The document assessed serum essential elements, glucose, and thyroid function tests in hypothyroid patients with good or poor responses to levothyroxine (LT) therapy. Patients with a good response had normal thyroid levels similar to controls, while those with a poor response had lower T3 and T4 and higher TSH compared to controls and good responders. Zinc, copper, and iron levels were significantly lower in poor responders compared to controls and good responders. Glucose levels did not differ significantly between groups. Thyroid levels correlated with trace element levels. The study found lower trace elements in poor responders, suggesting trace elements may influence thyroid function and response to LT therapy.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Study of serum magnesium and fasting blood glucose in hypertensioniosrjce
A study was carried out to determine the fasting blood glucose and serum magnesium levels in
patients with hypertension. A total of 80 hypertensive patients were evaluated, of which, 58 were males and 22
were females. The mean ages of male and female hypertensive subjects were 48.06±6.53 and 50.83±7.62
respectively. Hypomagnesemia was observed in 61.25% subjects and raised fasting blood glucose was identified
in 55.1% of individuals. Therefore occurrence of low serum magnesium and raised blood sugar level in patients
with hypertension was observed
A comparative analysis of biochemical and hematological parameters in diabeti...amsjournal
This study evaluated the biochemical and the hematological parameters in diabetic and non- diabetic patients. The measured biochemical parameters were fasting blood sugar, serum alanine aminotransferase (SGPT/ALT), total cholesterol, urea, creatinine and hematological parameters were hemoglobin, total white blood cell, neutrophil, lymphocyte,monocyte, eosinophil and ESR. There were 403 diabetic and 320 non-diabetic subjects included in this study and the study was carried out in BIRDEM (Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders) General Hospital). It was observed that the mean values of SGPT/ALT (p<0.001),><0.001)><0.001)><0.001),><0.004),><0.001) of hematological parameters were significantly higher in diabetic patients than in the non-diabetic patients. In univariate analysis, all biochemical parameters and only four hematological parameters were found significantly associated with fasting blood sugar after adjusted with age and sex. The fasting blood sugar correlates highly with the other biochemical parameters but less or none with the hematological parameters. Our findings demonstrated that control of increased biochemical parameters and abnormal hematological levels in the early stage of diabetes mellitus may help the patients to raise quality of life.
International Journal of Pharmaceutical Science Invention (IJPSI) inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Study of serum magnesium and fasting blood glucose in hypertensioniosrjce
A study was carried out to determine the fasting blood glucose and serum magnesium levels in
patients with hypertension. A total of 80 hypertensive patients were evaluated, of which, 58 were males and 22
were females. The mean ages of male and female hypertensive subjects were 48.06±6.53 and 50.83±7.62
respectively. Hypomagnesemia was observed in 61.25% subjects and raised fasting blood glucose was identified
in 55.1% of individuals. Therefore occurrence of low serum magnesium and raised blood sugar level in patients
with hypertension was observed
A comparative analysis of biochemical and hematological parameters in diabeti...amsjournal
This study evaluated the biochemical and the hematological parameters in diabetic and non- diabetic patients. The measured biochemical parameters were fasting blood sugar, serum alanine aminotransferase (SGPT/ALT), total cholesterol, urea, creatinine and hematological parameters were hemoglobin, total white blood cell, neutrophil, lymphocyte,monocyte, eosinophil and ESR. There were 403 diabetic and 320 non-diabetic subjects included in this study and the study was carried out in BIRDEM (Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders) General Hospital). It was observed that the mean values of SGPT/ALT (p<0.001),><0.001)><0.001)><0.001),><0.004),><0.001) of hematological parameters were significantly higher in diabetic patients than in the non-diabetic patients. In univariate analysis, all biochemical parameters and only four hematological parameters were found significantly associated with fasting blood sugar after adjusted with age and sex. The fasting blood sugar correlates highly with the other biochemical parameters but less or none with the hematological parameters. Our findings demonstrated that control of increased biochemical parameters and abnormal hematological levels in the early stage of diabetes mellitus may help the patients to raise quality of life.
International Journal of Pharmaceutical Science Invention (IJPSI) inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Thyroid hormones parameters of patients with thyroid disorders attending spe...Premier Publishers
Thyroid hormones, triiodothyronine (T3) and Thyroxin (T4), affect almost all metabolic activities of tissues and are produced under influence of the interior pituitary hormone, the thyroid stimulating hormone (TSH), which stimulates secretion of thyroid releasing hormone (TRH). The present study was conducted to observe the effect of non-detectable levels of TSH on thyroid hormones, on the basis of gender and age. A total of 88 patients (50 patients with hyperthyroidism and hypothyroidism and 33 healthy people as control) attending special out-patient clinic were involved in the study. Serums T3, T4 and TSH were measured using the commercially available kits (Abbot Laboratories) through Enzyme Immune Assay (EIA) technique (Roche Diagnostics GmbH). Analysis of data using SPSS software version 15.0 revealed that prevalence of thyroid disorders in the studied group was more among female population. However, the disorders were not age dependent. Most common conditions associated with sub-clinical hyperthyroidism. As males are equally exposed to these environmental factors, hence further investigations are required to know why these factors affect females more than the males. In our opinion, TSH and FT4 are the most valuable indicators in assessing thyroid function in a healthy population and TSH and TT4 are the most meaningful in hyperthyroidism and hypothyroidism.
Background: Anemia is a common Feature of chronic kidney disease, but the management of anemia in children is complex. Erythropoietin and Supplemental iron are used to maintain hemoglobin levels. The aim of this study to determine the Frequency of anemia and possible Risk Factors Among children with End stage renal disease.
Methods: A total of 96 children, 61males (63.5%) and 35 Females (36.5%), were attended at hemodialysis units in Khartoum state were enrolled in the study and Frequency of anemia was estimated by analyzing CBC on blood counter (sysmex). The concentration of iron profile, C-reactive protein and parathyroid hormone was measured using COBAS INTEGRA 400 PLUS and COBAS E411.
Results: 99% of children were anemic, 4.17% of them were suffering from iron deficiency anemia and there are other causes contributing to anemia in ESRD patients which are inflammation and hyperparathyroidism.
Conclusion: The prevalence of anemia in children on hemodialysis in Sudan appears to be higher than that reported in other studies despite extensive use of rHuEPO and iron supplementation.
