
diabetes. According to a projection from various studies on
thyroid disease, about 42 million people in India are
estimated to be suffering from one or the other type of
thyroid disease.5India has a prevalence of hypothyroidism
to be around 10.95%.6 Thyroid disorder could be either due
to excess or relative lack of thyroid hormones i.e.
hyperthyroidism or hypothyroidism. Hypothyroidism itself
can either be of overt hypothyroidism, in which the serum
level of thyroxine is lesser than the expected normal or
subclinical type, where serum level of thyroid hormones is
within normal level, but serum TSH is raised. Thyroid
hormones are essential for survival, being important for
regulating metabolic rate. Any abnormality in its serum
level presents with multitude of symptoms.

Patients having hyperthyroidism present with palpitation,
weight loss, diarrhea, warm skin, hypo-menorrhea,
nervousness, excess sweating, heat intolerance, where as
those with hypothyroidism present with cold intolerance,
skin dryness, constipation, sluggishness & weight gain. Of
particular interest to this study is deranged thyroid profile
and its association with gall stone disease. Hypothyroidism
has been shown to be an important contributor to gall stone
formation, which is brought into effect by several
mechanisms.
 Hypothyroidism affects the flow of bile into intestine.7
 Deranged cholesterol metabolism in hypothyroidism
leading to super saturation of bile.8
 Decreased relaxation of sphincter of Oddi in
hypothyroidism.3
 This present study has been designed to evaluate the
prevalence of deranged thyroid function test in patients of
different types of Gall stone disease.

REVIEW OF LITERATURE
 The process of formation of gall bladder stones is itself a very
complex one. There can be numerous factors that can ultimately
lead to cholelithiasis in patients having hypothyroidism. The
decreased serum thyroxine levels affect the metabolism of
cholesterol and that in turn leads to the process of super
saturation. It also affects the filling of the gall bladder and
contractility of the gall bladder. This in turn leads to the
retention of cholesterol in the gall bladder and provokes the
nucleation and maturation of the gallbladder stones. The
hypothyroid state decreases the secretion of bile, leading to
precipitation and formation of the stones. It also decreases the
sphincter of Oddi's relaxing tendency, leading to further stasis of
the bile as it expresses the thyroid hormone receptors named TR
beta 1 and beta 2.9 A prospective study proved that the
subclinical hypothyroidism state also is comparatively more
among common bile duct (CBD) stone patients.10

 Völzke et al conducted a study to investigate those associations using data of
the population-based Study of Health in Pomerania. There were 385 persons
(10.3%) with low (<0.3 mIU/L), 3 321 persons (88.6%) with normal and 43
persons (1.2%) with high serum TSH levels (>3 mIU/L). The proportion of
cholelithiasis among males and females was 14.4% and 25.3%, respectively.
Among males, there was an independent relation between high serum TSH
and cholelithiasis (OR 3.77; 95%-CI 1.06-13.41; P<0.05). Also among males,
there was a tendency towards an elevated risk of cholelithiasis in persons with
low serum TSH (OR 1.40; 95%-CI 0.96-2.02; P = 0.07). In the female
population, no such relation was identified. There is an association between
thyroid and gallstone disease with a gender-specific relation between
hypothyroidism and cholelithiasis.11
 Issa et al did a study to assess the prevalence of hypothyroidism in patients
with gall stones and try to establish hypothyroidism as a possible etiological
factor for gallstones formation. Out of 232 patients of gallstone, 200 patients
were euthyroid and 32 patients were hypothyroidism, 22 patients were
diagnosed as subclinical hypothyroidism and 10 patients were diagnosed as
clinical hypothyroidism. Regarding lipid profile, 175(75.4%) of patients with
gall stone had increased lipid profile, while 57(24.6%) had normal lipid profile.
Hypothyroidism which may lead to elevation of serum lipid profile and thus
act as a cause of gall stone formation.12

