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Background: Thyroid and kidney is known to have interelated functions. Hypothyroidism can cause renal dysfunction by altering renal hemodynamics. Hypothyroidism still remains an underrecognised cause of kidney dysfunction which is often overlooked. Most studies are looking at the prevalence of hypothyroidism patients with kidney disease than the prevalence of kidney disease in hypothyroid patients as done in our study. Aims: To evaluate changes in serum creatinine, estimated GFR and creatine phosphokinase in hypothyroid patients before and 6 weeks after treatment with levothyroxine. Materials and Methods: This prospective study was conducted over 6 months in the outpatient department of general medicine and endocrinology in pushpagiri medical college hospital, Thiruvalla. Patients with newly diagnosed hypothyroidism with TSH more than 10 and age more than 18 years were included. Patients with previous renal disease, on newly initiated RAAS inhibitor therapy and SGLT2 inhibitors were excluded. Results: Out of 147 newly diagnosed treatment naïve patients, mean age of our study population was 34.2 years (range: 18–72 years) with females predominant (70.2%). The mean TSH at diagnosis was 40.72 ± 9.8 mIU/L, and the mean free T4 value was 0.67 ± 0.24 ng/dl. The mean serum creatinine on the first consultation was 1.01±.21 mg/dl. The mean eGFR at diagnosis was 80.14 ± 19.6 mL/min/1.73 m2 and mean CPK at presentation was 243.75 ± 38.1 IU/L. There was a significant difference in TSH levels after treating hypothyroidism for 6 weeks, TSH value falling to 4.5+/- 1.8. Pearson correlation tests are done to explore the correlation between TSH, free T4, serum creatinine and eGFR. Serum creatinine and serum CPK had a positive correlation with serum TSH value among patients with primary hypothyroidism (P < 0.05). Free T4 and serum creatinine values had a strong negative correlation. The eGFR at diagnosis had a negative correlation with the initial TSH values (P < 0.01) and CPK (P = 0.021). Conclusion: There is indeed an improvement in the renal function when we treat hypothyroidism. Although the changes may be subtle, they are important for individual patients especially those who are on concomitant treatment with drugs associated with narrow therapeutic range. The improvement of the renal function was most apparent in the young adult age group perhaps reflecting their increased lean muscle mass, thus requiring a more careful assessment of thyroid function in this group. In addition, mild increase in GFR may lead to unnecessary investigations. Therefore, it is better to reassess the renal function in hypothyroid patients following restoration of euthyroidism. we can conclude that hypothyroidism can be a reversible cause of renal dysfunction. [ABSTRACT FROM AUTHOR]

Background: Thyrotoxic periodic paralysis is an uncommon presentation of thyrotoxicosis, predominantly affecting the young Asian males (Incidence 1.8-2%). Classically seen with Grave's disease. Aims and Objectives: To the study the etiology of thyrotoxic periodic paralysis. To study the clinical profile, precipitating causes and response to treatment of thyrotoxic periodic paralysis. Materials and Methods: All patients diagnosed to have thyrotoxic paralysis in the departments of Medicine, neurology and endocrinology in Pushpagiri Institute of medical science and research centre, Thiruvalla were included in the study. A total of 20 patients were included in the study. The Thyroid functions, CPK, Na+, K +, Ca++, Phosphate and Magnesium were estimated for all patients. All patients underwent a thyroid ultrasound and Technetium uptake scan, to find the etiology of thyrotoxicosis. Waynes Index was calculated to look at severity of thyrotoxicosis. Results: Out of the 20 patients, 14 patients had Graves disease, 4 had toxic MNG, and 2 had thyroiditis. All patients were male, and 7 patients were manual labourers. Bowel, bladder pharyngeal muscles, respiratory muscles and sensory were not involved in any patient. Only 6 patients had Waynes Index more than 19. In majority of patients paralysis was precipitated by carbohydrate. Recurrent episodes of paralysis was seen in 7 patients, and 13 had a single episode. The mean free T4 was 3.43 ng/ml with range from 2.84 - 4.02. The serum K+ levels ranged from 1.73 meq/L to 3.45 meq/L (mean 2.59). The CPK levels were elevated in eight patients, all with Grave's disease. The paralysis resolved in all patients after K+ correction and Propranolol. Four patients had rebound hyperkalemia. Conclusions: Graves disease still remains the commonest cause of thyrotoxic paralysis, but can occur with Toxic MNG and thyroiditis. The weakness does not correlate with the severity of toxicosis or Potassium values. The paralysis responds to Potassium correction, but can result in rebound hyperkalemia. [ABSTRACT FROM AUTHOR]

