Evaluation of thyroid function in patients with type 2 diabetes mellitus

 

 

Abstract              Background: Thyroid disorders and diabetes mellitus are the two most common endocrinopathies encountered in clinical practice. We intended to take up this study in order to establish the possible relationship between Type 2 diabetes mellitus and thyroid disorder. Methods: The study was carried on patients with diagnosis of Type 2 diabetes mellitus who were admitted in medical wards and attending medical OPD in the department of medicine, Krishna Hospital, Karad during the study period of 1 October 2016 to 31 march 2018.It was an observational Cross-sectional study. Clinical data and laboratory reports were collected and compared for different age groups, gender and duration of diabetes mellitus and its correlation with thyroid disorder. Results: Out of total 400 patients studied, 97(24.25%) patients had thyroid disorder. Among the patients who had thyroid disorder, we had 52(53.6%) with subclinical hypothyroidism and 30(30.93%) who had hypothyroidism. There were 11(11.34%) who had subclinical hyperthyroid and 4(4.12%) who had frank hyperthyroidism. Both Clinical and Subclinical Hypothyroidism were found more in Females as compared to males and the association was found to be highly significant (p < 0.0001). Thyroid disease increased as there was increase in the age. Conclusion: Thyroid disorder is seen maximum in patients with the duration of 11-15 years of type 2 diabetes mellitus. The study population had an obvious Thyroid dysfunction; hence it is prudent to screen for or to ask for Thyroid profile in patients with type 2 Diabetic patients.

Key Word: type 2 diabetes mellitus.

 

INTRODUCTION

Thyroid disorders and diabetes mellitus are the two most common endocrinopathies encountered in clinical practice. Diabetes mellitus is a clinical syndrome characterized by hyperglycemia caused by absolute or relative deficiency of insulin.¹ The thyroid gland produces two hormones, thyroxine (T4) and triiodothyronine (T3), acting through the thyroid hormone receptors α and β, these hormones play a major role in cell differentiation during development and help maintain thermogenic and metabolic homeostasis in adults.¹ Both conditions frequently coexist and many studies documented higher prevalence of thyroid dysfunction in patients with diabetes in general population than normal prevalence of thyroid dysfunction in non-diabetic population.² The association between diabetes and thyroid dysfunction was seen since long. It was first published in 1979. How Thyroid hormones affect glucose metabolism via several mechanisms in diabetes, is a matter of investigation.³ There has been estimated that prevalence of thyroid dysfunction among diabetes patients varies with range from 2.2 to 17%, however, few studies also have estimated high prevalence of thyroid dysfunction in diabetes up to 46.5%. We intended to take up this study in order to establish the possible relationship between Type 2 diabetes mellitus and thyroid disorder.

 

AIM AND OBJECTIVES

• The study was undertaken with an aim of studying the relationship between Type 2 diabetes mellitus and thyroid disorders.
• Objectives were to know the prevalence of thyroid disorders in Type 2 diabetic patients and to estimate the need for annual screening of thyroid profile in Type 2 diabetic patients.

 

MATERIAL AND METHODS

Source of data: The study was carried on patients with diagnosis of Type 2 diabetes mellitus who were admitted in medical wards and attending medical OPD in the department of medicine, Krishna Hospital, Karad during the study period of 1 October 2016 to 31 March 2018. It was an observational cross-sectional study. Total 400 patients with diagnosis of type 2 diabetes mellitus were included in the study with age more than 18 years. Patients who are previously diagnosed as cases of Type 1 diabetes mellitus, those with chronic illness were excluded.

Ethical clearance from college and university committee was taken. After ethical clearance, permission was taken from head of departments.

Informed written consent of the participants was taken and data was collected.

Data Collection: Patients were interviewed to obtain the demographic characteristics such as age and sex, presenting complaints, diabetic history and history of other co-morbidities. These patients were subjected to clinical examination and the findings including vitals and systemic examination findings were noted. These findings were recorded on a predesigned and pretested Performa.

Statistical analysis: Data was analysed for mean, percentage, standard deviation, chi square test, multiple correlation and multivariate analysis, by using SPSS-10(Statistical Package for the Social Sciences) for Windows (SPSS, Chicago, IL).

