ABSTRACT
INTRODUCTION: Hypothyroidism is a silent epidemic of our times. In India, the prevalence of hypothyroidism is 11%. The effect of hypothyroidism on respiratory system is debatable with studies suggesting both obstructive and restrictive disease patterns. The symptoms range from mild dyspnoea to life-threatening respiratory failure. This study emphasizes the effect of hypothyroidism on dynamic respiratory functions. AIM: To find out the changes in dynamic respiratory functions (FVC, FEV1, FEV1% and PEFR) in both male and female hypothyroid patients within age group of 18-45 years. MATERIALS AND METHODS: This cross-sectional study was conducted in Jubilee Mission Medical College, Thrissur, Kerala, India. Total number of 60 newly detected cases of both sexes in 18-45 years age group attending endocrinology outpatient department were enrolled. Patients with previous respiratory diseases and history of smoking were excluded. Proforma was filled up followed by clinical examination. Spirometry was performed using a computerised spirometer 'microQuark'. The data was analysed by paired t-test and Analysis of Variance (ANOVA) test. RESULTS: The mean of the observed values in all the dynamic pulmonary parameters showed highly significant difference from the predicted mean of the parameters (p<0.001). They also decreased considerably with age, gender and BMI which were statistically significant (p<0.05). CONCLUSION: The above findings suggest that respiratory abnormality in newly detected cases of hypothyroidism shows a mixed pattern. This highlights that while investigating a patient with respiratory disorder, the thyroid status should always be probed into, as the effects of hypothyroidism can be reversed with proper treatment.
ABSTRACT
AIMS: To study the prevalence of upper airway obstruction (UAO) in "apparently asymptomatic" patients with euthyroid multinodular goitre (MNG) and find correlation between clinical features, UAO on pulmonary function test (PFT) and tracheal narrowing on computerised tomography (CT). MATERIALS AND METHODS: Consecutive patients with apparently asymptomatic euthyroid MNG attending thyroid clinic in a tertiary centre underwent clinical examination to elicit features of UAO, PFT, and CT of neck and chest. STATISTICAL ANALYSIS USED: Statistical analysis was done with SPSS version 11.5 using paired t-test, Chi square test, and Fisher's exact test. P value of <0.05 was considered to be significant. RESULTS: Fifty-six patients (52 females and four males) were studied. The prevalence of UAO (PFT) and significant tracheal narrowing (CT) was 14.3%. and 9.3%, respectively. Clinical features failed to predict UAO or significant tracheal narrowing. Tracheal narrowing (CT) did not correlate with UAO (PFT). Volume of goitre significantly correlated with degree of tracheal narrowing. CONCLUSIONS: Clinical features do not predict UAO on PFT or tracheal narrowing on CT in apparently asymptomatic patients with euthyroid MNG.
ABSTRACT
OBJECTIVE: To describe the clinical presentation, localization techniques, surgical procedures and outcome in patients with insulinoma. METHODS: Retrospective analysis of case records of patients diagnosed with insulinoma between January 1993 and June 2009 at a tertiary-care hospital was done. Seventeen patients underwent diagnostic 72-h fast. The sensitivity of computed tomography (CT) of pancreas was judged using intraoperative findings as the gold standard. RESULTS: Twenty-six patients (19 women) with mean age 42.2 years (median age 39.5 years) with biochemical/imaging evidence of insulinoma were included. All patients who underwent 72-h fast developed symptomatic hypoglycemia within 48 h. The sensitivity and positive predictive value (PPV) of CT of pancreas was 68.4% and 92.8%, respectively. Twenty patients underwent surgery, of whom four were operated on without preoperative localization. Four patients had recurrence of symptoms. Of the six patients who were not operated upon, the lesion was localized in four. CONCLUSION: This audit shows that all patients with insulinoma develop hypoglycemia within 48 h of fasting. CT of pancreas localizes the lesion in two thirds of cases and would be a useful initial investigation in patients with suspected insulinoma.