Impact of Hemodialysis on lipid profile among chronic renal failure patients ...Neeleshkumar Maurya
Chronic Renal Failure (CRF) patients are at risk of cardiovascular diseases due to the elevation of various forms of lipids. Many a time CRF patients live on hemodialysis on regular basis. Chronic renal failure (CRF) is complicated by characteristic dyslipidemias. We sought to evaluate the pattern of lipid profile in CRF patients with and without hemodialysis. Study were divided into 2 groups, Group-I: CRF patients who never undergone hemodialysis (24) and Group-II: CRF patients on hemodialysis (24). We obtained serum samples from patients in the morning after an overnight fast and were analyzed for total cholesterol (TC), triglycerides (TGs), HDL, LDL and VLDL. Significant change (p<0.05) was found in Total cholesterol (TC), HDL-C, VLDL-C, HDL-C(level) between first and second group.
Keywords: Chronic renal failure, cardiovascular disease, Haemodialysis, CKD stage – 5
Methylenetetrahydrofolate Reductase Gene (MTHFR_677CT) Associated with the de...ijsrd.com
Globally, Depression is widespread neuropsychiatric disorders affecting around 5% of the population and has been described as millennia linked with neurobiology showing association with direct neuro-chemicals and biochemical incredible factors, interact with "gene-gene", "gene-environment" as long as a scaffold potential for better exploration. The aetiology of depression is still unknown but believes to be the interaction between gene and environment including some of the other factors responsible for development of depression. The PCR-RFLP analysis of MTHFR (C677T) gene showed 0.45% in CT (heterozygous) genotype in patients of depression in comparison to controls (0.15%), suggesting increased risk of depression in those individuals. However, the odd ratio was also calculated at 95% confidence interval for MTHFR C677T gene which revealed non- significant difference between cases and control, may be because of small sample size.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Co relation of Lipid Profile with Proteinuria in Sickle Cell Nephropathy Pati...ijtsrd
Pulmonary hypertension PH in sickle cell disease SCD is an emerging and important clinical problem. In a single institution adult cohort of 75 patients, we investigated lipid and lipoprotein levels and their relationship to markers of intravascular hemolysis, vascular dysfunction and PH. In agreement with prior studies, we confirm significantly decreased plasma levels of total cholesterol, high density lipoprotein cholesterol HDL C , and low density lipoprotein cholesterol LDL C in SCD vs. ethnically matched healthy controls. Several cholesterol parameters correlate significantly with markers of anemia, but not endothelial activation or PH. More importantly, serum triglyceride levels are significantly elevated in SCD compared to controls. Elevated triglyceride levels correlate significantly with markers of hemolysis lactate dehydrogenase and arginase both p 0.0005 , endothelial activation soluble E selectin, p 0.0001 soluble P selectin, p=0.02 soluble vascular cell adhesion molecule 1, p=0.01 , inflammation leukocyte count, p=0.0004 erythrocyte sedimentation rate, p=0.02 and PH amino terminal brain natriuretic peptide, p=0.002 prevalence of elevated tricuspid regurgitant velocity TRV , p 0.001 . In a multivariate analysis, triglyceride levels correlate independently with elevated TRV p=0.002 . Finally, forearm blood flow studies in adult patients with SCD demonstrate a significant association between increased triglyceride HDL C ratio and endothelial dysfunction p 0.05 . These results characterize elevated plasma triglyceride levels as a potential risk factor for PH in SCD. Dr. Prafull Dawale | Neha Jain "Co-relation of Lipid Profile with Proteinuria in Sickle Cell Nephropathy Patients for Local Area of Chhattisgarh" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd42438.pdf Paper URL: https://www.ijtsrd.commedicine/other/42438/corelation-of-lipid-profile-with-proteinuria-in-sickle-cell-nephropathy-patients-for-local-area-of-chhattisgarh/dr-prafull-dawale
ABSTRACT- Diabetes mellitus is associated with hyperglycemia and patients are at an increased risk of cardiovascular disease. The present study
was carried out to evaluate the diagnostic value of Glycated hemoglobin (HbA1c) in predicting risk of development of diabetic dyslipidemia. 70 clinically
diagnosed cases of type 2 diabetes mellitus with the age range 30-75 years were included in the study group. Out of which 35 diabetic patients
with good glycemic control were included under Group A and 35 diabetic patients with poor glycemic control were included under Group B. 70 age
and sex matched healthy individuals served as controls. HbA1c demonstrated positive and significant correlation with total cholesterol (TC), low
density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and LDL/HDL-C, non-HDL-C and TC/HDL-C ratio. Patients
with HbA1c value > 7.0% had significantly higher value of TC, Triacylglycerol (TAG), LDL-C, LDL-C/HDL-C ratio, non-HDL-C and TC/HDL-C
ratio as compared to the patients with HbA1c ≤ 7.0%. However, there was no significant difference in value of HDL-C between two groups. Thus
HbA1c can be used as a potential dual marker of glycemic control and dyslipidemia in type 2 diabetes mellitus.
Keywords: - Type2 Diabetes Mellitus, Glycated hemoglobin, Dyslipidemia, Cardiovascular disease, Lipid Profile panel
Definition & incidence of Hypertension
Classification of Hypertension
Diagnosis/ Confirmation of Hypertension
Technique of Hypertension Measurement
White coat Hypertension
Type of Hypertension
Suspicion of secondary hypertension
Management of Hypertension(Stage 1& 2)
Why treatment is necessary
Life style modification
Drug treatment of Hypertension
Rationalae of combination
Hypertension management in special situation/ with complications
Indications of ARBs
Mechanism of action of ARBs
Comparison of different ARBs-pharmacology, efficacy
Safety of ARBs-Recall, Malignancy
Study on Telmisartan
Abstract—Subclinical Hypothyroidism is a much more common disorder with a world-wide occurrence as compared to overt Hypothyroidism. Overt Hypothyroidism is associated with abnormalities of lipid metabolism, but the significance of dyslipidemia in subclinical hypothyroidism (SCH) remains controversial.
Aims: To compare the lipid profile between subclinical hypothyroid patients & healthy controls (age & sex matched) so as to determine any association between lipid profile & subclinical hypothyroidism.
Materials and Methods: In a case-control study, Thyroid stimulating hormone (TSH), free T3, free T4, anti thyroperoxidase (TPO) antibodies, total cholesterol, high density lipoprotein(HDL) cholesterol, low density lipoprotein (LDL) cholesterol, Very low density lipoprotein (VLDL) cholesterol, serum triglycerides were measured in 50 patients with subclinical hypothyroidism and 50 age- and sex-matched Euthyroid controls after an overnight fasting.
