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ABSTRACT
Year : 2020  |  Volume : 17  |  Issue : 1  |  Page : 43-50

ITSCON 2020 Abstracts


Date of Web Publication24-Apr-2020

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-0354.283223

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How to cite this article:
. ITSCON 2020 Abstracts. Thyroid Res Pract 2020;17:43-50

How to cite this URL:
. ITSCON 2020 Abstracts. Thyroid Res Pract [serial online] 2020 [cited 2020 Aug 7];17:43-50. Available from: http://www.thetrp.net/text.asp?2020/17/1/43/283223




  Abstracts for Poster Presentation Top



  Orbital radiation therapy is a safe and effective mode of treatment in Graves ophthalmopathy not responding to pulse methyl prednisolone and rituximab – A rare case report Top


Kishore Kumar Behera, Saroj Das Majumdar, Mantyu Chhatria, Smruti Ranjan Behera

Departments of Endocrinology,1Radiotherapy and2Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

E-mail: endocrin_kishore@aiimsbhubaneswar.edu.in

Introduction: Graves' disease develop a manifestation localizing to the orbit, called thyroid associated orbitopathy (TAO). we report a case with severe go not responding to pulse methyl prednisolone and rituximab but excellent response to Orbital radiation therapy.

Methods: Clinical Activity Score (CAS) was used to assess the response to the treatment. Decrease in Clinical Activity Score (CAS) by 2 points or reaching a CAS <3 is considered as response to the treatment.

Case: A 60 yrs. old man presented to us with 4 months history of itching and gritty sensation in both the eyes associated with lacrimation, redness and pain on eye movements. Then he noticed gradual protrusion of both eyes (Rt>Lt) and double vision. At baseline the CAS was 7/7 in right eye and 2/2 in left eye respectively indicating unilateral severe TAO. He was treated with a total cumulative dose of pulse methyl prednisolone of 6.5 gm along with rituximab (RTX) 2 gm was given. There is partial response to the treatment as assessed by clinical activity score (CAS). At baseline the CAS was 7/7 in right eye and 2/2 in left eye respectively; after above treatment CAS was still of 3/7 in right eye and 4/7 in left eye respectively. Hence he was treated with external beam lens sparing orbital radiotherapy. Two months after local RT, complete resolution of active eye disease with CAS was of 0/0 in right eye and 0/0 in left eyes, however he developed bilateral diplopia.

Conclusion: Severe TAO is rare but if not treated promptly can lead to vision loss. Refractory case needs multi-disciplinary approach. Radiotherapy is effective and safe mode of treatment.


  A novel case series of long standing untreated primary hypothyroidism Top


Anudeep Gaddam

Department of Endocrinology, Narayana Medical College, Nellore, Andhra Pradesh, India

E-mail: Anudeep.smile@gmail.comn

Introduction: With increasing availability of the thyroid function tests and easy availability of levothyroxine, it is rare in the recent days to find patients with long standing untreated hypothyroidism. Here we present such a case with various features, that are rarely seen in the present era.

Case 1: A-30-year-old gentleman, while being a part of an orphanage promotional event, was accidentally noticed by an endocrinologist and was suspected to have hypothyroidism. Patient had generalized body swelling, lethargy, cramps and difficulty in walking. His pulse rate was 67/min and blood pressure was 150/110 mmHg. He weighed 32.05 kg and was extremely short (height-114cm) with normal body proportions (US/LS: 1.1). He had broad, depressed nasal bridge, myxedematous facies, thick lips, macroglossia, dry, coarse skin cold extremities, and distended abdomen. He had waddling and antalgic gait. Sexual maturity rating was A1, P2,SPL:7cm,Rt testes: 15 cc and left testes: 12cc. Laboratory evaluation revealed undetectable free T4 with elevated TSH (76.52mIU/L). Anti TPO was slightly elevated 18.8 IU/ml. Serum creatinine was 1.18 mg/dl and serum albumin (4.2g/dl) and urine examination were normal. He had normocytic normochromic anemia (Hb-9.1g/dL). Roentgenography revealed grossly delayed bone age (8 years), irregular carpal bone and radial epiphyses with sclerosed margins, dysgenesis of long bone epiphyses with severe dysgenesis and dislocation of both femoral heads. Other radiological findings included Wormian bones in skull, deciduous teeth and reduced heights of vertebral bodies with widened disc spaces. Patient was started on incremental doses of levothyroxine replacement.

