Background:Diabetes mellitus (DM) is a chronic disease characterized by insulin deficiency or peripheral resistance resulting in hyperglycemia. Poor glycemic control leads to diabetic complications. Hyperuricemia has been reported with increased risk of renal insufficiency. The aim of this study was to evaluate the relationship between serum uric acid concentration, degree of urinary albumin excretion (UAE) and glycated hemoglobin (HbA1c) in Type 2 DM (T2DM) patients.Materials and Methods:Serum uric acid concentrations, urine microalbumin, and HbA1c were measured in fifty T2DM patients. We then evaluated relationship between uric acid concentrations, degree of UAE and glycemic control as well as other confounding variables.Results:Serum uric acid concentration correlated positively with UAE (r = 0.323, P < 0.05), age (r = 0.337, P < 0.05), age at onset (r = 0.341, P < 0.05), and duration of DM (r = 0.312, P < 0.05). Multiple regression analysis demonstrated that serum uric acid concentration (β = 0.293, P < 0.0001), duration of DM (β = 0.261, P < 0.0001), HbA1c (β = 0.173, P < 0.005), and systolic blood pressure (β = 0.268, P < 0.005) were independent determinants of UAE.Conclusions:Serum uric acid concentration is associated with microalbuminuria and HbA1c in T2DM patients.
Background: Amenorrhea is the absence of menstrual periods. It has multiple social consequences as it may leads to infertility. This case control study was conducted for determining the association of thyroid hormones with hyperprolactinemia in patient with amenorrhea.Methods: We investigated 50 women with diagnosed cases of secondary amenorrhoea, who attended UCMS hospital, for hormonal evaluations. Fifty two healthy women were taken as the controls. The thyroid dysfunction and serum prolactin level were reviewed in cases and in the controls. Results: Mean serum prolactin level was found to be significantly higher in the cases as compared to the controls. Mean serum fT3 and fT4 level in the hyperprolactinemic cases (mean = 2.67, SD = 1.04 pg/ml) and (mean = 1.38, SD = 0.51 ng/dl respectively) were slightly lower as compared to normoprolactinemic cases (mean = 3.21, SD = 1.86 pg/ml) and (mean = 1.73, SD = 1.37 ng/dl) respectively. Mean TSH of normoprolactinemic and hyperprolactinemic cases were comparable (P = 0.049). There was positive correlation between prolactin, BMI and TSH whereas negative correlation of prolactin was seen with fT3, fT4 and age. In hyperprolactainemic cases, prolactin was found to be negatively correlated with TSH (r = -0.155, P = 0.491) whereas prolactin was positively correlated with TSH (r = 0.296, P = 0.126) in normoprolactainemic cases.Conclusions: Thus, hyperprolactinemia with thyroid dysfunction may be contributory hormonal factor in patient with amenorrhoea and as such, estimation of prolactin, fT3, fT4 and TSH should be included for diagnostic evaluation of amenorrhea.
INTRODUCTION:Hypothyroidism is the most common cause of secondary dyslipidemia. Thus, thyroid function test should be carried out before starting any hypolipidemic drugs. Even among thyroid disorder, hypothyroidism is more associated with cardiovascular and associated problems and if not detected earlier, it leads to severe clinical consequences. Our study assesses the frequency and spectrum of dyslipidemia in various types of thyroidal illness in the population residing in south western part of Nepal. MATERIALS AND METHODS:This is a cross sectional study carried out in suspected thyroid disorder patients (n=276) and categorized as Euthyroidism (n=55), Subclinical Hypothyroidism (n=89), Primary Hypothyroidism (n=122) and Primary Hyperthyroidism (n=10) patients and to see the association with lipid profiles in the Department of Biochemistry, Universal College of Medical Sciences Teaching Hospital, Bhairahawa Nepal. Serum fT / fT4 and TSH estimations were carried out by competitive 3 ELISA method and Sand-wich double antibody ELISA method respectively using commercially supplied reagents (Human, Germany). The criteria for dyslipidemia was obtained by National Cholesterol Education Expert Panel/ Adult Treatment Protocol III (NCEP/ATPIII). RESULTS:Out of 276 cases the dyslipidemia was observed in 183 cases (66.30%).The dyslipidemia was mostly associated with primary hypothyroidism (55.07%) followed by Subclinical Hypothyroidism (38.04%) than Euthyroid (5.79 %) and Primary Hyperthyroidism (3.62 %) respectively. Out of all cases, the spectrum of dyslipidemia was mostly observed for decreased HDL (18.5 %) followed by increased TG (10.1 %). Moreover, it is significantly differ in relation in HDL (p=0.009), TG/HDL (p=0.02) and Non-HDL/HDL (p=0.033) where as non significant as compared to other lipid profile in different groups. CONCLUSION:Our study revealed the close association of thyroidal illness with dyslipidemia with increased TG, low HDL, increased TG/HDL and Non-HDL/HDL. The increased TG/HDL and/or Non-HDL/HDL could be better indicator than single lipid abnormality which needs to be ascertained prospectively in large population.
BACKGROUND: Lithium is known to cause both hypo- and rarely hyper- thyroidism. It inhibits release of thyroid hormone and reduces the intrathyroidal iodothyronine/iodothyrosine ratio. Due to direct toxic or immunostimulatory effect, lithium can also cause thyroiditis. Lithium-induced thyroiditis is a rare entity with an incidence rate of about 1.3 cases per 1000 person-years. Given its generally painless and transient nature, symptoms of thyrotoxicosis may erroneously be attributed to an exacerbation of mania. Clinical Case: We report the case of a 29 y/o man with bipolar disorder on lithium therapy who presented with a 2 week history of intermittent palpitations, increased irritability, racing thoughts, insomnia, tremors, increased bowel movement frequency, and 8 lbs weight loss despite an excellent appetite. He denied ocular symptoms, and did not have any recent illness, or new stressors. He had been on a stable dose of lithium for four years. The physical exam was notable for: pulse 78 bpm and regular, exophthalmos, and a palpable, non-tender, non-nodular, thyroid. Labs: TSH 0.008 uIU/ml [0.350 - 5.50], FT3 6.5 pg/ml [2.0 - 4.4], T3 2.08 ng/mL [0.6–1.94] and FT4 1.96 ng/dl [0.8 - 2.7]. TPO, TSI and anti-thyroglobulin antibodies were negative. The lithium level was in the therapeutic range. Thyroid Uptake Scan showed decreased uptake of 2.6 % [normal 10–35%]. He was started on methimazole 20mg daily and atenolol, lithium was changed to risperidone by Psychiatry. After 2 months, hyperthyroid symptoms had resolved, and he was biochemically hypothyroid (FT4 0.85 ng/dl, TSH 20uIU/ml). Methimazole and atenolol were discontinued, with sustained euthyroid state. Conclusion: Hyperthyroidism may develop after several years of lithium therapy. It may be mistaken for aggravation of mania, or for Grave’s disease, especially since lithium and Graves’ are both associated with exophthalmos. Key issues for management are whether to continue lithium and deciding if the incorporation of antithyroid medications is necessary. Of utmost importance is regular monitoring of thyroid function tests to ensure resolution of thyroiditis and to avoid the development of overt hypothyroidism.
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