Results: Mean serum triglycerides (TG) and very low-density cholesterol (VLDL) were significantly higher in patients with SCH than controls (P < 0.05). No association was found between serum total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and SCH.
Conclusions: Dyslipidemia is more common in SCH compared to controls. High serum triglycerides and VLDL were observed in patients with SCH.
Thyroid Abnormalities in Correlation with Stage of CKD in Tribal Population o...ijtsrd
Chronic Kidney Disease is a worldwide health problem with an increasing incidence and prevalence. Abnormalities in the structure and function of the thyroid gland and in the metabolism and plasma concentration of thyroid hormones are common in patients with CKD. In view of variability of thyroid profile in CKD patients in previous studies, a prospective study of various thyroid function has been undertaken to establish a correlation if any between thyroid dysfunction and severity of renal diseases . Total number of 50 patients with Chronic Kidney Disease on conservative management fulfilling the criteria for CKD who were admitted in Department of Medicine under nephrology unit, Dr. Bhimrao Ambedkar Hospital Raipur C.G. , during the period of February 2018-March 2018 were selected in this prospective study. The result showed that out of the 50 patients with CKD 29 patients had low T3 syndrome 0.2-2.0ng ml, mean 0.67 which accounts for 58 of the patients, 12 patients had low T4 syndrome 0.5-8.5µg ml, mean 5.65 which accounts for 24 of the patients and 4 patients had primary hypothyroidism TSH 20µIU ml. Excluding Primary Hypothyroidism, analysis of serum T3, T4 and TSH in the study subjects shows very high significance, p 0.001. Thyroid Dysfunction occurred in 66 of the patients with chronic kidney disease in our study, it does not indicate a state of hypothyroidism, but a reflection of the state of chronic illness malnutrition. The low T3 state of CKD can be viewed as being protective, promoting conservation of protein. The number of patients with low T3 syndrome progressively increases with the severity of renal failure. Priya Banjare "Thyroid Abnormalities in Correlation with Stage of CKD in Tribal Population of Chhattisgarh" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21418.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/21418/thyroid-abnormalities-in-correlation-with-stage-of-ckd-in-tribal-population-of-chhattisgarh/priya-banjare
Thyroid hormones parameters of patients with thyroid disorders attending spe...Premier Publishers
Thyroid hormones, triiodothyronine (T3) and Thyroxin (T4), affect almost all metabolic activities of tissues and are produced under influence of the interior pituitary hormone, the thyroid stimulating hormone (TSH), which stimulates secretion of thyroid releasing hormone (TRH). The present study was conducted to observe the effect of non-detectable levels of TSH on thyroid hormones, on the basis of gender and age. A total of 88 patients (50 patients with hyperthyroidism and hypothyroidism and 33 healthy people as control) attending special out-patient clinic were involved in the study. Serums T3, T4 and TSH were measured using the commercially available kits (Abbot Laboratories) through Enzyme Immune Assay (EIA) technique (Roche Diagnostics GmbH). Analysis of data using SPSS software version 15.0 revealed that prevalence of thyroid disorders in the studied group was more among female population. However, the disorders were not age dependent. Most common conditions associated with sub-clinical hyperthyroidism. As males are equally exposed to these environmental factors, hence further investigations are required to know why these factors affect females more than the males. In our opinion, TSH and FT4 are the most valuable indicators in assessing thyroid function in a healthy population and TSH and TT4 are the most meaningful in hyperthyroidism and hypothyroidism.
Background: Anemia is a common Feature of chronic kidney disease, but the management of anemia in children is complex. Erythropoietin and Supplemental iron are used to maintain hemoglobin levels. The aim of this study to determine the Frequency of anemia and possible Risk Factors Among children with End stage renal disease.
Methods: A total of 96 children, 61males (63.5%) and 35 Females (36.5%), were attended at hemodialysis units in Khartoum state were enrolled in the study and Frequency of anemia was estimated by analyzing CBC on blood counter (sysmex). The concentration of iron profile, C-reactive protein and parathyroid hormone was measured using COBAS INTEGRA 400 PLUS and COBAS E411.
Results: 99% of children were anemic, 4.17% of them were suffering from iron deficiency anemia and there are other causes contributing to anemia in ESRD patients which are inflammation and hyperparathyroidism.
Conclusion: The prevalence of anemia in children on hemodialysis in Sudan appears to be higher than that reported in other studies despite extensive use of rHuEPO and iron supplementation.
Impact of Hemodialysis on lipid profile among chronic renal failure patients ...Neeleshkumar Maurya
Chronic Renal Failure (CRF) patients are at risk of cardiovascular diseases due to the elevation of various forms of lipids. Many a time CRF patients live on hemodialysis on regular basis. Chronic renal failure (CRF) is complicated by characteristic dyslipidemias. We sought to evaluate the pattern of lipid profile in CRF patients with and without hemodialysis. Study were divided into 2 groups, Group-I: CRF patients who never undergone hemodialysis (24) and Group-II: CRF patients on hemodialysis (24). We obtained serum samples from patients in the morning after an overnight fast and were analyzed for total cholesterol (TC), triglycerides (TGs), HDL, LDL and VLDL. Significant change (p<0.05) was found in Total cholesterol (TC), HDL-C, VLDL-C, HDL-C(level) between first and second group.
