Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
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Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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

Important Notice

Original article / research
Year : 2011 | Month : April | Volume : 5 | Issue : 2 | Page : 213 - 216

The prevalence of thyroid dysfunction among South Indian women with Metabolic Syndrome

GAURAV AGARWAL, SUDHAKAR MK, MOHINI SINGH, SENTHIL N, AMARABALAN RAJENDRAN

Dept of General Medicine Sri Ramachandra University

Correspondence Address :
Dr. M K Sudhakar, Professor, Department of General Medicine, Sri
Ramachandra University, Address: No.2/650, 2nd Cross street,
VGN nagar, Iyyapanthangal,Chennai-600056, Tamilnadu, India.
Email: mksmedsrmc@gmail.com, Phone: 044-43800168

Abstract

Metabolic syndrome and thyroid dysfunction are independent risk factors of atherosclerotic cardiovascular disease and the coexistence of the two will substantially increase cardiovascular risk. In the present study, our aim was to investigate the prevalence of thyroid dysfunction in women with metabolic syndrome in a South Indian population. This study was carried out in a tertiary care teaching hospital in Chennai city, South India. The study protocol was approved by the institutional ethics committee and informed consent was obtained from all the participants at the start of study. Seventy six females with metabolic syndrome (NCEP – ATP III criteria) were included in the study. After obtaining the demographic data, fasting blood samples were obtained from the subjects and glucose, total cholesterol, high density lipoprotein (HDL), low density lipo protein (LDL) and triglyceride levels were estimated. The serum thyroid stimulating hormone and free thyroxine levels were also measured. Of the seventy six patients 53% had subclinical hypothyroidism, 25% had overt hypothyroidism and 22% were euthyroid. Overt hyperthyroidism was not present in any of the patients. The mean age of the study group was 52.68, with a standard deviation of 10.20. Women in the 40-60 year age group had a higher incidence of thyroid dysfunction as compared to those in the other age groups. Our study indicates the higher prevalence of thyroid hypofunction in South Indian women with metabolic syndrome and thus it necessitates the need for evaluating the thyroid status in women with metabolic syndrome.

Keywords

Metabolic syndrome, Thyroid dysfunction, Subclinical hypothyroidism

How to cite this article :

GAURAV AGARWAL, SUDHAKAR MK, MOHINI SINGH, SENTHIL N, AMARABALAN RAJENDRAN. THE PREVALENCE OF THYROID DYSFUNCTION AMONG SOUTH INDIAN WOMEN WITH METABOLIC SYNDROME. Journal of Clinical and Diagnostic Research [serial online] 2011 April [cited: 2019 Aug 26 ]; 5:213-216. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=April&volume=5&issue=2&page=213-216&id=1203

INTRODUCTION
Metabolic syndrome (MetS) is generally characterized as a clustering of the abnormal levels of blood lipids (low HDL and high triglycerides), impaired fasting glucose, elevated blood pressure, and excess abdominal obesity (1). Insulin resistance is supposed to be the central pathophysiological phenomenon underlying this clustering (2). Obesity, insulin resistance, physical inactivity, advanced age and hormonal imbalance have been suggested as the underlying risk factors for the development of this syndrome (3). Metabolic syndrome (MetS) affects approximately one quarter of the population in developed countries. People with metabolic syndrome are at an increased risk of atherosclerotic cardiovascular disease and type 2diabetes (4). Several studies have reported that higher TSH (thyroid stimulating hormone) concentrations are associated with a higher likelihood for the occurrence of metabolic syndrome, especially in females. Additionally, thyroid disease, especially overt hypothyroidism, is associated with atherosclerotic cardiovascular disease. Since metabolic syndrome and thyroid dysfunction are independent risk factors of atherosclerotic cardiovascular disease (CVD), the concurrent existence of the two will substantially increase the risk of CVD. Several studies have shown a significant association which links metabolic syndrome with subclinical and overt hypothyroidism and the association seems to be more in females. Uzunlulu et al (5) reported that the prevalence of subclinical hypothyroidism was more in females with metabolic syndrome. The HYOGA study reported that hypercholesterolaemic women above 50 years of agelipoand a poorer quality of life, even when the TSH value was less than 10mIU/L(6). In a study by Bauer DC et al, it was shown that among older white women, high TSH levels were associated with deleterious changes in serum lipids and that women with multiple lipid abnormalities were twice as likely to have increased TSH levels (7). The present study was carried out to assess the prevalence of thyroid dysfunction in female patients with metabolic syndrome in a South Indian population. with subclinical hypothyroidism, had symptoms of hypothyroidism

