Impairment of Health-related Quality of Life among Indian Patients with Hypothyroidism.

CONTEXT: Health-related quality of life (HRQL) is an important outcome measure for various diseases, although there are sparse data regarding HRQL among Indian patients with hypothyroidism. AIMS: This study aimed to assess HRQL among Indian patients with hypothyroidism using the SF-36 questionnaire. METHODS: This cross-sectional study evaluated 244 consecutive patients with hypothyroidism who were treated at the Vydehi Institute of Medical Sciences and Research Centre in Bengaluru. All patients were >18 years old and visited the outpatient department for endocrine treatment. Perceived health status was evaluated using the SF-36 questionnaire. The patients' data were compared to data from 250 age-matched and sex-matched healthy controls. RESULTS: Compared to the healthy controls, the patients with hypothyroidism had significantly lower scores for six of the eight SF-36 scales. No significant intergroup differences were observed in the "role emotional" and "social functioning" dimensions. INTERPRETATION AND CONCLUSIONS: Hypothyroidism was associated with reduced HRQL among Indian patients. These patients generally experienced greater reductions in physical dimensions, compared to social and emotional dimensions.

Frequent Occurrence of Faulty Practices, Misconceptions and Lack of Knowledge among Hypothyroid Patients.

INTRODUCTION: Hypothyroidism is a common endocrine disorder with a reported prevalence of 4%-10%. Previous studies have reported significant gaps in the basic knowledge about the condition in hypothyroid patients. It has also been observed that faulty practices prevail among these patients. There is paucity of data on the assessment of knowledge and practices among treated hypothyroid patients. AIM: The present study was aims to assess the knowledge, awareness and practices in treated hypothyroid patients. MATERIALS AND METHODS: The current cross-sectional study was conducted on 244 consecutive hypothyroid patients, attending the Endocrinology Outpatient Department (OPD). The patients were asked to fill a structured questionnaire pertaining to knowledge and practices about various aspects of hypothyroidism. RESULTS: Only two-thirds of the participants correctly identified thyroid as a gland and 41% were aware that hypothyroidism is caused due to decreased function of the thyroid gland. The most common symptom attributed to hypothyroidism was weight gain (139 responses). Nearly 45% of the patients believed alternative forms of medicine can be used for treatment of hypothyroidism. It was believed by 42% of the patients that hypothyroidism runs in the family and about 10% believed it could be transferred to their spouses. Only 33% of the patients gave one hour gap between levothyroxine and food intake. CONCLUSION: The study demonstrates the lack of knowledge about basic aspects of hypothyroidism among the patients. In addition, there is a high prevalence of misconceptions and faulty practices. The study highlights the need for comprehensive patient education to improve therapeutic outcomes and compliance among hypothyroid patients.

High Prevalence of Serine Protease Inhibitor Kazal Type 1 Gene Variations Detected by Whole Gene Sequencing in Patients with Fibrocalculous Pancreatic Diabetes.

AIM OF STUDY: The aim is to study the prevalence and pattern of serine protease inhibitor Kazal type 1 (SPINK1) gene variations in patients with fibrocalculous pancreatic diabetes (FCPD) using whole gene sequencing. MATERIALS AND METHODS: A total of 56 consecutive patients of FCPD were recruited for the study. Diagnosis of FCPD was based on the presence of diabetes mellitus in patients having chronic pancreatitis with radiological evidence of ductal calcifications, in the absence of other known causes for pancreatitis. Ethylenediaminetetraacetic acid samples were collected from all patients, and complete gene sequencing was performed for SPINK1 gene using Sanger technique. RESULTS: Overall 35 patients (62.5%) were detected to have genetic alterations in SPINK1 gene. N34S polymorphism was seen in 23 participants (41.07%) out of which 3 were homozygous. N34S was seen to be in linkage disequilibrium with IVS1 - 37T>C (18/23) and IVS3-69insAAAA (19/23) polymorphisms. Seven patients (12.5%) had a 272 C>T 3'UTR polymorphism while one patient (1.8%) had a P55S polymorphism. Two patients (3.5%) had an IVS3 + 2T>C mutation which has been shown to be associated with loss of function of SPINK protein. Overall 48.2% of FCPD patients had genetic variations that were significant compared to the control population. There was no difference in anthropometric and biochemical parameters between those with or without SPINK1 gene variations. CONCLUSIONS: Variations in SPINK1 gene are frequently observed in FCPD. N34S polymorphism was the most common variation followed by intronic variations. Two patients had the pathogenic intronic IVS3 + 2T>C mutation. Whole gene sequencing of the SPINK1 gene enabled detection of an additional 7.1% of patients with significant SPINK1 gene variations as compared to targeted screening for the N34S variation.

