Thyroid Disorders Among People with Type 2 Diabetes in Misan Province: Prevalence Study

Diabetes mellitus type 2 (DMT2) with thyroid disorders are common endocrine disorders, and both of themmostly come close in any clinical practice. Hormones of the thyroid gland can in luence carbohydrate metabolism. On the other side, there is a degree of insulin resistance in DMT2. The study aimed is to determine the prevalence of thyroid dysfunctions in DMT2. A cross-sectional study was done enrolling 100 participants included, (n= 40) men, and (n= 60) women, their age ranged between 20-90 years old. Evaluation for thyroid status and assessment of T3, T4, and TSH levels were done. The results were 60% euthyroid, 33% hypothyroid, and 7% hyperthyroid cases from 100 patients with diabetes mellitus; among them, 17% in young adults, 49% in middle age, and 34% in the old age patients, the diabetic patients’ results comprised betweenboth sexeswere 40%male and60% females. In a comparison between rural and urban patients, the results were 44% rural and 56% urban. The study found there’s 22% of thyroid dysfunction patients were with family history, and 42% of DM patients with family history, besides, there is 28%of patients suffered from hypertension and 33% of patients were smokers. So, the study showed a high prevalence of dysfunction among those with DMT2, especially hypothyroidism. Family history and DM might be pre-existing factors to the development of thyroid dysfunction. Hypertension and tobacco smokingmight be a risk factor for thyroid dysfunction.

Diabetes mellitus, hypothyroidism, hyperthyroidism ABSTRACT Diabetes mellitus type 2 (DMT2) with thyroid disorders are common endocrine disorders, and both of them mostly come close in any clinical practice. Hormones of the thyroid gland can in luence carbohydrate metabolism. On the other side, there is a degree of insulin resistance in DMT2. The study aimed is to determine the prevalence of thyroid dysfunctions in DMT2. A cross-sectional study was done enrolling 100 participants included, (n= 40) men, and (n= 60) women, their age ranged between 20-90 years old. Evaluation for thyroid status and assessment of T3, T4, and TSH levels were done. The results were 60% euthyroid, 33% hypothyroid, and 7% hyperthyroid cases from 100 patients with diabetes mellitus; among them, 17% in young adults, 49% in middle age, and 34% in the old age patients, the diabetic patients' results comprised between both sexes were 40% male and 60% females. In a comparison between rural and urban patients, the results were 44% rural and 56% urban. The study found there's 22% of thyroid dysfunction patients were with family history, and 42% of DM patients with family history, besides, there is 28% of patients suffered from hypertension and 33% of patients were smokers. So, the study showed a high prevalence of dysfunction among those with DMT2, especially hypothyroidism. Family history and DM might be pre-existing factors to the development of thyroid dysfunction. Hypertension and tobacco smoking might be a risk factor for thyroid dysfunction.

INTRODUCTION
The two most common endocrinopathies encountered in clinical practice are diabetes mellitus (DM) and thyroid dysfunction (TD) (Sarode et al., 2017), and the relation between them was irst published in 1979 (Vikhe et al., 2013). Thyroid dysfunction manifest as hyperthyroidism or hypothyroidism (Ahmed et al., 2017). The metabolic process of normal growth and development regulated by thyroid hormones (Silva et al., 2017). DM is accompanied by chronic hyperglycemia and associated with carbohydrate, lipid, and protein metabolism disturbances (Ahmed et al., 2017). The prevalence of TD in diabetic patients is signi icantly higher than in healthy people (Manjunath et al., 2013). There are many records that, show that iodothyronines are insulin antagonist with elevated levels being diabetogenic while absence might inhibit the development of DM (Uppal et al., 2013).

Study design and setting
A cross-sectional observational study conducted to determined the prevalence of TD in adult patients (aged 20-90 years) with DMT2, attending the outpatient's clinic at the Diabetes and Endocrinology Center at Misan, during 2018-2019.

Participants
A total of 100 DM participants, included, 40men and 60 women. A complete history was taken, and clinical examination and laboratory investigations were done.