 

RESULT

The study had 97(24.25%) patients who had thyroid disorder and there were 303(75.75%) who had no thyroid disorder.

Table 1: Distribution of patients based on thyroid disease

(DF:1; p value:<0.0001)

In our study, among the patients who had thyroid disorder, we had 52(53.6%) with subclinical hypothyroidism and 30(30.93%) who had hypothyroidism. There were 11(11.34%) who had subclinical hyperthyroid and 4(4.12%) who had frank hyperthyroidism.

 

 

Table 2: Distribution of patients based on type thyroid disorder

Type of Thyroid disorder	Number	Percentage %
Subclinical Hypothyroidism	52	53.61
Hypothyroidism	30	30.93
Subclinical Hyperthyroidism	11	11.34
Hyperthyroidism	4	4.12
Total	97	100

(DF:3; p value:<0.0001)

 

Figure 1: Type of Thyroid disorder

In our study, we saw for association between thyroid disease and gender and we found that there was high significance between the association. Females were seen to be having more thyroid disorders because of excess need and failure to fulfil the demand also.

Table 3: Association of Thyroid disorder and Gender.

X² = 38.83, p < 0.0001 (Highly Significant)

Figure 2: Association of Thyroid disorder and Gender

Both Clinical and Subclinical Hypothyroidism were found more in Females as compared to males and the association was found to be highly significant (p < 0.0001).

 

 

Table 4: Association of Gender and Hypothyroidism (primary and Subclinical)

X² = 28.92, p < 0.0001

Figure 3: Association of Gender and Hypothyroidism (primary and Subclinical)

In the study we were able to see significant association between the thyroid disorders and age group too. Thyroid disease increased as there was increase in the age. This could be due to the failure of body’s mechanism to compensate for the losses and

 

Table 1: Association of Thyroid disorder and age

X² = 16.96, p = 0.0002

Efficient production of the hormone. In our study we had significant association between duration of diabetes and thyroid disorder, as there was increase in duration of diabetes, there was increase in the thyroid disorder percentage.

 

Table 6: Association of Thyroid disorder and duration of diabetes

X² = 10.77, p = 0.013

 

DISCUSSION

Diabetes mellitus is a major endocrine disorder worldwide in clinical practice. Despite of advances in treatment,a large group of patients present with complications because of poor glycaemic control. One of the factors that contribute to poor glycaemic control is thyroid dysfunction, which tends to occur concomitantly with diabetes mellitus. The prevalence of both endocrinal diseases has become an attention in epidemiological studies since the last decade. This study sought to find out the prevalence of thyroid disorders in patients with type 2 diabetes mellitus. In this study out of 400 type 2 diabetic patients 24.25% had abnormal dysfunction while 75.75% had normal thyroid profile (T3, T4, TSH). The prevalence was seen high as compared with Pranav kumar Raghuwanshi et al (prevalence of 8.8%), Imam Subekti et al (prevalence of 9.9%), Athanasia Papazafiropoulou et al (prevalence of 12.3%), Palma et al (prevalence of 14.7%), Ashok Khurana (prevalence of 16%), Anuradha Deuri et al (prevalence of 22.5%), Kanhaiya Prasad et al (prevalence of 23%); whereas the prevalence was seen less as compared to C. E. J. Udiong et al (prevalence of 46.5%), Gurjeet Singh et al (prevalence of 30%), Palanisamy Pasupathi et al (prevalence of 28%), Ravishankar. S. N. et al (prevalence of 29%), Elmenshawi et al (prevalence of 29%), Ashish Sarode et al (prevalence of 29%) and Ajaz Ahmad et al studies(prevalence of 29%).^4-18 In the study out of 24.25%, 53.61% were subclinical hypothyroidism, 30.93% were hypothyroidism, 11.34% subclinical hyperthyroidism, 4.12% were hyperthyroidism of type 2 diabetic patients. Udiong et al study 26.6% had low thyroid hormone levels, if we compared to our study only 7.5% had low thyroid levels, while hyperthyroidism was seen in 19.9% diabetic population which is high as to our study. There is no evidence of subclinical hypothyroidism and hyperthyroidism in C.E.J. Udiong study which is seen in our current study.⁴ Pranav Kumar Raghuwanshi et al study which had hypothyroidism and subclinical hypothyroidism found to be 4(10.00%) and6 (15.00%) respectively and subclinical hyperthyroidism and hyperthyroidism found to be 0(0.0%) and 1(2.5%) respectively which was very low compared to our current study.¹¹ In our study, we saw for association between thyroid disease and gender, we found that there was high significance between the association. Females were seen to be having more thyroid disorders because of excess need and failure to fulfil the demand. The findings are found to be similar to the study by Ashok Khurana et al,¹²Ajaz Ahmad et al,¹⁷Ashish Sarode et al,¹⁶ Elmenshawi et al,¹⁵ Kanhaiya Prasad et al,⁶²and Anuradha Deuri et al.⁶¹ In the study we were able to see significant association between the thyroid disorders and age group. Thyroid disease increased as there is increase in the age group seen in Ashok Khurana et al,⁶⁰ Anuradha Deuri et al,⁶¹ Kanhaiya Prasad et al,¹⁴Elmenshawi et al ¹⁵studies, but in our study we have high thyroid disorder in age group of 40-60 years. This could be due to the failure of body’s mechanism to compensate for the losses and efficient production of the hormone.Also with increasing prevalence of diabetes, even the younger populations are having more deranged blood sugars, low glycemic control and thus its complications like thyroid disorders.^12,15,18 We also found that females are maximum in this age group (40-60 years), the most common thyroid disorder was hypothyroidism (primary, subclinical) this can be due to low estrogen levels due to menopause which causes low iodine absorption and altered liver function.

