Article Type : Research Article
Authors : Osmana RAA, Khalida MO, Saeeda AA, Altahera TAA, Mahjafb GM, Gorishc BMT and Abdelmulad WIY
Keywords : Diabetes mellitus; Thyroid stimulating hormone; Free thyroxine; Thyroid hormones
Background: Diabetes
Mellitus is a group of metabolic diseases characterized by hyperglycemia
resulting from defects in insulin secretion, insulin action, or both. Thyroid
disease is found commonly in most forms of diabetes and is associated with
advanced age, particularly in type 2 diabetes and underlying autoimmune disease
in type 1 diabetes. Objective: This study aims to evaluate TSH and Free T4
among Diabetes Mellitus Patients in the Shendi locality, from August to
December 2021.
Methodology: Thirty
plasma samples were collected from diabetic patients of different ages and 20
plasma samples from healthy non-diabetic subjects of the same period for the
cases of hormone comparison thyroid (TSH) and free T4. Thyroid hormone levels in
the study were estimated using the 360 Automated Immunoassay Analyzer (TOSOH).
And the results were analyzed using the computer program SPSS (Social Science
Statistical Package).
Results: The result
of this study showed that the mean concentration of TSH and Free T4 level in
the diabetic subjects was (Mean ± SD): (1.6 ± 0.99) (13.5 ± 2.3) and control
(2.0 ± 0.81) (12.5 ± 2.0) respectively with P. value =0.148, 0.124 which is
insignificant. Also showed the mean concentration of TSH and FT4 according to
gender is (1.6, 14.7) respectively for males (1.7, 12.7), and a female with P.
value (0.718 for TSH which is insignificant) and (0.016 of Free T4 which is
significant). There are an insignificant association of diabetes on TSH, and
Free T4 levels with P. value (0.417, 0.277) respectively. And the significant
association of the presence of hypertension on the level of TSH and FreeT4 with
P. value (0.043, 0.018). Also the significant association of history on Free T4
level with P. value (0.018), insignificant on TSH level with P. value (0.773).
Also showed the mean concentration of TSH, and FreeT4 with the intake of the
treatment of diabetic and seafood, which was insignificant.
Conclusion: There is
no statistical difference between TSH and FT4 levels between cases and
controls. There was a correlation between FT4 levels and gender, with FT4 being
higher in females than in males. FT4 is significantly elevated in patients with
a family history of diabetes. No significant difference in FT4 levels by age.
Materials
and Methods
The present study was a cross-sectional, case-control
study. Conducted in the Shendi locality, from August to November 2021, the
study included Sudanese diabetes mellitus patients as a case group and healthy
individuals as a control group. 30 Sudanese patients with diabetes mellitus
were controlled as the study group and 20 healthy Sudanese were controlled.
Their ages are (30–55 years old). Venous blood was collected using a sterile,
single-use plastic syringe, the venipuncture site was washed with 70% ethanol,
and the blood was placed in a heparin container and mixed gently. Each sample was
centrifuged at 4000 (rpm) for 5 minutes to separate the plasma and stored at
-20°C until analysis. TSH and Free T4 were estimated using Automated Immune
assay Analyzer 360 (TOSOH).
Quality
Control
The precision and accuracy of the method used in this
study were checked and analyzed by commercially prepared control sera.
Statistical
Analysis
Data were analyzed by using the SPSS computer program.
The means and standard deviations of serum levels of TSH, and free T4 were
detected, and at-test was used for comparison (P. value of < 0.05 is
significant).
Ethical
Approval and Consent
Ethical approval for the study was obtained from the
Board of the Faculty of Graduates Studies at Shendi University. The written
informed consent form was obtained from each guardian of the participant as
well as from the subject himself before recruitment into the study. All
protocols in this study were done according to the Declaration of Helsinki
(1964).
Results
The result of this study showed that the mean
concentration of TSH and Free T4 level in the diabetic subjects was (Mean ±
SD): (1.6 ± 0.99) (13.5 ± 2.3) and control (2.0 ± 0.81) (12.5 ± 2.0)
respectively with P. value =0.148, 0.124 which is insignificant (Table 1,2).