Inclusion criteria
1. Individuals with DMT2 were treated with oral hypoglycemic drugs 2. Those received insulin in addition to oral therapy.

Exclusion criteria
1. Those refused including in the study.

Procedure
All patients were evaluated for thyroid status, and assessment of T3, T4 and TSH levels.
In Table 3, we compared the female and male patients depending on the functional status of the thyroid gland, wherein male. It was: 26% Euthyroid, 3% Hyperthyroid, and 11% Hypothyroid. Whereas in female, it was 34% Euthyroid, 4% Hyperthyroid, and 22% Hypothyroid.

DISCUSSIONS
The TD had been reported to be highly prevalent in DMT2, and both hypothyroidism and hyperthyroidism are known to have adverse effects on glycaemic control (Petry, 2002). Our study entails screening for biochemical evidence of thyroid disorders in DMT2. The indings from the results were 40% thyroid dysfunctions (33% hypothyroid and 7% hyperthyroid), and this is consistence with previous similar studies performed by Telwanietal., Sarodeetal., where their results were 29%, 31.2 %, 32.4% respectively, in addition to the study of Sarodeetal found 29% patients were detected with thyroid disorders (22% hypothyroid and 7% hyperthyroid) (Telwani et al., 2017;Sarode et al., 2017). In Nigeria, there was a study had shown a high incidence reached to 46.5% (Udiong et al., 2007). The cause may be due to the fact of the DMT2 results from insulin resistance (Wang, 2013). Sometimes, the abnormality of thyroid hormones level associate with insulin resistance, lead to decline conversion of T4 to active T3, also decline hypothalamus thyrotropin-releasing hormone (TRH) in DM (Ahmed et al., 2017).
The results appeared that prevalence of DMT2 increased with older age group. These result agreed with studies of Gesing and Barbesino (Gesing, 2015;Barbesino, 2019). The ageing process decreases insulin sensitivity and alteration compensation of beta-cell function in the face of increasing insulin resistance (Chang and Halter, 2003). This decrement in beta cell proliferation capacity enhanced sensitivity to apoptosis (Maedler et al., 2006). Noh et al. showed the initial and second phase of insulin secretion typically that which decrease at the       (Noh et al., 2018).
In comparison between female and male depending on the functional status of the thyroid gland, the results were in male less than female. These results agreed with studies of Khuranaetal and Ding (Khurana et al., 2016;Ding et al., 2017). That woman have a higher incidence of TD than men (Meng et al., 2015).
For the residential area, randomly selected cases of DMT2, which were 44% in the rural area and 56% in the urban area, the results were elevated of thyroid disorders in urban more than rural people. This result was agreed with Aungetal (Aung et al., 2018). The cause of DMT2 was higher in the more deprived areas relative to the more af luent areas (Connolly, 2000). In the study of Santos et al. described the socio-demographic variables, he found that the elderly individuals residing in the urban area displayed a more signi icant number of veri ied comorbidities. The old aged group DM is living in rural sites have better health (Santos et al., 2013).
The study of Dudzińskaetal found differences between groups depending on the place of living, and this did not have a signi icant in luence on the DM metabolic control. Moreover, these data are consistence with the previous study conducted by Childs (Dudzinska et al., 2013;Childs, 2016).
The results appeared that there's 42% family history of DM, and this result agreed with many other studies such as Arslanian and Saad, Valdez and Liu (Arslanian et al., 2005;Valdez et al., 1999).
In case of risk factors, the results discovered 28% known facts of hypertension which correspond to other studies such as Saito and Saruta; and 33% smokers as a risk factor for both T2DM and TD, as the previous study of Chang, Maddatuetal, they found that tobacco smoking, related with a variety disorder of endocrine systems (Chang, 2012;Maddatu et al., 2017).

CONCLUSIONS
TD has a higher prevalence in DMT2, and more in women. Hypothyroidism was the most common disorder. Family history and DM might be pre-existing factors to develop thyroid dysfunction. Hypertension and tobacco smoking might be a risk factor for thyroid dysfunction.