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Hadgu R, Worede A, Ambachew S. Prevalence of thyroid dysfunction and associated factors among adult type 2 diabetes mellitus patients, 2000-2022: a systematic review and meta-analysis. Syst Rev 2024; 13:119. [PMID: 38689302 PMCID: PMC11061916 DOI: 10.1186/s13643-024-02527-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 04/12/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Thyroid dysfunction (TD) and type 2 diabetes mellitus (T2DM) frequently co-occur and have overlapping pathologies, and their risk increases with age. Thyroid dysfunction along with T2DM will worsen macro- and microvascular complications, morbidity, and mortality. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline was followed. The databases used were Embase, ScienceDirect, PubMed, and Google Scholar. The Joana Briggs Institute (JBI) scale was used to assess the quality of the included studies. The data was extracted by Microsoft Excel and analyzed through STATA version 14 software. The overall pooled prevalence of TD and its main components were estimated using the random-effects model. The consistency of studies was assessed by I2 test statistics. Pooled meta-logistic regression was used to present the pooled prevalence with a 95% confidence interval (CI). Besides, subgroup and sensitivity analyses were employed. RESULT Thirty-eight studies were included. The pooled prevalence of TD was 20.24% (95% CI: 17.85, 22.64). The pooled prevalence of subclinical hypothyroidism, hypothyroidism, subclinical hyperthyroidism, and hyperthyroidism was found to be 11.87% (95% CI: 6.90, 16.84), 7.75% (95% CI: 5.71, 9.79), 2.49% (95% CI: 0.73, 4.25), and 2.51% (95% CI: 1.89, 3.13), respectively. Subgroup analysis based on continent revealed a higher prevalence of TD in Asia and Africa. Factors like being female, HbA1c ≥ 7%, DM duration > 5 years, family history of TD, central obesity, smoking, the presence of retinopathy, and neuropathy were found associated with TD. CONCLUSION The current systematic review and meta-analysis showed that the TD's pooled prevalence was relatively higher than the general population. Therefore, regular screening of TD should be done for T2DM patients.
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Affiliation(s)
- Rishan Hadgu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, P.O. Box 21, Arba Minch, Ethiopia.
| | - Abebaw Worede
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Sintayehu Ambachew
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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Song JL, Hu JW, Li LR, Xu ZL, Li JJ, Sun SR, Chen C. Association of thyroid autoimmunity with extra-thyroid diseases and the risk of mortality among adults: evidence from the NHANES. Front Endocrinol (Lausanne) 2024; 15:1323994. [PMID: 38405150 PMCID: PMC10884096 DOI: 10.3389/fendo.2024.1323994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Background Thyroid autoimmunity is one of the most prevalent autoimmune diseases. However, its association with extra-thyroid diseases and mortality risk in the general population remains uncertain. Our study aims to evaluate the association of thyroid autoimmunity with extra-thyroid disease and the risk of mortality. Methods A prospective cohort study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) with participants from 2007-2008, 2009-2010, and 2011-2012, tracking their mortality until 2019. Associations between thyroid autoimmunity, which was defined as having positive thyroid peroxidase antibody (TPOAb) and/or thyroglobulin antibody (TgAb), and extra-thyroid disease including diabetes, hypertension, cardiovascular disease, chronic lung disease, arthritis, cancer and chronic renal disease and the risk of mortality were investigated. Results A total of 7431 participants were included in this study. Positive The prevalence of positive TgAb was 7.54%, and positive TPOAb prevalence was 11.48%. TgAb was significantly associated with diabetes (Model 1: OR=1.64, 95% CI:1.08-2.50; Model 2: OR=1.93, 95% CI: 1.21-3.08) and hypertension (Model 1: OR=0.67, 95% CI: 0.49-0.91; Model 2: OR=0.62, 95% CI: 0.44-0.88). TPOAb was associated with a lower prevalence of chronic lung disease (model 1: OR=0.71, 95% CI: 0.54-0.95; model 2: OR=0.71, 95% CI: 0.53-0.95). No associations were observed between TgAb, TPOAb and other extra-thyroid diseases. Neither TgAb nor TPOAb were associated with all-cause mortality or heart disease mortality. Conclusion TgAb was linked to a higher prevalence of diabetes and a lower prevalence of hypertension, while TPOAb was associated with a decreased prevalence of chronic lung disease. However, neither TgAb nor TPOAb posed a risk for all-cause mortality or heart disease mortality.
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Affiliation(s)
| | | | | | | | | | - Sheng-Rong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chuang Chen
- *Correspondence: Chuang Chen, ; Sheng-Rong Sun,
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Grigoriadis G, Koufakis T, Kotsa K. Epidemiological, Pathophysiological, and Clinical Considerations on the Interplay between Thyroid Disorders and Type 2 Diabetes Mellitus. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2013. [PMID: 38004062 PMCID: PMC10673571 DOI: 10.3390/medicina59112013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
Thyroid disorders (TD) and diabetes mellitus (DM) are the two endocrinopathies with the highest prevalence in the general population that frequently coexist. Thyroid dysfunction is more common in people with type 2 diabetes mellitus (T2DM) compared to normoglycemic individuals. Untreated TD can impair glycemic control, increasing the risk of diabetes complications. Hyperinsulinemia can affect the morphology of the thyroid gland by promoting the proliferation of thyroid tissue and increasing the size of thyroid nodules. Metformin can confer benefits in both endocrinopathies, while other antidiabetics, such as sulfonylureas, can negatively affect thyroid function. Animal and human observational data suggest an increased risk of medullary thyroid carcinoma after treatment with glucagon-like peptide-1 receptor agonists. However, randomized trials have so far been reassuring. Furthermore, some observational studies suggest an association between thyroid cancer and T2DM, especially in women. This narrative review aims to shed light on the epidemiological, pathophysiological, and clinical aspects of the interplay between TD and T2DM. Taking into account the important clinical implications of the coexistence of T2DM and TD, proper screening and management strategies are needed for both endocrinopathies to ensure optimal patient care.
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Affiliation(s)
- Gregory Grigoriadis
- Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Theocharis Koufakis
- Second Propaedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Kalliopi Kotsa
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece;
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Iwakura H, Takagi T, Inaba H, Doi A, Ueda Y, Uraki S, Takeshima K, Furukawa Y, Ishibashi T, Morita S, Matsuno S, Nishi M, Furuta H, Matsuoka TA, Akamizu T. Thyroid function, glycemic control, and diabetic nephropathy in patients with type 2 diabetes over 24 months: prospective observational study. BMC Endocr Disord 2023; 23:146. [PMID: 37430240 PMCID: PMC10332001 DOI: 10.1186/s12902-023-01393-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/28/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The higher prevalence of thyroid dysfunction in type 1 diabetes patients has been well established, whereas it is a matter of debate whether that is also observed in type 2 diabetes patients. This study was conducted to reveal whether higher prevalence of thyroid dysfunction is observed in patients with type 2 diabetes. METHODS We examined thyroid functions and thyroid autoantibodies in 200 patients with type 2 diabetes and 225 controls, with 24 months follow up for those with type 2 diabetes. RESULTS Serum free triiodothyronine (fT3) levels and fT3/free thyroxine (fT4) ratio were significantly lower, while fT4 levels were significantly higher in patients with type 2 diabetes. The number of patients with thyroid dysfunction or patients positive for thyroid autoantibodies were not different between the two groups. The fT3/fT4 ratio was positively and negatively correlated with serum c-peptide and HbA1c levels, respectively, suggesting that the difference can be attributable to insulin resistance and diabetic control. In the follow-up observation, we found no significant correlation between basal thyrotropin (TSH), fT3, fT4 or fT3/fT4 ratio with the amounts of changes of HbA1c levels at 12 or 24 months after the basal measurements. There was a negative relationship between TSH levels and eGFR at baseline measurements, but TSH levels did not seem to predict future decline of eGFR levels. No relationship was observed between urine albumin/ g‧cre levels and thyroid function. CONCLUSION Thyroid dysfunction and thyroid autoantibodies were not different in prevalence between patients with type 2 diabetes and controls, although in patients with type 2 diabetes, the fT3/fT4 ratio was decreased. Basal thyroid function did not predict future diabetes control or renal function within 24 months of follow-up.
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Affiliation(s)
- Hiroshi Iwakura
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
| | - Tomoyuki Takagi
- Wakayama City Medical Association Seijinbyo Center, 2-1-2 Tebira, Wakayama, Wakayama, 640-8319, Japan
| | - Hidefumi Inaba
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Asako Doi
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Yoko Ueda
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Shinsuke Uraki
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Ken Takeshima
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Yasushi Furukawa
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Tatsuya Ishibashi
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Shuhei Morita
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Shohei Matsuno
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Masahiro Nishi
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Hiroto Furuta
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Taka-Aki Matsuoka
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Takashi Akamizu
- The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
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ERGENÇ H, KARACA OCAK Ö, AKSOY E, ERGENÇ Z. The effects of pathophysiological changes in Type-2 diabetic patients on thyroid dysfunction and nodular goiter development in Turkey. KONURALP TIP DERGISI 2023. [DOI: 10.18521/ktd.1159387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: The prevalence of thyroid dysfunction is higher in patients with diabetes, and its diagnosis could cause better diabetes management. The purpose of the present study is to examine the impact of pathophysiological changes in patients with Type-2 diabetes on the frequency of thyroid dysfunction, thyroid autoimmunity, thyroid nodule, and thyroid cancer in Turkey.
Methods: The study was conducted on a total of 3.276 patients with Type-2 diabetes who underwent thyroid tests and thyroid ultrasonography (US). The demographic characteristics, biochemical and hormonal values, thyroid US reports, and histopathology reports were collected from the patient's electronic records.
Results: Thyroid autoimmunity positive TPOab 15.9% (n = 524) and/or positive TGab 9.9% (n = 327), the rate of positivity of both antibodies (TPOab + TGab) in the same patient, and total thyroid autoimmunity was found to be 32.57% (n=1067) in Type-2 diabetic patients. Thyroid dysfunction was detected in 18.3% (n = 602) of these patients. The distribution of thyroid dysfunction was 9.09% (n = 298) subclinical hypothyroidism, 4.1% (n = 135) clinical hypothyroidism, 3.1% (n = 102) subclinical hyperthyroidism, 2.0% (n = 67) clinical hyperthyroidism. Also, 67.9% (n = 2225) thyroid nodules, and 5% (n = 164) thyroid cancer were detected.
Conclusion: Thyroid dysfunction was found to have increased in patients with Type-2 diabetes at significant levels.
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Jimoh AK, Ghazali MS, Ogundeji OA, Adeleke BA, Ajani OG, Gabriel-Alayode EO, Popoola GO, Adediran OS. Spectrum of thyroid function test among type 2 diabetic patients attending a rural health facility, southwest Nigeria: A hospital-based study. SAGE Open Med 2022; 10:20503121221097625. [PMID: 35600708 PMCID: PMC9118895 DOI: 10.1177/20503121221097625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: The thyroid gland produces hormones that have significant influence on carbohydrate metabolism; its disorders may affect carbohydrate metabolism in type 2 diabetic patients (T2DM) more than the non-diabetic (NDM) patients as reported in various studies. We determined the spectrum of thyroid function tests (TFTs) profile among T2DM in our rural health facility. Methods: T2DM patients and NDM patients were recruited for the study. The age, educational level, occupation, marital status, and duration of diabetes were extracted from interviewer’s administered questionnaire. The weight, height, body mass indices (BMIs), and the waist and hip circumferences were measured. Waist-hip ratios (WHR) were calculated for all participants. Venous blood was collected and assayed for free triiodothyronine (fT3), free thyroxine (fT4), and thyroid stimulating hormone (TSH) using a Chemiluminescence Immunoassay (CLIA) 2nd Generation Autoanalyzer. The mean, standard deviation, frequencies, and percentages were calculated for the variables. The student’s t-test and chi-square test were also determined as appropriate. Results: Seventy-eight patients made up of 56 T2DM and 22 NDM were evaluated in this study. Fifty-one were males while 27 were females; 67.9% and 59.1% of the female participants were T2DM and NDM, respectively. The WHR was significantly higher in T2DM than NDM (0.92 ± 0.05 versus 0.88 ± 0.06). The TSH was higher in T2DM than the NDM. Forty-four (78.6%) of the T2DM had euthyroid (normal) biochemical pattern; 12 (21.4%) showed abnormal biochemical pattern of euthyroid sick syndrome, subclinical hyperthyroid, and subclinical hypothyroid. Thirty (53.6%) of the T2DM were diagnosed less than five years ago. The value of TSH was increasing with the duration of diabetes but not in a statistically significant way. None of the T2DM showed overt hypothyroid or hyperthyroid test result. Conclusion: Thyroid function test may identify diabetics with altered thyroid hormone status that may impact on their metabolic control. Knowledge of the functional state of the thyroid gland can help in achieving a better metabolic control and attenuate the development of complications in T2DM.