Also showed the mean concentration of TSH and FT4 according to gender level is
(1.6, 14.7) respectively for males (1.7, 12.7), and a female (1.6, 14.7) with a
P. value (of 0.718 TSH which is insignificant) and (0.016 of Free T4which is
significant) (Table 3). There is an insignificant association of type of diabetic
on TSH, Free T4 level with P. value (0.417, 0.277) respectively (Table 4,5).
And the significant association of the presence of hypertension on the level of
TSH and FreeT4 with P. value (0.043, 0.018) (Table 6). Also the significant
association of history on Free T4 level with P. value (0.018), insignificant on
TSH level with P. value (0.773) (Table 7). Also showed that the mean
concentration of TSH, FreeT4 with intake in the treatment of diabetes was
insignificant (Table 8).
Table
1:
The Mean of TSH levels and St.d between case and control.
Variables |
No |
Mean ng\dl |
St.d |
P.value |
Case |
30 |
1.6 |
0.99 |
0.148 |
Control |
20 |
2.0 |
0.81 |
Table
2:
The Mean of FT4 levels and St.d between case and control.
Variables |
No |
Mean ng\dl |
St.d |
P.value |
Case |
30 |
13.5 |
2.3 |
0.124 |
Control |
20 |
12.5 |
2.0 |
Table 3: The concentration of TSH and FT4
according to gender among case group.
Gender |
Frequency |
Percent % |
Mean of TSH ng\dl |
Mean of FT4 ng\dl |
Male |
12 |
40% |
1.6 |
14.7 |
Female |
18 |
60% |
1.7 |
12.7 |
P. value |
0.718 |
0.016 |
Table
4:
The concentration of TSH and FT4 according to Age among case group.
Age |
No |
Mean of TSH ng\dl |
Mean of FT4 ng\dl |
30-40 |
2 |
2.5 |
13.8 |
41-50 |
12 |
1.6 |
14.8 |
51-60 |
16 |
1.6 |
12.6 |
P. value |
0.456 |
0.035 |
Table
5:
The concentration of TSH and FT4 according to Type of diabetic mellitus among
case group.
Type of diabetic
mellitus |
Mean of TSH ng\dl |
Mean of FT4 ng\dl |
Type1 |
1.9 |
12.8 |
Type2 |
1.5 |
13.8 |
P. value |
0.417 |
0.277 |
Table
6:
The concentration of TSH and FT4 according to presence of hypertension among
case group.
Hypertension |
Mean of TSH ng\dl |
Mean of FT4 ng\dl |
Yes |
2.1 |
12.7 |
No |
1.4 |
13.9 |
P. value |
0.043 |
0.018 |
Table
7:
The concentration of TSH and FT4 according to history of diabetes among case
group.
History
of D.M |
Mean of TSH ng\dl |
Mean of FT4 ng\dl |
Yes |
1.7 |
14.0 |
No |
1.5 |
11.6 |
P. value |
0.773 |
0.018 |
Table
8:
The concentration of TSH and FT4 according to uses of medication of D.M among
case group.
Treatment
of D.M |
Mean
of TSH ng\dl |
Mean
of FT4 ng\dl |
Regular |
1.8 |
13.5 |
Irregular |
1.2 |
13.6 |
P. value |
0.213 |
0.902 |
Diabetes mellitus and thyroid abnormalities are
the two most prevalent endocrine diseases [15]. Diabetes is one the fastest growing
non-communicable metabolic syndrome which is characterized by the increased
blood glucose level and is mainly due to a reduction of insulin secretion or
suppression in insulin action. It is global health anxiety, and its incidences
are increasing [16]. This
cross-sectional case-control descriptive study was conducted from July to
November 2021 in Shendi City to assess thyroid status and understand the
association between thyroid disease and diabetes mellitus. The population
included 50 of his participants in the study, 30 of whom were diabetic and 20
of whom were healthy as controls. There are 12 male and 18 female
representatives. Serum samples were collected in heparinized containers.