Keywords: Chronic renal failure, cardiovascular disease, Haemodialysis, CKD stage – 5
Methylenetetrahydrofolate Reductase Gene (MTHFR_677CT) Associated with the de...ijsrd.com
Globally, Depression is widespread neuropsychiatric disorders affecting around 5% of the population and has been described as millennia linked with neurobiology showing association with direct neuro-chemicals and biochemical incredible factors, interact with "gene-gene", "gene-environment" as long as a scaffold potential for better exploration. The aetiology of depression is still unknown but believes to be the interaction between gene and environment including some of the other factors responsible for development of depression. The PCR-RFLP analysis of MTHFR (C677T) gene showed 0.45% in CT (heterozygous) genotype in patients of depression in comparison to controls (0.15%), suggesting increased risk of depression in those individuals. However, the odd ratio was also calculated at 95% confidence interval for MTHFR C677T gene which revealed non- significant difference between cases and control, may be because of small sample size.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Co relation of Lipid Profile with Proteinuria in Sickle Cell Nephropathy Pati...ijtsrd
Pulmonary hypertension PH in sickle cell disease SCD is an emerging and important clinical problem. In a single institution adult cohort of 75 patients, we investigated lipid and lipoprotein levels and their relationship to markers of intravascular hemolysis, vascular dysfunction and PH. In agreement with prior studies, we confirm significantly decreased plasma levels of total cholesterol, high density lipoprotein cholesterol HDL C , and low density lipoprotein cholesterol LDL C in SCD vs. ethnically matched healthy controls. Several cholesterol parameters correlate significantly with markers of anemia, but not endothelial activation or PH. More importantly, serum triglyceride levels are significantly elevated in SCD compared to controls. Elevated triglyceride levels correlate significantly with markers of hemolysis lactate dehydrogenase and arginase both p 0.0005 , endothelial activation soluble E selectin, p 0.0001 soluble P selectin, p=0.02 soluble vascular cell adhesion molecule 1, p=0.01 , inflammation leukocyte count, p=0.0004 erythrocyte sedimentation rate, p=0.02 and PH amino terminal brain natriuretic peptide, p=0.002 prevalence of elevated tricuspid regurgitant velocity TRV , p 0.001 . In a multivariate analysis, triglyceride levels correlate independently with elevated TRV p=0.002 . Finally, forearm blood flow studies in adult patients with SCD demonstrate a significant association between increased triglyceride HDL C ratio and endothelial dysfunction p 0.05 . These results characterize elevated plasma triglyceride levels as a potential risk factor for PH in SCD. Dr. Prafull Dawale | Neha Jain "Co-relation of Lipid Profile with Proteinuria in Sickle Cell Nephropathy Patients for Local Area of Chhattisgarh" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd42438.pdf Paper URL: https://www.ijtsrd.commedicine/other/42438/corelation-of-lipid-profile-with-proteinuria-in-sickle-cell-nephropathy-patients-for-local-area-of-chhattisgarh/dr-prafull-dawale
ABSTRACT- Diabetes mellitus is associated with hyperglycemia and patients are at an increased risk of cardiovascular disease. The present study
was carried out to evaluate the diagnostic value of Glycated hemoglobin (HbA1c) in predicting risk of development of diabetic dyslipidemia. 70 clinically
diagnosed cases of type 2 diabetes mellitus with the age range 30-75 years were included in the study group. Out of which 35 diabetic patients
with good glycemic control were included under Group A and 35 diabetic patients with poor glycemic control were included under Group B. 70 age
and sex matched healthy individuals served as controls. HbA1c demonstrated positive and significant correlation with total cholesterol (TC), low
density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and LDL/HDL-C, non-HDL-C and TC/HDL-C ratio. Patients
with HbA1c value > 7.0% had significantly higher value of TC, Triacylglycerol (TAG), LDL-C, LDL-C/HDL-C ratio, non-HDL-C and TC/HDL-C
ratio as compared to the patients with HbA1c ≤ 7.0%. However, there was no significant difference in value of HDL-C between two groups. Thus
HbA1c can be used as a potential dual marker of glycemic control and dyslipidemia in type 2 diabetes mellitus.
Keywords: - Type2 Diabetes Mellitus, Glycated hemoglobin, Dyslipidemia, Cardiovascular disease, Lipid Profile panel
Definition & incidence of Hypertension
Classification of Hypertension
Diagnosis/ Confirmation of Hypertension
Technique of Hypertension Measurement
White coat Hypertension
Type of Hypertension
Suspicion of secondary hypertension
Management of Hypertension(Stage 1& 2)
Why treatment is necessary
Life style modification
Drug treatment of Hypertension
Rationalae of combination
Hypertension management in special situation/ with complications
Indications of ARBs
Mechanism of action of ARBs
Comparison of different ARBs-pharmacology, efficacy
Safety of ARBs-Recall, Malignancy
Study on Telmisartan
Abstract—Subclinical Hypothyroidism is a much more common disorder with a world-wide occurrence as compared to overt Hypothyroidism. Overt Hypothyroidism is associated with abnormalities of lipid metabolism, but the significance of dyslipidemia in subclinical hypothyroidism (SCH) remains controversial.
Aims: To compare the lipid profile between subclinical hypothyroid patients & healthy controls (age & sex matched) so as to determine any association between lipid profile & subclinical hypothyroidism.
Materials and Methods: In a case-control study, Thyroid stimulating hormone (TSH), free T3, free T4, anti thyroperoxidase (TPO) antibodies, total cholesterol, high density lipoprotein(HDL) cholesterol, low density lipoprotein (LDL) cholesterol, Very low density lipoprotein (VLDL) cholesterol, serum triglycerides were measured in 50 patients with subclinical hypothyroidism and 50 age- and sex-matched Euthyroid controls after an overnight fasting.
Results: Mean serum triglycerides (TG) and very low-density cholesterol (VLDL) were significantly higher in patients with SCH than controls (P < 0.05). No association was found between serum total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and SCH.
Conclusions: Dyslipidemia is more common in SCH compared to controls. High serum triglycerides and VLDL were observed in patients with SCH.
Thyroid Abnormalities in Correlation with Stage of CKD in Tribal Population o...ijtsrd
Chronic Kidney Disease is a worldwide health problem with an increasing incidence and prevalence. Abnormalities in the structure and function of the thyroid gland and in the metabolism and plasma concentration of thyroid hormones are common in patients with CKD. In view of variability of thyroid profile in CKD patients in previous studies, a prospective study of various thyroid function has been undertaken to establish a correlation if any between thyroid dysfunction and severity of renal diseases . Total number of 50 patients with Chronic Kidney Disease on conservative management fulfilling the criteria for CKD who were admitted in Department of Medicine under nephrology unit, Dr. Bhimrao Ambedkar Hospital Raipur C.G. , during the period of February 2018-March 2018 were selected in this prospective study. The result showed that out of the 50 patients with CKD 29 patients had low T3 syndrome 0.2-2.0ng ml, mean 0.67 which accounts for 58 of the patients, 12 patients had low T4 syndrome 0.5-8.5µg ml, mean 5.65 which accounts for 24 of the patients and 4 patients had primary hypothyroidism TSH 20µIU ml. Excluding Primary Hypothyroidism, analysis of serum T3, T4 and TSH in the study subjects shows very high significance, p 0.001. Thyroid Dysfunction occurred in 66 of the patients with chronic kidney disease in our study, it does not indicate a state of hypothyroidism, but a reflection of the state of chronic illness malnutrition. The low T3 state of CKD can be viewed as being protective, promoting conservation of protein. The number of patients with low T3 syndrome progressively increases with the severity of renal failure. Priya Banjare "Thyroid Abnormalities in Correlation with Stage of CKD in Tribal Population of Chhattisgarh" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21418.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/21418/thyroid-abnormalities-in-correlation-with-stage-of-ckd-in-tribal-population-of-chhattisgarh/priya-banjare
HYPOGONADISM 1Clinical evaluation and management of hypogoLizbethQuinonez813
HYPOGONADISM 1
Clinical evaluation and management of hypogonadism
United States University
FNP: 593 Acute illnesses across the lifespan
Brittany Chavez
12/10/2021
TITLE OF PAPER
Clinical evaluation and management of hypogonadism
The purpose of this paper is to discuss Hypogonadism in regard to clinical evaluation,
symptomatic presentation, management and evaluation of clinical guidelines. The paper will
explore differing viewpoints and key concepts in relation to hypogonadism. The effects of
cultural, spiritual and beliefs in treatment and evaluation, and the impact of research on this
endocrine imbalance. Also reviewed will be research studies addressing the clinical symptoms
and trials for new treatment options.