Case 2: A 24 year old female presented with primary amenorrhea, short stature , poor weight gain , headache, abdominal pain and altered slow responsiveness and no history of visual field disturbances/vomiting/head trauma/ chronic systemic illness and uneventful birth history . On examination patient is ill nourished with wt-16kg, ht- 112cm BMI- 12.76kg/m2. PR- 90bpm,regular normal volume and BP- 100/70 mm of Hg. Dry skin, generalized muscle wasting and hair loss noted. Dysmorphic features present with retrognathia, depressed nasal bridge, high arched palate and pallor +. No icterus, cyanosis and pedal edema. No thyromegaly. SMR- A1B2P1 Fundus showed generalized choriocapillary atrophy with pigmentary mottling with secondary macular deposits. Systemic examination is normal. Laboratory evaluation undetectable T4 with elevated TSH (>100 mIU/L). Anti TPO was slightly elevated 18.8 IU/ml. Serum creatinine was 0.65 mg/dl and serum albumin (3.15g/dl) and urine examination were normal. She had normocytic normochromic anemia (Hb-7.7g/dL). 2D echo revealed moderate pericardial effusion with cardiomegaly, EF- 50% and Bone age of approximately 3.5 years and MRI pituitary showed pituitary hypoplasia with partial empty sella . Patient was started on incremental doses of levothyroxine replacement.

Conclusion: Long standing untreated juvenile hypothyroidism cases still exist in India. All efforts should be made to identify these cases and ensure appropriate treatment of such cases because management of these cases are challenging.


  Epiphyseal dysgenesis: A forgotten radiological sign of hypothyroidism Top


Shambukari Praveen

Post Graduate, Department of Endocrinology, Narayana Medical College, Nellore, Andhra Pradesh, India

E-mail: sprskr@gmail.com

Introduction: With increasing availability of the thyroid function tests and easy availability of levothyroxine, it is rare in the recent days to find patients with long standing untreated hypothyroidism. Here we present such a case with various classical features, that are rarely seen in the present era.

Case: A-30-year-old gentleman, while being a part of an orphanage promotional event, was accidentally noticed by an endocrinologist and was suspected to have hypothyroidism. Patient had generalized body swelling, lethargy, cramps and difficulty in walking.His pulse rate was 67/min and blood pressure was 150/110 mmHg. He weighed 32.05 kg and was extremely short (height-114cm) with normal body proportions (US/LS: 1.1). He had broad, depressed nasal bridge, myxedematous facies, thick lips, macroglossia, dry, coarse skin cold extremities,and distended abdomen. He had waddling and antalgic gait. Sexual maturity rating was A1, P2,SPL:7cm,Rt testes: 15 cc and left testes: 12cc. Laboratory evaluation revealed undetectable free T4 with elevated TSH (76.52mIU/L). Anti TPO was slightly elevated 18.8 IU/ml. Serum creatinine was 1.18 mg/dl and serum albumin (4.2g/dl) and urine examination were normal. He had normocytic normochromic anemia (Hb-9.1g/dL). Roentgenography revealed grossly delayed bone age (8 years), irregular carpal bone and radial epiphyses with sclerosed margins, dysgenesis of long bone epiphyses with severe dysgenesis and dislocation of both femoral heads. Other radiological findings included Wormian bones in skull, deciduous teeth and reduced heights of vertebral bodies with widened disc spaces. Patient was started on incremental doses of levothyroxine replacement.

Conclusion: Long standing untreated juvenile hypothyroidism cases still exist in India, often in orphanages. All efforts should be made to identify these cases and ensure appropriate treatment of such cases.


  Unusual presentation of Grave's disease Top


M. Mowlika, Y. V. L. Narasimham

Department of Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India

E-mail: dr.mowlika@gmail.com

Summary: A 36 years old female presented with angioedema to casualty. She also had significant weight loss and small joint pains for 6 months and had diffuse goitre on examination .On evaluation she was found to have thyrotoxicosis. Rheumatoid factor and Anti-CCP Antibodies are also positive. Patient was treated with steroids, antihistamines , antithyroid drugs and immune-modulatory therapy. Patient improved and doing well.


  Effect of hypothyroidism on growth parameters in type 1 diabetes mellitus Top


Manasa Mynepally

Department of Endocrinology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

E-mail: manasaprasadmdr@gmail.com

Introduction: Autoimmune thyroid disease is the most prevalent immunological disease in patients with type 1 DM. Various studies have reported a prevalence of 12-20%.However,studies to determine the natural history of thyroid dysfunction and its effect on growth are lacking.We aim to study the association of hypothyroidism and type 1 diabetes and its impact on growth in these children.

Aims of the Study: To study the characteristics of children with type 1 DM with associated hypothyroidism. To study the impact of hypothyroidism on growth parameters in relation to the TSH level and duration of disease.