 Wang et al performed a study to investigate comprehensively the
effects of thyroid function on gallstone formation in a mouse model.
Gonadectomized gallstone-susceptible male C57BL/6 mice were
randomly distributed into three groups each of which received an
intervention to induce hyperthyroidism, hypothyroidism, or
euthyroidism. After 5 weeks of feeding a lithogenic diet of 15% (w/w)
butter fat, 1% (w/w) cholesterol, and 0.5% (w/w) cholic acid, mice were
killed for further experiments. The incidence of cholesterol
monohydrate crystal formation was 100% in mice with
hyperthyroidism, 83% in hypothyroidism, and 33% in euthyroidism,
the differences being statistically significant. Among the hepatic
lithogenic genes, Trβ was found to be up-regulated and Rxr down-
regulated in the mice with hypothyroidism. In contrast, Lxrα, Rxr, and
Cyp7α1 were up-regulated and Fxr down-regulated in the mice with
hyperthyroidism. In conclusion, thyroid dysfunction, either
hyperthyroidism or hypothyroidism, promotes the formation of
cholesterol gallstones in C57BL/6 mice. Gene expression differences
suggest that thyroid hormone disturbance leads to gallstone formation
in different ways. Hyperthyroidism induces cholesterol gallstone
formation by regulating expression of the hepatic nuclear receptor
genes such as Lxrα and Rxr, which are significant in cholesterol
metabolism pathways. However, hypothyroidism induces cholesterol
gallstone formation by promoting cholesterol biosynthesis.13

 Singha et al conducted a study to find out the prevalence of
previously undiagnosed hypothyroidism in cholelithiasis
patients. A total of 2.2%, 5.0% and 6.6% (total 13.8%, 69 of
500) of the cholelithiasis patients were diagnosed to have
clinical, subclinical and borderline subclinical
hypothyroidism. In women older than 50 year, the
prevalence of clinical and subclinical plus borderline-
hypothyroidism was 6.8% and 25.6% (11.7%±13.9%) and
clinical plus subclinical plus borderline-subclinical
hypothyroidism was 32.4% in cholelithiasis patients.
Although a low prevalence of hypothyroidism was found in
this study, but it is evident that subclinical and borderline
subclinical hypothyroidism were significantly more
common, compared with the clinical hypothyroidism and
with increasing age there was increase in its prevalence, so
we recommend that S-TSH level should be measured for
every patient with cholelithiasis older than 50 years.14

 Watali et al. did a study to determine association between
gallstones and hypothyroidism and to study the prevalence of
previously undiagnosed hypothyroidism in all patients of
gallstones. Both groups were comparable for age and sex of the
patients. On considering the thyroid profile of the patients in
both the groups we observed that 14% of patients were
hypothyroid in case group and 8% of the patients in control
group. On comparing the two groups, there was no statistically
significant difference in the prevalence of hypothyroidism (p
value 0.175) between the two groups. There was a significant
difference when serum cholesterol and bilirubin levels were
compared between the two groups. 7 patients out of 100
cholelithiasis had Choledocolithiasis too, these patients had
significantly raised cholesterol and deranged liver function tests.
No significant relation between gallstones and hypothyroidism
was found in this study (p value=0.175) and need further
evaluation. Among the hypothyroid patients the incidence of
gall stones was highest among 51-60 years of age so we
recommend that TSH level should be measured for every patient
with gallstone disease in this age range.15