Material and Methods

This study included seventy six female patients who attended the medicine outpatient department at a tertiary care teaching hospital in Chennai, who were diagnosed with metabolic syndrome. The study protocol was approved by the institutional ethics committee and informed consent was obtained from all the participants at the start of the study. The diagnosis of metabolic syndrome was based on the criteria by the American National Cholesterol Education Program Adult III Treatment Panel (NCEP-ATP III) (8). The participants were classified as having MetS if they had at least 3 components of an NCEP ATP III definition of MetS: (1) a fasting glucose level of 110 mg/dL or greater (to convert to mmol/L, multiplied by 0.0555), (2) a fasting triglycerides level of 150 mg/dL or greater, (3) an HDL level less than 50 mg/dL (to convert to mmol/ L, multiplied by 0.0259), (4) a blood pressure of 130/85 mm Hg or greater on pharmacological treatment for hypertension, and (5) waist circumference > 88 cms. At the baseline, the demographic data was collected and a detailed physical examination was done.The blood pressure was measured in the right arm in the supine position. 3 readings were taken and the mean value of the 3 readings was taken as the final recording. If the patient was a known hypertensive or if she was on antihypertensives, one reading was taken as the final one. The waist circumference was measured at the plane between the anterior superior iliac spines and between the lower costal margins at the narrowest part of the waistline while the patient was standing and during slight expiration. The fasting blood samples were collected, following an overnight fast of a minimum of 8 hours and the glucose, total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride levels were estimated. The serum TSH and FT4 measurements were also made. A high serum TSH level and a normal free thyroxine (FT4) level were required for the diagnosis of sub-clinical hypothyroidism (SCH). The patients were classified as overt hypothyroid when the TSH levels were high (TSH > 10 μIU/ml) and when the FT4 levels were low (FT4 < 0.93 ng/dl). Patients with normal TSH (0.27-4.2 µIU/ml) and FT4 (0.93-1.7)ng/dl levels were considered to be euthyroid. Patients who are taking any medication that could alter the thyroid functions or the lipid levels and pregnant women were excluded from the study, as were patients with renal disorders, liver disorders and congestive cardiac failure. Statistical analysis was done by using the SPSS software, version 17.1

Results

This study included seventy six female patients with metabolic syndrome. Their mean age was 52.68 ± 10.20. The age group distribution is shown in (Table/Fig 1). The general characteristics of the study patients are described in . (Table/Fig 2) Of the seventy six patients 53% had subclinical hypothyroidism, 25% had overt hypothyroidism and 22% were euthyroid (Table/Fig 3). None of them had overt hyperthyroidism. shows the distribution of the components of the metabolic syndrome in the study patients. The association of each component of the metabolic syndrome with thyroid dysfunction is demonstrated in (Table/Fig 4). Women with a waist circumference of more than 88 centimetres (35 inches) had a higher incidence of thyroid dysfunction as compared to the other components. Among the different age groups, women in 40-60 year age group had a higher incidence as compared to the other age groups. (Table/Fig 5)

