.

Assessment of hypothyroidism among Type II DM patients attending in a rural teaching hospital, Sangareddy

 

Pawan Arun Kulkarni¹, Nagababu Pyadala^1,2,*, Sarala Devi Tenepalli³,

Rathnagiri Polavarapu⁴

 

¹Assistant Professor, Department of Biochemistry, MNR Medical College and Hospital, Sangareddy, Telangana State, India.

²Research Associate, Department of Clinical Research Laboratory, Genomix Molecular Diagnostics Pvt. Ltd, Kukatpally, Hyderabad, India.

³Professor, Department of Biochemistry, MNR Medical College and Hospital, Sangareddy, Telangana State, India.

 

Abstract               Background: The present study was undertaken to assess the interdependent relationship between type 2 DM and hypothyroidism among Type 2 diabetic patients attending a teaching hospital. Materials and methods: In the present study, 100 type 2 diabetic subjects and 100 healthy nondiabetic subjects investigated for total triiodothyronine (T3), total thyroxine (T4), thyroid stimulating hormone (TSH), and Fasting blood sugar (FBS). Results: The level of T3 and T4 were significantly lower while the level of TSH and FBS was substantially higher in type 2 diabetics as compared to non-diabetics. Conclusion: Thus, the present study was conducted to find out the relationship between type 2 DM and hypothyroidism in patients with type 2 diabetes. Prevalence of Hypothyroidism is high among Type 2 Diabetes mellitus patients especially females. Therefore continuous screening for thyroid hormones is suggested in type 2 DM patients to reduce the vascular complications and management of diabetes and also reduce the risk of thyroid hormone dysfunction.

Keywords: Diabetes mellitus, Hypothyroidism, Triidothyronine (T3), Tetraidothyronine (T4), Thyroid stimulating hormone (TSH).

 

 

INTRODUCTION

Diabetes mellitus (DM) is most common endocrine disorder and characterized by high blood sugar levels over a prolonged period. DM occurs due to the deficiency of insulin secretion of insulin resistance or both. The impact of the DM depends upon the quality of life, and on mortality and morbidity through the complication that is affecting the large and small vessels resulting in neuropathy, nephropathy, and retinopathy. In India, the incidence is increasing day by day due to a sedentary lifestyle and high degree of genetic predisposition. By 2020 in India the frequency may reach to 70 million and WHO declared India as the diabetes capital of the world. If a person affected by DM, there is a chance to get another endocrine gland dysfunction that is thyroid gland.^1,2,3,4 Hypothyroidism is another common endocrine disorder resulting from a deficiency of thyroid hormone. Thyroid dysfunctions increasingly found in the T2DM patients and prevalence is around 13.4%⁵ The presence of thyroid dysfunction may affect DM control, and plasma lipid metabolism increases the risk of cardiovascular disease (CVD) and atherosclerosis. Among DM, Type 2 DM or Non-insulin dependent diabetes mellitus (NIDDM) is most common in India, and the incidence is increasing day by day. Patients with type 2 DM have the significantly higher prevalence of thyroid disorder especially hypothyroidism when compared with the healthy population.^6,7,8 Therefore the present study aimed to assess the association of hypothyroidism in type 2 DM patients attending a rural teaching hospital.

 

METHODS AND MATERIALS

The present study was carried out at MNR Medical College and Hospital situated in Sangareddy, Telangana state. A total of 200 study subjects of both gender groups selected from the medicine ward of MNR Hospital during the period from May 2017 to November 2017. This study approved by institutional ethical committee and investigations were carried out in the biochemistry laboratory, MNR Medical College and Hospital, Sangareddy.

Inclusion Criteria: All patients with Type 2 diabetes aged more than 30 years. All people with diabetes irrespective of glucose control. All people with diabetes regardless of treatment (OHA/insulin).

Exclusions criteria: Type 1 DM. Patients with: 1. Gestational diabetes mellitus. 2. Fibrocalculouspancreatitis. 3. Pancreatitis. 4. Steroid-induced Diabetes would exclude. All those who had proven thyroid disorder and on treatment.

