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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Calcium and Magnesium Levels in Subclinical and Overt Hypothyroidism: A Cross-sectional Study
Correspondence Address :
Dr. Suman Chatterjee,
Krishnanagar Road, Nabapally, Barasat, North 24 Parganas-700126, West Bengal, India.
E-mail: dr.sumanc2010@gmail.com
Introduction: Hypothyroidism, one of the most common thyroid gland disorders, can cause electrolyte disturbances in the body. Hypothyroidism can alter mineral metabolism by changing the levels of serum calcium and magnesium. Therefore, it is essential to study any abnormalities in calcium and magnesium metabolism in patients with hypothyroidism.
Aim: The aim of this study was to assess the levels of calcium and magnesium in patients with hypothyroidism and to study the correlation between Thyroid Stimulating Hormone (TSH), fT3, and fT4 with calcium and magnesium in subclinical and Overt Hypothyroidism (OH).
Materials and Methods: This cross-sectional study was held from August 2019 to January 2020 in the Department of Biochemistry, BS Medical College, Bankura. A total of 150 subjects were included in the study, distributed equally among three groups: euthyroidism, subclinical hypothyroidism, and OH. Serum TSH, fT3, fT4, calcium, and magnesium levels were determined in the laboratory, and the data obtained were statistically analysed using ANOVA test and Pearson’s correlation test.
Results: Out of a total of 150 subjects, 61 were female, among whom 23 had subclinical hypothyroidism and 21 had OH. There were significant differences in the mean levels of TSH, fT3, fT4, calcium, and magnesium between the SCH, OH, and euthyroid groups. The study showed that the mean serum calcium level was significantly lower in SCH and OH compared to euthyroids, while the level of serum magnesium was significantly increased in SCH and OH compared to euthyroid. There was a statistically significant negative correlation between TSH and serum calcium in both OH and SCH, while a statistically significant positive correlation was observed between TSH and serum magnesium levels in both groups.
Conclusion: The present study revealed that serum magnesium levels were high while serum calcium levels were low in both subclinical hypothyroidism and OH when compared to euthyroid subjects. Additionally, calcium levels negatively correlated with TSH, while magnesium levels positively correlated with TSH levels.
Electrolyte imbalance, Euthyroid, Thyroid gland, Thyroid stimulating hormone
The thyroid gland plays a significant role in regulating lipid, carbohydrate, protein, and mineral metabolism (1). Hypothyroidism (SCH) is defined as an elevated serum TSH level associated with normal serum levels of thyroxine (T4) and triiodothyronine (T3). OH is defined as an elevated TSH and decreased serum T3 and T4 levels. SCH is much more common than OH, so early diagnosis and treatment may prevent the onset of OH. Thyroid hormone is essential for the physiological growth and maturation of the skeletal system. Thyroid dysfunction is frequently associated with disturbances in calcium homeostasis and hypocalcaemia (2),(3).
Thyroid hormone causes the release of calcium from cells and regulates the blood levels of calcium. Previous research has found that as the level of thyroid hormone is low in hypothyroidism, the release of calcium from cells is decreased (4),(5). Thyroid disorders are an important cause of secondary osteoporosis. Some studies have shown normal serum calcium and phosphorous levels (6),(7), while others have shown decreased levels in hypothyroidism (5),(8). In a previous study, researchers found disturbances in magnesium metabolism in hypothyroidism (8). Researchers also found an increase in serum magnesium levels in hypothyroidism (9),(10).
Although the changes in calcium and magnesium are negligible in thyroid disorders, these disturbances may cause damage in the later stages of life (9). Few studies have shown that some metabolic disorders, hypertension, and cardiovascular disease are related to metabolic aberrations of divalent cations such as calcium and magnesium (10),(11).
A review of the literature shows a paucity of data in the West Bengal region. Hence, the present study was conducted to examine the changes in serum calcium and magnesium levels in subclinical and OH. Additionally, serum calcium and magnesium levels were compared among cases of hypothyroidism and euthyroid cases and the correlation between TSH, fT3, fT4 levels, and serum calcium and magnesium was assessed.
This institution-based cross-sectional study was conducted in the Department of Biochemistry, Bankura Sammilani Medical College, Bankura, West Bengal, for six months from August 2019 to January 2020. The study was approved by the institutional ethical committee (Memo no: PR-HC/6-119/111(53), dated 09/04/2019). Written consent was obtained from all the participants.
Inclusion criteria: Patients aged between 20 and 60 years who underwent thyroid profile evaluation in the institution were included in the study. Additionally, healthy controls with a normal thyroid profile, i.e., euthyroid, were included in the study.
Exclusion criteria: Patients with a history of hepatic disease, renal disease, bone disease, diabetes mellitus, alcoholism, or those who were on supplementation with calcium and other mineral supplements were excluded from the study.
Sample size: A total of 100 patients, 50 with SCH, 50 with OH, and 50 controls with a normal thyroid profile, i.e., euthyroid, were enrolled in the study using purposive sampling method.
Subclinical hypothyroidism: SCH is defined as increased TSH (ranging between 5.5 mIU/L and 10 mIU/L) and normal T3 and T4 levels.
Overt Hypothyroidism (OH): OH is defined as increased TSH and decreased T3 and T4 levels (TSH >10 mIU/L, fT4 <0.8 ng/dL, and fT3 is less than 1.4 pg/mL) (12).