Materials and Methods: Study was conducted in Department of Endocrinology on 60 patients with type 1 diabetes atleast for a period of one year. Anthropometric parameters(ht,wt BMI),mean HbA1c,mean TSH since the time of diagnosis, anti TPO antibodies were taken.

Results: Out of 60 patients with type 1 DM,10 patients had hypothyroidism(16.6%) and 6 had anti TPO positivity(10%) .Among anti TPO positive patients,4 had hypothyroidism.1 patient was excluded due to associated celiac disease.In the remaining 9 patients,8 were females and had a mean age at diagnosis of 14years 1 month.Mean duration of onset of hypothyroidism after the diagnosis of type 1 DM was 3 years,9 months.6 patients were identified as a part of screening program yearly,2 had symptoms and 1 had recurrent hypoglycemia.Mean HbA1c was 9.47% compared to 10.33% in patients without hypothyroidism.Mean ht SDS was -2.02 compared to -1.18, and mean BMI was 17.58kg/m2 compared to 17.41 in patients without hypothyroidism.Patients with higher mean TSH values and longer duration of hypothyroidism had greater deficit in heights.

Conclusion: Incidence of hypothyroidism was higher in females. HbA1c was lower and height deficit was greater in patients with hypothyroidism, particularly with higher TSH values and longer duration.Our study also reflects the importance of annual screening by serum TSH to detect asymptomatic thyroid dysfunction.


  Factors predicting the treatment outcome to radio iodine therapy in Grave's disease Top


C. M. Shyam Sundar, K. A. V. Subrahmanyam

Department of Endocrinology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

E-mail: Shyamsundarcm8790@gmail.com

Radioiodine is a safe and effective management option in Grave's disease. The aim of I131 treatment varies between centres although many now target hypothyroidism. Earlier studies have shown high t4 to be predictor of radio iodine therapy failure, some studies have shown no significant correlation among predictors. we studied the predictors to outcome after RIA.

Aims and Objectives: To study the correlation between various predictors with outcome upto 1 year after I131 ablation in Graves' disease.

Materials and Methods: Retrospective study, of patients who have undergone RIA between July 2018 and Dec 2018.

Inclusion Criteria: Graves' disease, aged 18-70yrs, treated with I131 de novo or after anti thyroid drugs.

Exclusion Criteria: Previous radio iodine therapy, toxic adenoma, multi nodular goitre.

Demographic data, Thyroid function test prior toI131therapy, at 3, 6 months and 1 year after the procedure was analysed. Outcome recorded as hypothyroid, euthyroid, hyperthyroid,

Results: 61 of the 96 patients were included in analysis. Females were 49, female to male ratio was 4:1. Mean age, 39 years. The average dose of I131was 12.10 mCi. 88.52% (54) patients became Hypothyroid or euthyroid, and 7 patients remained hyperthyroid. Female sex, age between 41-50 years, more than 10% technetium uptake, lower total T3 <300ng/dl, T3/T4 ratio >20 were associated with better outcome. 10 mCi I131 had better outcome than 15 mCi.

Conclusion: Various factors affect the outcome of RIA, there is no single predictor of outcome.




  Abstracts for Oral Presentation Top



  Effect of Vitamin D supplementation on thyroid autoimmunity among subjects of autoimmune thyroid disease in a coastal province of India: a randomized open label trial Top


Kishore Kumar Behera, Gautom Kumar Saharia1, Debasish Hota2, Durgesh Prasad Sahu3, Madhusmita Sethy4, Anand Srinivasan2

Departments of Endocrinology,1Biochemistry,2Pharmacology,3Community and Family Medicine and4Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

E-mail: endocrin_kishore@aiimsbhubaneswar.edu.in

Objective: Hashimoto's thyroiditis (HT) is a variant of autoimmune thyroid disorders (AITD) which has been associated with vitamin D (vit-D) deficiency. However, whether vit-D supplementation is linked to reduction of thyroid autoantibodies and improvement of thyroid function is not well characterized. The present study was planned to evaluate the effect of vit-D supplementation on possible improvement of thyroid autoantibody titre and thyroid hormone profile in patients with AITD subjects.

Methods: Twenty three patients of HT were given weekly supplementation of 60,000 IU vit-D for 8 weeks followed by once a month for another 4 months.

Results: Mean serum vit-D was increased significantly from 15.33 ± 5.71 to 41.22 ± 12.24 ng/mL (normal healthy levels) after supplementation. There were significant increase in thyroid autoantibody titre (from 746.8 ± 332.2 to 954.1 ±4 59.8 IU/ml; p = 0.006) and TSH level (7.23 ± 3.16 to 3.04 ± 2.62 (mU/mL); p = 0.01) following 6 months of vit-D supplementation.