 Pradeep Ghimire et al. performed a study to determine the association of
gallstone disease with clinical hypothyroidism, subclinical hypothyroidism and
to treat the patient as soon as the diagnosis is made and the prevalence of
thyroid deficiency (hypothyroidism and subclinical hypothyroidism) in
gallstone diseases patients. This study shows 75% female and 25% male, age
wise minimum age was 16 and maximum age was 83.The mean age was 42.68
years. All 160 patients had gallstone in ultrasound of the abdomen without
complication. The prevalence of hypothyroidism in gallstone patient in our
study was 26.7%.16
 Ghadhban et al. conducted a study to find out the prevalence and correlation
between the subclinical hypothyroidism and gall stone disease. Among 103
patients, the majority them were in 36–50 years age group, 84 (81.6%) of them
were females and 19 (18.4%) were males. Of the total number of patients, eight
of them (7.8%) found to have subclinical hypothyroidism and 95 (92.2%) of
them found to be euthyroid, most of patients in the subclinical hypothyroid
group were showing female gender predominance with 81.6%. While the
prevalence among males were found 18.4%, most patients with subclinical
hypothyroidism were found to had positive family history (75%), and (25%) of
them found to had negative family history. There is gender specific relationship
between subclinical hypothyroidism and gall stone disease as this study
sharing statistically increasing in prevalence of the subclinical hypothyroidism
among females in age group≥40 years, positive family history, and single
abdominal US gall stone. This subset of patients should be assessed for thyroid
dysfunction.8

 Ibrahim et al did a study, the impact of thyroid stimulating
hormone (TSH) levels and thyroid dysfunction on the
pathogenesis of gallstones and their compositions. The search
results showed significant increase in the rate of pathogenesis in
female, but TSH levels is higher in male than female (p < 0.001).
And cholesterol gallstone type is predominated (p < 0.0001).
Results were stated that the thyroid dysfunction had a role in the
formation of gallstones. There is a significant association
between the gallstones and thyroid dysfunction
Recommendations: the study recommends that must handling
and treatment the thyroid dysfunction and hormonal
dysfunction especially TSH.17
 Yousif et al. conducted a study to show the relation between
serum levels of thyroid stimulating hormone (TSH) and
cholesterol and types of gallstone. There was a remarkable
gender difference with predominance of female gender as it
constitutes 132 (88%) versus 18 (12%) males. Abnormal high
levels of serum TSH and cholesterol were reported in 12 cases
(8%) and in 15 cases (10%) respectively. Types of gallstones, were
cholesterol stones in 95 cases (63%), pigmented stone in 33 cases
(22 %) and mixed stone in 22 cases (15%). There was relationship
between high serum levels of TSH and cholesterol with types of
gallstones.18

RESEARCH QUESTION
 Is there any correlation between deranged thyroid
function and type of gall stone disease?

AIM AND OBJECTIVES
AIM
 To study the prevalence of deranged thyroid function
in different types of gall stone disease.
OBJECTIVES
 To measure prevalence of cholelithiasis and deranged
thyroid function in different age groups and gender.

MATERIAL AND METHODS
Study design
 The present study is a prospective observational study and will be conducted in
the Department of Surgery, Postgraduate Institute of Medical Sciences,
Rohtak, a tertiary care center in North India. This study includes cases coming
to PGIMS, Rohtak with the diagnosis of gall stone disease due to any etiology
and diagnosis will be made on the basis of clinical findings and imaging
findings of USG abdomen.
Study Period
 April 2023 to May 2024.
Sample size and Sampling technique
 Based on the findings of Kulkarni et al,9 the prevalence of deranged thyroid
function among cases of cholelithiasis was reported to be 5.7%. Therefore,
assuming (p) = 0.057 with relative precision of 0.5, the minimum required
sample size at 5% level of significance is 255 patients.

Inclusion criteria
 All cases of gall stone disease proven on ultrasonography whole
abdomen.
Exclusion criteria
 Pregnant females.
 Any patient with known thyroid pathology.
 Unstable hemodynamic status.
On admission, a good clinical history and proper physical examination
will be performed on all the subjects admitted with clinical or
radiological diagnosis of gall stone disease. After recording basic
information like name, age, sex and address of patient, a good clinical
history focusing on the abdominal pain i.e. onset duration, site. A good
general physical examination will be performed starting from general
look, vital signs like pulse rate and temperature will be recorded. The
patients will be subjected to routine haematological investigations and
USG abdomen.A fresh fasting blood sample will be collected and shall
be sent for thyroid profile and fasting lipid profile after proper patient
counselling and consent.