Review of topic and rationale for selection of topic
Hypogonadism is a common endocrine disorder originating from two causes. Primary
hypogonadism is caused from a direct androgen imbalance originating from the testes. This
clinical syndrome which the testes fail to produce physiologic levels of testosterone and a normal
number of spermatozoa due to defects in the hypothalamic-pituitary-gonadal axis at one or more
levels. (Ross & Bhasin, 2016). This topic was chosen due to the frequency of cases seen in the
family practice setting. Hypogonadism is a common disorder associated with low bone density,
poor muscle mass, anemia, and sexual dysfunction that affects men in a variety of ways. Among
secondary osteoporosis risk factors, male hypogonadism is one of the most important, accounting
for progressive bone loss in aging men, especially when late-onset hypogonadism is
diagnosed (LOH). (Rochira, 2020) This disorder can affect all aspects of life and greatly impact
the emotional state and feelings of self-worth. This paper will address primary hypogonadism in
terms of diagnostic, and treatment based on guidelines.
Evaluation of key concepts related to the topic
The key concepts evaluated for the paper includes disease process in formation of
androgen deficiency. Androgens are important for male reproductive and sexual functions, body
TITLE OF PAPER 3
composition, erythropoiesis, muscle and bone health, and cognitive functions. Symptoms
presentation commonly seen in the primary care setting. Diagnostic criteria in the evaluation to
determine the extent of deficiency in relation to the symptoms presented and the treatment
guidelines based on efficacy and positive outcomes.
Primary Hypogonadism (PHG) is often underdiagnosed in the clinical setting due to the
ambiguous symptoms presented often mimicking depression or often overlooked as normal
aging process. These symptoms may present with decreased libido, weight gain, fatigue, low
stamina, decrease in muscle mass, decreased energy, sleep disturbances, mood fluctuations and
irritability.
It is essential for the provider to consider hormonal deficiency into the differential
diagnosis to effectively diagnose and rule o ...
CLINICAL PRACTICE GUIDELINES FOR HYPOTHYROIDISM IN ADULTS:
COSPONSORED BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND THE AMERICAN THYROID ASSOCIATION
Ata aace guideline on hypothyroidism dr shahjada selim
Thyroid trace elements
1. Assessment of serum essential elements, serum glucose and …. Yaqoob Ayoob Yaqoob
Karbala J. Med. Vol.7, No.2, Dec, 2014
Original paper
Assessment of serum essential elements, serum glucose and
thyroid function tests in Iraqi hypothyroid patients have good and
poor responses to levothyroxine therapy
Yaqoob Ayoob Yaqoob1
, Ausama Ayoob Jaccob2*
1
Department of general surgery/ Al-shefa General Hospital/ Basra/ Iraq
2
Department of pharmacology and toxicology/ Pharmacy collage / Basra university/ Iraq
Abstract
ackground: Hypothyroidism is a syndrome resulting from deficiency of thyroid
hormones leading to generalized slowing of all metabolic processes. Many diseases
like hypertension, ischaemic heart disease, adverse lipid profile, and Metabolic
abnormalities developed in hypothyroid patients. Trace elements play essential roles in the
human body as cofactors of some enzymes and take part in the synthesis of many hormones
where normal thyroid status is dependent on the presence of many trace elements for both the
synthesis and metabolism of thyroid hormones.
Aim: The present study was designed to evaluate fasting serum Fe, Cu, and Zn
concentrations, fasting serum glucose concentration and thyroid function tests in hypothyroid
patients having good and poor response to LT therapy and to study correlations between these
parameters.
Materials and methods: The present study was a single center, cross sectional study
conducted in alshefa General hospital, basra, Iraq. During the period from June,2013 to Mar,
2014. 62 subjects aged 20 to 55 years were included. The patient groups consisted of 41
hypothyroid patients (38 females and 3 males) on LT therapy for at least 6 months duration.
21 Healthy age and gender matched group with thyroid function within normal limit were
selected as control group. Patients were screened for FT3, FT4 and TSH, those with high
TSH level above normal limit despite high dose of thyroxine considered as poor response to
treatment (PRLT) while those patient with TSH level within normal range considered as good
response to treatment (GRLT). After 12 hrs fasting, blood samples (5 ml) were obtained to
evaluate serum TSH, T3, T4, glucose and trace elements in all studies groups.
Results and discussion: In (GRLT)group 21 patients had thyroid function tests (TSH, FT4
and FT3) within normal range and there were no significant differences when compared with
control while in (PRLT) group, FT4 and FT3 significantly decreased when compared with
control and GRLT groups while serum TSH levels in all 20 hypothyroid patients were
significantly high. Serum Zn, Cu and Fe level of PRLT patients are significantly lower than
its level in control and (GRLP) groups, In (GRLP) there were no significant differences when
we compared trace element concentrations with control. Regarding FSG no significant
differences were reported in all studied groups. There are significant correlation between
thyroid function tests and trace element concentrations. Trace elements influence thyroid
hormones at levels of action, including hormone secretion and activity and binding to target
tissue. On the other hand, thyroid hormones itself influence trace metals metabolism at
several levels of action, including excretion and transport of trace metals. All these factors
collectively lead to significant reduction in trace elements concentrations in hypothyroid
patients c
B
*For Correspondence: E-Mail ausamaphdjaccob@yahoo.com
2. Assessment of serum essential elements, serum glucose and …. Yaqoob Ayoob Yaqoob
Karbala J. Med. Vol.7, No.2, Dec, 2014
ompared to normal control. Furthermore many reports demonstrate that effect of overt
hypothyroidism on glucose metabolism is still a subject of debate this came in agreement
with our study.