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Affiliation(s)
- Ahmed Kayode Jimoh
- Department of Chemical Pathology, Afe Babalola University, Ado-Ekiti, Nigeria
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Sangma H, Singh A, Srivastava A, Misra V. Prevalence of Latent Autoimmune Diabetes in Adult Based on the Presence of GAD 65 Antibodies in North-Eastern Uttar Pradesh, India. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2022. [DOI: 10.1055/s-0041-1741063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Objective The objective of this paper was (1) to study the prevalence of latent autoimmune diabetes in adult (LADA) in the region of north-eastern Uttar Pradesh, India, based on the positivity for glutamic acid decarboxylase 65 (GAD65) antibodies and (2) to compare the glycemic profile between GAD65-positive and GAD65-negative subjects.
Materials and Methods The subjects were of more than 30 years of age, with either recently diagnosed pre-diabetes/diabetes presenting with the hemoglobin A1c (HbA1c) level of ≥5.7% or already diagnosed cases of type 2 diabetes mellitus (T2DM) who had no requirement of insulin therapy for at least 6 months from the time of their diagnosis. All the patients were natives of north-eastern Uttar Pradesh. The GAD65 test was done by the enzyme-linked immunosorbent assay. Further, the glycemic status of GAD-positive and GAD-negative subjects were compared on the basis of fasting blood sugar (FBS), fasting insulin (FI), and homeostatic model assessment for insulin resistance (HOMA-IR).
Statistical Analysis The “unpaired t-test” was used to compare and assess the significance of differences between the glycemic profile of GAD65-positive and GAD65-negative subjects using the GraphPad Prism Scientific Software, San Diego, CA, United States. The p-value of <0.05 was considered to be significant.
Results A total of 77 patients were included in the study, with the age group ranging from 30 to 75 years (47.81 ± 12.9 years) with the male–female ratio of 1:2.6. The prevalence of LADA was found to be 51.95%. On comparing GAD65-positive and GAD65-negative groups, a higher value of HbA1c levels and FBS were found in the former, whereas FI and HOMA-IR were found to be higher in the latter. On testing for significance of difference, only FI and HbA1c values were significant (p-value <0.0001).
Conclusion LADA can no longer be considered a rare type of diabetes mellitus, with the present study showing a high prevalence of LADA in this north eastern region of Uttar Pradesh. Identification of adult-onset diabetics accurately as LADA or true T2DM is very crucial for the appropriate treatment, as LADA patients require insulin inevitably and much earlier than true T2DM patients, who can be managed mostly on oral hypoglycemic agents with seldom requirement of insulin.
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Affiliation(s)
- Himalina Sangma
- Department of Pathology, Motilal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Anshul Singh
- Department of Pathology, Motilal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Anubha Srivastava
- Department of Medicine, Motilal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Vatsala Misra
- Department of Pathology, Motilal Nehru Medical College, Prayagraj, Uttar Pradesh, India
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Foroutan M, Reshdat S, Mehri M, Pourkalhor S, Najmaldin A. Relationship between subclinical hypothyroidism and distal-symmetric diabetic polyneuropathy in type 2 diabetes mellitus referred to Kosar Hospital in Semnan and related indicators in 2019–2020. J Family Med Prim Care 2022; 11:1361-1368. [PMID: 35516707 PMCID: PMC9067195 DOI: 10.4103/jfmpc.jfmpc_1262_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/28/2021] [Accepted: 11/10/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Diabetes is one of the most common metabolic diseases and one of its important complications is diabetic neuropathy. Due to the relationship between diabetes and thyroid disorders, the present study was performed to determine the association between subclinical hypothyroidism and end-stage diabetic polyneuropathy in patients with type 2 diabetes. Materials and Methods: In this descriptive, analytical study, 154 patients with type 2 diabetes referred to Kosar Hospital in Semnan were evaluated. After recording their demographic information, samples were received for biochemical testing. The patients’ neuropathy was then evaluated based on the United Kingdom screening test (UKST). The results were recorded in the data collection form and then analyzed using SPSS Statistics 22 software. Results: In this study, 154 patients were studied, including 49 with subclinical hypothyroidism and 105 with euthyroid. The results of the present study showed that the mean age of patients in the subclinical hypothyroid group was 60.08 years and in the euthyroid group was 60.77 years. Mean ± standard deviation (SD) of the patients’ age, blood pressure, duration of diabetes, body mass index, fasting blood sugar (FBS) and Glucose, and 2-hour post prandial (2HPP) were not statistically significant between the two groups. The frequency of neuropathy severity based on clinical signs during examination and symptoms mentioned by the patients in the two groups was statistically significant (P = 0.005 and P = 0.001, respectively). The severity of neuropathy was not significantly associated with thyroid-stimulating hormone (TSH) levels (P > 0.05). Conclusion: From the results of the present study, it can be concluded that the severity of neuropathy based on the clinical signs during examination and the symptoms mentioned by the patient in diabetic patients is related to subclinical hypothyroidism. Further studies are recommended.
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Sangma H, Singh A, Srivastava A, Singh R, Misra V. Association of autoimmune thyroiditis with latent autoimmune diabetes of adults (LADA): A study from North India. JOURNAL OF DIABETOLOGY 2022. [DOI: 10.4103/jod.jod_121_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Al-Shammari MA, Abdel Wahab MM, AlShamlan NA, AlOmar RS, Althunyan AK, Alghamdi LM, Aldhawyan AF, AlAmer NA, Elmaki SA, Al Dandan O. Clinical, Laboratory, and Ultrasound Related Diagnoses of Thyroid Disorders: Using a Family Medicine Center Data to Assess Thyroiditis and Thyroid Nodules in the Eastern Province of Saudi Arabia. J Prim Care Community Health 2022; 13:21501319221095345. [PMID: 35465762 PMCID: PMC9036321 DOI: 10.1177/21501319221095345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction/Objectives: The prevalence of thyroid disorders is high in Saudi Arabia. Among the disorders, goiter and thyroiditis are the most common and have unique ultrasound (US) features, underscoring the need for US screening for thyroid pathologies. This study aimed to determine the prevalence of thyroiditis and thyroid nodules in patients attending the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University. Methods: This registry-based cross-sectional study analyzed laboratory and US data from 240 patients who attended the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University from January 2020 to December 2021. Abnormalities of the thyroid gland were categorized according to laboratory and US data. Associations between different types of thyroid pathology and clinical and laboratory findings were assessed using appropriate statistical methods. Results: The majority of participants were Saudi women. The prevalence of thyroiditis in the study population was 43%. Approximately 25% of these patients had more than 1 nodule, and fine-needle aspiration biopsy showed that most nodules were benign. Most nodules were found in clinically euthyroid patients. Thyroiditis might be associated with abnormal thyroid function. Conclusions: Thyroiditis and thyroid nodules were common in our cohort. Vitamin D deficiency, other autoimmune diseases, and a family history of thyroid disorders were associated with thyroiditis and thyroid nodules. US is useful for identifying the type of thyroid disease.
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Affiliation(s)
- Malak A Al-Shammari
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Moataza M Abdel Wahab
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nouf A AlShamlan
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Reem S AlOmar
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullatif K Althunyan
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Layla M Alghamdi
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Adam Fahad Aldhawyan
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Naheel A AlAmer
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sara A Elmaki
- Department of Radiology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Omran Al Dandan
- Department of Radiology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Ibrahim SH. Impact of Quercus infectoria Galls Extract on Thyroid Gland and Testicular Functions in Diabetic Rats. THE IRAQI JOURNAL OF VETERINARY MEDICINE 2021. [DOI: 10.30539/ijvm.v45i2.1268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Diabetes mellitus has been reported to be accompanied by thyroid and testicular dysfunctions. The objective of this study was to investigate the effect of Quercus infectoria galls (QIg) extract on the thyroid gland and testicular functions in diabetic rats. Sixteen rats were randomly divided into four equal groups, consisting of normal control, diabetic untreated control, diabetic treated with oral administration of 500 mg/kg BW and 1000 mg/kg BW, respectively for 15 days. Serum blood glucose, thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), testosterone (T), and luteinizing hormone (LH) were assessed. At the end of the experimental period, the rats were euthanized for histopathological analysis of thyroid gland and testis. Furthermore, immunohistochemistry was used to assess the expression of thyroid transcription factor-1 (TTF-1) in the thyroid gland of rats. The significant increase in serum blood glucose level in diabetic rats (DC) was markedly decreased by treatment with QIg extract (500 mg and 100 mg/kg BW) almost to the normal level. The reduced thyroid hormones, both the T3 and T4 were significantly recovered after 15 days of treatment with QIg extract (500 mg and 100 mg/kg BW). Whereas serum concentration of testosterone was significantly reduced in diabetic rats with QIg extract (500 mg and 100 mg/kg BW) treatment. Histopathological analysis of diabetic rats showed a wide range of morphological alterations in thyroid gland and testicular structures, which were almost completely, restored back to normal by treatment of rats with QIg extract. Furthermore, results showed overexpression of TTF-1 in the thyroid gland of diabetic rats, which was recovered back to normal expression after 15 days of treatment with QIg extract. These findings may provide new insights into the potential role of QIg extract as a promising therapeutic agent against diabetic complications in thyroid gland and testicular functions.
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Kim SY. Diabetes and Hyperthyroidism: Is There a Causal Link? Endocrinol Metab (Seoul) 2021; 36:1175-1177. [PMID: 34986300 PMCID: PMC8743583 DOI: 10.3803/enm.2021.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sang Yong Kim
- Division of Endocrinology, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
- Corresponding author: Sang Yong Kim Division of Endocrinology, Department of Internal Medicine, Chosun University College of Medicine, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea Tel: +82-62-220-3011, Fax: +82-62-223-3316, E-mail:
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Yadav A, Yadav GAM, Narsingrao KK, Nanda Kumar LG, Yadav GSN. Prevalence of thyroid disorders among patients with diabetes in rural South India. Diabetes Metab Syndr 2021; 15:885-889. [PMID: 33894503 DOI: 10.1016/j.dsx.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND & AIMS Diabetes mellitus (DM) and thyroid disorders are the most common endocrine disorders in clinical practice. Unrecognized thyroid disorders have an adverse effect on metabolic functions. The aim of the study is to demonstrate the prevalence of thyroid disorders in individuals with diabetes mellitus. METHODS A prospective observational study, conducted at Sree Sidhi Vinayaka Diabetic Center, between September 2013 to December 2019. A total of 5037 patients attended the outpatient clinic, among which 2470 met the inclusion criteria. All patients underwent a clinical and laboratory evaluation. RESULTS A total of 2321 individuals with diabetes had consented to be the part of the study, 102 had Type 1 diabetes mellitus (T1DM) and 2219 Type 2 diabetes mellitus (T2DM). The mean age was 48.4 ± 10.7, among which 1128 females and 1193 are males. 79.9% (1853) individuals with diabetes were euthyroid; 13.8% (321) subclinical hypothyroidism; 3.4% (79) clinical hypothyroidism, and 2.9% (68) were having hyperthyroidism. 14.1% of T2DM had subclinical hypothyroidism, in contrast, clinical hypothyroidism was common in T1DM (6.9%). CONCLUSION A high index of suspicion for thyroid dysfunction in diabetics should be considered to screen for thyroid function in them for early detection and effective management of both the conditions.
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Affiliation(s)
- Anurag Yadav
- Department of Biochemistry, MNR Medical College, Sangareddy, MNR Nagar, Sangareddy, Telangana State, 502295, India
| | | | - Karewad Kaveri Narsingrao
- Dept. of Physiology, MNR Medical College, Sangareddy, MNR Nagar, Sangareddy, Telangana State, 502295, India.
| | - L G Nanda Kumar
- Dept. of Physiology, MNR Medical College, Sangareddy, MNR Nagar, Sangareddy, Telangana State, 502295, India.
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Awad AS, Alshahrni FMM, Alhawyan FS, Ghazwani EY, Alasmary MY, Alshahrani MY, Tobaiqi MAA, Alshahrani SSM, Alghamdi SSA, Bakri STH, Ayed AA. Inference of link among diabetes, obesity, and thyroid dysfunction in data from a clinic at Saudi Arabia. Bioinformation 2021; 17:119-125. [PMID: 34393426 PMCID: PMC8340702 DOI: 10.6026/97320630017119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/31/2020] [Accepted: 01/26/2021] [Indexed: 01/04/2023] Open
Abstract
The clinical link among diabetes, obesity, and thyroid dysfunction is of interest. Hence, medical records of 601 patients with diabetes, obesity, and thyroid dysfunctions at the Abha Specialist Center and Military Diabetic Endocrine Center we used in this analysis. Approximately 28% of diabetic patients had thyroid dysfunction, and 12.4% were vitamin D deficient. The patients with thyroid dysfunction had significantly elevated triglyceride levels compared to the patients without thyroid dysfunction (173.6 vs. 128. p=0.009). Vitamin D deficient obese patients were significantly younger (33.99±10.69 vs. 43.68±14.42; p<0.001) and had significantly lower levels of HbA1c (5.73±1.16 vs. 6.83±2.08; p=0.014) and lower systolic BP (120.26±11.75 vs. 124.58±13.63; p=0.049) than non-vitamin D deficient obese patients. Vitamin D deficient thyroid patients had significantly lower diastolic BP (71.4±9.9 vs. 74.9±9.7; p=0.040) and higher HbA1c (8.7±3.6 vs. 6.4±1.7; p=0.003) in comparison to non-vitamin D deficient thyroid patients. Hence, analysis of metabolic disorders in these patients will help combat complications in these cases.
