Hypothyroidism in type 2 diabetics – a hospital-based prevalence study

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Results
A total of 104 participants with DM were included in the study.Among these 82.7% were euthyroid,     These effects include modifications of circulating insulin levels and counter-regulatory hormones, intestinal absorption, hepatic production and peripheral tissues uptake of glucose [13].Gender wise, in this study, thyroid defect was reported in 7.7% and 9.6%, respectively in male and female; statistically there was no significant difference (Table 2; P>0.05).A study done by Udiong CEJ. reported that TSH levels in diabetics were significantly lower than the level in non-diabetics and male diabetics had lower levels of TSH [6].In another report from India also reported a high Incidence of thyroid disorder among females; 36%, 22%, respectively and elder population with > 60 years, had more incidence of thyroid disorder [14].
Hypothyroidism or thyroid overactivity is most frequently induced by an autoimmune process.It was mentioned that the number of people with thyroid disorders in India exceeds 40 million [17].
Various studies in the recent past have revealed a higher incidence of thyroid dysfunction in diabetics compared to the normal population.In population studies, overt hypothyroidism or its subclinical manifestations range between 2-4% and 4-20% respectively both being significantly higher in women above the age of 60 years [16].
Hypothyroidism Literature also reported a high percentage of severe clinical hypothyroidism (SCH) [20].These changes might indicate that elevated TSH can affect blood lipids and vascular endothelium in patients with Type 2 diabetes, although whether SCH is the primary reason for the high prevalence of CHD remains controversial.Whereas dyslipidemia was reported to be 95.5% among the type 2 DM in one cross-sectional report [21,22,23].

Conclusion
With these study findings and the available kinds of literature, hypothyroidism is very common among type 2 DM individuals.However, thyroid hormones also exert profound effects in the regulation of glucose homeostasis prolonged peripheral glucose accumulation, gluconeogenesis, diminished hepatic glucose output and reduced disposal of glucose.So it is very clear that both can complement other metabolism.

Limitation
Small sample size is the major of the study.
What does the study add to the existing is very common among type 2 DM individuals.Most cases are euthyroid gender-wise, more common among females.This is increased with the age of the individual.

Introduction
Diabetes mellitus (DM), most common endocrine disorder, characterized by persistent hyperglycemia resulting from defects in insulin secretion, insulin action, or both.Development of diabetes involves several pathogenic processes ranging from autoimmune destruction of the β cells of the pancreas with consequent insulin deficiency to abnormalities that result in resistance to insulin action [1].Hyperglycemia is the principal cause of diabetic complications.Sedentary lifestyle, various diet patterns, ethnicity, and genetic predisposition are the major factors responsible for the causes of the epidemic [2].Thyroid disorders are also common in the general population and it is the second most common endocrine disorder.As a result, it is common for an individual to be affected by both thyroid disease and diabetes [3].Various studies have reported the low prevalence of thyroid dysfunction among diabetic patients, between 2.2 to 17 % in their respective populations [4,5].However, few studies have shown a higher prevalence of thyroid dysfunction in diabetes from 31 % to 46.5% [6,7].Thyroid hormones and insulin are the antagonists and both are involved in cellular metabolism of carbohydrates, proteins, and lipids.The functional impairment occurs in thyroid hormone as well as insulin if their levels changed [8].DM appears to influence thyroid function in two sites; firstly, at the level of hypothalamic control of TSH release and secondly at the conversion of T4 to T3 in the peripheral tissues.Hyperglycemia causes reversible reduction of the activity and hepatic concentration of T4 5'deiodinase, low serum T3, increase in reverse T3 and also variation in the level of [9].The recognition of this interdependent relationship between thyroid disease and diabetes is of importance to guide clinicians on the optimal management of both these conditions.With this, the study was planned to find the prevalence of thyroid dysfunction in type 2 DM.
Venous blood samples were taken from an antecubital vein of the arm by means of clean venipuncture after an overnight fast for fasting blood glucose and 2-hour post glucose blood sugar, glycosylated hemoglobin, and lipid profile.Venous blood also assayed for thyroid function (T3, T4, and TSH).Plasma glucose concentration was estimated using the GOD-POD (Glucose oxidase -Peroxidase) method and thyroid hormones were estimated using principle combining a one-step enzyme immunoassay.TSH levels are <10 mIU/L was considered subclinical hypothyroidism and >10mIU/L is clinical hypothyroidism.Serum lipids (total cholesterol, triglycerides, LDL cholesterol, and HDL plasma cholesterol concentrations) were measured by using the autoanalyzer.Chi-square test was used to compare differences in categorical variables and p<0.05 was considered statistically significant.

Discussion
Diabetes is a leading of morbidity and mortality worldwide.Its incidence is increasing day by day all over the world, posing a major threat to public health.The influence of endocrine and nonendocrine organs other than the pancreas on diabetes mellitus is documented.Thyroid disorders are also very common endocrine disorders in the general population.Hence it is common for an individual to be affected by both thyroid diseases and diabetes.The incidence is increasing day by day all over the world, posing a major threat to public health.The major alterations in the thyroid hormone system are a reduction in the TSH stimulation of the thyroid gland, probably caused by central hypothyroidism, and in the peripheral generation of T3 from T4 [4,10].Unrecognized thyroid dysfunction may worsen metabolic control and impede the management of diabetes.Therefore, diabetic patients need to be screened for thyroid dysfunction[11].The study examined the prevalence of subclinical, clinical hypothyroidism in subjects with type 2 diabetics and also examined how the duration of diabetes affects the prevalence of hypothyroidism in type 2 diabetics along with the emphasis on glycemic control and on long term complications.In the present study, out of 104 types 2 diabetic patients, the prevalence of hypothyroidism was more common in the age group of 41-70 years.This indicates that the peak incidence was in the 4th and 5th decades of life.In

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Study was conducted in department of General Medicine, GSL Medical College.