Gastroesophageal reflux disease (GERD) is a chronic digestive condition where stomach acid or bile irritates the lining of the esophagus. It occurs when the lower esophageal sphincter (LES), a muscle that acts as a valve between the esophagus and stomach, weakens or relaxes inappropriately, allowing stomach contents to flow back into the esophagus1. This backward flow of acid can cause symptoms such as heartburn, regurgitation, chest pain, difficulty swallowing, and a sour taste in the mouth. Over time, GERD can lead to more serious complications, including esophageal ulcers, narrowing, bleeding, or Barrett's esophagus, a condition that increases the risk of esophageal cancer. Managing GERD typically involves lifestyle changes, medications to reduce acid production, and, in severe cases, surgery2.In recent decades, there has been a noticeable increase in the incidence of gastroesophageal reflux disease (GERD), particularly among young people. GERD symptoms are reported in nearly half of the adult

population3, with recurrent heartburn, the leading symptom, affecting up to 40% of residents in industrialized countries. This condition significantly reduces the quality of life. Gastroesophageal reflux disease (GERD) is a common condition, and although it’s not directly related to thyroid health, it is a condition commonly seen in people with thyroid and autoimmune thyroid conditions  more commonly seen it in those with hypothyroidism and Hashimoto’s Thyroiditis, but it can be present in people with hyperthyroid conditions as well.  15 to 20% of the general population experience symptoms of GERD such as heartburn, regurgitation, and/or retrosternal pain4.The association between GERD and thyroid dysfunction is well-documented, with hypothyroidism being a significant factor in the development and worsening of GERD symptoms. Research indicates that individuals diagnosed with both GERD and thyroid dysfunction are at an increased risk of experiencing GERD-related symptoms. Hypothyroidism, which slows the body's metabolic processes, including digestion, can lead to hypomotility, affecting the smooth muscles of the gastrointestinal (GI) tract5. This dysfunction may result in gastroparesis, where the stomach empties more slowly, increasing pressure on the lower esophageal sphincter (LES). Additionally, thyroid hormones regulate muscle tone, and reduced metabolic efficiency in hypothyroidism can weaken muscles, including the LES6. A weakened LES allows acid to flow back into the esophagus, exacerbating reflux symptoms7.

AIM

To Study association of GERD with thyroid profile

This observational, hospital-based case-control study was conducted from January 2024 to November 2024 in the District Hospital Gyalshing, West Sikkim. The study included 86 patients presenting with gastrointestinal complaints, with thyroid profiles evaluated across normal, below normal, and above normal ranges. Inclusion criteria required patients to have gastrointestinal complaints, while exclusion criteria included individuals who did not provide consent for participation in the study.

       Table 1: Age distribution of study population

The age distribution of the study population shows that 16.2%  were aged ≤20 years,15.1%  were between 21-30 years, 29.06%  were between 31-40 years, 20.9%  where between 41-50 years, 12.7% (11) were between 51-60 years, 3.4% (3) were between 61-70 years, 5.8%  were between 71-80 years, and 1.16%  were older than 80 years.

       Table 2: Gender Distribution of study population

The gender distribution of the study population shows that 19.7% (17) were male, while 80.3% (69) were female.

 Table 3: Complaint of study population

 GERD is the most prevalent complaint, particularly among females, followed by APD with or without dyspepsia. The findings indicate a higher prevalence of gastrointestinal and throat-related complaints in females compared to males.

Table 4: Thyroid profile of study population

The majority of patients had normal thyroid function, but females showed a higher prevalence of abnormalities, particularly in T3, T4, and elevated TSH levels.

 Table 5: Association of GERD with thyroid profile

Most GERD patients had normal thyroid function, but a notable proportion exhibited abnormalities, particularly elevated TSH levels.

       Table 6: Association of age with GERD

GERD was most prevalent in the 31-40 age group, with fewer cases in older age groups and a limited association with hypothyroidism and other conditions.

In this study we investigated the association between thyroid profile and gerd, gerd with hypothyroidism and gerd with other conditions like LPR, anxiety, pain in throat.