Conclusion: Vit-D levels were low in AITD patients in eastern India. Vit-D supplementation in HT patients increased autoimmunity and there was significant reduction in serum TSH levels.


  Medullary and differentiated thyroid carcinoma as a collision tumor - A case report Top


M. Rajesh, B. Vivekananda, A. Mythili, Jayanthy Ramesh, K. A. V Subrahmanyam

Department of Endocrinology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

E-mail: Mvhs13@gmail.com

Introduction: Medullary and differentiated carcinoma of thyroid are two different thyroid malignancies. The simultaneous occurrence of both of them as collision tumour with mediastinal metastasis is a rare phenomenon.

Case Report: 39 year old woman with swelling in front of the neck underwent left hemithyroidectomy 10 years ago, in view of FNAC showing follicular neoplasm. She was asymptomatic and 10 years later presented with swelling on left side of neck and evaluation revealed medullary thyroid carcinoma for which completion thyroidectomy with lymph node dissection was done. Postoperative whole body iodine scan showed radioiodine avid significant functioning remnant thyroid tissue with mediastinal metastasis suggestive of differentiated thyroid carcinoma. Accordingly, radioiodine ablation was done and was on follow up with thyroglobulin and calcitonin levels. Conclusion: Collision tumours though rare, pose diagnostic as well as therapeutic challenge due to the dual pathology that they harbour. Treatment should be patient specific and is directed by the more aggressiveness of the tumours.




  Abstracts for Poster Presentation Top



  Thyrotoxic periodic paralysis: A subtle presentation of hyperthyroidism Top


Golla Anmol Manaswini Yadav, C. Venkateshwarlu, P. Amit Kumar, Varsha Reddy, Mounika, Manjula, Satya Shika

Department of General Medicine, Mallareddy Institute of Medical Sciences, Hyderabad, Telangana, India

Background: Thyrotoxic periodic paralysis (TPP) is a rare and potentially lethal complication of hyperthyroidism which is characterized by sudden onset paralysis associated with Hypokalemia. Management includes prompt correction of Serum Potassium, which results in recovery from paralysis and definitive treatment of hyperthyroidism resolves TPP completely.

Here we present a Case report of 33 yr old male presenting to medical emergency room (ER) at 6 am with chief complaints of weakness of both lower limbs and left upper limb of 5 hrs duration. No history of headache, vomiting, altered sensorium, increased appetite, diarrhoea, weight loss, palpitation and sweating. The patient was afebrile with pulse rate of 108/min, BP-110/70mmHg. Neurological examination revealed 0/5 power in both lower limbs, 3/5 in left upper limb (proximal more than distal) decreased to absent deep tendon reflexes, plantars equivocal with intact sensations and superficial reflexes. The right upper limb was normal. In ER, ECG showed ST depressions and U-waves suggestive of Hypokalemia. Initial serum potassium level was 1.8 mmol/L. Intravenous potassium was given, following which weakness improved completely within 8 hrs. Thyroid Stimulating Hormone (TSH) was <0.01 μIU/mL, free-T3 was 6.5 picogm/mL, free-T4 was 2.59 ngm/dL. Tc99m-Pertechnetate thyroid scan showed uniformly increased tracer uptake of thyroid gland which was consistent with Grave's disease.

Conclusion: TPP is typically reported among young Asian men and may be the first presenting feature of thyrotoxicosis and may be atypically present and likely to be overlooked at the first diagnosis. TPP should be taken into consideration in the differential diagnosis of sudden onset of motor weakness with hypokalemia among young male patients.

Keywords: Grave's disease, hyperthyroidism, hypokalemia, thyrotoxic periodic paralysis


  A distinctive and rare association of hypothyroidism with hypohidrotic ectodermal dysplasia syndrome Top


Afsar Fatima

Department of Endocrinology, Narayana Medical College, Nellore, Andhra Pradesh, India

E-mail: afsi.doc@gmail.com

Introduction: Hypohidrotic ectodermal dysplasia [HED] is a rare heterogeneous disorder of skin and its appendages, characterized by hypohidrosis, hypotrichosis, adentia, nail dystrophy, ophthalmic complications and enteropathy. The association of HED with primary hypothyroidism [HEDH syndrome] was first reported by Pabst etal(1981). Less than 5 such cases have been reported worldwide. It is inherited in X-linked recessive pattern, while autosomal dominant[AD] and recessive[AR] are relatively rare. We report this condition in a 17 year girl, with her two siblings who share the manifestations of HED but lacking thyroid abnormality.

