Reduced Thyrotropin in Euthyroid Goitrous Patients Suggesting Subclinical Hyperthyroidism

B a c k g r o u n d : Subclinical hypertyhroidism; a biochemical finding of low serum thyrotropin (TSH) with the serum levels of thyroxine (T4 ) and triiodothyronine (T3) within the reference range; could easily be ignored by clinicians; as it; usually; does not manifest with any thyroid specific symptoms. It is of two types : endogenous and exogenous. However; patients with the findings of low TSH; normal T4 and T3 develop some abnormalities in the cardiovascular system; such as atrial fibrillation; increasein left ventricular mass and diastolic dysfunction. It is believed that treatment intervention may reduce or halt the progression of the cardiac abnormalities. The main objective of the study was to determine how frequent subclinical hyperthyroidism was occurs and to serve as a reminder to the existence of the disorder. Methods : It was a hospital-based study carried out at the Jos University Teaching Hospital (JUTH). Consecutive clinically euthyroid goitre patients attending the outpatient department of JUTH; were studied for various parameters including TSH; T4 and T3. The serum concentrations of T4 and T3 were determined by enzyme-linked immunosorbent assay (ELISA) technique. The serum TSH concentration was estimated using a 2nd generation ELISA technique. Results : 98 patients participated in the study. Nine patients had non-specific symptoms not referable to the thyroid and found to have high levels of thyroid hormone concentration with depressed TSH and were excluded from further analysis; while 7 had subclinical hyperthyroidism giving a prevalence rate of 7.9among these clinical euthyroid goitre patients. The subjects with this condition were mainly above 60 years of age and mainly had long-standing goitre. Conclusion: Endogenous subclinical hyperthyroidism was present in 7.9of these clinically euthyroid goitre patients mainly 60 years and above; with long - standing goitre. This high prevalence rate calls for high index of suspicion as this condition is associated with morbidities that can raise mortality

Diabetes Co-existing with Chronic Liver Disease : Clinical Features and Reponse to Therapy

Background and objectives : Diabetes mellitus (DM) and chronic liver disease (cirrhosis) may co-exist in the same individual. Diabetes may cause non-alcoholic steatohepatitis with necroinflammatory changes and granuloma formation leading to hepatic fibrosis. Cirrhosis of the liver from alcohol and hepatitis C infection; on the other hand; may give rise to insulin resistance or may result in progressive impairment of insulin secretion leading to DM. We studied the clinical features and response to therapy of diabetic patients with the two conditions to determine if there are differences in the clinical features and effects of the chronic liver disease (CLD) on the management of DM. Methods: This was a prospective study conducted at the Diabetes Clinic at the Jos University Teaching Hospital (JUTH) over a period of two years. Newly diagnosed diabetics with features of CLD (cirrhosis) were enrolled into the study after obtaining a consent. Age; sex; body mass index (BMI); family history of diabetes were recorded; as well as symptoms and signs of DM or CLD. Serum fasting blood glucose (FBS); prothrombin time ratio (PTR); and serum fasting lipids (serum lipoproteins and serum triglycerides) were measured. Urinalysis was done. The responses to therapy were classified as very rapid; rapid and gradual based on our previous unpublished observations that diabetic patients with CLD responded briskly to antidiabetes therapy. Result : 26 patients (19 men; and 7 women) were seen with both diseases agreed to participate in the study. This accounted for 8.6of the diabetic population attending the diabetes clinic. The mean age of the patients was 54.6 (9.2 ) years spanning a range of 34-75 years. Mean BMI was 21.6 (6) kg/m2. The mean serum albumin concentration was 25.5 (8.5) g/l; mean FBS was 15.5 (3.4) mmol/l and PTR was 1.6 (0.43). Urinalysis showed glycosuriain all patients with only one patient showing trace of ketonuria. Clinical features of DM and CLD were few each. There was a brisk response to insulin therapy so that one needs to be cautious with insulin administration.Conclusion : Diabetes in patients with CLD has similar but fewer features compared to patients with type 2 DM. CLD affects the response to therapy; particularly insulintherapy and calls for caution; as these patients may be sensitive to therapy