Sample collection: Blood samples were collected, after 12 hours fast from the above study subjects. 5ml of blood from the cubital vein received in a plain bottle after explaining the procedure to the study subjects. Serum was separated from the blood samples by a centrifuged machine at 3000 rpm for 10 minutes in the biochemistry department. Following estimations are carried out on the serum samples by standard kit methods, and analyses performed on COBAS e411 autoanalyzer.

• Triidothyronine (T3)
• Tetraidothyronine (T4)
• Thyroid stimulating hormone (TSH)
• FBS

Blood glucose estimated by using GOD-POD method [Robonik-semi auto-analyser) and [1,2,3], T3, T4 and TSH-estimated by using (CLIA -method) chemi luminescence immune assay method [1,8,9].

Reference range: The normal reference ranges according to the kits are: TSH (0.7-6.4 μIU/ml), T3 (0.52-1.85 ng/ml), T4 (4.0-11.0 μg/dl. Normal values for FBS 70-110mg/dl.

Statistical analysis: The collected data were analyzed by SPSS software version 16.0. All results presented as the mean ± standard deviation (SD). A p-value of < 0.0001 was considered significant.

RESULTS

In the present study, total 200 subjects were included and divided into two groups, 100 controls (non-diabetic) and 100 cases (diabetic) with the age range of 30 – 60 years. Out of 100 non-diabetic controls 27 were females and 73 males and in 100 diabetic cases, 72 were females and 28 males as shown in the Table 1, Figure 1 and Figure 2.

DISCUSSION

In the present study, we assessed the association between hypothyroidism and typed 2 DM. in the present study the mean ± SD of the FBS and TSH were significantly increased in type 2 DM patients when compared with controls (non-diabetics) [ Table 2]. In the present study, high incidence of cases seen in 41-50. Similar studies reported by Kiran Kumar Akka et al., 2017¹, Desai JP, et al., 2015¹⁰, Luboshitzky, et al., 2002¹¹. Females subjects’ incidence is more than the males of total cases. Similar findings were reported by Bhandopadhyay SK et al., 2006.¹² According to Aminorroaya A et al., 2009; the percentage of thyroid dysfunction among women 13% and men only 5 %¹³ In the present study, the mean ± SD levels of fasting blood sugar significantly higher in type2 DM patients than that of healthy non-diabetic type subjects. Similar findings were reported by Swamy RM et al., 2012 [14], Reeta T, et al.¹⁵, Priti S, et al.¹⁶, and Samatha P, et al.¹⁷. The TSH level was significantly higher in diabetic subjects as compared to healthy control subjects. Similar findings were reported by Swamy RM et al., 2012¹⁴ and Singh G, et al.¹⁸ The T3 and T4 levels were significantly decreased in diabetic subjects as compared to healthy control subjects. Similar findings were reported by Swamy RM et al., 2012¹⁴, Kiran Kumar Akka et al., 2017¹ and Haque S S, et al.¹⁹ Thyroid hormones may influence glucose control through a variety of actions on intermediary metabolism. In patients with diabetes, hypothyroidism may affect metabolic control through effects on glucose metabolism, which include reductions in hepatic glucose output, gluconeogenesis, and peripheral glucose utilization. The result of these processes is a predisposition to hypoglycaemia.²⁰ Co-existent diabetes may also affect the efficacy of thyroid hormone treatment in patients with hypothyroidism.²¹

 

CONCLUSION

                Thus, the present study was conducted to find out the relationship between type 2 DM and hypothyroidism in patients with type 2 diabetes. Prevalence of Hypothyroidism is high among Type 2 Diabetes mellitus patients especially females. Therefore continuous screening for thyroid hormones is suggested in type 2 DM patients to reduce the vascular complications and management of diabetes and also reduce the risk of thyroid hormone dysfunction.

 

ACKNOWLEDGEMENT

We are thankful to Genomix Molecular Diagnostics Pvt. Ltd, Hyderabad, for their invaluable help and support.

 

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