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Affiliation(s)
- Alsamghan S Awad
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, KSA-61421
| | | | - Fatmah Salem Alhawyan
- Diabetes and Metabolism, Armed Forces Hospitals Southern Region, Khamis Mushait, Aseer, Kingdom of Saudi Arabia
| | - Eisa Yazeed Ghazwani
- Family and Palliative Medicine, Department of Family & Community Medicine, Faculty of Medicine, Najran University, Najran, Kingdom of Saudi Arabia
| | - Mohammed Yahia Alasmary
- Department of Medicine,Faculty of Medicine, Najran University, Najran, Kingdom of Saudi Arabia
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15
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Pillay S, Pillay D, Singh D, Pillay R. Human immunodeficiency virus, diabetes mellitus and thyroid abnormalities: Should we be screening? South Afr J HIV Med 2020; 21:1116. [PMID: 33240534 PMCID: PMC7670034 DOI: 10.4102/sajhivmed.v21i1.1116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022] Open
Abstract
Background Diabetes mellitus (DM) and human immunodeficiency virus (HIV) are associated with thyroid abnormalities. Scarce literature exists on the prevalence of thyroid abnormalities in people living with HIV (PLWH) and DM (PLWHD). Guidelines vary regarding thyroid-stimulating hormone (TSH) screening in PLWH and/or DM. Objectives This study describes thyroid abnormalities in PLWHD and HIV-uninfected people living with DM (PLWD). Method This was a cross-sectional analysis of demographic, clinical and biochemical data including TSH results of first-visit patients to the Edendale Hospital diabetes clinic between January 2016 and December 2017. Results A total of 915 patients were enrolled: 165 PLWHD and 750 PLWD. Overall prevalence of thyroid disorders in PLWD was 8.53% (64/750). The occurrence of ‘total’ thyroid disorders and of ‘subclinical-hypothyroidism’ (SCH) was higher in PLWHD than PLWD (23.03% vs. 8.53% and 20.61% vs. 4%, p < 0.001; respectively). People living with HIV and diabetes with thyroid disorders had lower CD4 counts than PLWHD without thyroid disorders (376.08 ± 333.30 vs. 509 ± 341.7 cells/mm3; p = 0.004). Subclinical-hypothyroidism was more common in patients on antiretroviral therapy [ART] (27/136 [19.85%] vs. 4/27 [14.81%], p < 0.001). A significant number of PLWHD acquired HIV before the onset of DM (107/165 [64.85%] vs. 58/165 [35.15%], p < 0.001). Patients on ART were more likely to develop DM, OR 2.66 (95% CI 1.11–6.38). Conclusion Our study showed an increased prevalence of thyroid disorders (especially SCH) in PLWD and a higher prevalence in PLWHD. Young, overweight, female PLWHD were at risk of SCH. People living with HIV and DM on ART demonstrated an increased prevalence of thyroid dysfunction and poor lipaemic control. The introduction of combined communicable–non-communicable disease clinics might provide an integrated patient screening option.
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Affiliation(s)
- Somasundram Pillay
- Department of Internal Medicine, King Edward VIII Hospital, Durban, South Africa.,Department of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Deepak Singh
- Department of Physics, Durban University of Technology, Durban, South Africa
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16
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Lack of Association between Poor Glycemic Control in T2DM and Subclinical Hypothyroidism. J Thyroid Res 2020; 2020:8121395. [PMID: 32963752 PMCID: PMC7495217 DOI: 10.1155/2020/8121395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/16/2020] [Accepted: 08/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background Hypothyroidism is a highly prevalent and multifactorial disorder and has been implicated in the causation of dyslipidemia, dermatological diseases, atherosclerosis, and myocardial dysfunction, as well as endothelial dysfunction. The relationship between subclinical hypothyroidism and type 2 diabetes mellitus is not well established. In the present study, we attempt to find out the prevalence of subclinical hypothyroidism in type 2 diabetes mellitus and its association with glycemic control. Materials and Methods This was an observational study in which 205 consecutive patients of T2DM visiting the outpatient department of medicine were recruited. Serum TSH, free thyroxine, free triiodothyronine, and lipid profile, as well as HbA1c assays, were done in the study participants, and they were categorized into three groups by HbA1c: <7%, 7–9%, and >9%. Results There is a high prevalence of subclinical hypothyroidism in type 2 DM patients. Mean HbA1c in diabetics without SCH was 7.89%, whereas it was 8.33% in diabetics with SCH. This difference was statistically not significant. TSH was not found to be significantly associated with HbA1c. Conclusion High prevalence of SCH in T2DM patients suggests that there is a need for regular follow-up to check the progression of SCH to overt hypothyroidism. High serum TSH is not a predictor of poor glycemic control.
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Bulut Arikan F, Özdemir FA, Şen D, Erdem S, Yörübulut S, Doğan H, Keskin L. TRPV2 POLYMORPHISMS INCREASE OR REDUCE THE RISK OF TYPE 2 DIABETES - HASHIMOTO THYROIDITIS COMORBIDITY. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:15-21. [PMID: 32685033 DOI: 10.4183/aeb.2020.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context Thyroid disorders are common in diabetics and related to severe diabetic complications. TRPV2 ion channels have crucial functions in insulin secretion and glucose metabolism which have an important role in the pathophysiology of diabetes. Also, they have a significant effect on various immunological events that are involved in the HT pathophysiology. Objective This study aimed to investigate rs14039 and rs4792742 polymorphisms of the TRPV2 ion channels in type 2 diabetes mellitus (T2DM, n=100) Hashimoto thyroiditis (HT, n=70) and comorbid T2DM and HT (T2DM+HT, n=100) patients and control (n=100). Design Case-control study. Subject and Methods RT-PCR genotyping was used to determine rs14039 and rs4792742 polymorphisms with DNA samples of subjects and appropriate primer and probes. Besides, required biochemical analyses were performed. Results It was determined that the frequencies of the rs14039 GG homozygote polymorphic genotype and the G allele were significantly higher in T2DM+HT patients compared to the control (p=0.03 and p=0.01, respectively) and that especially the GG genotype increases the risk of T2DM+HT 3.046-fold (p=0.01, OR=3.046). It was detected that the GG genotype increased the risk of HT 2.54-fold (p=0.05, OR=2.541). TRPV2 rs4792742 polymorphisms reduce the risk of HT and T2DM+HT comorbidity almost by half and have a protective effect against HT and T2DM+HT. Conclusion The rs14039 GG genotype of the TRPV2 gene significantly increases the risks of development of T2DM+HT and HT disorders, may have a significant role in the pathophysiology of these diseases, also leading to predisposition for their development. Conversely, rs4792742 polymorphic genotypes have a strong protective effect against the HT and T2DM+HT comorbidity.
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Affiliation(s)
- F Bulut Arikan
- Kırıkkale University, Faculty of Medicine, Dept. of Physiology, Elazig, Turkey
| | - F A Özdemir
- Kırıkkale University, Faculty of Medicine, Bingol University, Faculty of Science and Art, Dept. of Molecular Biology and Genetics, Elazig, Turkey
| | - D Şen
- Kırıkkale University, Faculty of Medicine, Fırat University, Faculty of Medicine, Dept. of Medical Genetics, Elazig, Turkey
| | - S Erdem
- Kırıkkale University, Faculty of Medicine, Dept. of Medical Biology, Elazig, Turkey
| | - S Yörübulut
- Kırıkkale University, Faculty of Medicine, Faculty of Science and Letters, Dept. of Statistics, Kırıkkale, Elazig, Turkey
| | - H Doğan
- Kırıkkale University, Faculty of Medicine, Private Hayat Hospital, Dept. of Internal Medicine, Elazig, Turkey
| | - L Keskin
- Kırıkkale University, Faculty of Medicine, Elazig Training and Research Hospital, Dept. of Endocrinology, Elazig, Turkey
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Alzahrani AS, Al Mourad M, Hafez K, Almaghamsy AM, Alamri FA, Al Juhani NR, Alhazmi AS, Saeedi MY, Alsefri S, Alzahrani MDA, Al Ali N, Hussein WI, Ismail M, Adel A, El Bahtimy H, Abdelhamid E. Diagnosis and Management of Hypothyroidism in Gulf Cooperation Council (GCC) Countries. Adv Ther 2020; 37:3097-3111. [PMID: 32488658 PMCID: PMC7467410 DOI: 10.1007/s12325-020-01382-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Indexed: 12/15/2022]
Abstract
Hypothyroidism is one of the most common chronic endocrine conditions. However, as symptoms of hypothyroidism are non-specific, up to 60% of those with thyroid dysfunction are unaware of their condition. Left untreated, hypothyroidism may contribute to other chronic health conditions. In the Arabian Gulf States, hypothyroidism is thought to be common, but is underdiagnosed, and management approaches vary. An advisory board of leading Saudi endocrinologists and policy advisers was convened to discuss and formulate recommendations for the diagnosis and management of hypothyroidism in Saudi Arabia based on their clinical expertise. The final document was shared with leading endocrinologists from the other Gulf Cooperation Council (GCC) and aconsensus report was generated and summerized in this article. While there is no consensus regarding population screening of hypothyroidism, current recommendations suggest screening patients with risk factors, including those with a history of head or neck irradiation, a family history of thyroid disease or pharmacological treatment that may affect thyroid function. Evidence from a cross-sectional study in Saudi Arabia suggests screening the elderly (> 60 years), at least in the primary care setting. In Saudi Arabia, the incidence of congenital hypothyroidism is approximately 1 in every 3450 newborns. Saudi nationwide population prevalence data are lacking, but a single-centre study estimated that the prevalence of subclinical hypothyroidism in the primary care setting was 10%. Prevalence rates were higher in other cross-sectional studies exclusively in women (13-35%). The recommendations included in this article aim to streamline the diagnosis and clinical management of hypothyroidism in the GCC, especially in the primary care setting, with the intention of improving treatment outcomes. Further study on the incidence, prevalence and risk factors for, and clinical features of, hypothyroidism in the GCC countries is required.
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Affiliation(s)
- Ali S Alzahrani
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
- Alfaisal University, Riyadh, Saudi Arabia.
| | - Mourad Al Mourad
- Scientific Committee to the General Directorate for Control of Genetic and Chronic Diseases, Assistant Agency for Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kevin Hafez
- Dr Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | | | - Fahad Abdulrahman Alamri
- Director General for Clinical Health Education and Promotion, Ministry of Health, Riyadh, Saudi Arabia
| | - Nasser R Al Juhani
- Department of Internal Medicine, East Jeddah Hospital, Jeddah, Saudi Arabia
| | - Alhussien Sagr Alhazmi
- Department of Obstetrics, Gynaecology and Infertility, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohammad Yahya Saeedi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Director General for Non-Communicable Diseases, Ministry of Health, Riyadh, Saudi Arabia
| | - Saud Alsefri
- Taif University, Taif, Saudi Arabia
- Department of Endocrinology and Diabetes, Al Hada and Taif Armed Forces Hospitals, Taif, Saudi Arabia
| | - Musa Daif Allah Alzahrani
- Unit of Pediatric Endocrinology and Diabetes, Children's Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - Nadia Al Ali
- Unit of Endocrinology and Metabolism, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
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Vamshidhar IS, Rani SSS. A Study of Association of Thyroid Dysfunctions in Patients with Type 2 Diabetes Mellitus. MAEDICA 2020; 15:169-173. [PMID: 32952680 PMCID: PMC7482697 DOI: 10.26574/maedica.2020.15.2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background: Type 2 diabetes mellitus is known to be associated with other endocrine dysfunctions and thyroid is one of them. In the current study we tried to evaluate the frequency of thyroid dysfunctions in patients with type 2 diabetes mellitus and compare them with a normal control population. Methods: This cross-sectional study was carried out in the Department of Physiology and Department of General Medicine, Kakatiya Medical College, and MGM Hospital, Warangal, India. A total of 50 consecutive patients with diabetes mellitus type 2 were selected as cases, and an equal number of age- and sex-matched individuals with normoglycemia as controls. Laboratory investigations included measurements of fasting blood sugar [FBS] and HbA1c values after overnight fasting for eight hours, serum triglycerides, along with serum TSH, FT3, and FT4, which were measured by chemiluminescence immunoassay. Results: Among all cases of type 2 diabetes mellitus, eight (16%) presented thyroid disorders, with 10% in male patients and 6% in female patients. The overall frequency of thyroid disorders was found in four (8%) cases, of which two (4%) in males and two in females. The values of TSH μIU/ml and FBS mg/dl in type 2 diabetes mellitus cases were plotted and a Pearson correlation coefficient of +0.70 was calculated, indicating a positive correlation between the TSH and FBS. Along with TSH levels, the values of HbA1c were plotted in patients with type 2 diabetes mellitus and a Pearson correlation coefficient of +0.76 was calculated. Conclusion: Within the limitations of the present study, it can be concluded that the prevalence of thyroid dysfunctions is more common in patients with type 2 diabetes mellitus. Also, a continuous positive correlation of TSH with FBS and HbA1c was found. Hence, a periodic screening for their coexistence in thyroid dysfunctions among diabetic patients is advisable.
