Influence of the Subclinical Hypothyroidism on the Left Ventricular Systolic and Diastolic Function (pilot study)

Introduction: The clinically manifested hypothyroidism is associated with systolic and diastolic dysfunction. Studies investigating the left ventricular function in subclinical hypothyroidism (ScH) have shown controversial results. The aim of the study was to assess whether ScH is associated with the left ventricular systolic and diastolic dysfunction. Material and methods: Seventeen consecutive patients with newly diagnosed ScH and 20 healthy euthyroid patients as controls were analyzed. The two groups were appropriate by: age, sex, and body mass index. Laboratory analyses were performed in all patients - determination of TSH, free thyroxin (FT4), free triijodothyronine (FT3), antibodies directed to thyroid peroxidase (TPOAb) and antitiroglobulin antibodies (TgAb), and the assessment of left ventricular systolic and diastolic function by M-mode, two-dimensional echocardiography, pulse, continuous and color-Doppler, advanced echocardiographic modalities Tissue Doppler (TDI) and two-dimensional speckle tracking. Results: ScH patients had statistically significant lower ejection fraction, smaller ratio s/d (where s is the systolic velocity and d is the diastolic velocity through the pulmonary veins) and lower negative longitudinal global strain compared with the control group (62.1 ± 2.1 vs. 58.7 ± 6.2%, p<0.05, 1.27 ± 0.12 vs. 1.06 ± 0.20, p<0.001, -0.21 ± 0.01 versus -0.19 ± 0.01%, p<0.05, respectively). There was a statistically significant negative correlation of TSH with s/d and S/ TDI (r = 0.43 and r = 0.26, p<0.05, respectively). There was a statistically significant negative correlation of free thyroxine with myocardial performance index (r = -0.17, p<0.05), and a positive correlatin with s/d (r =0.48, p<0.05). Conclusion: ScH was associated with a statistically significant reduction in global systolic and global longitudinal systolic function of the left ventricle

Comparison of Diet, Metformin and Insulin in the Treatment of Gestational Diabetes Mellitus

Objective: The aim of the study was to compare maternal and neonatal outcomes in patients with gestational diabetes mellitus (GDM) treated with metformin versus those with insulin, or diet alone. Material and methods: The study included 24 GDM women treated with metformin, 21 treated with insulin, and 17 women only on diet. All patients were from Outpatient Department of Endocrinology in the period from May, 2008 to October, 2010. Results: The three groups were comparable with respect to age, pre-pregnancy body mass index (BMI), weight gain during pregnancy, gestational week at enrolment, smoking cigarettes and positive family history for diabetes. Mean glycosylated haemoglobin (HbA1c) at 37 gestation week was lower in diet and metformin groups than insulin group (4,5±0,9, 5,3±0,7, and 6,1± 1,3 %, respectively, p< 0,01). Postprandial glycaemia (PPG) statistically significant differed in diet from metformin group (6,2±2,1 v.s. 7,5±1,1 mmol/L, p< 0,05) and in diet as to insulin group (6,2±2,1 v.s. 8,3±2,3 mmol/L, p< 0,01). There were statistically significant difference in mean gestational age at delivery, between the three (diet, metformin and insulin) groups (39,1±2,2; 38,7±1,6 and 37,3±2,4 gestation week, respectively, p< 0,05). The incidence of neonatal hypoglycemia was higher in the insulin group (52,4%) than in the metformin (33,3%) and diet group (17,6%), but there was statistically difference between insulin and diet group (p=0,04). No differences between the groups were observed in mode of delivery, birth weight, and incidence for large or small for gestational age. Conclusion: Metformin is effective, easy and safe in controlling GDM. Author Keywords: Gestational diabetes mellitus, metformin, insulin, glycaemia

Effect of lipid parameters on fetal growth in type 2 diabetes mellitus and gestational diabetes mellitus pregnancies

