EVALUATION OF THYROID DYSFUNCTION AND THYROID AUTOIMMUNITY IN DIABETES MELLITUS SUBJECTS AT EFFIA NKWANTA REGIONAL HOSPITAL, SEKONDI, WESTERN REGION

ABSTRACT
Diabetes mellitus and thyroid disorders are the two most common endocrine disorders in clinical practice. Presence of thyroid dysfunction in diabetic patients makes management of the disease more difficult. The objective of this hospital based cross sectional study at the Diabetic Clinic of Effia Nkwanta Regional Hospital, Sekondi, was to investigate the prevalence of thyroid dysfunction and thyroid autoimmunity in clinically euthyroid type 1 and type 2 diabetes mellitus patients and also to correlate the glycated haemoglobin levels with thyroid function markers. One hundred and thirty-two (132) clinically euthyroid type 1 and type 2 diabetes mellitus patients and 132 age-matched and sex- matched non-diabetic control subjects were included in the study. Data on sociodemography of patients and controls such as age, sex, duration of diabetes, mode of glycaemic control were obtained using a pre-tested questionnaire. The serum levels of thyroid biomarkers (TSH, FT3, FT4, anti-TPO anti-TG) were evaluated using standard methods. The mean serum FT3 (p = 0.2044) and TSH (p = 0.1869) in diabetic subjects were not significantly different when compared to their control peers but the levels of FT4 was significantly higher in the diabetic mellitus subjects compared to the levels recorded among the control group (p < 0.0001). The prevalence of thyroid dysfunction among the diabetic group was 11.36% (6.82% subclinical hypothyroidism and 4.54 % subclinical hyperthyroidism) with 117 (88.64 %) euthyroid. The prevalence of thyroid autoimmunity among the diabetic subjects was5.30% and 3.79 % respectively for anti-thyroid peroxidase autoantibody (anti-TPO) and anti- thyroglobulin autoantibody (anti-TG). Though not statistically different, the auto-antibody reactivity was observed to be higher among the diabetic group compared to the controls. Among the thyroid biomarkers assayed, increasing FT4 levels was significantly associated with increasing additive levels of fasting blood glucose and glycated haemoglobin after Bivariate Pearson correlations analysis.
In conclusion, this study has shown that, the prevalence of thyroid dysfunction among the diabetic population seen at Effia Nkwanta Regional Hospital in Sekondi, Ghana was 11.36 % and the prevalence of thyroid autoantibody reactivity (3.79-5.30 %) in the diabetes mellitus subjects was not significantly different from non-diabetic subjects.


CHAPTER ONE
INTRODUCTION
1.1       Background
Diabetes mellitus is a condition with multiple aetiologies arising from disturbances in glucose metabolism due to a defect either in insulin production and release, action or a combination of these leading to a high glucose level associated with other biochemical derangements (World Health Organization, 2002). Diabetes mellitus results from different metabolic disorders rather than a distinct pathological abnormality. Some known clinical manifestations are drowsiness associated with hyperglycaemia, excessive urination and thirst, weight loss, impaired vision and vulnerability to some infections. The severest form of increased glucose levels could lead to hyperosmolar syndrome and insulin deficiency as well as life-threatening ketoacidosis. Defects in carbohydrate metabolism coupled with the physiological system to undo the imbalance places a burden on other endocrine systems. Continuous breakdown in endocrine control worsens the metabolic imbalance and subsequently leads to hyperglycaemia (Bailey, 2000).

Worldwide, diabetes mellitus a well known endocrine metabolic abnormality is a main cause of mortality. It was projected that by the year 2000, 171 million people in the world would suffer from diabetes and at this rate the number is expected to increase to about 366 million in 2030 (Wild et al., 2004). Presently, in every population in the world, there are people who live with diabetes mellitus and other subtle forms of glucose metabolic disorders. It is feared that without proper intervention and preventive control measures, the burden of the disease and the other lesser forms of glucose metabolic disorders are likely to increase globally (Zimmet et al., 2001; Alberti., 2007). There is scanty information on the overall prevalence of diabetes among Ghanaians, however; the rate has been estimated to be about 6.3% among some inhabitants in the capital, Accra (Amoah et al., 2002).