Discussion

Metabolic syndrome is a cluster of cardiometabolic risk factors and it is characterized by inflammation (5). Our study revealed that the prevalence of thyroid dysfunction was more among the females with metabolic syndrome. Subclinical hypothyroidism was present in 53% of the cases and overt hypothyroidism was present in 25% of the patients. Uzunlulu et al also reported a high prevalence of subclinical hypothyroidism among the females with metabolic syndrome in their series. In a study by RV Jayakumar et al (9), it was reported that 60 percent of the cases with metabolic syndrome had thyroid function abnormalities in their case series. In a study by BM Singh et al, they found a significant positive correlation between the TSH and insulin levels, as well as between the TSH and HOMA IR (Homeostasis model of assessment) levels in the female population who was suffering from both SCH and OH (10). The Rotterdam study (11) found a 10.8 % prevalence of subclinical hypothyroidism among elderly women and The Frementle Diabetes study found a 8.6% prevalence among women with type 2 diabetes (12). In our study, the females in the 40-60 year age group had a higher incidence of thyroid dysfunction as compared to the other age groups. Our results were comparable with those of the above mentioned study. The incidence of thyroid dysfunction was more in patients with more than three components of the metabolic syndrome. The mean waist circumference which was noted in females with metabolic syndrome and thyroid dysfunction was 37.81 inches as compared to 37.50 inches in euthyroid females with metabolic syndrome. Uzunlulu et al also noted a higher mean waist circumference in patients with metabolic syndrome and subclinical hypothyroidism. In our study, among the components of the metabolic syndrome, women with a waist circumference > 35 inches (88 centimetres) had a higher incidence of thyroid hypofunction. The thyroid disease is much more prevalent in women than in men. The prevalence of the thyroid disease in patients with diabetes is significantly higher than that in the general population (13).This indicates a possible interplay between the thyroid status and insulin sensitivity. The main pathophysiological basis underlying the metabolic syndrome has been attributed to insulin resistance. Insulin resistance is a cardinal feature of type 2 diabetes mellitus and an increased risk of dyslipidaemia along with relatively frequently found mild thyroid dysfunction. Insulin resistance leads to an increased production of hepatic cholesterol and very low density lipoproteins (VLDL) and an increased HDL cholesterol (HDL-C) clearance (10). Bakker et al suggested that insulin resistance augments the deleterious effect of hypothyroidism on the lipid profile (14). Sub-clinical hypothyroidism (SCH) and overt hypothyroidism (OH) are established risk factors for insulin resistance, hyperlipidaemia, hypercoagulability and low grade inflammation (15), (16). Several studies have proved the association between insulin resistance and hypothyroidism for overt hypothyroidism, but the association between insulin resistance and subclinical hypothyroidism remains unclear. It is known that overt hypothyroidism leads to an increase in the plasma cholesterol levels. The complex interplay between thyroid function and insulin resistance has been implicated in diabetic dyslipidaemia (10). In a cross sectional study in 47 healthy euthyroid subjects, it was found that the concentrations of free Tri-iodothyronine (FT3) were associated with insulin production and hyperinsulinaemia (17). The association between dyslipidaemia with thyroid hypofunction is well established. Over 90% of the overtly hypothyroid patients have hyperlipidaemia. The thyroid hormone is known to play a role in regulating the synthesis, metabolism, and the mobilization of lipids. In patients with overt hypothyroidism, there is an increase in serum total cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein B, lipoprotein (a) [Lp(a)] levels, and possibly, triglyceride levels[ 18].Normally, thyroid hormones increase the expression of the cell surface LDL receptors, thus leading to LDL clearance from the serum. In hypothyroidism, the depletion of the thyroid hormones leads to a reduced number of LDL receptors in the liver, thereby decreasing the biliary excretion of cholesterol, thus resulting in elevated serum LDL and VLDL levels. It also decreases the lipoprotein lipase activity and causes hypertriglycridaemia (9). Cardiovascular manifestations are frequent in thyroid dysfunction. Overt hyperthyroidism induces a hyperdynamic cardiovascular state which is associated with an increased heart rate, enhanced left ventricular systolic and diastolic function and an increased prevalence of atrial fibrillation, whereas the opposite changes occur in overt hypothyroidism (9). Atrial fibrillation, the most common complication of hyperthyroidism, occurs in approximately 15% of the patients. It is more common among men and in those with advancing age (25 to 40% in individuals over the age of 60 years).Subclinical hyperthyroidism (low-TSH) is associated with a > 3 times increase and a risk of developing atrial fibrillation (19). Patients with subclinical hypothyroidism are at an enhanced risk for atherosclerosis and myocardial manifestations and thus, the thyroxine replacement in these patients has a beneficial effect on the low density lipoprotein cholesterol levels and the clinical symptoms of hypothyroidism. An improvement in the low density lipoprotein cholesterol levels in turn reduces the cardiovascular mortality by 9-31% (20), (21). Since the prevalence of hypothyroidism (subclinical and overt) is more among females with metabolic syndrome as evident from our study, early detection and thyroxine replacement could reduce the significant cardiovascular risk in these patients. However, there is still a controversy whether the patients with subclinical hypothyroidism would be benefited from thyroxine replacement.

Conclusion

It can be concluded that females with metabolic syndrome have a higher prevalence of thyroid dysfunction which predisposes them to cardiovascular events. Therefore, we recommend the routine screening of the thyroid function in females with metabolic syndrome.
FUTURE RECOMMENDATION This is a preliminary report which was aimed to find the prevalence of thyroid dysfunction among South Indian women with metabolic syndrome. Future studies with a larger sample size may be considered.

References

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Church TS. Metabolic Syndrome and Diabetes, Alone and in Combination, as predictors of cardiovascular disease mortality among Men. Diabetes Care,2009; 32(7) :1289-1294.
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Roos A, Bakker S JL, Links T P, Gans R OB, and Wolffenbuttel B HR. Thyroid function is associated with components of metabolic syndrome. JCEM ,2006;92(2):491-496.
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Grundy S M. Diagnosis and Management of the Metabolic Syndrome; An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement, 2005 ; 112: 2735-2752.
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Tkac I. Metabolic syndrome in relationship to type 2 diabetes and atherosclerosis. Diabetes Res Clin Pract,2005;68(suppl):S2-9. Uzunlulu M, Yorulmaz E, Oguz A. Prevalance of subclinical hypothyroidism in patients with metabolic syndrome. Endocr J,2007, 54:71-76.
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Leclere J, Cousty C, Schlienger JL, Wemeau JL. Subclinical hypothyroidism and quality of life of women aged 50 or more with hypercholesterolemia: results of the HYOGA study. Presse Med,2008; 37(11):1538-46.
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