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Affiliation(s)
- I S Vamshidhar
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bibinagar-508126, Telangana State, India
| | - S S Sabitha Rani
- Department of Pathology, Kamineni Institute of Medical Sciences (KIMS), Sreepuram, Narketpally, Telangana-508254, India
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Zamir S, Ijaz A, Umair M, Wazir RJ, Salman M, Nazir A. SERUM CONCENTRATION OF THYROID HORMONES AND THYROID STIMULATING HORMONE IN ALLOXAN-INDUCED TYPE 1 DIABETIC WISTAR ALBINO RATS. GOMAL JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.46903/gjms/17.04.2083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background: Literature has reported thyroid functional abnormalities in diabetes mellitus. The objectives of this study were to determine and compare the serum concentrations of T3, T4 and TSH in alloxan-induced type 1 diabetic and control Wistar albino rats.
Materials & Methods: It was an experimental animal study on 20 Wistar albino rats, extending over a period of eight weeks. Alloxan, a diabetogenic agent, was used to produce animal models of type 1 diabetes. Animals were divided equally into two groups: control and diabetic. The animals in the diabetic group were injected intraperitoneally with 150 mg/kg body weight of 10% alloxan to induce diabetes. After 72 hours, diabetes was confirmed with glucometer (glucose >350mg/dl). During the course of experiment, one rat in control group and 2 rats in diabetic group died. Blood was collected for estimation of serum concentrations of thyroid hormones, thyroid stimulating hormone at the end of experimental period. Serum T3, T4, and TSH were measured using ELISA kits.
Results: At the end of eight weeks, the mean concentration of serum T3 was 0.69 ±0.29 ng/ml and 0.44±0.02 ng/ml in control and diabetic groups, respectively. The mean concentration of T4 was
3.78±1.16 μg/dl and 2.24±0.86 μg/dl in control and diabetic groups respectively. The mean concentration of TSH was 0.77±0.20 μU/ml and 1.41±0.23 μU/ml in control and diabetic groups respectively. The mean serum concentrations of T3 (p=.0025) and T4 (p=<.00001) were significantly lower in diabetic and that of TSH (p=<.00001) were significantly higher in diabetic than control group.
Conclusion: This study concludes that the serum concentrations of both T3 and T4 are significantly lower and that of TSH is significantly higher in alloxan-induced type 1 diabetic as compared to control group in Wistar albino rats.
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Siddiqui K, George TP, Joy SS, Mujammami M. Variation in the Level of Thyroid Markers in Association with Inflammation in Patients with Type 2 Diabetes. Endocr Metab Immune Disord Drug Targets 2019; 20:924-929. [PMID: 31763969 DOI: 10.2174/1871530319666191125150929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND A possible relationship between thyroid hormones and glucose metabolism in diabetes has already been established. OBJECTIVES We aimed to evaluate the thyroid function markers and their relationship with inflammation, which is considered as a pathogenic condition of diabetes. METHODS This cross-sectional study included 276 patients with type 2 diabetes. Serum levels of thyroid (TSH, FT4, and FT3) and inflammatory markers (CRP, IL-6, and TNF-α) were measured. RESULTS The mean age of the subjects was 55.2 years and mean diabetes duration of 16.8 years. The inflammatory markers showed significant differences with the tertiles of TSH and thyroid hormones. TSH was significantly correlated with inflammatory markers, IL-6 (r = 0.13, P = 0.020) and TNF-α (r = 0.17, P = 0.003), while FT4 had a correlation only with TNF-α (r = 0.25, P = <0.001). FT3 was negatively correlated with inflammatory marker IL-6 (r = -0.14, P = 0.020), HbA1c (r = -0.12, P = 0 .040), and HOMA-IR (r = -0.17, P = 0.010). CONCLUSION Abnormalities in the thyroid hormone metabolism are related to the increased inflammatory activity as well as insulin resistance, and are associated with the disorders of glucose metabolism.
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Affiliation(s)
- Khalid Siddiqui
- Biochemistry Department, Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia,University Diabetes Center, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi
Arabia
| | - Teena P George
- Biochemistry Department, Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salini Scaria Joy
- Biochemistry Department, Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Mujammami
- Biochemistry Department, Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia,University Diabetes Center, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi
Arabia,Endocrinology and Diabetes Unit, Department of Medicine, College of Medicine and King Khalid University
Hospital, King Saud University, Riyadh, Saudi Arabia
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Biondi B, Kahaly GJ, Robertson RP. Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders. Endocr Rev 2019; 40:789-824. [PMID: 30649221 PMCID: PMC6507635 DOI: 10.1210/er.2018-00163] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
Thyroid dysfunction and diabetes mellitus are closely linked. Several studies have documented the increased prevalence of thyroid disorders in patients with diabetes mellitus and vice versa. This review critically discusses the different underlying mechanisms linking type 1 and 2 diabetes and thyroid dysfunction to demonstrate that the association of these two common disorders is unlikely a simple coincidence. We assess the current state of knowledge on the central and peripheral control of thyroid hormone on food intake and glucose and lipid metabolism in target tissues (such as liver, white and brown adipose tissue, pancreatic β cells, and skeletal muscle) to explain the mechanism linking overt and subclinical hypothyroidism to type 2 diabetes and metabolic syndrome. We also elucidate the common susceptibility genes and the pathogenetic mechanisms contributing to the autoimmune mechanism involved in the onset of type 1 diabetes mellitus and autoimmune thyroid disorders. An untreated thyroid dysfunction can impair the metabolic control of diabetic patients, and this association can have important repercussions on the outcome of both of these disorders. Therefore, we offer recommendations for the diagnosis, management, and screening of thyroid disorders in patients with diabetes mellitus, including the treatment of diabetic patients planning a pregnancy. We also discuss the major causes of failure to achieve an optimal management of thyroid dysfunction in diabetic patients and provide recommendations for assessing and treating these disorders during therapy with antidiabetic drugs. An algorithm for a correct approach of these disorders when linked is also provided.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - George J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - R Paul Robertson
- Department of Medicine, Division of Endocrinology and Metabolism, University of Washington School of Medicine, Seattle, Washington.,Department of Pharmacology, University of Washington, Seattle, Washington
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Zhu Y, Xu F, Shen J, Liu Y, Bi C, Liu J, Li Y, Wang X, Gao Z, Liang L, Chen Y, Sun W, Guan Q, Zhang J, Luo Z, Guo L, Cai X, Li L, Xiu L, Yan L, Li C, Shi X, Zhu M, Kuang J, Li G, Ji L. Prevalence of thyroid dysfunction in older Chinese patients with type 2 diabetes-A multicenter cross-sectional observational study across China. PLoS One 2019; 14:e0216151. [PMID: 31048873 PMCID: PMC6497275 DOI: 10.1371/journal.pone.0216151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/15/2019] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes [T2D] and thyroid dysfunction [TD] often co-occur, have overlapping pathologies, and their risk increases with age. Since 1995, universal salt iodization has been implemented in China to prevent disorders caused by iodine deficiency. However, after two decades of implementation of universal salt iodization, the prevalence of TD in elderly Chinese patients with T2D is not well described and may have been underestimated. We conducted a questionnaire-based survey across 24 endocrinology centers in China between December 2015 and July 2016. Demographic and clinical data from 1677 patients with T2D were obtained and analyzed to examine the prevalence of TD along with T2D in these patients. We assessed TD prevalence according to the four TD subtypes [subclinical hypothyroidism, clinical hypothyroidism, subclinical hyperthyroidism, and clinical hyperthyroidism], TD history, gender, and age. The diagnosis rates were calculated for TD and also for the TD subtype. The number of patients reaching treatment goals for T2D [hemoglobin A1c <7%] and TD [normal free thyroxine and thyroid-stimulating hormone [TSH]] and the incidences of complications and comorbidities were recorded. Among the enrolled patients with T2D [N = 1677], TD was diagnosed in 23.79% [399/1677] out of which 61% (245/399) were previously diagnosed and 38.59% (154/399) were newly diagnosed cases. Subclinical hypothyroidism, clinical hypothyroidism, subclinical hyperthyroidism, and clinical hyperthyroidism were reported in 4.89%, 9.3%, 1.13%, and 3.16% of the total population, respectively. Among patients previously diagnosed with TD, the incidence in women [166/795; 20.88%] was higher than in men [79/882; 8.96%]. The treatment goals for TD and T2D were attained in 39.6% [97/245] and 34.41% [577/1677] of the cases, respectively. Diabetic complications and comorbidities were reported in 99.7% of patients, with peripheral neuropathy being the most common [43.46%] followed by cataract [24.73%]. We had found that the incidences of dyslipidemia, elevated LDL levels, and osteoporosis were significantly higher in patients with TD than those without TD. TD is underdiagnosed in elderly Chinese patients with T2D.
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Affiliation(s)
- Yu Zhu
- Peking University People’s Hospital, Beijing, China
| | - Fengmei Xu
- General Hospital of Hebi Coal Industry [Group] Co., Ltd., Hebi, China
| | - Jie Shen
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Youshuo Liu
- The Second Xiangya Hospital of Central South University, Changsha, China
| | | | - Jing Liu
- Gansu Provincial Hospital, Lanzhou, China
| | - Yufeng Li
- Beijing Pinggu Hospital, Beijing, China
| | - Xueqin Wang
- Beijing Huairou Hospital of University of Chinese Academy Sciences, Beijing, China
| | - Zhengnan Gao
- Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian, China
| | - Linlang Liang
- The General Hospital of Shenyang Military Region, Shenyang, China
| | - Yanyan Chen
- Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Weiping Sun
- The First People’s Hospital of Xiangtan City, Xiangtan, China
| | - Qingbo Guan
- Shandong Provincial Hospital, Shandong, China
| | | | - Zuojie Luo
- The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | | | - Xiaopin Cai
- China-Japan Friendship Hospital, Beijing, China
| | - Ling Li
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Lingling Xiu
- First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Yan
- Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chunlin Li
- The General Hospital of the People's Liberation Army [301 Hospital], Beijing, China
| | - Xiaoyun Shi
- The General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Mei Zhu
- General Hospital, Tianjin Medical University, Tianjin, China
| | - Jian Kuang
- Guangdong General Hospital, Guangzhou, China
| | - Guangwei Li
- Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Linong Ji
- Peking University People’s Hospital, Beijing, China
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Association between Continuity of Care and the Onset of Thyroid Disorder among Diabetes Patients in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020233. [PMID: 30650629 PMCID: PMC6352198 DOI: 10.3390/ijerph16020233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/27/2018] [Accepted: 01/09/2019] [Indexed: 12/15/2022]
Abstract
Objectives: As the relationship between diabetes mellitus and thyroid dysfunction is well known, it is important to investigate the factors influencing this association. Continuity of care is associated with better quality of care and outcomes, such as reduced complications, among diabetes patients. Therefore, the purpose of this study was to investigate the association between continuity of care and the onset of thyroid dysfunction among diabetes patients. Methods: We used Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013. Our final study population included 16,806 newly diagnosed diabetes patients who were older than 45 years of age. Continuity of care was measured using the Continuity of Care index. The dependent variable was the onset of thyroid disorder. Cox proportional hazard regression models were used for statistical analyses. Results: Diabetes patients with low continuity of care were at increased risk of the onset of thyroid disorder compared with those with high continuity of care (hazard ratio (HR): 1.28, 95% confidence interval (CI): 1.07–1.54). Subgroup analyses showed that this association was significant within patients with type 2 diabetes (HR: 1.24, 95% CI: 1.01–1.52) or whose main attending site was a local clinic (HR: 1.32, 95% CI: 1.07–1.64). Conclusions: Our results show that diabetes patients with low continuity of care are more likely to experience the onset of thyroid disorder. Therefore, improving continuity of care could be a reasonable method of preventing complications or comorbidities, including thyroid disorder, among diabetes patients.