STATISTICAL ANALYSIS
 At the end of the study, the data will be collected and
analyzed by using appropriate statistical methods. A
p-value of less than 0.05 will be considered significant.
The data will be analyzed by using SPSS software
(version 21.0 for Microsoft Windows; SPSS Inc.).

INFORMED CONSENT FORM
Protocol/Study number:
Patient identification number for Thesis:
TITLE: Prevalence of deranged thyroid function in different types of gall
stone disease
Name of investigator:
Mobile No:
The contents of the information sheet dated (Version)
that was provided have been read carefully by me / explained
in detail to me, in a language that I comprehend, and I have understood the
contents. I confirm that I have had the opportunity to ask questions. The nature
and purpose of the study, and other relevant details of the study have been
explained to me in detail. I understand that my son/daughter’s participation is
voluntary and that I am free to withdraw my son/daughter at any time, without
giving any reason, without my son/daughter’s medical care or legal rights being
affected.

I understand that the information collected about my son/daughter from his/her
participation in this research and sections of any of my son/daughter’s medical notes may be
looked at by responsible individuals from or from regulatory
authorities where it is relevant to my son/daughter taking part in research and will be kept
confidential. I give permission for these individuals to have access to my son/daughter’s
records, to present in meetings & conferences, and publications if desired. I agree to let my
son/daughter take part in the above study.
Date:
(Signature / Left Thumb Impression) Place:
Name of the Participant:
Father/ Mother/Guardian:
Complete postal address:
This is to certify that the above consent has been obtained in my presence.
Date: Place:
Signature of Investigator
Witness-1 ____________________ Witness-2 __________
(Signature) (Signature)

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PATIENT INFORMATION SHEET
TITLE: Prevalence of deranged thyroid function in different types of gall
stone disease
Sponsor: None
Study Doctor: Dr. Kalpit Kumar Sahoo, Postgraduate student, Department of
Surgery, Pt. B.D. Sharma, PGIMS, Rohtak (Haryana)
Site: Department of Surgery, Pt. B.D. Sharma, PGIMS, Rohtak (Haryana)
Description of study: You have been asked to take part in a medical research
study. Before you decide you should read this form. This form called Information
and Consent form, explains the study. This form will let you know what you will
have to do during the study and the risks and benefits of the study. This form may
contain words or information that you do not understand clearly. If so please ask
the study doctor to explain these words and information. You may take home an
unsigned copy of this form to help you decide whether or not to participate in the
study. You can also discuss your participation with family, friends or anyone you
choose before making your decision. If you decide to participate in the study and
sign this form, you will be given a signed and dated copy of this form to keep for
your records. Do not sign this form unless the study doctor has answered all your
questions and you decide that you want to be a part of this study.

When reading this form, please note that the words “you” and
“your” refer to the person in the study rather than to a legally
authorized representative who might sign this form on behalf of
the person in the study.
Participating in the study is not the same as getting regular medical
care. The purpose of regular medical care is to improve your health.
The purpose of the research study is to gather information
regarding future treatment benefits. Being in this study doesn’t
replace your regular medical care.
About the study: The purpose of the study, to study the
prevalence of deranged thyroid function in different types of gall
stone disease.
Responsibilities of the study subject: To participate in this
study, you must tell your doctor if you are suffering from any
physical, medical or psychiatric illness or not and must be willing
to follow all the study procedures which includes visits,
investigations as required and application of certain scales. You
must follow the instructions you are given by the doctor.

What else should I know about the study procedures?
Benefits & Risks: Though we expect some additional benefits in study outcome,
but these cannot be assured. Moreover, your participation may not benefit you in
monetary terms. Also, your participation may benefit future patients from the
conclusions drawn from the results of the study.
Payment for participation: You will not get paid being in this study.
Payment for investigations: Not applicable
Treatment: Your treatment will not be affected in any way by participating in the
study. If you will be having problem, you will be provided appropriate treatment.
New Information: The study doctor will tell you if any new information becomes
available about your disorder and its management.
Legal rights: By signing this information and consent form and the
accompanying Informed consent form to participate in a research study, you are
not waiving any legal rights that you have as a subject in a research study.
Source of funding: Not applicable
Confidentiality: Except where required by law or by regulatory authorities, you
will not be identified by name, address, telephone number or any other direct
personal identifier in study records disclosed outside of the clinic.

