DIURNAL VARIATION OF THYROID DYSFUNCTION IN FASTING, POSTMEAL & RANDOM BLOOD SAMPLES IN PROLONGED DIABETICS

Dr Arun Tadas, Dr Monali Rewatkar, Mr Sanjay Agrawal

Abstract


BACKGROUND: Diabetes mellitus (DM) and thyroid dysfunction (TD) are the two most common endocrine disorders in clinical practice . Patients with diabetes mellitus are at an increased risk of developing thyroid diseases.[1] The frequency of thyroid dysfunction in diabetic patients is higher than that of the general population and up to a third of patients with diabetes (DM) ultimately develop thyroid dysfunction. Thyroid dysfunction may impair metabolic control and add to cardiovascular disease risk in prolonged diabetic patients.[2] The objective of this study was to investigate the prevalence of Thyroid dysfunction in patients with diabetes mellitus.

AIMS: Our aim is to study Pearsons correlation between thyroid dysfunction in  diabetes mellitus and to examine  thyroid disease screening strategies in routine diabetes care, in  diabetic patients (fasting,postmeal,Random blood samples) attending clinical biochemistry OPD at tertiary care Unit, IGGMC,Nagpur.

 

Materials & Methods – This  study include  about  150  patients attending  the clinical  Biochemistry OPD, IGGMC, Nagpur. All Diabetic patients ( more than 5 yrs) who were attending  biochemistry OPD for routine Blood sugar  tests were  selected for this study. History was taken as per designed proforma and consent form was obtained. We collect 50  Fasting Blood samples ,50 Postmeal & 50 Random blood samples  from known Diabetic patients .Collected sample was analysed  for  Blood sugar  as well as thyroid test ie T3,T4 & TSH. Blood sugar  test was run on Autoanalyser EM 460  in clinical Biochemistry Laboratory,IGGMC,Nagpur. Thyroid tests was run on Elisa reader & washer Serum values of Thyroid stimulating hormone (TSH), thyroxine (T4) and tri-iodo thyronine (T3) were assayed by ELISA tests and values were compared & correlated with Blood sugar level in Diabetics in all groups Fasting,Postmeal as well as Random Blood samples. The data was analysed  & Pearsons Correlation was obtained. Student's T-test was used  & . P value  <0.05 was considered statistically significant.

RESULTS: Results of our study shows Positive Pearsons correlation between TSH level & Blood sugar in Fasting, Postmeal & Random Blood samples of all Diabetic Patients while there is Negative Pearsons correlation between T3,T4 in all Diabetics. P value is found to be statistically significant in all groups (cases)

CONCLUSIONS:

We conclude that screening for thyroid disease among patients with diabetes mellitus should be routinely performed considering the prevalence of new cases diagnosed and the classical risk factors such as hypertension and dyslipidemia, arising from an undiagnosed thyroid dysfunction.


Keywords


Blood Sugar level, Fasting, Post meal & Random, Thyroid Profile Test,Prolonged Diabetes

Full Text:

PDF

References


L. H. Duntas, J. Orgiazzi, and G. Brabant, “The interface between thyroid and diabetes mellitus,” Clinical Endocrinology, vol. 75, no. 1, pp. 1–9, 2011. View at Publisher • View at Google Scholar • View at Scopus

J. L. Johnson, “Diabetes control in thyroid disease,” Diabetes Spectrum, vol. 19, no. 3, pp. 148–153, 2006.View at Publisher • View at Google Scholar • View at Scopus

D. H. Akbar, M. M. Ahmed, and J. Al-Mughales, “Thyroid dysfunction and thyroid autoimmunity in Saudi type 2 diabetics,” Acta Diabetologica, vol. 43, no. 1, pp. 14–18, 2006. View at Publisher • View at Google Scholar • View at Scopus

J. Feely and T. E. Isles, “Screening for thyroid dysfunction in diabetics,” British Medical Journal, vol. 1, no. 6179, p. 1678, 1979. View at Google Scholar • View at Scopus

P. Perros, R. J. McCrimmon, G. Shaw, and B. M. Frier, “Frequency of thyroid dysfunction in diabetic patients: value of annual screening,” Diabetic Medicine, vol. 12, no. 7, pp. 622–627, 1995. View at Google Scholar • View at Scopus

American Diabetes Association, “Standards of medical care in diabetes—2013,” Diabetes Care, vol. 36, no. 1, pp. S11–S66, 2013. View at Publisher • View at Google Scholar

A.-R. M. Radaideh, M. K. Nusier, F. L. Amari et al., “Thyroid dysfunction in patients with type 2 diabetes mellitus in Jordan,” Saudi Medical Journal, vol. 25, no. 8, pp. 1046–1050, 2004. View at Google Scholar • View at Scopus

J. J. Díez, P. Sánchez, and P. Iglesias, “Prevalence of thyroid dysfunction in patients with type 2 diabetes,” Experimental and Clinical Endocrinology and Diabetes, vol. 119, no. 4, pp. 201–207, 2011.View at Publisher • View at Google Scholar • View at Scopus

R. Kadiyala, R. Peter, and O. E. Okosieme, “Thyroid dysfunction in patients with diabetes: clinical implications and screening strategies,” International Journal of Clinical Practice, vol. 64, no. 8, pp. 1130–1139, 2010. View at Publisher • View at Google Scholar • View at Scopus

R. S. Gray, W. J. Irvine, and B. F. Clarke, “Screening for thyroid dysfunction in diabetics,” British Medical Journal, vol. 2, no. 6202, p. 1439, 1979. View at Google Scholar • View at Scopus

