BACKGROUND In the recent years, there has been a rapid increase in the number of patients getting diagnosed with clinical and subclinical hypothyroidism. We conducted a study to determine the current prevalence of this rising problem, and to identify rare clinical features for which patients seek medical help and get diagnosed as clinical or subclinical hypothyroidism. METHODS This study is a cross sectional study. The study was done over a period of 2 months (May and June 2018) on patients who visited the medicine and endocrine OPDs in SRM Medical College and Hospital, Kattankulathur. Seventy-six patients, who were proved to have either clinical or subclinical hypothyroidism and were satisfying all criteria were screened for different symptoms & signs of hypothyroidism with the help of a questionnaire. RESULTS On analysing the obtained data, it was observed that some of the features deemed as rare were in fact encountered in significant proportions of the population. 76.32% of the cases were women and the remainder were men. The overall ratio of clinical to subclinical cases was found to be 1.7:1. Overall, ages 14-24 had the maximum number of cases and ages 65+ had the minimum number of cases. Overall, most common symptom was found to be obesity, and the least common was found to be carpel tunnel syndrome. A more detailed explanation is given in the discussions part of this article.

Introduction: Morphometric evaluation of the pedicle and isthmus of second cervical vertebra (C2) (Axis) is extremely vital before contemplating any surgical stabilization involving the Craniovertebral region, in view of its proximity to the vertebral artery and the cervical nerve root. The dimensions of pedicles and isthmuses in C2 vary between individuals and there is paucity of data in the Indian population. This study strives to measure the average pedicle and isthmus dimensions in a sample of population, which would enable selection of screws with safest diameters to be used in C2; thereby avoiding injury to adjacent neurovascular structures. Materials and methods: One Hundred patients in the age group between 18 and 70 years who underwent CT scan of head and neck region were included in the study. The aim of this study was to assess the anatomic suitability of transarticular and pedicle screw placement in Axis vertebrae of Indian population and determine the maximum safe diameter for screw placement. The following parameters were measured in millimeters: Pedicle width, Pedicle angle, Internal height and Isthmic height. Results:The Mean maximum diameter of potential pedicle screw was 4.99 ± 1.1 mm for the right side with the left side being slightly wider at 5.20 ± 1.16 mm. Twenty eight (28%; 56 out of 200 pedicles) had a measurement < 4.5 mm. The internal height in sagittal images representing the pedicle height was found to be 4.79 ± 0.96 mm on the right side and 4.75 ± 1.04 mm on the left side. Sixty five (65) out of 200 pedicles (32.5%) had measurements < 4.5 mm in sagittal plane. The Mean maximum diameter of potential Transarticular screw (outer diameter of isthmus) was 5.05 ± 0.78 mm for the right side and 5.18 ± 0.84 mm on the left side. Discussion: Isthmic height < 4.5 mm could potentially violate the vertebral foramen when a 3.5 mm screw is used. In our study 22.5% isthmuses were narrow (<4.5 mm). The mean maximum safe diameter for a potential transarticular screw in the present study was 5.11 mm. Though our patients had smaller isthmus dimensions compared with literature, 77.5% of C2 could take a 4 mm transarticular screw quite comfortably considering the 0.5 mm margin on either side. In the present study, 28% of pedicles were found to be inappropriately sized (<4.5 mm) to accommodate the standard 3.5 mm screw. The mean maximum diameter of a potential pedicle screw in our study was 5.09 mm; and in 72% of patients a 4 mm screw could be placed with confidence. Though our patients on an average can accommodate a 4 mm screw comfortably, we suggest a protocol of obtaining CT measurements of C2 prior to operative intervention for identifying those individuals at risk of neurovascular injury; 22.5% for transarticular screw and 28% for pedicle screw.