Case Details: The proband is second among three affected by HED, born out of 30consanguinity to healthy parents. She presented for poor chest development from childhood, irregular menstruation and fatigue. She noticed swelling of neck from past 8 years, progressively increasing in size. She has recurrent respiratory tract infections in the past. She had an uneventful birth and developmental history but craniofacial dysmorphism was noticed around 8 years. On examination, was found to have hypotrichosis, absent dentition, decreased sweating with heat intolerance, photosensitivity, amastia which were noted in other siblings, hence a familial inherited AD disorder of HED was diagnosed. She is the shorter among siblings, thin built, BMI-16 Kg/m2, SMR-A1B1P2. Physical examination showed grade III goiter of 6*3*5cm, surface nodular, no fixity/bruit/lymphadenopathy. There was periorbital hyperpigmentation, nasal sebaceous gland hypertrophy and raspy voice. Her lab reports were unremarkable except for TSH-12.78 mIU/l,FT3-0.39ng/dl, FT4-1.48pg/ml, started on 25mcg thyroxin. Ultrasound thyroid showed inhomogeneous enlarged lobes with hypoechoic nodules. Anti-TPO is negative. USG breast showed no definite tissue, abdomen USG was normal. Dermatology opinion was sought and genetic analysis was planned.

Conclusion: the clinical findings in our case are analogous with Hypohidrotic Ectodermal Dysplasia, which is a rare condition with various clinically indistinguishable genetic entities. The occurrence of multiple systems including ectodermal derivatives with mesodermal thyroid, endodermal respiratory tract may be linked to a common embryological insult due to close proximity of thyroid under defective ectodermal tissue during development. Management is broadly conservative with genetic counselling. Hence a multidisciplinary approach is required to look for endocrine manifestations in such rare hereditary disorders.


  Case Report: An intriguing case of Graves' disease with dysphagia Top


J. Singh, A. Manglunia, S. Mangaraj, J. Swain,

J. B. Kanwar, A. Sahoo

Department of Endocrinology, IMS and SUM Hospital, Bhubaneswar, Odisha, India

E-mail: 11.jaspreet.singh@gmail.com

Graves' disease (GD) is a common endocrine disorders and is the most common cause of spontaneous hyperthyroidism. It is associated with various autoimmune disorders such as myasthenia gravis (MG) and type 1 diabetes mellitus. A 37 year old female, presented with palpitation, weight loss and generalized fatigability for last 2 months. On evaluation she was found to have diffuse grade 2 goitre and signs of overt thyrotoxicosis. On further enquiry she revealed occasional dysphasia for last 4 weeks. In view of above symptoms, a detailed neurological assessment was done. In addition to overt signs of thyrotoxicosis we also noticed presence of left eye ptosis and proximal muscle weakness. Detailed investigation including repeated nerve stimulation and AchR antibody testing were suggestive of Myasthenia gravis. She also had evidence of generalized alopecia. CECT Thorax revealed bilobed thymic hyperplasia. Due to above finding, final diagnosis of Autoimmune Polyendocrine Syndrome III was made. She was started on Anti thyroid drugs and medications pertaining to Myasthenia with prompt resolution of symptoms. The coexistence of GD and ocular MG poses a significant diagnostic dilemma to treating physicians. The ocular manifestations of myasthenia can be easily missed in case of GD and falsely attributed to thyroid associated ophthalmopathy due to closely mimicking presentations of both. An unrecognized and untreated hyperthyroidism aggravates myasthenia and can rarely precipitate a fatal myasthenia crisis. Hence, a high degree of the clinical vigil is necessary in such cases to appreciate their presence.


  Medullary thyroid carcinoma in a patient with hyperthyroidism: Unusual clinical coexistence Top


O. Raghupathi, B. Vivekanand, A. Mythili, K. A. V. Subrahmanyam, Jayanthy Ramesh

Department of Endocrinology, Andhra Medical College/King George Hospital, Visakhapatnam, Andhra Pradesh, India

E-mail: Raghu.mbbs07@gmail.com

Thyroid cancer is occasionally associated with hyperthyroidism. Papillary thyroid carcinoma is the most frequently reported histologic type followed by follicular thyroid carcinoma. Medullary thyroid carcinoma (MTC) has been rarely described in association with Graves' disease or other forms of hyperthyroidism. To our knowledge, only 15 cases have been described in which MTC was associated with hyperthyroidism. Our aim is to present a case in which we diagnosed MTC coexisting with hyperthyroidism resulting from a nodular goiter. A 33 years old female with hyperthyroidism for the last 4 years on irregular treatment with anti thyroid drugs presented with a recent increase in neck swelling with no compressive symptoms. On examination she had mucosal neuromas over the tongue. Evaluation of ultrasound of thyroid and FNAC suggestive of medullary thyroid carcinoma . She was diagnosed as hyperthyroidism with medullary thyroid carcinoma. Evaluated for other manifestations of MEN 2B and advised genetic analysis and treated with total thyroidectomy with neck exploration. This case is particularly interesting because 11 of the 15 cases in the literature had Graves disease but our case is toxic nodular goiter. Till now no case of medullary thyroid carcinoma with hyperthyroidism with mucosal neuromas has been reported.


