Abstract
Introduction: Thyroid disorder and DM are the two most common endocrine disorders encountered in clinical practice which have been shown to mutually influence each other and relationship between both the conditions had long been reported. A certain ECG changes have been recognized in thyroid disorder. this study conducted to see the relation of Thyroid gland with diabetes mellitus in already diagnosed diabetic patients.
Aim: To see the relation of Thyroid gland with diabetes mellitus in already diagnosed diabetic patients.
Material and Methods: A cross sectional study conducted in Rohilkhand Medical College and Hospital, Bareilly to see the relation of Thyroid gland with diabetes mellitus in already diagnosed diabetic patients. Total 130 Diabetes mellitus patients, 7 patients (5.4%) had T1DM and 123 patients (94.6%) had T2DM selected purposively for the study [Table 2].A patients were undergone to check the status of thyroid hormone, along with ECG. The data was collected and stastastically analyzed.
Results: Mean age of the all patients were 49.20 ± 13.2 years. The most common clinical signs are a narrowed pulse pressure, diastolic hypertension, low cardiac output, reduced EF impaired diastolic function and bradycardia.[18] Overt hypothyroidism is associated with accelerated atherosclerosis and CAD due to hypercholesterolemia and diastolic hypertension. 34% of hypothyroidism showed significant ST‑T ECG changes with angina and CAD on subsequent investigation. Reduced EF and diastolic dysfunction were also significant in this study. In hyperthyroidism, sinus tachycardia, AF, wide pulse pressure, dyspnoea on exertion, exercise intolerance are common.[17] Increased LV mass due to sustained volume overload with resultant cardiac work occurs in hyperthyroidism.[25] This may cause ST‑T ECG changes due to LV strain. In this study, sinus tachycardia was the commonest ECG finding (61%), LV chamber hypertrophy was the second common abnormality (43%). ST‑T ECG changes are due to LV strain occurs in 21% of cases of hyperthyroidism.
Conclusions: Horizontal ST- segment depression of 1mm or more 0.08 s from the J- point with T- wave inversion was the ECG finding in 15 hypothyroidism; 3 in anterior LV wall leads, 4 in inferolateral LV wall leads. 10 hypothyroidism has sinus bradycardia in ECG , being the second commonest ECG abnormality. All hypothyroidism with ST- T changes had stable angina. The present study findings are in conformity with earlier studies. Sinus tachycardia was the commonest ECG finding in the hyperthyroidism 6(40%);LV hypertrophy 3 (20%); prolonged Q-Tc interval 2(13.3%); LV strain(ST-T changes), Atrial fibrillation, Atrial ectopics and Ventricular ectopics 1(6.7%).
References
- Powers Alvin C. No Title. In: Harrison’s Principle of Internal Medicine. 18th ed.; 2008:2968-2969.
- World Health Organization. Global report on diabetes. World Health Organization; 2016. http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf.
- Wu P. Thyroid Disorders and Diabetes.; 2009. www.diabetesselfmanagement.com/about-diabetes/general-diabetes-information/thyroid-disorders-and-diabetes/
- Demitrost L, Ranabir S. Thyroid dysfunction in type 2 diabetes mellitus: A retrospective study. Indian journal of endocrinology and metabolism. 2012 Dec;16(Suppl 2):S334.
- Perros P, McCrimmon RJ, Shaw G, Frier BM. Frequency of thyroid dysfunction in diabetic patients: value of annual screening. Diabetic Medicine. 1995 Jul 1;12(7):622-7.
- Diez JJ, Sánchez P, Iglesias P. Prevalence of thyroid dysfunction in patients with type 2 diabetes. Experimental and Clinical Endocrinology & Diabetes. 2011 Apr;119(04):201-7.
- Radaideh AR, Mo MK, Amari FL, Bateiha AE, El-Khateeb MP, Naser PA, Ajlouni BK. diabetes mellitus in Jordan. Saudi Med J. 2004;25(8):1046-50.
- Papazafiropoulou A, Sotiropoulos A, Kokolaki A, Kardara M, Stamataki P, Pappas S. Prevalence of thyroid dysfunction among greek type 2 diabetic patients attending an outpatient clinic. Journal of clinical medicine research. 2010 Apr;2(2):75.
- Akbar DH, Ahmed MM, Al-Mughales J. Thyroid dysfunction and thyroid autoimmunity in Saudi type 2 diabetics. Acta Diabetologica. 2006 May 19;43 (1):14-8.
- Wu P. Thyroid disease and diabetes. Clinical diabetes. 2000 Jan 1;18(1):38.
- Kahaly GJ, Dillmann WH. Thyroid hormone action in the heart. Endocr Rev 2005;26:704‑
- Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med 2001;344:501‑
- Gursoy N, Tuncel E, Erturk E, Imamoglu S, Arinik A. The relationship between the glycemic control and the hypothalamus-pituitary-thyroid axis in diabetic patients. In DIABETOLOGIA 1997;1(40):1169-1169
- Coiro V, Volpi R, Marchesi C, Capretti L, Speroni G, Caffarri G, Chiodera P. Influence of residual C‐peptide secretion on nocturnal serum TSH peak in well‐controlled diabetic patients. Clinical endocrinology. 1997 Sep 1;47(3):305-10.
- Rezzonico J, Rezzonico M, Pusiol E, Pitoia F, Niepomniszcze H. Introducing the thyroid gland as another victim of the insulin resistance syndrome. Thyroid. 2008 Apr 1;18(4):461-4.
- Ayturk S, Gursoy A, Kut A, Anil C, Nar A, Tutuncu NB. Metabolic syndrome and its components are associated with increased thyroid volume and nodule prevalence in a mild-to-moderate iodine-deficient area. European Journal of Endocrinology. 2009 Oct 1;161(4):599-605.
- Klein I, Danzi S. Thyroid disease and the heart. Circulation 2007;116:1725‑35.
- Danzi S, Klein I. Thyroid Hormone and Blood pressure regulation. Curr Hypertens Rep 2003;5:513‑20.
- Cappola AR, Landenson PW. Hypothyroidism and atherosclerosis. J Clin Endocrinol Metab 2003;88:2438‑44.
- Biondi B, Klein I. Hypothyroidism as a risk factor for cardiovascular disease. Endocrine 2004;24:1‑13.
- Biondi B. How could we improve the increased cardiovascular mortality in patients with overt and subclinical hyperthyroidism? Eur J Endocrinol 2012;167:295‑9.
- Prakash A, Lal AK. Serum lipids in hypothyroidism: Our experience. Indian J Clin Biochem 2006;21:153‑5.
- Imaizumi M ischemic heart disease and all‑cause mortality in subclinical hypothyroidism. J Clin Endocrinol Metab 2004;89:3365‑70.
- Akahoshi M, Ichimaru S, Nakashima E, Hida A, Soda M, et al. Risk for
- Klein I, Hong C. Effects of thyroid hormone on cardiac size and myosin content of the heterotopically transplanted rat heart. J Clin Invest 1986;77:1694‑8.
- Greenfield WS. Autopsy findings in a 58 year old woman with myxoedema. Published as an appendix to Ord WM Med Chir Trans 1878;61:57.
Corresponding Author
Rakesh Kumar
Resident, Deptt. of General Medicine, Rohilkhand Medical College and Hospital, Bareilly, 243006, UP