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Abusharaha A, Alturki AA, Alanazi SA, Fagehi R, Al-Johani N, El-Hiti GA, Masmali AM. Assessment of tear-evaporation rate in thyroid-gland patients. Clin Ophthalmol 2019; 13:131-135. [PMID: 30662256 PMCID: PMC6327900 DOI: 10.2147/opth.s188614] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the tear-evaporation rate in thyroid-gland patients using a VapoMeter. Methods Twenty thyroid gland patients aged 18-43 years (mean 34.3±6.3 years) completed the study. Additionally, an age-matched control group of 20 patients aged 18-43 years (32.2±5.1 years) was enrolled in the study for comparison purposes. An Ocular Surface Disease Index dry-eye questionnaire was completed, followed by a test to determine the tear-evaporation rate using the VapoMeter. The test was performed three times per subject by the same examiner. Two readings were obtained each time. Results Significant differences (P<0.05) were found between mean Ocular Surface Disease Index and tear-evaporation-rate scores within the study and control groups. The average tear-evaporation rate was much higher in the study group (median 41.2 [IQR 41.4] g/m2⋅h) than the control group (15.7 [13.7] g/m2⋅h). Moreover, the average Ocular Surface Disease Index score for thyroid-gland patients was much higher (15.6 [23.4]) compared to the control group (5.5 [7.50]). Conclusion The tear-evaporation rate in thyroid-gland patients was found to be much higher than normal-eye subjects.
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Affiliation(s)
- Ali Abusharaha
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Abdulaziz A Alturki
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Saud A Alanazi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Raied Fagehi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Naji Al-Johani
- Department of Endocrinology and Thyroid Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11433, Saudi Arabia
| | - Gamal A El-Hiti
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Ali M Masmali
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
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Ogbonna SU, Ezeani IU, Okafor CI, Chinenye S. Association between glycemic status and thyroid dysfunction in patients with type 2 diabetes mellitus. Diabetes Metab Syndr Obes 2019; 12:1113-1122. [PMID: 31372021 PMCID: PMC6635896 DOI: 10.2147/dmso.s204836] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/14/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Thyroid dysfunction has been widely reported to be more common in patients with type 2 diabetes mellitus (T2DM) in various parts of the world; however, there is paucity of data on this in our environment. OBJECTIVE The aim of this study was to determine the possible relationship between glycemic status and thyroid dysfunction. METHODOLOGY A total of 354 T2DM patients and 118 non-diabetic persons (controls) were recruited for the study. A pretested questionnaire was filled for each subject after due explanations. Their blood samples were tested for HbA1c, fT3, fT4, and TSH. Information retrieved from patient's medical records included age at diagnosis of diabetes (DM) and duration of DM. Testing statistics done included Student's t-test, chi square test, and regression analysis. P-value of less than 0.05 was taken to be statistically significant. RESULTS The results show that 43.5% and 37.3% of T2DM and control subjects, respectively, were males. Mean HbA1c was significantly higher in T2DM patients than in the controls (7.8±2.0% vs 5.8±1.2%, p=0.001), while mean fT3 was significantly lower in T2DM patients than in the controls (2.3±1.5 pg/mL vs 2.7±2.2 pg/mL, p=0.03). Mean HbA1c was significantly higher in T2DM patients with thyroid dysfunction compared to their euthyroid counterparts (8.1±1.9% vs 5.1±1.2%, p=0.001). HbA1c had a positive linear relationship with the presence of thyroid dysfunction (regression coefficient=1.89, p=0.001). CONCLUSION There was a positive linear relationship between HbA1c and the presence of thyroid dysfunction in the T2DM patients in this study. There was an inverse relationship between HbA1c and serum fT3.
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Affiliation(s)
- SU Ogbonna
- Department of Internal Medicine, Federal Medical Center, Umuahia, Abia State, Nigeria
| | - IU Ezeani
- Department of Internal Medicine, Federal Medical Center, Umuahia, Abia State, Nigeria
- Correspondence: IU EzeaniDepartment of Internal Medicine, Federal Medical Center, PMB 7001, Umuahia, Abia State, NigeriaTel +234 806 069 2131Email
| | - CI Okafor
- Department of Internal Medicine, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
| | - S Chinenye
- Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
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Du W, Wang F, Zhao M, Zhang H, Zhang X, Zhao J, Gao L. Prevalence of thyroid disorders and associated risk factors with various glycemic status in North China. BIOTECHNOL BIOTEC EQ 2019. [DOI: 10.1080/13102818.2019.1656106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Wenhua Du
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
- Department of Endocrinology, Linyi People’s Hospital, Linyi, Shandong, PR China
| | - Fei Wang
- Department of Endocrinology, Weifang People’s Hospital, Weifang, Shandong, PR China
| | - Meng Zhao
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
- Scientific Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
| | - Haiqing Zhang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
- Scientific Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
| | - Xu Zhang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Jiajun Zhao
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
- Scientific Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
| | - Ling Gao
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
- Scientific Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
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Ogbonna SU, Ezeani IU. Risk Factors of Thyroid Dysfunction in Patients With Type 2 Diabetes Mellitus. Front Endocrinol (Lausanne) 2019; 10:440. [PMID: 31333585 PMCID: PMC6621929 DOI: 10.3389/fendo.2019.00440] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Thyroid dysfunction has been widely reported among persons with diabetes (DM) in other parts of the World. In Nigeria, few studies have been reported. This study focused on risk factors for thyroid dysfunction in type 2 diabetes mellitus (T2DM) patients and will therefore add to the Nigerian literature, more so, as it is the first in South-East Nigeria. Objective: To determine the risk factors of thyroid dysfunction in patients with Type 2 DM. Methodology: Three hundred and fifty-four T2DM patients and 118 non-diabetic persons (controls) were recruited for the study. A pretested questionnaire was filled for each subject after due explanations. The subjects were subsequently examined and the findings, including anthropometric values and clinical parameters were documented. Their blood samples were tested for HbA1c, fT3, fT4, and TSH. Information retrieved from patients medical records included: age at diagnosis of DM, duration of DM, complications of DM. The Student's t-test, chi square test and regression analysis were used in the analysis of the data obtained. P < 0.05 was taken to be statistically significant. Results: About 56.5% of the T2DM patients who participated in this study were females and 62.7% of the controls were females. The T2DM patients had significantly higher BMI than controls (27.6 ± 5.0 kg/m2 vs. 26.2 ± 3.8 kg/m2, p = 0.002). Mean HbA1c was significantly higher in T2DM patients than in the controls (7.8 ± 2.0% vs. 5.8 ± 1.2%, p = 0.001). Female gender (OR = 3.8, p = 0.002), central obesity (OR = 2.5, 95%CI = 1.5-5.2, p = 0.001), DM nephropathy (OR = 4.8, p = 0.001), HbA1c ≥7% (OR = 4.3, p = 0.025) and duration of DM >5years (OR = 3.3, p = 0.012) were significantly associated with thyroid dysfunction in T2DM patients in this study. Conclusion: Female gender, central obesity, DM nephropathy, above normal HbA1c, and duration of DM were risk factors of thyroid dysfunction in type 2 DM patients in this study.
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Alomar M, Almeneessier AS, Olaish AH, Alshiban A, Alomar A, BaHammam AS. Immune-mediated comorbidities in Saudi patients with narcolepsy. Nat Sci Sleep 2019; 11:35-43. [PMID: 31118849 PMCID: PMC6507108 DOI: 10.2147/nss.s195650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/16/2019] [Indexed: 01/27/2023] Open
Abstract
Background: Autoimmunity has been proposed as a cause of narcolepsy. A few studies have assessed comorbid autoimmune diseases in patients with narcolepsy, with conflicting results; however, no study has assessed autoimmune diseases in Arab narcolepsy patients. This study aimed to assess the coexistence of immune-mediated conditions such as allergies, autoimmune diseases, and autoinflammatory diseases in patients with narcolepsy type 1 (with cataplexy) (NT1) and narcolepsy type 2 (without cataplexy) (NT2). Methods: Personal and family history of autoimmune/autoinflammatory and allergic disorders was collected using a questionnaire in 80 consecutive Saudi patients with narcolepsy (46 NT1 and 24 NT2), who were diagnosed according to the International Classification of Sleep Disorders, Third Edition. The control group comprised 222 adults from the general population. Results: Comorbid autoimmune/autoinflammatory diseases were reported by 21.4% of the NT1 patients, and 12.2% of the controls, with no significant difference between cases and controls in a model adjusted for confounding covariates. However, allergic disorders were significantly more prevalent among NT1 patients. Both comorbid autoimmune/autoinflammatory and allergic disorders were significantly more prevalent among NT2 patients compared to controls. No differences in demographic and clinical characteristics were detected between narcolepsy patients with and without autoimmune/autoinflammatory diseases. Conclusion: NT1 is not associated with increased comorbid autoimmune diseases in the studied sample of Saudi patients. However, autoimmune diseases are associated with NT2, and allergic disorders are associated with both NT1 and NT2. These findings suggest the existence of dysregulation in the immune system of narcolepsy patients that requires further research.
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Affiliation(s)
- Majed Alomar
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aljohara S Almeneessier
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Awad H Olaish
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Alshiban
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alomar
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed S BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, King Saud University, Riyadh, Saudi Arabia
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Bener A, Ozdenkaya Y, Al-Hamaq AO, Barisik CC, Ozturk M. Low Vitamin D Deficiency Associated With Thyroid Disease Among Type 2 Diabetic Mellitus Patients. J Clin Med Res 2018; 10:707-714. [PMID: 30116441 PMCID: PMC6089577 DOI: 10.14740/jocmr3507w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/18/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the relationship between vitamin D deficiency and thyroid diseases among type 2 diabetes mellitus (T2DM) patients. METHODS This was a cohort case and control study, 546 T2DM patients and 546 control study participants were enrolled, aged between 25 and 65 years. The subjects were also investigated for fasting blood glucose levels (FBG), post prandial glucose (PPG,) glycosylated hemoglobin (HbA1c), thyroid stimulating hormone (TSH), T3, T4, and presence of other comorbid conditions. Thyroid fine needle aspiration biopsy was suggested to patients whose thyroid nodules were greater than 1.00 cm. RESULTS There were significant differences between T2DM patients and control subjects regarding BMI (kg/m2), physical activity, cigarette smoking, sheesha smoking, family history of diabetes, hypertension and family history of thyroid nodules. The clinical biochemistry values among T2DM for vitamin D, calcium, magnesium, potassium, phosphorous, fasting blood glucose, cholesterol, HbA1c, HLDL, LDL, triglyceride, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower than control subjects, but higher in creatinine, albumin, TSH, T3, and T4 which appeared statistically significant differences (P < 0.001). Also, the study revealed statistically significant differences between subjects vitamin D deficiency and with thyroid nodules for calcium, magnesium, phosphorous, HbA1c, high density lipoprotein (HDL), SBP and DBP, TSH, T3, and T4 among T2DM patients and control subjects (P < 0.001). Multivariable stepwise logistic regression analysis showed that TSH, HbA1c, vitamin D deficiency, SBP (mm Hg), BMI, family history of DM, serum calcium level and family history of thyroid were considered at higher risk as predictors of thyroid among T2DM patients. CONCLUSIONS This study suggests that obesity, HbA1c, the environment, and genetic susceptibility among T2DM, may increase the risk of thyroid disease and cancer. Although evidence has shown that thyroid cancer incidence has been rising more rapidly over time than the occurrence of cancers of other sites, due to an increase of obesity, diabetes and lack of physical activity, this study lacks of direct evidence supporting this conclusion.
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Affiliation(s)
- Abdulbari Bener
- Department of Biostatistics and Medical Informatics, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The university of Manchester, Manchester, UK
- Department. of Endocrinology, Medipol International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Yasar Ozdenkaya
- Qatar Diabetic Associations and Qatar National Research Foundation, Doha, Qatar
| | - Abdulla O.A.A. Al-Hamaq
- Department of Surgery, Medipol School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Cem Cahit Barisik
- Department of Radiology and Pathology, Medipol School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mustafa Ozturk
- Department. of Endocrinology, Medipol International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Prevalence and Associations of Hypothyroidism in Indian Patients with Type 2 Diabetes Mellitus. J Thyroid Res 2018; 2018:5386129. [PMID: 30174822 PMCID: PMC6106958 DOI: 10.1155/2018/5386129] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/27/2018] [Accepted: 08/05/2018] [Indexed: 12/18/2022] Open
Abstract
Both type 2 diabetes and hypothyroidism are highly prevalent disorders in the community. The existing data regarding prevalence of hypothyroidism in patients with diabetes comes mostly from small studies. There are only two studies with a sample size of more than 1000 diabetic patients, none of which have been done in South Asians. The present study evaluated patients with type 2 diabetes for presence of hypothyroidism and the clinical factors associated with it. The demographic, anthropometric, clinical, and biochemical parameters of consecutively enrolled patients with diabetes were systematically collected and analyzed. A total of 1152 middle aged patients with type 2 diabetes with a mean duration of diabetes of around 10 years were enrolled. Nearly 40 percent of the patients were obese and overweight, respectively, for South Asian standards and abdominal obesity was seen in around 90% patients. Clinical hypothyroidism (TSH>10 mIU/ml) was present in 113 of patients (9.83%) and another 68 patients (5.9%) had subclinical hypothyroidism (TSH 5-10 mIU/ml). Anemia (odds ratio : 2.19), overweight/obese status (odds ratio 2.07), and known dyslipidemia (odds ratio : 1.99) were found to have independent association with clinical hypothyroidism. HbA1c, abdominal obesity, poor control of hypertension, lipid parameters, microalbuminuria, and renal dysfunction showed no difference among patients with hypothyroidism when compared with euthyroid patients. Subclinical hypothyroid patients had no difference in any of the above analyzed parameters when compared to the euthyroid patients. This study shows that a significant proportion of type 2 diabetes patients suffer from clinical or subclinical hypothyroidism and screening for the same may be appropriate.