Table 7: Comparison of prevalence of different studies

The prevalence of Thyroid disorder in our study was 24.25% of which Subclinical hypothyroidism was 53.61%, followed hypothyroidism 30.93%, followed by subclinical hyperthyroidism 11.34% and hyperthyroidism 4.12% in type 2 diabetic patients.

 

CONCLUSION

In our study we found prevalence of thyroid disorder was 24.25% in type 2 Diabetes mellitus patients. The maximum numbers of patients in the study were between 40-60 years. Males outnumbered females in the study but the prevalence of thyroid disorder was more in females as compared to males. Of the all thyroid disorders, the prevalence of subclinical hypothyroidism was highest in the thyroid disorders in our study. Thyroid disorder were seen maximum in patients with the duration of 11-15 years of type 2 diabetes mellitus. The study population had an obvious Thyroid dysfunction; hence it is prudent to screen for or to ask for Thyroid profile in patients with type 2 Diabetic patients.

 

REFERENCES

1. Nicki RC, Brian RW, Stuart HR. Davidson’s Principles and Practice of Medicine.21st ed., Churchill Livingstone: Elsevier; 2010.
2. Hage M, Zantout MS, Azar ST. Thyroid Disorders and Diabetes Mellitus. Journal of Thyroid Research 2011;2011: 439463. Published online 2011 July 12. doi:10.4061/2011/439463
3. Wang C. The Relationship between Type 2 Diabetes Mellitus and Related Thyroid Diseases. Journal of Diabetes Research, vol. 2013, 390534, 9 pages, 2013. doi:10.1155/2013/390534.
4. C. E.J. Udiong, A .E. Udoh et al. Evaluation Of Thyroid Function In Diabetes Mellitus In Calabar, Nigeria. Indian Journal of Clinical Biochemistry, 2007 / 22 (2) 74-78
5. Palanisamy Pasupathi, Govindaswamy Bakthavathsalam et al. Screening for Thyroid Dysfunction in the Diabetic/Non-Diabetic Population. Thyroid Science 3(8):CLS1-6, 2008.
6. Athanasia Papazafiropoulou, Alexios Sotiropoulos et al. Prevalence of Thyroid Dysfunction Among Greek Type 2 Diabetic Patients Attending an Outpatient Clinic. J Clin Med Res 2010 Apr; 2(2): 75–78.
7. Gurjeet Singh, Vikas Gupta et al. Evaluation of Thyroid Dysfunction Among type 2 diabetic Punjabi Population. Advances In Bioresearch Volume 2, Issue 2, December 2011: 03-09
8. Vinu Vij et al. Evaluation of Thyroid Dysfunction among Type 2 Diabetic Patients. International Journal of Pharmacy and Biological Sciences. Volume: Issue 4;OCT-DEC,2012,150-155.
9. Dr. Ravishankar, S.N, Dr. Champakamalini et al. A prospective study of thyroid-dysfunction in patients with Type 2 diabetes in general population. iMedPub Journals: Vol. 5 No. 1:2, 2013.
10. Palma et al: Prevalence of thyroid dysfunction in patients with diabetes mellitus. Diabetology and Metabolic Syndrome. 2013, 5:58.