Also individuals from Ethics Review Committee may also look and copy
the health information generated or collected about you as part of this
study, both to assure quality control and to analyze the information.
The results of this study conducted by the study doctor may be published
or presented at meetings but will not include your name or any other
information that reveals your identity.
Your authorization for use and disclosure of health information generated
or collected as part of study has no expiry date.
Voluntary participation/ Withdrawal: Your participation in the study
is voluntary. You may choose not to participate in the study or, if you
agree to participate in the study at any time. This will not affect your
treatment in anyway.
Your participation in the study may also be terminated at any time,
without your consent, under the following circumstances:
If you do not follow the instructions of the study doctor or the study staff;
If the study doctor determines that participating in the study is not
appropriate for your condition; or

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eq>s v/;;u izfØ;kvksa ds ckjs esa vkSj D;k tkuuk pkfg,

ykHk vkSj tksf[ke% gkykafd ge v/;;u ds ifj.kke esa dqN
vfrfjDRk ykHk dh mEEkhn djrs gSa] ysfdu budk vk”oklu
ugha fn;k tk ldrk gSA blds vykok] vkidh Hkkxhnkjh vkidks
ekSfnzd lanHkZ esa ykHk ugha ns ldrh gSA lkFk gh] vkidh
Hkkxhnkjh Hkfo’; ds jksfx;ksa dks v/;;u ds ifj.kkeksa ls fudkys
x, fu’d’kksZa ls ykHkkfUor dj ldrh gSA
Hkkxhnkjh ds fy, Hkqxrku% vkidks bl v/;;u esa Hkqxrku
ugha feysxkA
tkap ds fy, Hkqxrku% ykxw ughaA
mipkj% v/;;u esa Hkkx ysus ls vkidk mipkj fdlh Hkh rjg ls
izHkkfor ugha gksxkA ;fn vkidks leL;k gks jgh gS] rks vkidks
mfpr mipkj iznku fd;k tk,xkA
ubZ tkudkjh% v/;;u fpfdRld vkidks crk,xk fd D;k vkids fodkj
vkSj mlds izca/ku ds ckjs esa dksbZ ubZ tkudkjh miyC/k gSA
dkuwuh vf/kdkj% bl tkudkjh vkSj lgefr QkWeZ ij gLrk{kj
djus vkSj ,d “kks/k v/;;u esa Hkkx ysus ds fy, lwfpr lgefr
QkWeZ ds lkFk] vki fdlh Hkh dkuwuh vf/kdkj dks ugha
NksM+ jgsa gSa tks vkids ikl ,d “kks/k v/;;u esa ,d fo’k; ds :Ik
esa gSA

xksiuh;rk% dkuwu }kjk ;k fu;ked vf/kdkfj;ksa }kjk vko”;d gksus ds
vykok] vkidks Dyhfud ds ckgj crk, x, v/;;u fjdkWMZ esa uke] irk]
VsyhQksu uacj ;k fdlh vU; izR;{k O;fDRkxr igpkudÙkkZ }kjk ugha
igpkuk tk,xkA
,fFkDl fjO;w desVh ds O;fDRk Hkh bl v/;;u ds ,d Hkkx ds :Ik esa
vkids }kjk mRiUUk ;k ,df=r dh xbZ LokLF; lwpukvksa dks ns[k ldrs
gSa vkSj mudh udy dj ldrs gSa] tks xq.koÙkk fu;a=.k vkSj tkudkjh
dk fo”ys’k.k djus ds fy, vk”oLr djrs gSaA
v/;;u fpfdRld }kjk fd, x, bl v/;;u ds ifj.kkeksa dks cSBdksa esa
izdkf”kr ;k izLrqr fd;k tk ldrk gS] ysfdu blesa vkidk uke ;k dksbZ
vU; tkudkjh “kkfey ugha gksxh tks vkidh igpku crkrh gSA
v/;;u ds fgLls ds :Ik esa mRiUUk ;k ,d= dh xbZ LokLF; tkudkjh ds
mi;ksx vkSj izdVhdj.k ds fy, vkids izkf/kdj.k ds ikl dksbZ lekfIr frfFk
ugha gSA
LoSfPNd Hkkxhnkjh@fudklh% v/;;u esa vkidh LoSfPNd gSA vki
v/;;u esa Hkkx ysus ds fy, ugha pqu ldrs gSa ;k] ;fn vki fdlh Hkh le;
v/;;u esa Hkkx ysus ds fy, lger gSaA ;g oSls Hkh vkids mipkj dks
izHkkfor ugha djsxkA
fuEUkfyf[kr ifjfLFkfr;ksa esa vkidh lgefr ds fcuk] v/;;u esa vkidh
Hkkxhnkjh dks fdlh Hkh le; lekIr fd;k tk ldrk gS%
;fn vki v/;;u fpfdRld ;k v/;;u deZpkfj;ksa ds funsZ”kksa dk ikyu