High rates of diabetes reversal in newly diagnosed Asian Indian young adults with type 2 diabetes mellitus with intensive lifestyle therapy.

AIMS: There are variable reports on the reversibility of type 2 diabetes mellitus (type 2 DM) with higher rates among younger patients with short duration of diabetes. Hence, we studied the reversibility of diabetes among young adults with newly diagnosed type 2 DM. METHODS: This prospective study included 32 patients with newly diagnosed type 2 DM. All type 2 DM patients were initially treated with intensive lifestyle therapy (ILT) (low-calorie diet [1500 kcal/day] and brisk walking for 1 h/day]). Four patients who with HbA1C <9.0% were treated with ILT alone. Except for three patients with concomitant infections who were treated with insulin, remaining 25 patients with HbA1C ≥9.0% were treated with metformin (1000-2000 g) in addition to ILT. When fasting plasma glucose was <126 mg/dl or HbA1C was <6.5% antidiabetic drug dose was reduced or stopped. The patients were followed for a minimum period of 2 years. RESULTS: Reversal/remission rates at 3 months, 1 year, and 2 years were 24 (75%), 24 (75%), and 22 (68.75%), respectively. Seventeen (53.1%) patients achieved complete reversal and seven (21.9%) patients achieved partial reversal at 3 months. Rates of complete and partial remission at 1 year were 50% and 25% and at 2 years were 46.9% and 21.9%, respectively. CONCLUSION: Young adults with newly diagnosed type 2 DM have high rates of diabetes reversal and should receive ILT to achieve reversal of diabetes.

Etiology and clinical profile of patients with Cushing's syndrome: A single center experience.

BACKGROUND: There is little published literature on the profile of patients with Cushing's syndrome (CS) from India. The aim of this study was to compile data of CS patients treated at this hospital. MATERIALS AND METHODS: Patients referred to the endocrine services of this hospital for diagnosis/treatment of CS from January 1985 to July 2012 were the subjects for this study. All patients had detailed medical history, physical examination and biochemical and hormonal assays (which changed with availability of tests and changing views). Assays for plasma adrenocorticotropic hormone (ACTH) (late 90s), salivary cortisol estimation, IJV sampling for ACTH and corticotrophin releasing hormone stimulation tests were added on later. Imaging included computed tomography (CT), magnetic resonance imaging (since the late 80's) and (68)Ga DOTA-TOC/FDG PET-CT (2008). RESULTS: Three hundred sixty-four patients (250 females, 114 males, age 6 months to 65 years, mean 28 years + 12 years) were diagnosed to have CS during this period. Two hundred and ninety-three patients (80.5%) were ACTH dependent (CD 215, ectopic ACTH syndrome 22, occult ACTH source 56) while 71 (19.5%) were ACTH independent (adrenal carcinoma 36, adenoma 30, primary pigmented nodular adrenal disease 4, AIMAH 1). Pituitary macro adenoma was seen in 14% of the CD cases. The most common presenting complaints were hypertension and diabetes mellitus. A total of 63% patients complained of weight gain while 15% had lost weight. Myopathy, infections, skeletal fractures and psychiatric problems were the other common observations in our patients. CONCLUSION: The clinical spectrum was broad. CD was the most common cause for CS.

Graves' Disease during pregnancy--results of antithyroid drug therapy.

AIM OF STUDY: To assess the maternal and fetal outcome of pregnancies in thyrotoxic women. METHOD: Thyrotoxic women who conceived while on treatment or who conceived within two years after stopping treatment, were recruited into the study. The antithyroid drugs (PTU and methimazole) dosage were adjusted to keep T3 and T4 within the upper normal range for these women. Cord blood and baby's blood (between days 4 and 10) were assayed for T3, T4 and TSH. RESULTS: Thirteen women (16 pregnancies) required antithyroid drugs during pregnancy. The drug dosage remained the same during pregnancy in 8 women while it was increased in 5 women and reduced in 3 women. One woman who was in remission at the time of conception remained euthyroid throughout her pregnancy. There were 14 spontaneous vaginal deliveries and 3 Caesarean sections. One baby had a small VSD while no other congenital malformations or perinatal death occurred. CONCLUSIONS: Drug therapy can adequately control thyrotoxicosis during pregnancy and improve maternal and fetal outcome.