Conclusions: There are significant decrease in serum Zn, Cu and iron in hypothyroid patients
have poor response to LT therapy compared to normal subject. There is no significant change
in serum glucose concentrations in all tested groups. Our finding revealed significant
correlation between thyroid function tests and serum trace elements.
Key words: essential elements, serum glucose, hypothyroidism, levothyroxine
Introduction
Hypothyroidism is a syndrome resulting
from deficiency of thyroid hormones
namely thyroxine (T4) and tri-
iodothyronine (T3), leading to generalized
slowing of all metabolic processes, it was
divided in to overt and subclinical
hypothyroidism in both serum thyroid-
stimulating hormone (TSH) levels outside
the reference range (1,2)
. The prevalence of
hypothyroidism varied from 2-5%,
increasing to 15% in elderly over 75 years,
with a higher incidence in females (3)
.
Many processes in the body like in growth,
development, and metabolism in humans
are under the direct or indirect control of
the thyroid hormones. Full activity of the
thyroid hormones requires the deiodination
of T4 toT3, which capable of modulating
expression of control regions of target
genes(4)
. Actually many diseases like
hypertension, ischemic heart disease,
adverse lipid profile, endothelial
dysfunction and Metabolic abnormalities
have been suggested to be the major
consequences of hypothyroidism, (5-7)
.
Meanwhile hypothyroidism in infants and
children results in growth and mental
development retardation (8)
. So successful
treatment are required to normalize thyroid
hormone levels in peripheral tissues this
accomplish by using Levothyroxine
replacement therapy for reversing such
direct or indirect problems (9)
. There were
cross connection between thyroid
hormones, insulin and trace elements
poorly discuses that may lead to
unexpected or predictable complications
(10,7)
. It is well known that trace elements
play essential roles in the human body as
cofactors of some enzymes and take part in
the synthesis of many hormones where
abnormal level may be the end results of
many disease or the causes of some
diseases thus precise determination and
monitoring of trace elements has clinically
become an important key marker for
diagnosing wide diseases (11)
. Normal
thyroid status is dependent on the presence
of many trace elements for both the
synthesis and metabolism of thyroid
hormones(12)
In other hand hypothyroidism
may affect trace element levels where
many studies have been reported that the
disorder of thyroid hormones can influence
the homeostasis of trace metals in the
body, such as Ca, Mg, Mn, Cu, and Zn (13)
.
prevalence of anemia in patients with
hypothyroidism has been shown to be high
(20-60%) (14,15)
.
Thyroid hormones are important mediators
of glucose homeostasis, it can stimulate
the expression and activation of large
numbers of proteins that are candidates for
regulating insulin sensitivity via
sympathetic projections to the liver (16)
this
fact could explain the relationship between
thyroxine and serum glucose level. For
these huge effects, T4 therapy, using
synthetic levothyroxine (LT), is the
standard of care for thyroid hormone
therapy in patients with hypothyroidism
(17)
. Moreover there were variations in
hypothyroid patient’s response to T4
therapy so measurement of serum thyroid
stimulating hormone is the cornerstone of
monitoring LT replacement, the exception
being people with pituitary disease. After
starting LT, thyroid stimulating hormone
and free thyroxin levels should be
measured at8 to 12 weeks and adjustments
3. Assessment of serum essential elements, serum glucose and …. Yaqoob Ayoob Yaqoob
Karbala J. Med. Vol.7, No.2, Dec, 2014
made to the dose accordingly (18)
. Many
patients still having high TSH level despite
adequate doses of T4 , Patient non-
compliance with LT therapy can
sometimes be a problem and less than 10%
of patients poorly responded to LT, with
no clear reasons (19)
. In view of the role of
trace element as a constituent of T3
nuclear receptors and may involve in T4
T3 conversion (20)
, Therefore, in order to
illustrate the influence of LT therapy on
the homeostasis of trace elements, serum
glucose level, the objective of current
study we compare fasting serum Fe, Cu,
and Zn concentrations, fasting serum
glucose concentration and thyroid function
tests in hypothyroid patients having good
and poor response to LT therapy with age
and gender matched individuals as control
group, searching for reasons or
correlations that explain such controversy
in response.
Materials and methods
The present study was a single center,
cross sectional study conducted in alshefa
Ceneral hospital, basra, Iraq. During the
period from June,2013 to Mar, 2014. 62
subjects aged 20 to 55 years were
included. The patient groups consisted of
41 hypothyroid patients (38 females and 3
males) on LT therapy for at least 6 months
duration. 21 Healthy age and gender
matched group with thyroid function
within normal limit were selected as
control group. The study protocol was
approved by the local clinical research
ethics committee. Patients were given
detailed information about the aims of the
study and written consent forms were
obtained. Patients with hypothyroidism on
LT therapy included in the study. Patients
with interfering illnesses or who were
taking drugs that could alter thyroxine
absorption or metabolism were excluded.
Patients were screened for FT3, FT4 and
TSH. Based on these values, patients were
either classified as cases of good response
to LT therapy(TSH within normal
range)(n=23)or as poor response to LT
therapy and still having
hypothyroidism(high TSH value)(n=18)
according to Vaidya B and Pearce SH
(2008) classification (19)
. After 12 hrs
fasting, blood samples (5 ml) were
obtained from each patients and controls.
Fasting venous blood specimens collected
in the morning, specimens were placed on
polyethylene tube; blood samples are left
to clot and centrifuged at 10000 rpm for 20
minutes. The separated serum was divided
into several aliquots for analysis and
estimation of fT3, fT4 and TSH .The
remaining serum samples were kept frozen
for later analysis for the estimation of Zn,
Cu and Fe.