;fn vki v/;;u esa Hkkx ugha ysus ;k v/;;u ls ihNs gVus dk p;u djrs gSa ;k ;fn
v/;;u esa vkidh Hkkxhnkjh lekIr gks tkrh gS] rks vkidks dksbZ naM ugha
gksxk ;k dksbZ ykHk ugha gksxk ftlds vki vU;Fkk gdnkj gSaA
iz”u
;fn vkids ikl v/;;u ;k vkidh fLFkfr ds ckjs esa dksbZ iz”u gSa] rks vkidks
v/;;u fpfdRld ls laidZ djuk pkfg,A
fof”k’V tkapdÙkkZ fooj.k dk v/;;u djsa%
MkWŒ dfYir dqekj lkgw] ihth Nk=] ltZjh foHkkx] ihthvkbZ,e,l]
jksgrd ¼$91&7381583816½
MkWŒ HkfoUnz dsŒ vjksM+k] izksQslj] ltZjh foHkkx] ihthvkbZ,e,l]
jksgrdA
lkbV fooj.k% ltZjh foHkkx] iaŒ chŒMhŒ “kekZ] ihthvkbZ,e,l] jksgrdA
;fn vkids ikl “kks/k fo’k; ds :Ik esa v/;;u ;k vkids vf/kdkjksa ds ckjs esa iz”u
gSa] rks vki vkpkj leh{kk lfefr ls laidZ dj ldrs gSaA
lkbV fooj.k% ltZjh foHkkx] iaŒ chŒMhŒ “kekZ] ihthvkbZ,e,l] jksgrdA
bl tkudkjh vkSj lgefr QkWeZ ij gLrk{kj u djsa ;k fdlh “kks/k v/;;u esa Hkkx
ysus ds fy, lwfpr lgefr QkWeZ ij gLrk{kj u djsa tc rd fd vkidks loky iwNus
dk ekSdk ugha feyk gks vkSj vkids lHkh lokyksa ds larks’ktud mÙkj feys
gksaA

REFERENCES
1. Bailey and Love. Short Practice of Surgery.27thEd. 2018, Chapter 67, pp 1198.
2. Jordan GL Jr: Choledocholithiasis. CurrProbl Surg. 1982, 19:722-98. 10.1016/0011-
3840(82)90012-0
3. Thistle JL: Pathophysiology of bile duct stones. World J Surg. 1998, 22:1114-8.
4. Behar J, Lee KY, Thompson WR, Biancani P: Gallbladder contraction in patients with
pigment and cholesterol stones. Gastroenterology. 1989, 97:1479-84.
5. UshaMenon V, Sundaram KR, Unnikrishnan AG, Jayakumar RV, Nair V, Kumar
H: High prevalence of undetected thyroid disorders in an iodine sufficient adult south
Indian population. J Indian Med Assoc. 2009, 107:72-7.
6. Jazrawi RP, Pazzi P, Petroni ML, et al.: Postprandial gallbladder motor function:
refilling and turnover of bile in health and in cholelithiasis. Gastroenterology. 1995,
109:582-91.
7. Laukkarinen J, Sand J, Saaristo R, Salmi J, Turjanmaa V, Vehkalahti P, Nordback I. Is
bile flow reduced in patients with hypothyroidism? Surgery. 2003:288-93.
8. Ghadhban BR, Abid FN. The prevalence and correlation between subclinical
hypothyroidism and gall stone disease in Baghdad teaching hospital. Annals of
Medicine and Surgery. 2019 37:7-10.