Data collection: After 12 hours of overnight fasting, a 3 mL venous blood sample was collected in a yellow or red top vacuum-evacuated tube with clot activator. Samples were centrifuged at 3000 rpm for 10 minutes, and the obtained serum samples were analysed for fT3, fT4, TSH, calcium, and magnesium levels using a CLIA-based fully automated analyser (ADVIA Centaur CP). The reference values in the laboratory were as follows: TSH: 0.50-5.50 μIU/mL, fT3: 1.4-4.2 pg/mL, and fT4: 0.8-2.0 ng/dL. Serum magnesium and calcium were estimated using the Calmagite Dye (13) and o-Cresolphthalein Complexone (OCPC) (14) methods, respectively. The normal reference values for calcium and magnesium were 8.7-11.0 mg/dL and 1.3-2.5 mEq/L, respectively (13),(14).
Statistical Analysis
The data were statistically analysed using SPSS version 27.0. An ANOVA test was used for comparison, and Pearson’s correlation analysis was conducted to determine the relationship between the different parameters among groups.
The mean age in the control and case groups was 33.32±4.75 years and 35.31±7.56 years, respectively. Among the total of 150 subjects, 27 males had Subclinical Hypothyroidism (SCH) and 29 males had Overt Hypothyroidism (OH), while 23 females had SCH and 21 females had OH. There was no significant difference found in gender distribution among the groups (Table/Fig 1).
The mean TSH level was significantly higher in the OH group compared to the SCH and euthyroid groups. The mean serum calcium level was significantly lower in both the SCH and OH groups compared to the euthyroid group. Similarly, the levels of serum magnesium were significantly increased in both the SCH and OH groups compared to the euthyroid group (Table/Fig 2).
The present study showed a statistically significant negative correlation between TSH and serum calcium levels in both the OH and SCH groups. Additionally, a statistically significant positive correlation was observed between TSH and serum magnesium levels in both groups (Table/Fig 3),(Table/Fig 4).
Reduced production of thyroid hormone is the central feature of the clinical state termed hypothyroidism. Although a number of clinical manifestations have been associated with this early or mild phase of hypothyroidism, the term “subclinical” is used here to describe this group. Subclinical hypothyroidism is defined as an elevated serum TSH level with a normal serum fT4 concentration. It can progress to OH and may be associated with various manifestations. In some patients, these manifestations can be improved with treatment (15).
In this present study, the mean calcium levels were 8.31±1.21 mg/dL and 8.09±0.99 mg/dL in SCH and OH patients, respectively. The study also showed a statistically significant negative correlation between TSH and serum calcium levels in both OH and SCH groups. Additionally, the serum calcium level was significantly lower in both the SCH and OH groups compared to the euthyroid groups. These findings in the present study may be due to long-term hyperthyroidism resulting in a net negative calcium ion (Ca2+) balance in response to increased skeletal turnover. It is noteworthy that a long-term hyperthyroid state is also associated with calcium malabsorption and increased bone resorption.
A study conducted by Shivallela MB et al., found a significant decrease in serum calcium levels in hypothyroid patients compared to controls, which was similar to the present study (8). In that study, the mean calcium level in hypothyroidism was 9.14±0.51 mg/dL, whereas in the present study, calcium levels were 8.31±1.21 mg/dL in SCH and 8.09±0.99 mg/dL in OH. An animal study conducted by Kumar V et al., observed an increase in renal calcium was increased in rats with high TSH levels (16). A study done by Roopa M et al., revealed that thyroxin can normally regulate blood calcium levels by releasing calcium from cells and decreasing T4 levels in the blood (17). This finding is similar to the present study. The significant negative correlation of TSH with serum calcium levels found in this study was the same as reported in several human and animal studies (18),(19).
In the present study, the serum magnesium levels were 2.22±0.17 mg/dL and 2.54±0.36 mg/dL in the SCH and OH groups, respectively. The study also showed a statistically significant positive correlation between TSH and serum magnesium levels in both groups. Additionally, the present study observed significantly elevated levels of serum magnesium in both the subclinical and OH groups compared to euthyroid individuals, which was similar to a study done by Jaskin K et al., (20). The mean calcium and magnesium levels were 8.99±0.53 mg/dL and 1.27±0.28 mg/dL, respectively, which were closer to the findings of the present study. In this study, we observed a significant positive correlation between magnesium levels and TSH in both overt and subclinical hypothyroidism. However, literature suggests a decrease in magnesium levels in hypothyroidism compared to controls and also shows a negative correlation with thyroid hormones (21),(22).
To the best of our knowledge, no similar study has been conducted in this region. The present study may be helpful in the early detection of morbidity in hypothyroidism.
Limitation(s)
Since this study was a cross-sectional study, no follow-up could be conducted. However, future studies with a larger sample size and follow-up can be pursued.
Our study revealed that serum calcium levels were decreased in both patients with subclinical and overt hypothyroidism, compared to euthyroid individuals, with a negative correlation observed between serum TSH levels and serum calcium in both cases. Additionally, we observed that serum magnesium levels were increased in both patients with subclinical and overt hypothyroidism, and a significant correlation between TSH and serum magnesium was found in both cases. Hence, thyroid disorders can be associated with disturbances in calcium and magnesium metabolism. Clinicians should consider screening hypothyroidism patients for these analytes to enable early detection of bone and mineral metabolic disorders.
The authors express their gratitude to the staff of the Department of Biochemistry, B.S. Medical College, Bankura, as well as the editorial board for their assistance in necessary rectifications.
DOI: 10.7860/JCDR/2023/63791.18465
Date of Submission: Feb 27, 2023
Date of Peer Review: May 20, 2023
Date of Acceptance: Jul 19, 2023
Date of Publishing: Sep 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 28, 2023
• Manual Googling: Jun 03, 2023
• iThenticate Software: Jul 15, 2023 (13%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
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