Association Of Hypothyroidism in Gall Bladder Stone Disease -- An Observational Study

The earliest known evidence of gallstones was found in the mummy of a priestess of Amen from Egypt’s 21st Dynasty (1085–945 BC). Gallstones, or cholelithiasis, were first described by the Greek physician Alexander Trallianus in the 5th century. The first documented cholecystectomy was later performed by Carl Langenbuch in Berlin in 1882.[1]

The incidence of gallstones is notably higher in South-East Asian countries, where a strong association with gallbladder carcinoma has been observed. The development of gallstones is influenced by several factors, including bile supersaturation within the gallbladder, bile stasis resulting from sphincter of Oddi dysfunction, the presence of biliary sludge, and chemical imbalance among the components of bile. [2]

Thyroid disorders constitute a significant group of endocrine diseases with important implications for biliary physiology. In hypothyroidism, bile supersaturation may occur as a result of elevated serum cholesterol levels. The thyroid hormones thyroxine (T4) and triiodothyronine (T3) regulate the activity of HMG-CoA reductase, a key enzyme in cholesterol metabolism. Consequently, reduced thyroid hormone levels lead to diminished cholesterol metabolism, resulting in hypercholesterolemia and dyslipidemia.[3]

Furthermore, hypothyroidism reduces relaxation of the sphincter of Oddi, leading to gallbladder hypomotility, decreased contractility, and diminished bile flow. This impaired biliary emptying results in prolonged bile retention, reduced flow capacity, and delayed clearance, thereby promoting bile nucleation and the subsequent formation of gallstones.[4,5]

Hypothyroidism may present as either overt or subclinical disease. Overt hypothyroidism is characterized by a reduction in serum thyroxine (T4) concentrations below the normal reference range,[6] while subclinical hypothyroidism (mild thyroid failure) is defined by normal serum thyroid hormone levels accompanied by mildly elevated serum thyroid-stimulating hormone (TSH) levels.[7]

This study was undertaken to evaluate the potential correlation between hypothyroidism and cholelithiasis. Given that thyroid hormones influence lipid metabolism, gallbladder motility, and sphincter of Oddi function, alterations in thyroid function may contribute to gallstone formation. By assessing thyroid profiles, lipid parameters, and gallbladder characteristics in patients with cholelithiasis, this study aims to determine the prevalence of overt and subclinical hypothyroidism in this population and to explore the possible mechanistic link between thyroid dysfunction and gallstone disease. Understanding this relationship could provide insight into risk stratification and management strategies for patients with gallstones