Thyroid hormone levels in this study were estimated using the Automated Immune
Assay Analyzer 360 (TOSOH). The results were analyzed using the Statistical
Package of Social Sciences (SPSS) computer program. The results of this study
showed that there was no significant difference in TSH and FT4 levels between
diabetic and non-diabetic subjects (P. value = 0.148 and 0.124,
respectively). This result is in agreement with the result obtained by Islam
and her colleague in South East Asia (2008), who denoted that there is no
significant statistical difference in TSH and FT4 levels among diabetic and
non-diabetic participants [17]. This
result was opposed to a study carried out by Panneerselvam and his collage in
2015, they showed that serum levels of FT4 were significantly lower in diabetic
subjects as compared to the non-diabetic subjects while serum level of TSH was
found to be significantly higher in type 2 diabetes mellitus patients as
compared to normal individuals [13]. Refluxes
that different in results to a geographical area or environmental difference
between countries. Also, there is a correlation between FT4 level and gender,
the level of FT4 increased in males (Mean =14.7) than in females (Mean=12.7)
with a statistically significant difference between them (P. value =0.016)
this result consensus with Kaur I and his team’s 2017, said that hypothyroidism
is frequently observed and most commonly seen in female patients [5]. Although there are
statistically insignificant differences between the level of TSH and the gender
(P.value= 0.718) and this was infringing with a study carried out by
Uppal Vand and his classmates Said Hypothyroidism was more common in females
(15%) than in males (4%) [18]. these
differences belong to Thyroid hormone levels may be altered by various
medications that diabetic subjects used to take and determine the change in
body composition. Moreover, there was a statistically significant difference in
FT4 according to age (P. value=0.035) and this is agreed by SU Ogbonna
2010 and his colleague were show that T2DM increases were prevalent with age.
Also, there are no differences in age in TSH between diabetic patients with (P.
value=0.456) this disagree with the study carried out by Khalid S Aljabri
who said there was a statistically non-significant difference between thyroid
dysfunctions in males compared to females (P<0.0001) [19]. This might be due to the sociodemographic and lifestyle
differences in the represented populations. Also this study show, there is no
variation among type one diabetic and type two in the level of TSH, and FT4
with insignificant value (P. value= 0.456)( P. value =
0.277) respectively this result differs from the study conducted by Mirella
Hage, and his team It has been shown that thyroid dysfunctions are more
prevalent in people with diabetes and particularly type 1 diabetes this belong
to social status or the genetic factor of the population who shared in the
study [20]. The result
of conducted study denoted that there is a significant statistical variation of
diabetic people were have hypertension disease with (P. value =0.043)
of TSH and (P. value= 0.014) of FT4, this is close to the study carried
by Pradeep Talwalkar and his pals in India 2019, reported a high prevalence of
hypothyroidism in patients with T2DM (24.8%), hypertension (33.5%), and T2DM +
hypertension (28.9%) [21]. on
another hand, there is a significant difference between the history of diabetes
in FT4 with (P. value= 0.018) and no difference in TSH level. In this
conducted study there was no different statistical study in patients who intake
the treatment of diabetes in the level of TSH and FT4 with insignificant value
(P. value= 0.213), (0.902) respectively and this is not accepted with a
study conducted in Iraq in 2019 by Khalid Ibrahim Al-Lehibi and his college
were accessed to metformin has a significant TSH lowering effect in hypothyroid
patients. This change in result probably back to variation in physical
activities or nutrition status [22].
There is no statistical difference
between TSH and FT4 levels between cases and controls. There was a correlation
between FT4 levels and gender, with FT4 being higher in females than in males.
FT4 is significantly elevated in patients with a family history of diabetes. No
significant difference in her FT4 levels by age.
The authors are thankful to the
Department of Clinical chemistry, Faculty of Medical Laboratory Sciences,
Shendi University, Shendi, Sudan, for their support during the study period.
There was no specific grant for this research
from any funding organization in the public, private, or nonprofit sectors.
Authors have declared that no
competing interests exist.