Background: During pregnancy,complex changes occur in lipid profiles. The aim of the study was to evaluate the effect of lipid parameters on fetal growth in type 2 diabetes mellitus (D.M) and gestational diabetes mellitus (GDM) pregnancies. Material and methods: In forty three type 2D.M. and two hundred GDM women pregnancies were analyzed: age, body mass index (BMI), lipid parameters, HbA1c in first, second and third trimester of pregnancy, preeclampsia, and baby birth weight. Results: D.M. tip 2 and GDM group were statistically significant different in the following variables: total lipids, triglycerides, total cholesterol, BMI, age, baby birth weight, and incidence of SGA (9.4±2,3 vs. 11,0±2,3mmol/L, 2,4±1,4 vs. 3,4±1,6mmol/L, 5,5±1,2 vs. 6,4±1,4mmol/L, 30,6±5,4 vs. 26,9±5,2 kg/m2, 34±7,8 vs. 31,5±5,6 years, 3183±972 vs. 3533±699 g., 20% vs. 7,5%, respectively, p<0,05). Statistically significant correlations were found between triglycerides and HbA1c (r=0,18, p<0,05), HDL-C and HbA1c (r=-0,19, p<0,05), HDL-C and large for gestational age (LGA) (r=-0,17, p<0,05), small for gestational age (SGA) and Hba1c (r=0,29, p<0,05). LinearmultipleregressionanalysisdemonstratedthatLDL-C,triglycerides, and total cholesterol were independent predictors of LGA (p<0,05). Conclusion:LDL-C and triglycerides are predictors for macrosomia in type 2 D.M and GDM pregnancies.Thus, with good regulation of lipid profile we can avoid macrosomia from type 2 D.M and GDM pregnancies. Key words: lipid parameters, gestational diabetes mellitus, type 2 diabetes mellitus, macrosomia

Effects of Hormone Replacement Therapy on Insulin Resistance in Postmenopausal Diabetic Women

BACKGROUND: Insulin resistance (IR) is closely associated with diabetes mellitus. On the other hand, increased visceral fat in menopause is also associated with IR, which makes postmenopausal diabetic women in a big risk for cardiovascular diseases. There are conflicting reports about the effects on hormone replacement therapy (HRT) on IR.AIM: The aim of the study was to investigate the effects of HRT on IR.METHODS: A total of 40 postmenopausal women with type 2 diabetes were enrolled and followed for 12 months. Half of them were assigned to take HRT, while the other half made the control group. Fasting plasma glucose (FPG) and insulinemia were measured in both groups at baseline and after 12 months. IR was represented by Homeostatic model assessment for IR (HOMA-IR).RESULTS: HRT was associated with significant decrease in HOMA-IR, FPG and insulinemia in the examined group. There was no significant reduction in FPG and no significant increase in insulinemia levels and HOMA-IR values in control group after 12 months.CONCLUSION: HRT was associated with statistically signifficant increase of insulin sensitivity. Larger clinical trials will be necessary to understand whether HRT may improve insulin resistance and glucose homeostasis in women with diabetes, especially when given shortly after entering menopause

Sensitivity and specificity of anti-cyclic citrullinate peptide antibody and IGM rheumatoid factor in serologic diagnosis of rheumatoid arthritis

Introduction. In recent years, anti-cyclic citrullinated peptide (anti-CCP) antibodies have been used as highly specific and sensitive markers in diagnosis of rheumatoid arthritis (RA). The aim ot he study was to determine sensitivity and specificity of anti-CCP antibodies and IgM rheumatoid factor in patients with RA and their association with serological markers of disease activity. Methods. We retrospectively analyzed 60 patients with RA and 40 without RA (with other rheumatoid disease) who had attended the Rheumatology Clinic because of joint pain in the first six months of 2009. The following parameters were studied: age, sex, disease duration, morning stiffness, familiar history, erythrocyte sedimentation rate, haematocrit, number of leucocytes and trombocytes, CRP, IgM RF, anti-CCP, DAS (disease activity score) 28, and joint erosion. Results. Sensitivity and specificity of anti-CCP antibodies for rheumatoid arthritis diagnosis, based on American Rheumatoid Association were 66.7% and 95%, respectively. Sensitivity and specificity for IgM RF were 71.2% and 82.5%, respectively. There was no significant difference between anti-CCP(+) and anti-CCP(-) as well as between RF(+) and RF(-) groups for the analyzed parameters. There was a significant correlation between anti-CCP and IgM RF (r=0.51, p<0.001) in patients with RA. Conclusion. Anti-CCP antibodies are more specific than IgM RF for diagnosing RA, and may be useful in serologic diagnosis of RA. There was no difference in disease activity between anti-CCP(+) and anti-CCP(-) and/ or RF(+) and RF(-) patients with RA. Key words: rheumatoid arthritis, anti-CCP antibodies, rheumatoid factor, disease activity join erosio