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Ozair M, Noor S, Raghav A, Siddiqi SS, Chugtai AM, Ahmad J. Prevalence of thyroid disorders in North Indian Type 2 diabetic subjects: A cross sectional study. Diabetes Metab Syndr 2018; 12:301-304. [PMID: 29279270 DOI: 10.1016/j.dsx.2017.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a major health burden worldwide with many patients encountering thyroid dysfunction later in their life. Various studies have found that diabetes and thyroid disorders mutually influence each other and both disorders tend to coexists. However, the prevalence of thyroid dysfunction and associated clinical variables in these patients has not been investigated. OBJECTIVES The study aimed at determining the incidence and prevalence of thyroid dysfunction in patients with T2DM in relation to age, sex, metabolic syndrome and other co-morbid conditions. RESEARCH DESIGNS & METHODS In this cross-sectional study, 250 Type 2 DM patients were enrolled aged between 40 and 75 years. All the patients were evaluated for thyroid dysfunction by testing thyroid profile (T3, T4 and TSH. These subjects were also investigated for fasting blood sugar (FBS), post prandial glucose (PPG) glycosylated hemoglobin (HbA1c), serum cholesterol, serum triglycerides, high density lipoprotein (HDL), low density lipoprotein(LDL), very low density lipoprotein(VLDL), blood urea, serum creatinine and presence of other co-morbid conditions. The observations and interpretations were recorded and results obtained were statistically analyzed. RESULTS A high prevalence of thyroid dysfunction (28%) was observed in type 2 diabetic patients with subclinical hypothyroidism (18.8%) as the commonest thyroid disorder. Thyroid dysfunction was more prevalent in females, with presence of dyslipidemia, retinopathy, poor glycemic state (HbA1c ≥7) and longer duration of diabetes as significant contributing factors associated. CONCLUSIONS In addition to glycemic status, screening of thyroid disorder should be routinely done in type 2 diabetic subjects along with other comorbid conditions.
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Affiliation(s)
- Maaz Ozair
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, India
| | - Saba Noor
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, India
| | - Alok Raghav
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, India
| | - Sheelu Shafiq Siddiqi
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, India
| | - Anjum Mirza Chugtai
- Department of Medicine, Faculty of Medicine, Aligarh Muslim University, Aligarh, India
| | - Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, India.
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Jali MV, Kambar S, Jali SM, Pawar N, Nalawade P. Prevalence of thyroid dysfunction among type 2 diabetes mellitus patients. Diabetes Metab Syndr 2017; 11 Suppl 1:S105-S108. [PMID: 28057505 DOI: 10.1016/j.dsx.2016.12.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/12/2016] [Indexed: 11/19/2022]
Abstract
AIMS To determine the prevalence of Thyroid dysfunction among Type 2 Diabetes mellitus. METHODOLOGY A cross-sectional hospital-based study is conducted to find out the prevalence of thyroid dysfunction. 713 type 2 diabetes mellitus (T2DM) subjects were enrolled in the survey. These subjects were investigated for fasting blood sugar (FBS), glycosylated haemoglobin (HbA1c), total triiodothyronine (T3), total thyroxine (T4), and thyroid-stimulating hormone (TSH). RESULTS Prevalence of thyroid dysfunction in T2DM was found in 16.2%. Gender-specific prevalence found higher in females (25%) compared to males (10.1%) (P<0.001). Age-specific prevalence found higher in the age group ≥50 yrs. (19%) Compared to other age groups (P=0.036). Subjects with poor glycaemic control demonstrated higher prevalence (27.9%) (P=0.012). Subjects with long-standing T2DM had an increased risk for thyroid dysfunction (19.8%) though findings were not statistically significant. (P=0.42). CONCLUSION The prevalence of thyroid dysfunction with T2DM (16.2%) was high in females compared to males and especially hypothyroidism being more typical. Failure to recognise the presence of thyroid dysfunction among T2DM patients may be a primary cause of poor management of diabetes. We recommend universal screening and regular monitoring of thyroid dysfunction in T2DM patients.
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Affiliation(s)
- M V Jali
- KLES Diabetes Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, 590010, India.
| | - Sanjay Kambar
- KLES Diabetes Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, 590010, India; Department of Community Medicine, KLE University's J. N. Medical College, Belagavi, 590010, India
| | - Sujata M Jali
- KLES Diabetes Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, 590010, India; Department of Paediatrics, KLE University's J. N. Medical College, Belagavi, 590010, India
| | - Nandita Pawar
- KLES Diabetes Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, 590010, India
| | - Prachi Nalawade
- KLES Diabetes Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, 590010, India
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Al Houssien AO, Al Houssien RO, Al-Hawass A. Magnitude of diabetes and hypertension among patients with Dry Eye Syndrome at a tertiary hospital of Riyadh, Saudi Arabia - A case series. Saudi J Ophthalmol 2017; 31:91-94. [PMID: 28559720 PMCID: PMC5436380 DOI: 10.1016/j.sjopt.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/02/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the magnitude of chronic diseases among patients suffering from Dry Eye Syndrome (DES) and compare them with published findings in the literature. Methods Patients diagnosed in 2016 suffering from DES based on presenting symptoms and findings of ocular examination were included in this study. The demographic information included age and gender. Chronic diseases among them were identified through case records, assessment and ongoing medications. Results This case series had 62 patients (58% males) of DES. The mean age was 60.2 ± 16.6 years. The prevalence of hypertension, dyslipidemia and diabetes among them was 48.5% (95% confidence interval (CI) 31.5–65.5), 55.9% (95% CI 40.1–71.7) and 47.1% (95% CI 29.8–64.4) respectively. The rate of thyroid diseases (16.2%), renal diseases (6.5%), and liver diseases (6.7%) was not significant in this series. Conclusions This series in central Saudi Arabia suggests that the magnitude of chronic diseases such as diabetes, hypertension, obesity and dyslipidemia seems to be higher in patients with DES compared to the population.
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Affiliation(s)
- Abdullah Omar Al Houssien
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Rana Omar Al Houssien
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Al-Hawass
- Division of Ophthalmology Surgery, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Sarfo-Kantanka O, Sarfo FS, Ansah EO, Yorke E, Akpalu J, Nkum BC, Eghan B. Frequency and determinants of thyroid autoimmunity in Ghanaian type 2 diabetes patients: a case-control study. BMC Endocr Disord 2017; 17:2. [PMID: 28143459 PMCID: PMC5286684 DOI: 10.1186/s12902-016-0152-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/29/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The link between type 1 diabetes and thyroid autoimmunity is well described. The same cannot be said for type 2 diabetes where results have been mixed so far. We investigated the prevalence and determinants of thyroid autoimmunity among Ghanaian type 2 diabetes patients. METHODS This was a case-control study involving 302 type 2 diabetes patients and 310 non - diabetic controls aged 40-80 years. Anthropometric and blood pressure measurements were obtained. Fasting samples were analyzed for glucose, thyroid function, and antibodies to thyroglobulin and thyroid peroxidase. RESULTS The prevalence of thyroid autoimmunity was significantly higher among T2DM subjects (12.2% vs. 3.9%, p = 0.0004). Among T2DM subjects, 44 (14.7%) tested positive for TPOAb, 5 (1.7%) tested positive for TGAb and 15 (5.0%) tested positive for both autoantibodies. Females T2DM subjects showed a 3-fold increased risk of thyroid autoimmunity compared to males (OR:3.16, p =0.004), T2DM subjects with hyperthyroidism had a 41% increased risk of thyroid autoimmunity (OR: 1.41, p < 0.001), sub-clinical hyperthyroidism increased the risk of thyroid autoimmunity by 2 fold, (OR:2.19, p < 0.001), subclinical hypothyroidism increased the risk of autoimmunity by 4-fold, (OR:3.57 95% p < 0.0001), and hypothyroidism was associated with a 61% increased risk of thyroid autoimmunity (OR: 1.61,1.35-2.23). Dyslipidaemia was associated with a 44% increased risk of thyroid autoimmunity (OR: 1.44, p = 0.01) and a percentage increase in HbA1c was associated with 46% increased risk of thyroid autoimmunity (OR:1.46, p < 0.0001). CONCLUSION We observed a high prevalence of thyroid autoimmunity in Ghanaian T2DM subjects compared to the general population. Thyroid autoimmunity in T2DM subjects was significantly associated with female gender, thyroid dysfunction, dyslipidaemia and poor glycemic control.
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Affiliation(s)
- Osei Sarfo-Kantanka
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O. Box 1934, Kumasi, Ghana
| | - Fred Stephen Sarfo
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O. Box 1934, Kumasi, Ghana
- Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eunice Oparebea Ansah
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O. Box 1934, Kumasi, Ghana
| | - Ernest Yorke
- Department of Medicine, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Josephine Akpalu
- Department of Medicine, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Bernard C. Nkum
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O. Box 1934, Kumasi, Ghana
- Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benjamin Eghan
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O. Box 1934, Kumasi, Ghana
- Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Barmpari ME, Kokkorou M, Micheli A, Alexiou I, Spanou E, Noutsou M, Thanopoulou A. Thyroid Dysfunction among Greek Patients with Type 1 and Type 2 Diabetes Mellitus as a Disregarded Comorbidity. J Diabetes Res 2017; 2017:6505814. [PMID: 29214182 PMCID: PMC5682912 DOI: 10.1155/2017/6505814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/27/2017] [Accepted: 10/08/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine the prevalence of thyroid dysfunction in Greek patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus as well as its possible relations to glycaemic control and to diabetic complications. METHODS A total of 1015 patients, consecutively followed in the Outpatient Diabetes Center, were studied. Anthropometric and biochemical measurements, occurrence of diabetes complications, and classical comorbidities were assessed. Average HbA1c of the previous year was calculated. Wellbeing was determined, using a 10-point optimal scale. All the above parameters were compared between subjects with or without thyroid disease. RESULTS All patients were euthyroid at the time of the study, either on thyroid medications or not. Hypothyroidism occurrence did not differ between T2DM and T1DM patients (37.1% versus 43.5%, p > 0.05). Nodular goiter was observed more frequently in T2DM patients (34.1% versus 18.8%, p < 0.05). T2DM patients with hypothyroidism compared to those without hypothyroidism had higher HbA1c (7.27% versus 6.98%, p < 0.01), TChol (184.97 mg/dl versus 168.17 mg/dl, p < 0.001), and higher HDL-Chol (51.28 mg/dl versus 46.77 mg/dl, p < 0.01). T2DM patients without hypothyroidism had a better wellness feeling (7.5 versus 5.3 points, p < 0.01). CONCLUSIONS Screening for thyroid disease among T2DM patients should be routinely considered, as it is found to be an additional commorbidity. If it remains undiagnosed, it could aggravate the clinical course of the disease.
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Affiliation(s)
- Maria E. Barmpari
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Maria Kokkorou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Anastasia Micheli
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Irene Alexiou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Elefteria Spanou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Marina Noutsou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Anastasia Thanopoulou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
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Malaguarnera R, Vella V, Nicolosi ML, Belfiore A. Insulin Resistance: Any Role in the Changing Epidemiology of Thyroid Cancer? Front Endocrinol (Lausanne) 2017; 8:314. [PMID: 29184536 PMCID: PMC5694441 DOI: 10.3389/fendo.2017.00314] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/30/2017] [Indexed: 12/13/2022] Open
Abstract
In the past few decades, the incidence of thyroid cancer (TC), namely of its papillary hystotype (PTC), has shown a steady increase worldwide, which has been attributed at least in part to the increasing diagnosis of early stage tumors. However, some evidence suggests that environmental and lifestyle factors can also play a role. Among the potential risk factors involved in the changing epidemiology of TC, particular attention has been drawn to insulin-resistance and related metabolic disorders, such as obesity, type 2 diabetes, and metabolic syndrome, which have been also rapidly increasing worldwide due to widespread dietary and lifestyle changes. In accordance with this possibility, various epidemiological studies have indeed gathered substantial evidence that insulin resistance-related metabolic disorders might be associated with an increased TC risk either through hyperinsulinemia or by affecting other TC risk factors including iodine deficiency, elevated thyroid stimulating hormone, estrogen-dependent signaling, chronic autoimmune thyroiditis, and others. This review summarizes the current literature evaluating the relationship between metabolic disorders characterized by insulin resistance and the risk for TC as well as the possible underlying mechanisms. The potential implications of such association in TC prevention and therapy are discussed.