Biochemical methods
Determination of thyroid hormones
Serum fT3, fT4 and TSH concentrations
were by electrochemiluminescence
immunoassay (ECLIA) technique intended
for use on the Elecsys reagent kits supplied
by Roche Diagnostics GmbH (Mannheim,
Germany) and run on cobase 601
immunoassay analyzer from Roche
Diagnostics Ltd, Switzerland. The
reference range for serum fT3 (2.0-4.4
pg/mL), fT4 (0.93-1.7 ng/dL) and TSH
(0.27-4.20 mIU/mL). fasting Serum
glucose values were obtained through an
enzymatic process Axthat uses the
enzymes hexokinase and glucose-6-
phosphate dehydrogenase, using test strip
of the Accu-Chek® glucose meter
Determination of trace elements levels
(Zn, Cu and Fe)
Concentrations of Zn, Cu and Fe were first
must be released from the protein matrix
by wet digestion method (21)
and
determined by atomic absorption
spectrophotometer using a Buck Model
211-VGP spectrophotometer, with a
detection limit of 0.005 ppm for Zn and
Cu, and 0.05 ppm for Fe. The flame
conditions were fixed as recommended by
the instrument manufacturer for Zn, Cu
and Fe, (wavelengths 214, 324, 247 nm,
respective-ely). The band pass was 0.7 nm
for Zn, Cu while 0.2 for Fe and the
4. Assessment of serum essential elements, serum glucose and …. Yaqoob Ayoob Yaqoob
Karbala J. Med. Vol.7, No.2, Dec, 2014
measuring time was 3 second. Standard
solutions (1000 ppm STD supplied by
Buck company) of those elements were
first aspirated to calibrate the atomic
absorption spectrophotometer (AAS)
before the aspiration of the samples. From
the prepared standard curves the
concentration of each element was
calculated using the following formula
(22): (Sample concentration= Read
concentration × dilution factor) trace
element concentrations were presents as
(μg/dl).
Statistical analysis
Values were expressed as mean ± S.D; the
values were statistically evaluated using
unpaired Student's t-test and one way
analysis of variance (ANOVA), supported
by Bonferroni’s post hoc analysis. Values
with P < 0.05 were considered
significantly different. Analysis was
performed using GraphPad Prism software
for Windows (version 5.0, GraphPad
Software, Inc., San Diego, CA).
Results
Most study subjects (92%) were women,
41 hypothyroid patients on LT therapy and
21 healthy subjects serve as control group.
In the group with good response to
levothyroxine therapy (GRLT) 21 patients
had thyroid function tests (TSH, FT4 and
FT3) within normal range and there were
no significant differences when compared
with control while in group with poor
response to levothyroxine therapy (PRLT),
FT4 and FT3 significantly decreased when
compared with control and GRLT groups
while serum TSH levels in all 20
hypothyroid patients were significantly
higher than the control group. Regarding
T3/T4 ratio there were no significant
differences between all studied groups. All
these data clearly summarized in figure
(1).
The levels of serum trace elements (Zn, Cu
and Fe) in both groups who had good or
poor response to treatment as comparison
with control group and each other are
listed in Figure (2). The results of serum
trace elements expressed as
mean±standard deviation. Serum Zn, Cu
and Fe level of PRLT patients are
significantly lower (p<0.05) than the level
in Control and (GRLP) groups, whereas,
there were no significant difference
(p>0.05) when we compared trace element
concentrations between (GRLP) group and
control.
In this study, we have analyzed fasting
serum glucose (FSG) concentrations
among hypothyroid treated groups and
control. As shown in figure (3) we’ve seen
FSG concentration decrease in PRLT
group but not significantly when compared
with control and GRLP groups.
With such a high prevalence of both
thyroid dysfunction and metabolic
syndrome with trace elements deficiency
we might suspect there are connections
between these parameters. Accordingly In
the present study, we have analyzed the
correlation between thyroid hormones,
fasting Serum glucose levels and trace
elements among hypothyroid patients and
control groups. Table(1) showed there
were significant associations between FT4
and serum trace elements (Cu and Fe)
concentrations in GRLT group while in
PRLT the correlation observed with serum
Cu and Zn. The same finding observed
when we make correlation between FT3
and trace elements in both GRLT and
PRLT groups. Moreover there were
significant negative correlations between
TSH and serum trace elements in GRLT
while in PRLT the correlation observed
with serum glucose and iron.
Discussion
The maintenance of optimal health
requires an adequate supply of
carbohydrates, proteins lipids,
macronutrients, micronutrients, and trace
elements. (23)
. Although there are some
previous studies about the serum
concentrations of thyroid hormone and
trace elements in hypothyroidism , there is
5. Assessment of serum essential elements, serum glucose and …. Yaqoob Ayoob Yaqoob
Karbala J. Med. Vol.7, No.2, Dec, 2014
little information about the effects and role
of such trace element in hypothyroid
patients have poor response to LT therapy.
Trace elements play an essential role in
large number of biological processes
through their action as activators or
inhibitors of enzymatic reactions, by
influencing the permeability of cell
membranes, or by other mechanisms.
GRLP PRLP Control
0
10
20
30
a
b
a
A)Serum free thyroxine concentrations. values were
presented as mean±S.D; values with non-identical letters
(a,b,c) represent significant differences
FT4concentration(Pmol/l)
GRLP PRLP control
0
2
4
6
8
a
b
c
B)Serum free T3 concentrations values were
presented as mean±S.D; values with non-identical
letters (a,b,c) represent significant differences
FT3concentration(Pmol/l)
GRLP PRLP Control
0
2
4
6
8
10
a
C)Serum TSH concentrationS values were
presented as mean±S.D; values with non-
identical letters (a,b,c) represent significant
differences
TSHconcentration(mIU/L)
GRLP PRLP Control
0
10
20
30
40
D)Serum T3/T4 percentage. values were
presented as mean±S.D; No significant
differences
T3/T4ratio
Figure(1) thyroid function tests in both GRLT and PR LT hypothyroid and
control groups
A B
C D
6. Assessment of serum essential elements, serum glucose and …. Yaqoob Ayoob Yaqoob
Karbala J. Med. Vol.7, No.2, Dec, 2014
7. Assessment of serum essential elements, serum glucose and …. Yaqoob Ayoob Yaqoob
Karbala J. Med. Vol.7, No.2, Dec, 2014
Table 1. Correlation analysis among different parameters of control, GRLT and PRLT
groups in the studied subjects. Data expressed as mean ± SD. * = significantly different
(P<0.05): ** = significantly different(P<0.0001)
Paramet
er
Group Pearson Correlation Coefficient (P Value)
Serum Glucose Serum Iron Serum Copper Serum Zinc
TSH GRLP 0.3917 (0.1199) -0.6998 (0.0018)* -0.7496 (0.0005)* -0.5493 (0.0224)*
PRLP 0.6417 (0.0055)* -0.4839 (0.0490)* -0.2167 (0.4034) -0.2207 (0.3946)
Control 0.3291 (0.1970) -0.4561 (0.0657) -0.2531 (0.3269) 0.2423 (0.3487)
FT4 GRLP -0.4666 (0.0590) 0.8722 (<0.0001)** 0.8555 (<0.0001)** 0.6376 (0.0059)
PRLP 0.2897 (0.2593) 0.1647 (0.5275) 0.8516 (<0.0001)** 0.9060 (<0.0001)**
Control 0.2850 (0.2674) -0.3493 (0.1692) -0.1334 (0.6096) 0.0565 (0.8293)
FT3 GRLP -0.4702 (0.0568) 0.5811 (0.0144)* 0.5037 (0.0392)* 0.2243 (0.3868)
PRLP 0.3836 (0.1284) 0.3185 (0.2127) 0.6646 (0.0036)* 0.6248 (0.0073)*
Control 0.1573 (0.5464) 0.0306 (0.9070) 0.2509 (0.3312) 0.2338 (0.3664)
Trace elements influence thyroid
hormones at levels of action, including
hormone secretion and activity and
binding to target tissue. In other hand,
thyroid hormones itself influence trace
metals metabolism at several levels of
action, including excretion and transport of
trace metals. (24,25)
In the present study
serum concentration of trace elements (Zn,
Cu and Fe) decrease significantly in PRLT
group as compared to control and GRLT
groups, this could be an explanation
describing a persistent high TSH level in
PRLT group despite taking a high dose of
LT. Such patients may require supportive
therapy with trace element preparations in
order to obtain desired response to LT
therapy. Our finding came in agreement
with many studies that conclude normal
thyroid status is dependent on the presence
of many trace elements for both the
synthesis and metabolism of thyroid
hormones, for example selenium is
required for conversion of T4 to T3 by
deiodinase enzyme (26)
. Furthermore
copper deficiency enhances the effect of
hypothyroidism and there are significant
positive correlation between the serum
concentration of copper and T3 (27,28)
.