  Thyroid dysfunction in patients with type 2 diabetes mellitus Top


Y. Kavyachand, T. Ramanamurthy, S. V. Parvathisam

Q1 Hospitals, Health City, Visakhapatnam, Andhra Pradesh, India

E-mail: chandk2010@gmail.com

Introduction: Prevalence of thyroid diseases are higher in people with diabetes mellitus than those without diabetes mellitus. Among the thyroid dysfunctions subclinical hypothyroidism is the most common abnormality as per previous studies. Autoimmunity is the main reason explaining the association between type 1 diabetes mellitus and thyroid dysfunction. Though the mechanism behind association between type 2 diabetes mellitus and thyroid dysfunction is not clear it could be due to abnormal TSH response to TRH, absence of nocturnal TSH peak and a low T3 state. Recognition and management of thyroid dysfunction in diabetes mellitus helps to achieve a good glycemic control & decrease the cardiovascular risk.

Aims and Objective: The aim of the present study was to find the prevalence of thyroid dysfunction in patients with type 2 Diabetes mellitus (type 2 DM) attending an outpatients department and medical wards at Q1hospitals-VIZAG.

Materials and Methods: Diabetic patients attending diabetic clinic OPD and admitted in medical wards OF Q1HOSPITALS,VIZAG (50 diabetic patients (type II) and 50 non diabetic)were included in study group. All patients with diseases (DKA and CRF) and drugs (Lithium and Amiodarone)that can affect thyroid disease were excluded. Sample taking and Biochemical markers: Criteria used in the study for diagnosis of type 2 DM (According to American Diabetic Association) are 1)FBS (Fasting Blood Sugar) - ≥ 110 mg/dl and 2) RBS (Random Blood Sugar) - ≥ 200 mg/dl or taking hypoglycemic drugs and/or using insulin and did not have any ketosis in the past. Venous Blood sample were taken and assessed for thyroid function tests such T3, T4 and TSH and other biochemical markers such as FBS, HbA1c. Normal range of the serum13levels were 70-210 ng/dl for T3; 5.5-11.8 μg/dl for T4and 0.3-5.5 μIU/ml for TSH.

Methods: T3 and T4 estimated by using Chemi Lumination Immuno Assay (CLIA) and TSH was estimated using Ultra Sensitive CLIA method. Normal ranges for FBS is 70-110 mg/dl; for HbA1c is 4.0-6.0%; for Total cholesterol is 150-200 mg/dl; for Serum triglycerides is 40-160 mg/dl; for Serum HDL is 35-60 mg/dl; for Serum LDL is <130 mg/dl; for Serum VLDL is 5-35 mg/dl; FBS was measured by GOD POD method; HbA1c by Hyper performance Lipid Chromatography (HPLC); TG by Enzymatic Colonometry method; HDL ,LDL and VLDL by Homogenous Enzymatic Colonometry Assay method.

Results: The sex and age distribution of diabetic and non diabetic patients is shown in table 1. Type 2 DM patients include 18 males and 32 females whereas non diabetic patients include 22 males and 28 females with mean age of 43.16 ± 5.06 and 45.37 ± 6.19 respectively. 2) This study shows the levels of various biochemical parameters in diabetic and non diabetic patients. Serum cholesterol, serum TG, LDL, VLDL, Fasting blood sugar and HbA1c were significantly higher in diabetic patients as compared to non diabetic patients. 3] This study shows the level of serum thyroid hormones in diabetic and non diabetic patients. The serum levels of T3and T4 were significantly lower in diabetic compared to non diabetic patients whereas level of serum TSH was significantly higher in diabetic patients as compare to non diabetic patients. 4] This study shows thyroid disorder according to the gender in type 2 DM and non diabetic control subjects. Out of 50 type2 DM subjects, 30 % shows abnormal thyroid functions (22% had hypothyroidism and 8 % had hyperthyroidism) and 70 % shows normal thyroid functions. The incidence of thyroid disorder is more in females as compare to males in type 2 DM.