The age distribution among the patients showed that 14 individuals (16.2%) were aged 20 or younger, 13 (15.1%) were between 21 and 30, 25 (29.06%) were in the 31-40 range, 18 (20.9%) were aged 41-50, 11 (12.7%) were between 51 and 60, 3 (3.4%) were aged 61-70, 5 (5.8%) were between 71 and 80, and 1 (1.16%) was older than 80.

In our study the patients, 17 were male, accounting for 19.7% of the total, while 69 were female, making up 80.3%.

Among the patients, APD with or without dyspepsia was reported in 2 males (2.32%) and 9 females (10.4%), while FB sensation in the throat with or without dyspepsia was noted in 1 male (1.16%) and 6 females (6.9%). Dyspepsia was absent in males but observed in 3 females (3.48%). Pain or irritation in the throat/neck with difficulty in swallowing was seen in 2 males (2.32%) and 5 females (5.8%), whereas dryness, discomfort, and obstruction in the throat were reported only in females (5 cases, 5.8%). GERD was prevalent in 12 males (13.9%) and 28 females (32.5%), with GERD associated with hypothyroidism in 2 females (2.32%) and GERD with other conditions in 5 females (5.8%). Gastritis was noted in 2 females (2.32%), while other complaints such as AGE, LPR, and cough were observed in 4 females (4.64%).

In our study the patients, T3 levels were below the normal range in 1 male and 11 females, within the normal range in 16 males and 57 females, and above the normal range in 1 female. T4 levels were below the normal range in 10 females, normal in 17 males and 57 females, and above the normal range in 2 females. TSH levels were below normal in 2 males and 2 females, within the normal range in 12 males and 48 females, and above normal in 3 males and 19 females.

In our study the patients, GERD cases had T3 levels below normal in 5 cases, normal in 35 cases, and none above normal, while GERD with hypothyroidism had 2 cases within the normal range. GERD with other conditions showed T3 levels below normal in 3 cases and normal in 3 cases. For T4, GERD cases had 3 below normal, 35 within the normal range, and 1 above normal, while GERD with hypothyroidism and GERD with other conditions had minimal variations. TSH levels were below normal in 2 GERD cases and 1 GERD with other conditions case, while normal TSH levels were seen in 22 GERD cases, 1 GERD with hypothyroidism case, and 3 GERD with other conditions cases. Elevated TSH was observed in 15 GERD cases, 1 GERD with hypothyroidism case, and 2 GERD with other conditions cases. Savina LV8 in their study shows that Hiatus hernia and gastroesophageal reflux disease as a manifestation of a newly revealed hypothyroidism. The latter in HT patients is associated with gastrointestinal motor-evacuatory disturbances rather than with acid exposition in the distal esophagus.

The age distribution among patients with GERD and associated conditions showed that GERD was most prevalent in the 31-40 age group, with 9 cases, followed by 8 cases in the 21-30 age group and 7 cases in the 41-50 age group. Among those with GERD and hypothyroidism, 1 case was reported in both the 31-40 and 41-50 age groups. GERD with other conditions was noted in 2 cases in the 31-40 age group, 1 case each in the ≤20, 21-30, 41-50, and 71-80 age groups. Fewer cases were observed in older age groups, with only 1 GERD case in patients above 80 years and no GERD with hypothyroidism or other conditions in this age group.

Our study found a higher prevalence of GERD in females, with common symptoms including heartburn, dyspepsia, and throat discomfort. Thyroid dysfunction, particularly hypothyroidism, was associated with GERD, as evidenced by abnormal thyroid profiles, including altered T3, T4, and TSH levels. Most GERD cases had normal T3 levels, but several cases showed abnormal TSH, especially with coexisting hypothyroidism. The findings highlight the need for careful thyroid assessment in GERD patients, particularly females, to better understand the role of thyroid dysfunction in GERD development. This study underscores the importance of addressing both GERD and thyroid issues together for more effective management.

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