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Increased Prevalence of Subclinical Hypothyroidism in Common Bile Duct Stone Patients

Department of Gastroenterology and Alimentary Tract Surgery (J.L., S.R., H.P., J.S., I.N.), Tampere University Hospital, Tampere FIN-33520, Finland; Department of Gastroenterology (G.K.), Kaunas Medical University Hospital, LT-3007 Kaunas, Lithuania; and Department of Surgery (M.L., E.K., C.H.), Helsinki University Hospital, FIN-00290 Helsinki, Finland

Address all correspondence and requests for reprints to: Johanna Laukkarinen, M.D., Ph.D., Boston Pancreas Group, Department of Surgery, #37, Tufts-New England Medical Center, 750 Washington Street, Boston, Massachusetts 02111. E-mail: johanna.laukkarinen{at}fimnet.fi.

Context: Earlier, we have shown an increased prevalence of previously diagnosed hypothyroidism in common bile duct (CBD) stone patients and a delayed emptying of the biliary tract in hypothyroidism, explained partly by the missing prorelaxing effect of T₄ on the sphincter of Oddi contractility.

Objective: In this study, the prevalence of previously undiagnosed subclinical hypothyroidism in CBD stone patients was compared with nongallstone controls.

Patients: All patients were clinically euthyreotic and without a history of thyroid function abnormalities. CBD stones were diagnosed at endoscopic retrograde cholangiopancreatography (group 1; n = 303) or ruled out by previous medical history, liver function tests, and ultrasonography (control group II; n = 142).

Main Outcome Measures: Serum free FT₄ and TSH (S-TSH) were analyzed; S-TSH above the normal range (>6.0 mU/liter) was considered as subclinical and S-TSH 5.0–6.0 mU/liter as borderline-subclinical hypothyroidism.

Results: A total of 5.3 and 5.0% (total 10.2%; 31 of 303) of the CBD stone patients were diagnosed to have subclinical and borderline-subclinical hypothyroidism, compared with 1.4% (P = 0.05) and 1.4% (total 2.8%, four of 142; P = 0.026) in the control group, respectively. In women older than 60 yr, the prevalence of subclinical hypothyroidism was 11.4% in CBD stone and 1.8% in control patients (P = 0.032) and subclinical plus borderline-subclinical hypothyroidism 23.8% in CBD stone and 1.8% in control patients (P = 0.012).

Conclusion: Subclinical hypothyroidism is more common in the CBD stone patients, compared with nongallstone controls, supporting our hypothesis that hypothyroidism might play a role in the forming of CBD stones. At minimum, women older than 60 yr with CBD stones should be screened for borderline or overt subclinical hypothyroidism.