Discussion and Conclusion: This study show high prevalence (30 %) of thyroid dysfunction in type 2 DM. Subclinical hypothyroidism being the most common in type 2 DM. So, routine assay of thyroid hormones in type 2 DM And treatment is needed in those patients whose conditions are difficult to manage.


  Study of high sensitive C-reactive protein and lipid profile in subclinical hypothyroidism Top


Shambukari Praveen

Department of Endocrinology, Narayana Medical College, Nellore, Andhra Pradesh, India

E-mail: sprskr@gmail.com

Background and Objectives: Subclinical hypothyroidism is much more common than overt hypothyroidism. Subclinical hypothyroidism may be associated with increased risk of coronary artery disease (CAD),left ventricular diastolic dysfunction, peripheral vascular disease, and its markers like hsCRP and various biochemical abnormalities including increased LDL levels, increased total cholesterol and serum triglyceride values.Therefore, early diagnosis and treatment may prevent the onset of overt hypothyroidism and its associated effects.In this study we tried to estimate hsCRP and lipid abnormalities and left ventricular diastolic dysfunction in subclinical hypothyroidism.

Methods: We studied 50 subclinical hypothyroid subjects and estimated their hsCRP,lipid profile and their cardiovascular function by echocardiography and analysed the data .

Results: hsCRP was in high risk (>3mg/L) in 72% of subclinical hypothyroid .60% had elevated total cholesterol and 42% had elevated LDL.68% of subclinical hypothyroid had left ventricular diastolic dysfunction.

Interpretation and Conclusion: In our study we found that subclinical hypothyroid subjects have significant elevation in hsCRP and total cholesterol and LDL. It is also associated with left ventricular diastolic dysfunction and hsCRP is a strong predictor.And hence it is necessary to screen and treat high risk group for subclinical hypothyroidism and its adverse outcomes to minimize serious complications.

Keywords: High sensitive C-reactive protein, left ventricular diastolic dysfunction, low density lipoprotein, subclinical hypothyroidism, total cholesterol


  Study of subacute thyroiditis in community-based endocrine practice Top


V. Madhava Rao

Consultant Endocrinologist, GIDE Hospital, Kakinada,

Andhra Pradesh, India

E-mail: drmadhavaiims@rediffmail.Com

Objective: To describe clinical features, T3/T4 ratio and TSH receptor antibodies (TRAB) in individuals with subacute thyroiditis (SAT).

Methods: Retrospective case series of 11 individuals from a community endocrine practice over 4 years.

Results: Female: male ratio was 9:2. Mean age of the study subjects was 40.9 years. Mean T3/T4 Ratio was (12.38). TRAB was done in five individuals and in all the five individuals it was below the cutoff for Graves' disease.

Conclusion: T3/T4 Ratio less than 15 had 81.8 % sensitivity.TRAB excluded Graves' disease in all the individuals with clinical diagnosis of SAT in this study. T3/T4 ratio is a simple biochemical test to differentiate SAT from Graves' disease in our setting.


  Selective degradation of thyroglobulin to control thyroxin formation in hyperthyroidism (Graves' disease) Top


Navya Sree Susarla, Ravikiran S. Yedidi

Post Graduate Bsc.2nd Year, The Centre for Advanced-Applied Biological Sciences and Entrepreneurship

E-mail: tcabse.india@gmail.com

Hyperthyroidism/Graves' disease causes hyper metabolism due to the excess production and release of thyroxin (T4). Thyroglobulin (Tg) protein is critical in the production of T4. In this study, we hypothesize that by selective degradation of Tg through a small molecule PROTAC one can decrease the production and release of T4 in hyperthyroidism. At present, we performed the structural analysis of Tg to identify the binding sites for the proposed PROTAC molecule. The molecule has to be synthesized and evaluated further.


  Inhibitor targeting the epitopes on human thyroid peroxidase to protect human thyroid peroxidas from auto-antibodies in Hashimoto's disease Top


Sonanjali Uddaraju, Ravikiran S. Yedidi

Post Graduate Bsc.3rd Year, The Centre for Advanced-Applied Biological Sciences and Entrepreneurship

E-mail: tcabse.india@gmail.com

Hypothyroidism (Hashimoto's diseases) is a condition commonly seen due to the development of autoimmunity against thyroid proteins such as the human thyroid peroxidase (hTPO). The hTPO is critical in the production of thyroxin (T4). We hypothesize that by designing small molecule inhibitors that specifically bind the epitopes on hTPO, one can protect the hTPO from the attacking auto-antibodies and rescue the normal levels of T4 in the blood. The epitopes have been computationally analysed and the inhibitors have been designed which are yet to be synthesized and evaluated in future.