Objective: The objective was to determine the role of various components of metabolic syndrome (MetS) as independent risk factor for erectile dysfunction (ED). Materials and Methods: A total of 113 subjects of MetS, as recommended by recent IDF and AHA/NHLBI joint interim statement were selected for study who presented for ED. After doing Anthropometric examination, fasting laboratory assay for fasting plasma glucose (FPG), fasting insulin, hemoglobin A1c, triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and 2 h oral glucose tolerance test (OGTT) was done. Erectile function was assessed by completing questions one through five of the International Index of Erectile Function (IIEF-5). A multiple linear regression analysis was carried out on 66 subjects with IIEF-5 score as dependent variable and components of MetS FPG, 2 h OGTT, TG, HDL, and waist circumference as independent variables. Results: Using a multiple linear regression analysis, we observed that presence of the various components of MetS was associated with ED and a decrease IIEF-5 score and this effect was greater than the effect associated with any of the individual components. Of the individual components of the MetS, HDL (B = 0.136; P = 0.004) and FPG (B = −0.069; P = 0.007) conferred the strongest effect on IIEF-5 score. However, overall age had most significant effect on IIEF-5 score. Conclusion: It is crucial to formulate strategies and implement them to prevent or control the epidemic of the MetS and its consequences. The early identification and treatment of risk factors might be helpful to prevent ED and secondary cardiovascular disease, including diet and lifestyle interventions.

Background and Objectives: While both Graves and thyroiditis leads to thyrotoxicosis, differentiating them is a priority as treatment is grossly different. Nuclear scan or TSH receptor antibody is the confirmatory test for the same. Available studies suggest serum CRP, eosinophil/monocyte, free T3/free T4 ratio values prove doubtful in differentiating between two types of thyrotoxicosis. The study aims to find out whether serum ferritin levels could differentiate thyroiditis from Graves. Materials and Methods: Thyrotoxic patients who attended the Medicine OPD of PIMS were included in the study. Data was collected from 42 thyrotoxic patients who attended the OPD which gave the study a confidence level of 99% and confidence interval of 5%, assuming 60% prevalence of thyrotoxicosis. Non random sampling was done. Considering inclusion and exclusion criteria required sample was recruited. Inclusion criteria included all patients with a diagnosis of thyrotoxicosis attending OPD. Exclusion criteria were patients with anemia, renal failure, receiving blood transfusions, chronic liver disease Connective tissue disorders, Chronic infection, Inflammatory states, Toxic adenoma /Toxic MNG (based on uptake scan). After obtaining written informed consent from patient, required details and investigations were recorded. Patient's FT3, FT4, TSH, TC, DC, ESR, Ferritin, Albumin were recorded. Uptake scan was done to diagnose Graves' disease, thyroiditis. Mann-Whitney U test was used to find the difference between median ferritin levels of graves and thyroiditis. Sensitivity, specificity and predictive values along with ROC curve was drawn using ferritin values considering nuclear uptake scan as the gold standard. Results: Out of the 34 patients studied, 21 patients havesubacute thyroiditis, 10 had Graves, and 3 had toxic MNG. Ferritin levels were significantly high in the SAT group (412.3+/- 42.3 mcg/l) as compared to the Graves group (175.3+/- 42.3 mcg/L) and toxic MNG group (225.7+/- 63.1.mcg/L). A high ferritin level had a sensitivity of 85.1%, specificity of 80.00%, positive predictive value of 90% and negative predictive value of 71.2% in differentiating SAT from Graves' disease Conclusions: Serum ferritin levels is emerging as a useful laboratory investigation in differentiating thyroiditis from Graves' disease. This simple lab test may replace the more expensive and laborious Technetium scan in differentiating thyroiditis from Graves' disease. [ABSTRACT FROM AUTHOR]

Aims and Objectives: (1). To assess the efficacy of intra-articular injection of high molecular weight sodium hyaluronate (SH) on functional outcome in frozen shoulder in diabetes mellitus (DM) type 2 patients, and (2). To compare it with the efficacy of corticosteroid (methylprednisolone). Materials and Methods: This prospective, double blind, RCT included 67 patients. They were randomized in two groups: Group-A (methyl-prednisolone) and Group-B (SH). Three-weekly intra-articular injections of respective drugs (preceded by intra-articular injection of xylocaine as local anesthetic) were given by posterior technique under ultrasound guidance. Sixty-one patients completed treatment and follow-up. Quick DASH score, total shoulder flexion, and total shoulder abduction (passive) were used for assessment of outcome. Follow-up period was 6 months. Result and Conclusion: Both SH and corticosteroid caused significant improvement in shoulder function beginning within 1 week and lasting for at least 6 months. No significant adverse effects were observed in SH group. Corticosteroid group had 10% incidence of moderate to severe pain in GH joint lasting 12-24 hours. Intra-articular corticosteroid has known adverse effects like worsened glycemic control, osteoporosis, tendon rupture, and decreased immunity at local site. Hence, we suggest that SH may be used as an alternative drug to popular steroid use for the patients of frozen shoulder in DM type 2. [ABSTRACT FROM AUTHOR]