9. Kulkarni V, Ramteke H, Lamture Y, Gharde P. A Review of Synchronous Findings of
Hypothyroidism and Cholelithiasis. Cureus. 2022 ;14
10. Inkinen J, Sand J, Nordback I: Association between common bile duct stones and
treated hypothyroidism. Hepatogastroenterology. 2000, 47:919-21.
11. Völzke H, Robinson DM, John U. Association between thyroid function and gallstone
disease. World journal of gastroenterology: WJG. 2005 11(35):5530.
12. Issa AH, Mohammed MM, Al Jawher MH. The prevalence of hypothyroidism in
patients with gall stone disease. J Med Sci Clin Res. 2018:918-22.
13. Wang Y, Yu X, Zhao QZ, Zheng S, Qing WJ, Sanjay J. Thyroid dysfunction, either hyper
or hypothyroidism, promotes gallstone formation by different mechanisms. Journal of
Zhejiang University. Science. B. 2016 (7):515.
14. Singha D, Pawar NM, Prabhu BJ, Kumar N, Gopalarathnam S. Prevalence of previously
undiagnosed hypothyroidism in patients with cholelithiasis in a tertiary care center,
North-East India. International Surgery Journal. 2017 4(3):932-5.
15. Watali YZ, Jain R, Bali RS, Mittal A. Is hypothyroidism a risk for gall stone disease? a
study to assess the association. International Surgery Journal. 2017:2665-9.
16. Pradeep Ghimire MS, Frcs ED. Association of Gallstone Disease with Hypothyroidism
in Western Region of Nepal. IOSR J Dental and Med Sci. 2017; 16(8):40-2.
17. Ibrahim SL, Abdulbary M. The Impact of thyroid dysfunction and TSH on the
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gallstones. Iraqi Postgraduate Med J. 2011 28;10(1):7-12.

PROFORMA
Name : CR No.
Age : Sex :
Address :
Mobile No. :
Occupation :
Date of admission :
Date of operation :
Date of discharge :
CHIEF COMPLAINTS
 Pain abdomen
 Post meal distention of abdomen
 Vomiting
 Hypothyroid symptoms : feeling cold, skin dryness, constipation, sluggishness, weight
gain
 Hyperthyroid symptoms : Palpitations, Weight loss, diarrhea, warm skin, hypo
menorrhea, nervousness, excess sweating, heat intolerance
 Other complaints if any

PAST HISTORY
 History of previous surgery
 Any comorbid illness- DM/HTN/TB/Asthma
PERSONAL HISTORY
 Smoker-
 Alcoholic-
 Veg./Non Veg.
GENERAL PHYSICAL EXAMINATION
 Anthropometry-
 Height
 Weight
 BMI

Vital signs
 Pulse
 Blood pressure
 Temperature
EXAMINATION OF THE ABDOMEN
EXAMINATION OF OTHER SYSTEMS
 Cardiovascular system
 Respiratory system
 Nervous system
INVESTIGATIONS
Blood investigation
 Hb
 TLC
 PT/INR
 Thyroid profile
 Lipid profile

Radiological investigations
 USG abdomen – presence, location of stones
OPERATIVE PROCEDURE DONE
OPERATIVE FINDINGS
 Cholecystitis
 Type of stone (by macroscopic observation)
 Biopsy report to confirm type of stone
HOSPITAL STAY
Signature of Candidate

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