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      Therapeutics and Clinical Risk Management (submit here)

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      Thyroid dysfunction among type 2 diabetic female Egyptian subjects


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          High prevalence of thyroid disorders is more common in type 1 diabetes compared to type 2 diabetes, due to associated autoimmunity. Hypothyroidism is the most common disorder. The objective was to assess the prevalence of thyroid dysfunction among type 2 diabetic Egyptian females and to find the correlation between metabolic syndrome components and autoimmune thyroid dysfunction.

          Materials and methods

          The study included 62 type 2 diabetic Egyptian females and 27 sex- and age-matched controls. All patients in the study were subjected to anthropometric measures, including HbA 1c, lipid profile, serum uric acid, thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, anti-thyroid peroxidase (TPO), antithyroglobulin (anti-Tg), and thyroid ultrasound.


          Hypothyroidism was found in 45.2% of patients (5.49±3.37 μIU/mL) versus 11.1% of controls (1.79±1.21 μIU/mL) ( P<0.001). Anti-TPO was found in 75.8% (347.15±244.87 IU/mL) of patients versus 7.4% (32.89±33.26 IU/mL) of controls ( P<0.001). Anti-Tg was found in 61.3% (508.03±369.16 IU/mL) of patients versus 0 (51.26±35.53 IU/mL) controls ( P<0.001). A significant positive correlation was found between TSH and antithyroid antibodies (anti-Tg, anti-TPO; P=0.002 and P=0.043, respectively) and between TSH and thyroid-gland volume ( P=0.002) in diabetic patients. No correlation was found between any components of metabolic syndrome and thyroid antibodies in diabetic patients.


          Autoimmune thyroid disease is more common in Egyptian women with type 2 diabetes than nondiabetic women, and thus points to a role of autoimmunity in the pathogenesis of type 2 diabetes.

          Most cited references36

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          Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002).

          Describe thyrotropin (TSH) and thyroxine (T4) levels in the U.S. population and their association with selected participant characteristics. Secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) collected from 4392 participants, reflecting 222 million individuals, during 1999-2002. Hypothyroidism prevalence (TSH > 4.5 mIU/L) in the general population was 3.7%, and hyperthyroidism prevalence (TSH < 0.1 mIU/L) was 0.5%. Among women of reproductive age (12-49 years), hypothyroidism prevalence was 3.1%. Individuals aged 80 years and older had five times greater odds for hypothyroidism compared to 12- to 49-year-olds (adjusted odds ratio [OR] = 5.0, p = 0.0002). ORs were adjusted for sex, race, annual income, pregnancy status, and usage of thyroid-related medications (levothyroxine/thyroid, estrogen, androgen, lithium, and amiodarone). Compared to non-Hispanic whites, non-Hispanic blacks had a lower risk for hypothyroidism (OR = 0.46, p = 0.04) and a higher risk for hyperthyroidism (OR = 3.18, p = 0.0005), while Mexican Americans had the same risk as non-Hispanic whites for hypothyroidism, but a higher risk for hyperthyroidism (OR = 1.98, p = 0.04). Among those taking levothyroxine or desiccated thyroid, the adjusted risk for either hypothyroidism (OR = 4.0, p = 0.0001) or hyperthyroidism (OR = 11.4, p = 4 x 10(-9)) was elevated. Associations with known factors such as age, race, and sex were confirmed using this data set. Understanding the prevalence of abnormal thyroid tests among reproductive-aged women informs decisions about screening in this population. The finding that individuals on thyroid hormone replacement medication often remain hypothyroid or become hyperthyroid underscores the importance of monitoring.
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            [Volumetric analysis of thyroid lobes by real-time ultrasound (author's transl)].

            Thyroid volume as measured by real-time ultrasound in cadavers was compared with direct measurements obtained by submersion. Length X width X thickness of the thyroid lobe multiplied by factor pi/6, correspond to a rotation ellipsoid, while the best calculated volume of the lobe is obtained by multiplying with the optimised correction factor f = 0.479. The correctness of this calculation is, by definition, 100%; average error of the method is 16%. The measurements are easy to do and require no additional equipment for planimetry or calculations. Volumetric analysis of the thyroid gland is especially necessary in assessing results of treatment and for measuring dosage in connection with radioiodine therapy.
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              IDF diabetes atlas


                Author and article information

                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                21 November 2016
                : 12
                : 1757-1762
                [1 ]Department of Internal Medicine, Diabetes, and Endocrinology
                [2 ]Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Giza, Egypt
                Author notes
                Correspondence: Randa F Salam, Department of Internal Medicine, Cairo University, Cairo University Road, Giza, Egypt, Tel +20 10 0140 7278, Email randa.salam@ 123456live.com
                © 2016 Elebrashy et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research

                autoimmune thyroid dysfunction,tsh,anti-tpo,anti-tg,t2 diabetes,metabolic syndrome
                autoimmune thyroid dysfunction, tsh, anti-tpo, anti-tg, t2 diabetes, metabolic syndrome


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