  Selective degradation of thyroglobulin to control thyroxin formation in hyperthyroidism (Graves' disease) Top


Swarnalatha Gandi, Ravikiran S. Yedidi

Post Graduate Bsc.2nd Year, The Centre for Advanced-Applied Biological Sciences and Entrepreneurship

E-mail: tcabse.india@gmail.com

Graves' disease (hyperthyroidism) is one of the thyroid disorders in which the blood levels of thyroxin (T4) are higher than physiologically required. T4 release is controlled by the lysosomal protease-mediated degradation of thyroglobulin. In this study, we hypothesize that if one can selectively inhibit the lysosomal proteases, then the release of T4 can be controlled in Graves' disease. Inhibitors were designed using computational tools. These inhibitors are to be synthesized and evaluated in future.


  Etiological profile of thyroid disorders in children and adolescents at a tertiary care hospital in South India Top


Afsar Fatima

Department of Endocrinology, Narayana Medical College, Nellore, Andhra Pradesh, India

E-mail: Afsi.doc@gmail.com

Introduction: Normal thyroid gland function is critical for early neurocognitive development as well as for growth and development throughout childhood and adolescence. Thyroid hormone abnormalities are the commonest endocrine disorder in India and also most common preventable and reversible cause of mental retardation. In the absence of neonatal screening, thyroid disorders remain largely unrecognized in Indian children and adolescents.

Aim: To determine the prevalence, clinical profile, aetiology and associated co-morbidities of thyroid dysfunction in children and adolescents.

Materials and Methods: A retrospective, hospital based, observational study was conducted at a tertiary care hospital in south India. Patients younger than 18years of age attending Endocrinology out-patient department with proven thyroid dysfunction were included in the study. Demographic data, history and clinical features of the recruited children were noted .Routines with Thyroid profile consisting of Tri-iodothyronine (T3), thyroxine (T4) , free hormones and Thyroid stimulating hormone (TSH) levels were tested in all. Investigations for identifying cause and complications of hypothyroidism were carried out.

Results: A total of 93 children found to have thyroid function abnormalities were studied, of which 51 are female, 42 male. Graves was noted in 4, hypothyroidism noted in 88 , majority being Hashimoto(50), subclinical(16), congenital central(8)., ectopic thyroid and dyshormonogenesis in 4 and 6 cases respectively. Ratio of congenital to aquired cause in age group <1,1-5, 5-10,>10 years are 100:0, 66.6:33.3, 17.3:82.6, 13.4:86.5 respectively. A host of co-morbidities, developmental delay, maternal risk factors were observed along with thyroid dysfunction on lab and radiological procedures.

Conclusion: There is a high occurrence of autoimmune hypothyroidism in paediatric age group in south India and need for similar studies from different regions of the country covering larger population are in dire need as early diagnosis may abate subsequent residual sequelae.


  The relation between thyroid stimulating hormone and visceral adiposity Top


S. L. Sagar Reddy, B. Vivekanad, A. Mythili, Jayanthy Ramesh, K. A. V. Subrahmanyam

Department of Endocrinology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

E-mail: Sagarreddy0mbbs@gmail.com

Introduction: Visceral obesity is a major risk factor for many medical conditions. Though correlation exists between TSH and adipose tissue, scarce and conflicting data is present for TSH and visceral adiposity. Westerink et al showed positive correlation between TSH and visceral fat, whereas no association was found in a study by Witte et al. Ultrasonography is a low-cost, reproducible, reliable, non-invasive and validated technique for measurement of VAT.

Aims: To determine relation between TSH and visceral adiposity in Anti- TPO negative euthyroid subjects. To determine if similar relation extends into subclinical hypothyroidism(SCH).

Materials and Methods: 58 Anti –TPO negative euthyroid subjects and 21 SCH , aged 18 -70 years were included in the study. Anthropometry, thyroid functions, lipid functions were measured and visceral fat(VAT) and subcutaneous fat(SAT) measurements were taken using ultrasonography.

Results: (1) Anti –TPO negative subjects had average age of 20.41years, BMI of 21.07kg/m2, Mean SAT of 1.61cm and Mean VAT of 5.96cm. (2) SCH patients had average age of 42 years, BMI of 25.9kg/m2, Mean SAT of 1.95cm and Mean VAT of 9.02cms. (3) On correlation analysis, higher TSH quartiles positively correlated with increasing VAT,SAT and BMI.

Conclusion: Higher plasma TSH in normal range were associated with more visceral fat. This relation persisted even in Subclinical Hypothyroidism patients.






 

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