J. G. Hollowell, N. W. Staehling, W. Dana Flanders et al., “Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III),” Journal of Clinical Endocrinology and Metabolism, vol. 87, no. 2, pp. 489–499, 2002. View at Publisher • View at Google Scholar • View at Scopus

M. F. Celani, M. E. Bonati, and N. Stucci, “Prevalence of abnormal thyrotropin concentrations measured by a sensitive assay in patients with type 2 diabetes mellitus,” Diabetes Research, vol. 27, no. 1, pp. 15–25, 1994. View at Google Scholar • View at Scopus

T. G. A. Strieder, M. F. Prummel, J. G. P. Tijssen, E. Endert, and W. M. Wiersinga, “Risk factors for and prevalence of thyroid disorders in a cross-sectional study among healthy female relatives of patients with autoimmune thyroid disease,” Clinical Endocrinology, vol. 59, no. 3, pp. 396–401, 2003. View at Publisher • View at Google Scholar • View at Scopus

C. Wang, “The relationship between type 2 diabetes mellitus and related thyroid diseases,” Journal of Diabetes Research, vol. 2013, Article ID 390534, 9 pages, 2013. View at Publisher • View at Google Scholar

R. W. V. Flynn, T. M. MacDonald, A. D. Morris, R. T. Jung, and G. P. Leese, “The thyroid epidemiology, audit, and research study: thyroid dysfunction in the general population,” Journal of Clinical Endocrinology and Metabolism, vol. 89, no. 8, pp. 3879–3884, 2004. View at Publisher • View at Google Scholar • View at Scopus

M. A. Michalaki, A. G. Vagenakis, A. S. Leonardou et al., “Thyroid function in humans with morbid obesity,” Thyroid, vol. 16, no. 1, pp. 73–78, 2006. View at Publisher • View at Google Scholar • View at Scopus

K. Boelaert, P. R. Newby, M. J. Simmonds et al., “Prevalence and relative risk of other autoimmune diseases in subjects with autoimmune thyroid disease,” American Journal of Medicine, vol. 123, no. 2, pp. 183–e1, 2010. View at Publisher • View at Google Scholar • View at Scopus

R. W. Holl, B. Böhm, U. Loos, M. Grabert, E. Heinze, and J. Homoki, “Thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus. Effect of age, gender and HLA type,” Hormone Research, vol. 52, no. 3, pp. 113–118, 1999. View at Google Scholar • View at Scopus

G. E. Umpierrez, K. A. Latif, M. B. Murphy et al., “Thyroid dysfunction in patients with type 1 diabetes: a longitudinal study,” Diabetes Care, vol. 26, no. 4, pp. 1181–1185, 2003. View at Publisher • View at Google Scholar • View at Scopus

S. A. P. Chubb, W. A. Davis, and T. M. E. Davis, “Interactions among thyroid function, insulin sensitivity, and serum lipid concentrations: the Fremantle diabetes study,” Journal of Clinical Endocrinology and Metabolism, vol. 90, no. 9, pp. 5317–5320, 2005. View at Publisher • View at Google Scholar • View at Scopus

O. Kordonouri, A. Klinghammer, E. B. Lang, A. Grüters-Kieslich, M. Grabert, and R. W. Holl, “Thyroid autoimmunity in children and adolescents with type 1 diabetes: a multicenter survey,” Diabetes Care, vol. 25, no. 8, pp. 1346–1350, 2002. View at Publisher • View at Google Scholar • View at Scopus

J.-K. Yang, W. Liu, J. Shi, and Y.-B. Li, “An association between subclinical hypothyroidism and sight-threatening diabetic retinopathy in type 2 diabetic patients,” Diabetes Care, vol. 33, no. 5, pp. 1018–1020, 2010. View at Publisher • View at Google Scholar • View at Scopus

M. P. J. Vanderpump, W. M. G. Tunbridge, J. M. French et al., “The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey,” Clinical Endocrinology, vol. 43, no. 1, pp. 55–68, 1995. View at Google Scholar • View at Scopus

N. Friedrich, S. Schwarz, J. Thonack, U. John, H. Wallaschofski, and H. Völzke, “Association between parity and autoimmune thyroiditis in a general female population,” Autoimmunity, vol. 41, no. 2, pp. 174–180, 2008. View at Publisher • View at Google Scholar • View at Scopus

F. Santini, L. Chiovato, R. Rocchi, M. Marinò, and A. Pinchera, “Influences of thyroid diseases in diabetic pregnant women,” Annali dell'Istituto Superiore di Sanita, vol. 33, no. 3, pp. 441–445, 1997.View at Google Scholar • View at Scopus

“IDF Diabetes Atlas 5th edition 2012 update,” International Diabetes Federation,http://www.idf.org/diabetesatlas/5e/the-global-burden.

American diabetes Association, “Standards of Medical care in diabetes—2010,” Diabetes Care, vol. 33, supplement 1, pp. S11–S61, 2010. View at Publisher • View at Google Scholar

G. Caldwell, H. A. Kellett, and S. M. Gow, “A new strategy for thyroid function testing,” The Lancet, vol. 1, no. 8438, pp. 1117–1119, 1985. View at Google Scholar • View at Scopus

H. Lindner, “The Non-Clinical ATA/AACE 2012 Hypothyroidism Guidelines,”http://hormonerestoration.com/files/ResponsetoGuidelines.pdf.


Refbacks

  • There are currently no refbacks.