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Affiliation(s)
- Roberta Malaguarnera
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Veronica Vella
- School of Human and Social Sciences, “Kore” University of Enna, Enna, Italy
- *Correspondence: Veronica Vella, ; Antonino Belfiore,
| | - Maria Luisa Nicolosi
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Antonino Belfiore
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- *Correspondence: Veronica Vella, ; Antonino Belfiore,
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Elebrashy IN, El Meligi A, Rashed L, Salam RF, Youssef E, Fathy SA. Thyroid dysfunction among type 2 diabetic female Egyptian subjects. Ther Clin Risk Manag 2016; 12:1757-1762. [PMID: 27920545 PMCID: PMC5123662 DOI: 10.2147/tcrm.s112302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose High prevalence of thyroid disorders is more common in type 1 diabetes compared to type 2 diabetes, due to associated autoimmunity. Hypothyroidism is the most common disorder. The objective was to assess the prevalence of thyroid dysfunction among type 2 diabetic Egyptian females and to find the correlation between metabolic syndrome components and autoimmune thyroid dysfunction. Materials and methods The study included 62 type 2 diabetic Egyptian females and 27 sex- and age-matched controls. All patients in the study were subjected to anthropometric measures, including HbA1c, lipid profile, serum uric acid, thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, anti-thyroid peroxidase (TPO), antithyroglobulin (anti-Tg), and thyroid ultrasound. Results Hypothyroidism was found in 45.2% of patients (5.49±3.37 μIU/mL) versus 11.1% of controls (1.79±1.21 μIU/mL) (P<0.001). Anti-TPO was found in 75.8% (347.15±244.87 IU/mL) of patients versus 7.4% (32.89±33.26 IU/mL) of controls (P<0.001). Anti-Tg was found in 61.3% (508.03±369.16 IU/mL) of patients versus 0 (51.26±35.53 IU/mL) controls (P<0.001). A significant positive correlation was found between TSH and antithyroid antibodies (anti-Tg, anti-TPO; P=0.002 and P=0.043, respectively) and between TSH and thyroid-gland volume (P=0.002) in diabetic patients. No correlation was found between any components of metabolic syndrome and thyroid antibodies in diabetic patients. Conclusion Autoimmune thyroid disease is more common in Egyptian women with type 2 diabetes than nondiabetic women, and thus points to a role of autoimmunity in the pathogenesis of type 2 diabetes.
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Affiliation(s)
| | - Amr El Meligi
- Department of Internal Medicine, Diabetes, and Endocrinology
| | - Laila Rashed
- Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Randa F Salam
- Department of Internal Medicine, Diabetes, and Endocrinology
| | - Elham Youssef
- Department of Internal Medicine, Diabetes, and Endocrinology
| | - Shaimaa A Fathy
- Department of Internal Medicine, Diabetes, and Endocrinology
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Awad SAS, Ashraf EM, Khaled AS, Salih BS, Yousef S, Abeer AS, Anna A. The epidemiology of thyroid diseases in the Arab world: A systematic review. ACTA ACUST UNITED AC 2016. [DOI: 10.5897/jphe2015.0713] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Fontes R, Teixeira PDFDS, Vaisman M. Screening of Undiagnosed Hypothyroidism in Elderly Persons with Diabetes according to Age-Specific Reference Intervals for Serum Thyroid Stimulating Hormone and the Impact of Antidiabetes Drugs. J Diabetes Res 2016; 2016:1417408. [PMID: 27403442 PMCID: PMC4925962 DOI: 10.1155/2016/1417408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/05/2016] [Accepted: 05/23/2016] [Indexed: 12/30/2022] Open
Abstract
Background. Studies have suggested that hypothyroidism is more frequent in the elderly with diabetes mellitus. However, an adaptation of TSH levels to age should be considered in this assessment. Some antidiabetes drugs reportedly interfere with TSH levels. The objectives of this study were to evaluate the prevalence of undiagnosed hypothyroidism in patients with diabetes and the influence of antidiabetes drugs. Material and Methods. 1160 subjects, 60 years and older (751 with diabetes), were studied; results were compared according to diabetes treatment and with persons without diabetes. TSH, FT4, antithyroperoxidase, fasting glucose, and HbA1c were measured. Results and Discussion. 6.4% of patients with diabetes had hypothyroidism, a higher prevalence compared with persons without diabetes (5.1%), but lower than observed in many studies. The use of age-specific TSH reference interval (RI) could explain this difference. Patients taking metformin (MTF) had TSH (showed in medians) slightly lower (2.8 mU/L) than those not on MTF (3.3 mU/L), p < 0.05. MTF doses influenced TSH levels. Conclusions. The use of specific TSH RI could avoid the misdiagnosis of hypothyroidism in elderly with diabetes. Patients in use of MTF as single drug had lower TSH than those using other medications and persons without diabetes.
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Affiliation(s)
- Rosita Fontes
- Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, 20241260 Rio de Janeiro, RJ, Brazil
- Diagnosticos da America SA, Rio de Janeiro, RJ, Brazil
- *Rosita Fontes:
| | | | - Mario Vaisman
- Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, 20241260 Rio de Janeiro, RJ, Brazil
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Zhao M, Tang X, Yang T, Zhang B, Guan Q, Shao S, Xue F, Zhang X, Liu Z, Yuan Z, Song Y, Zhang H, Fang L, Yu C, Li Q, Zhang X, Gao L, Xu C, Zhao J. Lipotoxicity, a potential risk factor for the increasing prevalence of subclinical hypothyroidism? J Clin Endocrinol Metab 2015; 100:1887-94. [PMID: 25742513 DOI: 10.1210/jc.2014-3987] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT Subclinical hypothyroidism (SCH) is an important public health problem worldwide for its increasing prevalence and potential deleterious effects, whereas its etiology has not been fully elucidated. Lipotoxicity exerts extensive and serious impact on human health, but so far, the potential effect of lipotoxicity on thyroid is unclear. OBJECTIVE The objective of the study was to assess the association between serum triglyceride levels and the risk for SCH. DESIGN, PARTICIPANTS, AND METHODS We conducted a population-based case-control study. A total of 24 100 subjects with similar and stable iodine nutrition status were recruited from China. Cases of 5033 SCH patients were identified and equal controls were matched by age, gender, and region. Conditional logistic regression was used to analyze the association between serum triglyceride levels and risk for SCH. RESULTS Hypertriglyceridemia was associated with an approximately 35% increased risk for SCH in both men (odds ratio 1.325; 95% confidence interval 1.002-1.753) and women (odds ratio 1.397; 95% confidence interval 1.217-1.604), even after adjustment for potential confounders. Notably, the risk for SCH increased progressively following the elevation of serum triglyceride levels. Compared with individuals with serum triglyceride levels less than 0.97 mmol/L, the risk for SCH increased approximately 1.9-fold in men and 1.4-fold in women, respectively, when triglyceride levels were greater than 1.99 mmol/L. CONCLUSION Our findings suggested that hypertriglyceridemia was positively associated with the risk for SCH.
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Affiliation(s)
- Meng Zhao
- Department of Endocrinology and Metabolism (M.Z., Q.G., S.S., Xu.Z., Y.S., H.Z., L.F., C.Y., Q.L., Xi.Z., C.X., J.Z.), Clinical Laboratory (B.Z., Z.L.), and Scientific Center (L.G.), Shandong Provincial Hospital affiliated to Shandong University, Institute of Endocrinology and Metabolic Diseases (M.Z., Q.G., S.S., Xu.Z., Y.S., H.Z., L.F., C.Y., Q.L., Xi.Z., L.G., C.X., J.Z.), Shandong Academy of Clinical Medicine, and Department of Epidemiology and Biostatistics (F.X., Z.Y.), Shandong University, Jinan, 250021 Shandong, China; School of Public Health, Shandong University, Jinan, 250012 Shandong, China; Department of Endocrinology (X.T.), The First Hospital of Lanzhou University, Lanzhou, 730000 Gansu, China; and Department of Endocrinology (T.Y.), The First Hospital affiliated to Nanjing Medical University, Nanjing, 210029 Jiangsu, China
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Werhun A, Hamilton W. Thyroid function testing in primary care: overused and under-evidenced? A study examining which clinical features correspond to an abnormal thyroid function result. Fam Pract 2015; 32:187-91. [PMID: 25782692 DOI: 10.1093/fampra/cmv010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIM Diagnostic testing is increasing in primary care, including for thyroid disease. This study examined which clinical features were associated with an abnormal thyroid stimulating hormone (TSH) result. DESIGN AND SETTING This was a cross-sectional study in one general practice of 16,487 patients in Exeter, Devon, UK. METHODS We examined the primary care records relating to every TSH test taken in the year from August 2012, and extracted symptoms and/or the indication for testing. Associations with an abnormal result were tested using multivariable logistic regression. A cohort study was then performed of 100 patients newly recorded with each of the six features associated with an abnormal test result in the cross-sectional study, and the proportions tested for TSH and the results of that testing identified. RESULTS Two thousand thirty-five patients (12% of the practice population) had TSH testing in the year. Of these 35 (1.7%) had a TSH >4.5 mIU/l, suggesting hypothyroidism, and 7 (0.3%) had TSH <0.01 mIu/l suggesting hyperthyroidism. Features associated with an abnormal TSH were: pregnancy, odds ratio 41 (95% confidence interval 9.3-180), constipation 9.7 (2.1-45), palpitations 23 (3.4-150), hair loss, 21 (2.0-230), weight gain, 18 (1.6-190) and diarrhoea, 13 (1.2-130); in separate analyses only pregnancy and constipation were associated with a raised TSH, and the remaining four features with a low TSH. CONCLUSION The diagnostic yield of thyroid disease in this study was 2.1% suggests testing could be better targeted without missing diagnoses. The symptoms associated with thyroid disease differ from those generally reported. This may represent fewer patients presenting with advanced disease.
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Aljohani NJ, Al-Daghri NM, Al-Attas OS, Alokail MS, Alkhrafy KM, Al-Othman A, Yakout S, Alkabba AF, Al-Ghamdi AS, Almalki M, Buhary BM, Sabico S. Differences and associations of metabolic and vitamin D status among patients with and without sub-clinical hypothyroid dysfunction. BMC Endocr Disord 2013; 13:31. [PMID: 23962199 PMCID: PMC3751774 DOI: 10.1186/1472-6823-13-31] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/20/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sub-clinical hypothyroid dysfunction, a relatively understudied disorder in the Kingdom of Saudi Arabia (KSA), has significant clinical implications if not properly monitored. Also from KSA, more than 50% of the population suffer from hypovitaminosis D (<50 nmol/l). In this cross-sectional case-control study, we described the differences and associations in the metabolic patterns of adult Saudis with and without hypothyroid dysfunction in relation to their vitamin D status, PTH, calcium and lipid profile. METHODS A total of 94 consenting adult Saudis [52 controls (without subclinical hypothyroidism), 42 cases (previously diagnosed subjects)] were included in this cross-sectional study. Anthropometrics were obtained and fasting blood samples were taken for ascertaining lipid and thyroid profile, as well as measuring PTH, 25(OH) vitamin D and calcium. RESULTS Cases had a significantly higher body mass index than the controls (p < 0.001). Circulating triglycerides was also significantly higher in cases than the controls (p = 0.001). A significant positive association between HDL-cholesterol and PTH (R = 0.56; p = 0.001), as well as a negative and modestly significant negative association between LDL-cholesterol and PTH (R = - 20.0; p = 0.04) were observed. FT3 was inversely associated with circulating 25 (OH) vitamin D (R = -0.25; p = 0.01). CONCLUSIONS Patients with hypothyroid dysfunction possess several cardiometabolic risk factors that include obesity and dyslipidemia. The association between PTH and cholesterol levels as well as the inverse association between vitamin D status and FT3 needs to be reassessed prospectively on a larger scale to confirm these findings.