Fine Needle Aspiration in Thyroid Nodules - One Year Experience

AIM: To estimate suspect nodule for benign or malignant characteristics, and to verify cytological features of the node with the fine needle aspiration (FNA) under ultrasound. DESIGN: A total of 106 patients were analyzed. FNA biopsy was performed at outpatient clinic via ultrasound. Inform consent was signed for each patient. Preparation of procedure with local anaesthesia was made by assistant nurse. PROCEDURE: Parallel approach of ultrasound guided fine needle aspiration (USGFNA) was used for each patient. This approach allows the operator to observe needle penetration, location and pathway of the entire needle within the neck, thyroid and nodule, which remain visible on the monitor. As a side effect commonly noticed mild pain and dizziness were recorded. RESULTS: General findings: According the gender, 96 (90.5%) of them were women and 10 (9.5%) men. Median age was 47 ± 9 years. Cytological findings: 5 patients were with papillary carcinoma, 3 with Hurtle cell metaplasia, 1 follicular tumour and 1 with unclear differentiation. CONCLUSION: Close collaboration between endocrinologists, morphologists and surgeons in a multidisciplinary frame is the key to correct preoperative thyroid cancer diagnosis and optimal treatment. FNA biopsy remains the most accurate diagnostic method in detecting thyroid cancer

Correlation between Thyroid Hormone Values and Carotid Intima Media Thickness in Patients with Subclinical Hypothyroidism

Purpose: The aim of the study was to investigate the influence of thyroid-stimulating (TSH) and free thyroxin (fT4) hormones on carotid intima media thickness (cIMT). Material and methods: Sixty nine consecutive patients who attended to the Department of University Clinic of Endocrinology, Diabetes and Metabolic disorders with newly diagnosed subclinical hypothyroidism (ScH) were evaluated for mean and maximal cIMT. ScH were defined as elevated TSH with normal fT4 serum values. Results: Mean TSH, fT4, cIMT, and max cIMT were: 7,9±3,6 mU/L, 14,5±2,8 pmol/L, 0,61±0,1 mm, and 0,65±0,1 mm, respectively. Statistically significant positive correlation were evaluated between TSH value and mean and max cIMT (r=0,28, and r=0,29, respectively p<0,05). While fT4 statistically significant negative correlated with mean and max cIMT (r=-0,35, and r=-0,33, respectively p<0,01). Conclusion: Thyroid hormone values are correlated with carotid intima media thickness in patients with subclinical hypothyroidism. Key words: carotid intima media thickness, thyroid-stimulating hormone, subclinical hypothyroidism

Subclinical Hypothyroidism and Risk to Carotid Atherosclerosis

ABSTRACT OBJECTIVE: The aim of this study was to assess whether subclinical hypothyroidism (SCH) is associated with carotid atherosclerosis, as well as dyslipidemia, and arterial hypertension. SUBJECTS AND METHODS: The study included 69 consecutive patients with newly diagnosed SCH, and 30 matched healthy controls. Body mass index (BMI), TSH, fT4, antibodies to thyroid peroxidase (TPOabs), lipids, blood pressure, mean and maximum carotid intima-media thickness (CIMT) were determined in all participants. RESULTS: Mean values of CIMT, triglycerides, and total cholesterol/HDL-C ratio were significantly different in SCH patients versus matched controls. Linear multiple regression analysis demonstrated that TSH, diastolic blood pressure and triglycerides were independent predictors of mean CIMT, fT4 for maximum CIMT; and that TSH, fT4, age, and total cholesterol/HDL-C ratio were independent predictors of the presence of carotid plaques. CONCLUSION: Our data revealed that SCH is associated with increase in CIMT and presence of carotid plaques, independent of classical risk factors for atherosclerosis. Keywords: Subclinical hypothyroidism; atherosclerosis; dyslipidemia; arterial hypertension; carotid intima-media thicknes