Thyroid diseases generally show as either over production of thyroid hormones or under production of the thyroid hormones. It can also result from swelling due to a neoplastic process or due to the pressure effects on the thyroid gland from close anatomical structures (Jayakumar, 2011). Thyroid disease is a pathological condition that interferes with the management and control of diabetes mellitus. According to Der et al., (2013), the prevalence of thyroid disorders varies according to some factors. For example dietary iodine intake of the population is known to affect the prevalence of thyroid disorders seen in that population. In clinical practice, thyroid diseases and diabetes mellitus are the two most common endocrine disorders seen. The state of glycaemic dysregulation and thyroid dysfunction have been observed to equally affect each other and the relationship between the two conditions have been established previously(Feely and Isles, 1979). Thyroid hormones contribute to the regulation of carbohydrate metabolism and pancreatic function, while diabetes mellitus affects thyroid function tests. Rohdenburg (1920) used the term 'thyroid diabetes' to explain the effect of thyroid hormone excess on the effective control of glucose metabolism. Thyroid hormones oppose the action of insulin and both insulin and thyroid hormones take part in metabolism of various cells. Functional abnormalities can occur as a result of overproduction or under production of either insulin or thyroid hormones (Satish and Mohan, 2003). The prevalence of thyroid disease in patients with diabetes has been shown to be significantly higher compared to the general population which suggests a possible relationship between thyroid status and insulin resistance (Goswami and Mallika, 2010). For example, Papazafiropoulou (2010) showed that 12.3 % of Greek diabetic patients had thyroid dysfunction and Akbar et al., (2006) also showed that the thyroid dysfunction was prevalent in 16 % of type 2 diabetes mellitus subjects from Saudi Arabia.

1.2       Objectives of the study
* To compare thyroid hormone levels and prevalence rates of thyroid dysfunction in diabetes mellitus subjects with age-matched and sex- matched nondiabetic control group.

* To compare the prevalence of thyroid autoimmunity by estimating anti- thyroid peroxidase and anti-thyroglobulin levels in types 1 and 2 diabetes mellitus and their control subjects.

* To determine the type of thyroid disorders associated with the diabetic subjects.

* To determine the relationship between glycaemic control and thyroid dysfunction.

1.3       Justification of the objectives
The prevalence and pattern of various diseases including thyroid dysfunction vary from country to country and also shows temporal changes over centuries. This difference is mainly because of the fact that the causes of most of the diseases are multi factorial that is to say they depend on race, genetic makeup, dietary habits, lifestyle of individual as well as environmental factors which keep changing from place to place and time to time. Since the symptoms of hypothyroidism and hyperthyroidism are very similar to many other conditions and even in states of normal health (Abalovich et al., 2007), it is therefore important that thyroid function is tested biochemically alongside a careful clinical assessment of all diabetes mellitus patients. It is known that unidentified thyroid dysfunction could make management of diabetes and its complications more difficult. Therefore, management of thyroid dysfunction in patients with diabetes may prove useful.

For example, American Diabetes Association (ADA) has proposed that people with diabetes to be checked for thyroid disorders (Thakkar and Jain, 2011). A study among type 2 diabetes mellitus subjects at Korle- Bu Teaching Hospital in Accra, Ghana showed that 10.1 % type 2 diabetes mellitus population studied had thyroid dysfunction. However, data is not available on thyroid dysfunction and thyroid autoimmunity among the diabetes mellitus patients seen at Effia Nkwanta Regional Hospital, Sekondi, Ghana. This study aims to determine the frequency and types of thyroid dysfunction and thyroid autoimmunity among diabetic subjects at Effia Nkwanta Regional Hospital.

1.4       Expected benefits of the study
Determination of frequency and types of thyroid dysfunction and thyroid autoimmunity among diabetic patients in Ghana will help inform clinicians whether it will be worthwhile screening all diabetic patients for thyroid dysfunction. Epidemiological data would also be available on thyroid dysfunction and thyroid autoimmunity among diabetes mellitus patients seen at Effia Nkwanta Regional Hospital in Sekondi, which will serve as foundation for further studies.

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Item Type: Ghanaian Project Material  |  Attribute: 88 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH50  |  Delivery: Within 30Mins.
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