Naufal Rizwan, T A (2011) Clinical study of Hypothyroidism in patients of Diabetes Mellitus. Masters thesis, Coimbatore Medical College, Coimbatore.
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Abstract
INTRODUCTION1 Diabetes is the most common endocrine disorder seen in clinical practice. The prevalence of diabetes in West is between 6-7.6 %. India has already become the “diabetes capital” of the world with over 4 crore affected patients. Between 1995 and 2025, there is predicted to be a 35% increase in the worldwide prevalence of diabetes. The rising number of people with diabetes will occur mainly in population of developing countries, leading to more than 300 million people with diabetes globally by 2025. The disease has tremendous impact on the quality of life, and morbidity and mortality occur ue to complications that affect the small vessels resulting in retinopathy, nephropathy, neuropathy and large vessels resulting in ischemic heart disease and stroke. Various studies done suggest that thyroid disorders are more common in diabetics (both type I and type II) than in the general population, highest in type I diabetic females and lowest in type II diabetic males. Thyroid dysfunction is more common in older patients.Several alterations in thyroid function are found in DM.The most profound changes occur in patients with IDDM. Plasma T4 is normal but plasma T3 is diminished.Plasma level of T3 is elevated in DKA or in patients with severely uncontrolled diabetes.Thyroid peroxidase (TPO) antibodies (also called as anti-microsomal antibodies, AMA) is found in large percentage of IDDM with elevated TSH levels and when positive in those with normal TSH levels, indicate future probability of the development of hypothyroidism in a diabetic.Patients with hypothyroidism usually present with vague and subtle symptoms like generalized weakness, lethargy, weight gain and some present with hoarseness of voice to ENT surgeon, decreased urine output (nephritic syndrome) to nephrologist, carpal tunnel syndrome to neurologist, cardiomegaly to cardiologist, irregular and heavy bleeding to gynecologist. Also clinically, it is frequently difficult to differentiate the clinical features of hypothyroidism from that of diabetes mellitus like peripheral neuropathy and autonomic neuropathy. Thyroid function tests are especially recommended in patients with clinical suspicion and /or unexplained changes in glycemic control or serum cholesterol. The ability to diagnose and treat unsuspected hypothyroidism in these population may greatly enhance the quality of life. OBJECTIVES : 1. To do the clinical study of hypothyroidism in patients of diabetes mellitus, during the study period in Coimbatore Medical College. 2. To study the patients having both endocrine disorders and their thyroid function status, in relation to the age and sex, the type of diabetes, age at detection of either condition, the clinical features, relation to the lipid profile, body mass index and other comorbid conditions. METHODOLOGY : Study Subjects: This study was conducted at Coimbatore Medical college Hospital,Coimbatore from March 2009 to August 2010. Outpatients attending to the outpatient department and inpatients admitted to the wards who were either previously or newly diagnosed diabetic were included in the study. Inclusion Criteria: Patients of diabetes mellitus either previously or newly diagnosed aged more than 19 years were included in the study. Exclusion Criteria: 1. All patients less than or equal to 19 years of age. 2. Hypothyroidism arising as a result of thyroid surgery or radiotherapy. Study Design: 1. Randomly selected diabetic patients were subjected to evaluation for thyroid function clinically and biochemically. 2. Diagnosis of Diabetes mellitus was done as per WHO guidelines. a. Fasting venous plasma glucose > 126 mg/dl (7.0 mmol/L) b.Two hour venous plasma glucose (post 75 gm glucose) > 200 mg/dl (11.1 mmol/L) 3. Diagnosis of hypothyroidism was based on values given in table 3 on page 16. 4. Patients already known to have both diabetes mellitus and hypothyroidism were also included. 5. The patients having both the conditions included in the study, underwent other relevant investigations at first visit and on follow-up. 6. All data regarding patients included was documented as per proforma enclosed in the annexure. 7. Ethical clearance was taken from the institution prior to the commencement of the study. 8. Interpretation of data was done by various statistical methods. CONCLUSION : The coexistence of diabetes mellitus with hypothyroidism is a known clinical observation. Various meta-analyses done show the prevalence of hypothyroidism in general population to be about 1%. Routine screening of thyroid function in diabetics gives a greater yield - 5 to 15 times than that found in the general population. • Hypothyroidism in these diabetics may cause subtle symptoms especially weight gain and tiredness, also commonly seen in diabetic patients, and difficult to control hyperglycemic state and dyslipidemia. • In patients having both clinical hypothyroidism and diabetes mellitus, diabetes is detected earlier in most patients. • Increased prevalence of hypothyroidism is seen in female sex, type 1 diabetics and in elderly type 2 diabetics. • The ability to diagnose and treat unsuspected hypothyroidism in diabetic populations may result in better control of the diabetic as well as of the dyslipidemic states, thereby greatly enhancing the quality of life by preventing premature atheroscelerosis and Coronary artery diseases. • This study justifies the view that all diabetic patients should be screened for hypothyroidism.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Hypothyroidism ; patients ; Diabetes Mellitus ; Clinical study. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 17 Feb 2018 21:01 |
| Last Modified: | 17 Feb 2018 21:01 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5852 |
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