Assessment of left ventricular systolic and diastolic function in subclinical hypothyroidism

Objective: Studies investigating systolic and diastolic left ventricle function in subclinical hypothyroidism (ScH) have shown controversial results. As myocardium is a target organ of thyroid hormone action, the aim of the study was to assess the left ventricular systolic and diastolic function in ScH. Methods: Fifty-four patients with newly diagnosed ScH and 30 euthyroid controls, patients of the University Clinic of the Endocrinology, Diabetes, and Metabolic Disorders Clinic were enrolled. Transthoracic echocardiography, using M-mode, two-dimensional (2D), pulsed, continuous and color-Doppler, and advanced echocardiographic modalities Tissue Doppler and two-dimensional speckle tracking was performed in all subjects. Results: Although normal echocardiographic values of all measured parameters, SCH patients were significantly different from their matched controls: the ratio between E/A was statistically significantly lower (1,26±0,36 vs. 1,03±0,29, p<0,01), the ratio between Е/е’ sep. was statistically significantly higher (6,04±1,64 vs. 7,62±2,29, p<0,01), MPI was statistically significantly higher (0,43±0,07 vs. 0,47±0,08, p<0,05), GLS had statistically significantly lower negative value (-20,9±1,7 vs. -19,55±2,3%, p<0,001), and S/TDI was statistically significantly lower (0,092±0,011 vs. 0,077±0,013, p<0,01). TSH negatively correlated with EF (r=-0,15, p<0,05), E/A(r=-0,14, p<0,05), GLS (r=-0,26, p<0,001), S/TDI (r=-0,22, p<0,01), and positively correlated with E/e 'sep. (r=0,14, p<0,05). Conclusion: Subclinical hypothyroidism contributes to changes in certain parameters involved in the assessment of global and longitudinal systolic and diastolic left ventricular function compared to healthy individual

Dyslipidaemia and Hypertension in Patients with Subclinical Hypothyroidism

Abs t r a c t: Objective. The aim of this study was to assess whether subclinical hypothyroidism (SCH) is associated with dyslipidaemia and arterial hypertension. Methods. At the Department of Endocrinology, Diabetes and Metabolic Disorders, Skopje, R. Macedonia, we examined 24 consecutive patients with SCH and 13 healthy controls in a period of 6 months. SCH was defined as an elevated thyrotropin (TSH) (> 4.2 mU/l) and normal free thyroxine (fT4) level (10.3–24.45 pmol/l). None of the patients had been previously treated with thyroxine. In all participants we determined blood pressure, body mass index (BMI), TSH, fT4, antibodies to thyroid peroxidise (TPOabs), total lipids (TL), total cholesterol (TH), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides. Results. Mean diastolic blood pressure increased in SCH patients vis-a-vis controls (85 vs. 74 mmHg; p < 0.05). Mean values of TL, TH, HDL-C, LDL-C, triglycerides, TC/HDL-C, and LDL-C/HDL-C were no different in patients with SCH compared with controls. Individual analysis revealed that the percentages of patients with SCH having arterial hypertension (29%), hypertriglyceridaemia (34.78%), elevated LDL-C (41.66%), elevated TC/HDL-C (21.7%), and LDL-C/HDL-C (21.74%) ratios were higher than the percentages in controls. No significant correlation between TSH and biochemical parameters was detected. Conclusion. Our study revealed that SCH patients have a greater prevalence of dyslipidaemia and arterial hypertension, and, as well, a greater value of mean diastolic pressure vs. control patients. . Key words. Subclinical hypothyroidism; arterial hypertension; dyslipidaemia; atherosclerosis; risk factors