Irreversible Thyrotoxic Dilated Cardiomyopathy: Case Reports and Review of Literature.

Irreversible dilated cardiomyopathy due to thyrotoxicosis is a rare clinical entity. We report two cases, one who presented with congestive cardiac failure and other presented with severe left ventricular dysfunction and atrial fibrillation. Both cases were diagnosed as dilated cardiomyopathy with severe left ventricular dysfunction (ejection fraction <30%) due to thyrotoxicosis. Inspite of vigorous medical therapy, there was only symptomatic improvement. Restoration of euthyroid levels did not revert the cardiomyopathy but led to definite clinical improvement.

Assessment of Hypogonadism with Reference to Clinical Features and Serum Testosterone Levels in Asian-Indian Male Type 2 Diabetics.

Objective: To assess the prevalence of hypogonadism in Asian-Indian males with type 2 diabetes (T2DM) with reference to clinical feature and total serum testosterone levels. Material and methods: In the cross-sectional study of 50 diabetics of 30-76 years age group preferably without chronic illness, total testosterone, body mass index (BMI) and waist circumference (WC) were measured. Overt hypogonadism was defined as the presence of clinical symptoms of hypogonadism and low testosterone level (total testosterone <8 nmol/l). Borderline hypogonadism was defined as the presence of symptoms and total testosterone of 8-12 nmol/l. Results: A low serum testosterone level was common in diabetic men and a significant proportion of these men had symptoms of hypogonadism. Overt hypogonadism was seen in 30% of men with total testosterone levels <8 nmol/l and borderline hypogonadism was found in 28% of men with total testosterone levels 8-12 nmol/l. Total serum testosterone levels significantly and negatively correlated with both BMI (r = –0.334, p < 0.05) and WC (r = –0.443, p < 0.001), with the association being stronger for WC. HbA1C also significantly and negatively correlated with serum testosterone levels (r = –0.503, p < 0.001). Conclusions: Testosterone levels are frequently low in men with T2DM and the majority of these men have symptoms of hypogonadism, even in the younger age group (early-onset hypogonadism). Obesity and BMI are also associated with low testosterone levels in Asian-Indian diabetic men.