11. Pranav Kumar Raghuwanshi, Devendra Pratap Singh Rajput et al. Evaluation of thyroid dysfunction among type 2 diabetic patients: Asian Journal of Medical Sciences, May-Jun 2015, Vol 6, Issue 3.
12. Ashok Khurana, Preeti Dhoat et al. Prevalence of thyroid disorders in patients of type 2 diabetes mellitus: Journal, Indian Academy of Clinical Medicine. Vol. 17, No. 1, January-March, 2016.
13. Dr. Anuradha Deuri, Dr. J. Thakuria et al. A Prospective Study of Thyroid Dysfunction in Patients with Type2 Diabetes Mellitus in A Tertiary Care Hospital (Faamch, Barpeta, Assam, India). IOSR Journal of Dental and Medical Sciences Volume 15, Issue 7 Ver. II (July 2016), PP 21-25.
14. Kanhaiya Prasad, Shivnath Singh. Prevalence of Thyroid Disorders amongst Patients with Diabetics - A Hospital based Study. International Journal of Contemporary Medical Research: Volume 4, Issue 7, July 2017.
15. Ibrahim M Elmenshawi, Sultan S Alotaibi et al. Prevalence of thyroid dysfunction in diabetic patients. J Diabetes Metab Disord Control. 2017; 4(2):55‒60
16. Ashish Sarode et al. Thyroid disorders in type 2 diabetes mellitus. MedPulse – International Medical Journal, Volume 4, Issue 1January 2017 page 64-68
17. Ajaz Ahmad Telwani, Zahid Hussain Wani et al Prevalence of thyroid dysfunction in type 2 diabetes mellitus: a case control study. International Journal of Research in Medical Sciences: October 2017.Vol 5, Issue 10: 4527-4531
18. Imam Subekti, L. A. ( 2017). Thyroid Dysfunction in Type 2 Diabetes Mellitus Patients. Acta Medica Indonesiana , Vol 49, No 4
19. C. E.J. Udiong, A .E. Udoh et al. Evaluation Of Thyroid Function In Diabetes Mellitus In Calabar, Nigeria. Indian Journal of Clinical Biochemistry, 2007 / 22 (2) 74-78
20. PalanisamyPasupathi, GovindaswamyBakthavathsalam et al. Screening for Thyroid Dysfunction in the Diabetic/Non-Diabetic Population. Thyroid Science 3(8):CLS1-6, 2008.
21. AthanasiaPapazafiropoulou, Alexios Sotiropoulos et al. Prevalence of Thyroid Dysfunction Among Greek Type 2 Diabetic Patients Attending an Outpatient Clinic. J Clin Med Res 2010 Apr; 2(2): 75–78.
22. Gurjeet Singh, Vikas Gupta et al. Evaluation of Thyroid Dysfunction Among type 2 diabetic Punjabi Population. Advances In Bioresearch Volume 2, Issue 2, December 2011: 03-09
23. VinuVij et al. Evaluation of Thyroid Dysfunction among Type 2 Diabetic Patients. International Journal of Pharmacy and Biological Sciences. Volume: Issue 4; OCT-DEC,2012,150-155.
24. Dr. Ravishankar, S.N, Dr.Champakamalini et al. A prospective study of thyroid-dysfunction in patients with Type 2 diabetes in general population. iMedPub Journals: Vol. 5 No. 1:2, 2013.
25. Palma et al: Prevalence of thyroid dysfunction in patients with diabetes mellitus. Diabetology and Metabolic Syndrome. 2013, 5:58.

 

 

 

 

 

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