EVALUATION OF THYROID DYSFUNCTION IN TYPE 2 DIABETIC PATIENTS IN SOKOTO METROPOLIS

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ABSTRACT


Diabetes Mellitus (DM) and Thyroid Dysfunction (TD) are the two most common endocrinopathies seen in general population.Type 2 diabetes mellitus(T2DM) is commonly associated with altered thyroid function.The aim of theresearch is to evaluate TD in patients with T2DM attending Endocrinology Clinic of UsmanuDanfodiyo University Teaching Hospital,Sokoto.Blood samples were collected from 80 Type 2 diabetic patients and 80 non diabetic (control) and analyze for fasting blood sugar (FBS), glycatedhemoglobin (HbA1c),thyroid stimulating hormone (TSH),triiodothyrorine (T3),thyroxin (T4), cholesterol, triglycerides (TG), high density lipoprotein (HDL-C)and low density lipoproteins(LDL-C).The levels, of FBS, HbA1c,Cholesterol, TG and LDL-C were observed to be significantly high andthe level of HDL-C was significantly low in diabetics as compared to control(non diabetic patients).The levelsof T3 and T4 weresignificantly low while the level of TSH was significantly high in Type 2 diabetics as compared to non diabetics.Pearson correlation shows a very strong positive relationship between FBS and HbA1c and weak positive relationship between thesesugars and Thyroid hormones(TSH,T3,andT4). Thyroid dysfunction maycomplicates metabolic control in diabetes mellitus (DM).It is therefore patients to recognize and where necessary treat thyroid dysfunction in order to stabilize metabolic control.


TABLE OF CONTENTS

TITLE PAGE
TABLE OF CONTENTS
LIST OF TABLES
LIST OF ABBREVIATIONS
ABSTRACT

CHAPTER ONE
1.0       INTRODUCTION
1.1       Justification
1.2       Aim
1.3       Specific Objectives

CHAPTER TWO
2.0       LITERATURE REVIEW
2.1       Definition of the Diabetes Mellitus
2.2       Diagnostic Feature (Diagnosis of Diabetes Mellitus (DM)
2.3       Non Insulin Dependent Diabetes Mellitus (NIDDM )Type 2
2.4       Causes of Non Insulin Dependent Diabetes Mellitus (NIDDM) Type 2
2.5       Thyroid Gland
2.6       Features of Thyroid Gland
2.6.1    Thyroid Hormones
2.6.2    Role of Thyroid Hormones
2.7       Thyroid Hormone Effects on Diabetes
2.7.1    Effect of Thyroid Hormone Imbalance: Hypothyroidism
2.7.2    Effects of Thyroid Hormone Imbalance: Hyperthyroidism
2.7.3    Causes of Thyroid Disease
2.8       Thyroid Dysfunction (TD) In Type 2 Diabetes Mellitus (T2DM)
2.8.1    Epidemiology
2.8.2    Pathophysiology
2.8.3    Role of Insulin Resistance and other Factors

CHAPTER THREE
3.0       MATERIALS AND METHODS
3.1       Materials
3.2       Reagents
3.3       Methods
3.3.1    Study Area
3.3.3    Study Population
3.3.4    Blood Sample Collection
3.3.5    Fasting Blood Sugar (FBS) GPO-PAP Method
3.3.7    Thyrotropin (TSH) Sandwish Method
3.3.8    Triiodothyronine (T3)
3.4.0    Triglyceride (GPO-PAP METHOD)
3.4.1    Cholesterol (Cholesterol Oxidase Peroxidase  Method)
3.4.2    HDL Cholesterol (Precipitation Method)
3.4.3    Statistical analysis

CHAPTER FOUR
4.0       RESULTS AND DISCUSSION
4.1       Results
4.1.1    Biochemical Parameters in Diabetic and Non Diabetic Patients
4.1.3    Pearson Correlation between Thyroid Hormones and Sugar in Type 2 diabetic patients
4.2       DISCUSSION
4.3       Conclusion

REFERENCES


CHAPTER ONE


1.0     INTRODUCTION

Diabetes mellitus (DM) and thyroid dysfunction (TD) are the two most common endocrine disorders seen in adult population(Diezet al., 2011).The prevalence of Type2 diabetes mellitus (T2DM) is rising faster than any other form of diabetes because of increased urbanization which encourages development of obesity due to reduced physical activities,increase consumption of refined foods and snacks globally (Zimmet, 1999; Zimmetet al., 2001).Thyroid hormones, namely Triiodothyronine (T3) and Thyroxine (T4); either or both of which may be elevated or reduced have both direct and indirect effect on blood glucose homeostasis (Udionget al.,2007).

Elevated levels of free circulating thyroid hormones (hyperthyroidism) produce hyperglycemia by causing polyphagia,enhancing glucose absorption from gastro-intestinal tract, accelerating insulin degradation and stimulating glycogenolysis (Webb,2004).Reduced level of the hormones hypothyroidism may cause hypoglycemia (Webb,2004; Cooper, 2003).


Hypothyroidism, the most commonly diagnosed thyroid dysfunction has greater implications for Type2 diabetic in whom there is pre-existing dyslipidemia and risk of cardiovascular disease (Cooper,2003;Rama et al; 2003; Johnson, 2006).Moreover, thyroid hormones have significant effects on the synthesis, mobilization and metabolism of lipid (Dias et al., 2011; Murray et al., 2000). Overt hypothyroidism is associated with significant increase in circulating concentration of total and low density lipoproteins cholesterol (LDL-C) (Elder et al.,1990; Staubet al.,1992; O’Brien et al.,1993)....


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