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Affiliation(s)
- Naji J Aljohani
- Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
| | - Nasser M Al-Daghri
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
| | - Omar S Al-Attas
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
- Center of Excellence in Biotechnology Research Center, King Saud University, Riyadh, Saudi Arabia
| | - Majed S Alokail
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M Alkhrafy
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Al-Othman
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- College of Applied Medical Sciences, King Saud University, Riyadh, KSA, Saudi Arabia
| | - Sobhy Yakout
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz F Alkabba
- Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed S Al-Ghamdi
- Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mussa Almalki
- Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Badurudeen Mahmood Buhary
- Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shaun Sabico
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
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Wang C. The Relationship between Type 2 Diabetes Mellitus and Related Thyroid Diseases. J Diabetes Res 2013; 2013:390534. [PMID: 23671867 PMCID: PMC3647563 DOI: 10.1155/2013/390534] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 03/15/2013] [Indexed: 12/12/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) has an intersecting underlying pathology with thyroid dysfunction. The literature is punctuated with evidence indicating a contribution of abnormalities of thyroid hormones to type 2 DM. The most probable mechanism leading to T2DM in thyroid dysfunction could be attributed to perturbed genetic expression of a constellation of genes along with physiological aberrations leading to impaired glucose utilization and disposal in muscles, overproduction of hepatic glucose output, and enhanced absorption of splanchnic glucose. These factors contribute to insulin resistance. Insulin resistance is also associated with thyroid dysfunction. Hyper- and hypothyroidism have been associated with insulin resistance which has been reported to be the major cause of impaired glucose metabolism in T2DM. The state-of-art evidence suggests a pivotal role of insulin resistance in underlining the relation between T2DM and thyroid dysfunction. A plethora of preclinical, molecular, and clinical studies have evidenced an undeniable role of thyroid malfunctioning as a comorbid disorder of T2DM. It has been investigated that specifically designed thyroid hormone analogues can be looked upon as the potential therapeutic strategies to alleviate diabetes, obesity, and atherosclerosis. These molecules are in final stages of preclinical and clinical evaluation and may pave the way to unveil a distinct class of drugs to treat metabolic disorders.
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Affiliation(s)
- Chaoxun Wang
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai 201399, China
- *Chaoxun Wang:
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Al-Geffari M, Ahmad NA, Al-Sharqawi AH, Youssef AM, AlNaqeb D, Al-Rubeaan K. Risk Factors for Thyroid Dysfunction among Type 2 Diabetic Patients in a Highly Diabetes Mellitus Prevalent Society. Int J Endocrinol 2013; 2013:417920. [PMID: 24454365 PMCID: PMC3884781 DOI: 10.1155/2013/417920] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/01/2013] [Indexed: 11/17/2022] Open
Abstract
Diabetes and thyroid dysfunction found to exist simultaneously. In this regard, the present study looked into the prevalence of different forms of thyroid dysfunction and their risk factors among Type 2 diabetic Saudi patients. Methodology. A cross-sectional retrospective randomized hospital-based study of 411 Type 2 diabetic Saudi patients of >25 years of age was conducted to test the prevalence of different types of thyroid dysfunction and their risk factors. Results. The prevalence of different types of thyroid dysfunction is 28.5%, of which 25.3% had hypothyroidism, where 15.3%, 9.5%, and 0.5% are clinical, subclinical, and overt hypothyroidism, respectively. The prevalence of hyperthyroidism is 3.2%, of which subclinical cases accounted for 2.7% and overt hyperthyroidism accounted for 0.5%. Risk factors for thyroid dysfunction among Saudi Type 2 diabetic patients are family history of thyroid disease, female gender, and duration of diabetes of >10 years, while the risk was not significant in patients with history of goiter and patients aged >60 years. Smoking and parity show a nonsignificant reduced risk. Conclusion. Thyroid dysfunction is highly prevalent among Saudi Type 2 diabetic patients, and the most significant risk factors are family history of thyroid disease, female gender, and >10 years duration of diabetes.
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Affiliation(s)
- Metab Al-Geffari
- Family and Community Medicine Department, Qassim University, P.O. Box 143, Buraidah 51411, Saudi Arabia
| | - Najlaa A. Ahmad
- Biostatistics Department, University Diabetes Center, King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia
| | - Ahmad H. Al-Sharqawi
- Biostatistics Department, University Diabetes Center, King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia
| | - Amira M. Youssef
- Registry Department, University Diabetes Center, King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia
| | - Dhekra AlNaqeb
- Research Department, University Diabetes Center, King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia
| | - Khalid Al-Rubeaan
- University Diabetes Center, King Saud University, P.O. Box 18397, Riyadh 11415, Saudi Arabia
- *Khalid Al-Rubeaan:
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Incremental Healthcare Expenditures Associated with Thyroid Disorders among Individuals with Diabetes. J Thyroid Res 2012; 2012:418345. [PMID: 23304635 PMCID: PMC3529892 DOI: 10.1155/2012/418345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 10/27/2012] [Accepted: 11/06/2012] [Indexed: 12/17/2022] Open
Abstract
Objective. To estimate incremental healthcare expenditures associated with thyroid disorders among individuals with diabetes. Research Design and Methods. Cross-sectional study design with data on adults over 20 years of age with diabetes (N = 4, 490) from two years (2007 and 2009) of the Medical Expenditure Panel Survey (MEPS) was used. Ordinary least square regressions on log-transformed total expenditures and type of healthcare expenditures (inpatient, emergency room, outpatient, prescription drug, and other) were performed to estimate the incremental expenditures associated with thyroid disorders after controlling for demographic, socioeconomic, health status, lifestyle risk factors, macrovascular comorbid conditions (MCCs), and chronic conditions (CCs). Results. Among individuals with diabetes, those with thyroid disorders had significantly greater average annual total healthcare expenditures ($15,182) than those without thyroid disorders ($11,093). Individuals with thyroid disorders had 34.3% greater total healthcare expenditures compared to those without thyroid disorders, after controlling for demographic, socio-economic, and perceived health status. Furthermore, controlling for CCs and MCCs, this increase in expenditures was reduced to 21.4%.
Conclusions. Among individuals with diabetes, thyroid disorders were associated with greater healthcare expenditures; such excess expenditures may be due to CCs and MCCs. Comanagement of CCs and reducing MCCs may be a pathway to reduce high healthcare expenditures.
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Karakosta P, Alegakis D, Georgiou V, Roumeliotaki T, Fthenou E, Vassilaki M, Boumpas D, Castanas E, Kogevinas M, Chatzi L. Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. J Clin Endocrinol Metab 2012; 97:4464-72. [PMID: 23015651 DOI: 10.1210/jc.2012-2540] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Maternal thyroid dysfunction, especially in early pregnancy, may lead to pregnancy complications and adverse birth outcomes. Few population-based prospective studies have evaluated these effects and results are discrepant. OBJECTIVE We examined the association of thyroid function and autoimmunity in early pregnancy with adverse pregnancy and birth outcomes. SETTING AND PARTICIPANTS The study used data from the prospective mother-child cohort "Rhea" study in Crete, Greece. A total of 1170 women with singleton pregnancies participated in this analysis. Maternal serum samples in the first trimester of pregnancy were tested for thyroid hormones (TSH, free T(4), and free T(3)) and thyroid antibodies (thyroid peroxidase antibody and thyroglobulin antibody). Multivariable log-Poisson regression models were used adjusting for confounders. MAIN OUTCOME MEASURES Outcomes included gestational diabetes, gestational hypertension/preeclampsia, cesarean section, preterm delivery, low birth weight, and small-for-gestational-age neonates. RESULTS The combination of high TSH and thyroid autoimmunity in early pregnancy was associated with a 4-fold increased risk for gestational diabetes [relative risk (RR) 4.3, 95% confidence interval (CI) 2.1-8.9)] and a 3-fold increased risk for low birth weight neonates (RR 3.1, 95% CI 1.2-8.0) after adjustment for several confounders. Women positive for thyroid antibodies without elevated TSH levels in early pregnancy were at high risk for spontaneous preterm delivery (RR 1.7, 95% CI 1.1-2.8), whereas the combined effect of high TSH and positive thyroid antibodies did not show an association with preterm birth. CONCLUSIONS High TSH levels and thyroid autoimmunity in early pregnancy may detrimentally affect pregnancy and birth outcomes.
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Affiliation(s)
- Polyxeni Karakosta
- Department of Social Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion 71003, Crete, Greece
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Abstract
INTRODUCTION Type 2 diabetes mellitus (DM) is a growing problem in our country and we have observed that many patients are associated with thyroid dysfunction later in their life. However, the prevalence of thyroid dysfunction in these patients has not been investigated. AIMS AND OBJECTIVES To find the prevalence of thyroid dysfunction in type 2 DM in Manipur, India. MATERIALS AND METHODS In this retrospective study, data of 202 Type 2 DM patients who attended the diabetic clinic of the Regional Institute of Medical Sciences, Imphal from January 2011 to July 2012, and whose thyroid stimulating hormone (TSH) level was investigated were included. The inclusion criteria are known cases of type 2 DM. Exclusion criteria are patients with previous history of hypothyroidism and those on drugs affecting the thyroid profile. RESULTS Out the 202 type 2 DM patients for the study of which 61 are males and 141 are females, 139 (68.8%) are euthyroid, 33 (16.3%) have subclinical hypothyroidism (10 males and 23 females), 23 (11.4%) have hypothyroidism (6 males and 17 females), 4 (2%) have subclinical hyperthyroidism and 3 (1.5%) are hyperthyroidism cases. Maximum cases were of hypothyroidism (subclinical and clinical) seen in the age group of 45-64 years. Patients with BMI > 25 were at increased risk of having hypothyroidism (P < 0.016). CONCLUSION Prevalence of hypothyroidism is quite high in type 2 DM patients above 45 years and more so if their BMI is over 25.
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Affiliation(s)
- Laloo Demitrost
- Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Salam Ranabir
- Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
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Abstract
AIMS We aimed to assess the relative risk for hypothyroidism in patients with Type 2 diabetes. METHODS In this study, 1112 patients with Type 2 diabetes (58% women, mean age 66.7 years, median duration of diabetes 10 years, 179 with previous history of thyroid disease) and 911 subjects without diabetes were evaluated. RESULTS The gender-, age- and weight-adjusted relative risk (odds ratio) of newly identified hypothyroidism in patients with Type 2 diabetes in comparison with control subjects was 2.81 (1.77-4.48). This odds ratio was significant in patients over 65 years [4.02 (1.95-8.31)], as well as in both men [4.84 (1.58-14.80)] and women [2.60 (1.54-4.38)], in obese patients [2.56 (1.36-4.82)] and non-obese patients [3.11 (1.56-6.20)] and in individuals with [4.26 (1.73-10.46)] and without [2.93 (1.50-5.75)] thyroid autoantibodies. Logistic regression analysis showed that newly diagnosed hypothyroidism was significantly and directly related not only with thyroid autoimmunity [19.15 (8.73-42.01)], but also with the presence of macroangiopathy [2.85 (1.51-5.35)] and metformin treatment [2.51 (1.28-4.92)]. CONCLUSIONS Our results favour screening for hypothyroidism in patients with Type 2 diabetes older than 65 years, especially in the presence of diabetic macroangiopathy or treatment with metformin.
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Affiliation(s)
- J J Díez
- Department of Endocrinology, Hospital Ramón y Cajal, Madrid, Spain.
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Farasat T, Cheema AM, Khan MN. Hyperinsulinemia and insulin resistance is associated with low T₃/T₄ ratio in pre diabetic euthyroid Pakistani subjects. J Diabetes Complications 2012; 26:522-5. [PMID: 22795338 DOI: 10.1016/j.jdiacomp.2012.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 05/21/2012] [Accepted: 05/23/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the relationship of thyroid hormones in glucose homeostasis in impaired glucose-tolerant subjects with normal thyroid functions. METHODS Cross-sectional analysis was carried out in (n=260) impaired glucose-tolerant (IGT) and normal glucose-tolerant (NGT) subjects. Thyrotropin (TSH), total triiodothyronine (TT₃), total thyroxin (TT₄) free T₃ (fT₃), free T₄ (fT₄), and insulin were assessed by enzyme-linked immunoassays (ELISA). Fasting plasma glucose (FPG) and HbA1c were measured by glucose oxidase and low-pressure cation exchange chromatography. Homeostasis model of assessment (HOMA-IR) was employed to assess the level of insulin resistance; fT₃/fT₄ ratio was calculated. Anthropometric measurement and habits were recorded. RESULTS Marked hyperinsulinemia and insulin resistance were observed in IGT subjects. Serum TT₃ and fT₃ levels were significantly low in the IGT as compared to normal glucose-tolerant (NGT) controls. TT₄ and TSH were higher in IGT subjects as compared to control subjects. There was a significant positive correlation of TSH with BMI only in the control group (r=0.351; P<0.05). Correlation of insulin with TT₃, fT₃,and TSH was significant (P<0.05) in IGT subjects. A significant low fT₃/fT₄ ratio was observed in IGT subjects as compared to NGT subjects (P<0.01). In multiple regression analysis, TSH, TT₄ and fT₃ contributed significantly to the variance of fasting insulin and insulin resistance in IGT subjects. CONCLUSION Hyperinsulinemia and insulin resistance are associated with low T₃/T₄ ratio in pre-diabetic euthyroid Pakistani subjects.
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Affiliation(s)
- Tasnim Farasat
- Department of Zoology, Lahore College for Women University, Lahore, Pakistan.
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