Meanwhile, Cu deficiencies may be a
result of thyroxine hormone insufficiency
and the fortification of T4 may help to heal
serum Cu disorders (29)
. Zinc play a crucial
role in thyroid function it has been found
that Zinc supplementation appeared to
have a favorable effect on thyroid
hormone levels, particularly total T3, and
resting metabolic rate, actually Zn is a
constituent of T3 nuclear receptors (30)
. In
addition there was a significant correlation
of serum zinc levels with thyroid volume
in nodular goitre patients, with thyroid
autoantibodies in AITD and with free T3
in patients with normal thyroid. (31)
. These
results came in tune with our study were
significant positive correlation had been
reported between Zn, Cu and iron with
both T3 and T4. Moreover, Thyroid
hormones influences zinc metabolism. In a
study carried out in nephrectomized rats, it
was observed that reduced thyroid function
was strongly related to low serum zinc
level (32)
.Prasad et al.(1999) reported that
thyroid hormones not only affected by zinc
deficiency, it may modulate zinc transport
activity in rat renal and intestinal brush-
border membrane affecting zinc level
(33)
.One possible explanation for decrease
serum zinc concentration, that
gastrointestinal absorption of zinc is
severely impaired in hypothyroidism
subjects. An alternative explanation would
be a change in zinc distribution; the low
zinc level may reflect sequestration of zinc
by the liver or other tissues (34,35)
. In fact
the role of iron, zinc and copper t in the
thyroid are less well defined but sub-or
super optimal dietary intakes of all these
elements can adversely affect thyroid
hormone metabolism (36)
. Several
literatures demonstrated low serum iron
concentration in hypothyroid patients
8. Assessment of serum essential elements, serum glucose and …. Yaqoob Ayoob Yaqoob
Karbala J. Med. Vol.7, No.2, Dec, 2014
similar to our finding. Studies in animals
and humans have shown that iron
deficiency with or without anemia impairs
thyroid hormone metabolism meanwhile
nutritional iron deficiency has been shown
to significantly lower the circulating levels
of both thyroxine and triiodothyronine in
rats (37)
- and reduce conversion of T4 to
T3.(38)
. Other study indicates that the
degree of iron deficiency may affect
thyroid hormone status in iron-deficient
adolescent girls and The mean serum iron
level was significantly lower than those of
healthy individuals (39)
. Conversely
decrease iron level may adversely affect
thyroid hormones concentration where
secondary and subclinical hypothyroidism
were found in iron deficiency anemia and
hormonal changes returned to normal
values with iron supplementation. One
possible explanation that iron deficiency
can affect the thyroid hormone metabolism
and peroxidase enzyme which catalyzed
initial steps of thyroid hormone synthesis
that dependent on the iron. Other possible
explanation in studies carried out in rats
have indicated that iron is required during
conversion of T4 to T3 (37)
. Moreover,
When iron and thyroxine were mixed
together in vitro, a poorly soluble purple
complex appeared that indicated the
binding of iron to thyroxine and this
interaction should be considered when
these drugs administered together (40)
.
The present study observed no significant
difference when we compared serum
glucose concentrations in GRLT and
PRLT groups with control subject. In
contrast to this idea overt hypothyroidism
showed increase levels of A1C and
glycated albumin also abnormal glucose
metabolism where thyroid hormone
replacement is associated with a decrease
in A1C level,. (41)
, however such
decrement could be due to increased
erythropoiesis rather than by changes in
glucose level. Many studies revealed that
T3 and insulin both stimulate the
expression of hexokinases and glycogen
synthase which are respectively
responsible for uptake and disposal of
glucose via formation of glucose-6
phosphate and glucose-1 phosphate . At a
molecular level, microarray studies
performed on mice liver have
demonstrated that most of the enzymes
involved in gluconeogenesis are positively
regulated by thyroid hormone (42)
. Other
reports demonstrate that effect of overt
hypothyroidism on glucose metabolism is
still a subject of debate (43)
this came in
agreement with our study. The high TSH
values and low FT4 in the present study in
PRLT group give an idea about positive
feedback mechanism on pituitary gland
while in GRLT group TSH values
normalize and return to reference range
with normal FT4 level. This hypothalamus
pituitary thyroid glands axis maintains
normal thyroid secretion when exogenous
thyroid hormones were administered. (44)
Conclusions
There are significant decrease in serum
Zn,Cu and iron in hypothyroid patients
have poor response to LT therapy
compared to normal subject and
hypothyroid patients having good response
to LT therapy. There is no significant
change in serum glucose concentrations in
all tested groups. Our finding revealed
significant correlation between thyroid
function tests and serum trace
elements.The findings underline the
importance of trace element replacement
in un controlled hypothyroidism .
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