Rheopheresis treatment of diabetic foot syndrome

The present study was conducted to assess the interrelationship and the influence of the coexistence of diabetes and hypothyroidism on thyroid hormone levels, insulin levels and biochemical variables related to carbohydrate, lipid and protein metabolism in addition to thyroid gland and Islets of Langerhans histological changes and antioxidant defense system. Diabetes mellitus was induced by intraperitoneal injection of streptozotocin to fasting albino rats at dose level of 45 mg/kg b. w. Hypothyroidism in diabetic and normal rats was induced by adding methimazole in drinking water (0.02% w/v) for 4 weeks. The obtained results revealed that hypothyroidism interacts with diabetes in a way that prevents the progress of the hyperglycemic state. This may be due to the increase in the insulin secretory response in diabetic hypothyroid than diabetic rats. Serum T3 level decreased in order in diabetic (− 26.63%), hypothyroid (− 61.89%) and diabetic hypothyroid (− 65.69%) rats while T4 level was increased in diabetic rats and decreased in hypothyroid ones. The decrease in T3 level in diabetic animals in spite of T4 increase may be attributed to the decrease in conversion of T4 to T3 as a result of hepatic 5′-DI decreased activity. Liver glycogen content was threefold decreased in diabetic rats and was not significantly altered in both hypothyroid and diabetic hypothyroid rats. The serum leptin level and body weight gain were decreased in diabetic and diabetic hypothyroid rats; the leptin level was more deteriorated in diabetic hypothyroid rats while body weight gain was more affected in diabetic rats. Serum triglycerides level was more increased in diabetic rats than in diabetic hypothyroid ones on one hand, while total lipids, total cholesterol, LDL-cholesterol levels as well as cardiovascular indices were more deteriorated in diabetic hypothyroid rats than diabetic ones on the other hand. Serum total protein and globulin levels were decreased in diabetic rats and were increased in hypothyroid and diabetic hypothyroid rats. Hepatic total thiols and glutathione contents and catalase and peroxidase activity were profoundly decreased in diabetic rats while they (except glutathione) were increased in hypothyroid and diabetic hypothyroid rats. In conclusion, the hypothyroidism may have a counteracting effect on the hyperglycemic state and the elevated serum T4 level as well as the deteriorated antioxidant defense system found in diabetes mellitus, but both experimentally-induced diseases may synergize in inducing more elevation of serum total lipids, total cholesterol and LDL-cholesterol and more decrease in leptin levels.

Australasian Medical Journal, 2024

Background Presence of hypothyroidism in Diabetes Mellitus (DM) is a foundation for development of complications. Thyroid hormones have been hypothesised to affect and be affected by hepatorenal function. These hypotheses warrant further study into the topic. Materials & methods 81 diabetics and 81 age & sex-matched healthy volunteers participated in the study. Their blood samples were analysed for Fasting Blood Glucose (FBG), Glycosylated Hemoglobin (HbA1C), total Triiodothyronine (T3), total Thyroxine (T4), Free T3 (FT3), free T4 (FT4), thyroid-stimulating hormone (TSH) and liver & renal function tests. Data was analysed using appropriate statistical tests. Results 42 males and 39 females each were recruited as cases and controls. FBG, HbA1c, FT4, TSH, serum Alanine Transaminase (ALT), Alkaline Phosphatase (ALP) and Serum Creatinine (CR) were higher in diabetics. T3 and FT3 were lower in diabetics. T3, FT3, and albumin (ALB) were lower in diabetics with CR ≥ 1.30 mg/dL. FBG, Direct Bilirubin (DBIL), ALP and CR were higher and T3 and FT3 were lower in hypoproteinemic diabetics. Total Proteins (TPRO) and ALB positively correlated with T3 and FT3. TBIL positively correlated with FBG. ALP positively correlated with HbA1c. Conclusion Hypoproteinemia predicts poor glycemic control, renal dysfunction and hypothyroidism. High-normal circulating levels of T3 and FT3 being correlated with lower levels of CR may imply that a thyroid-sufficient state is largely protective against renal dysfunction in DM. In summary, routine LFT and RFT investigations can be indicative of subclinical hypothyroidism and thus an underlying cause of resistance to anti-hyperglycaemic therapy; treating the same may improve therapeutic outcomes.

IOSR Journals , 2019

Objective: Mostly Diabetes & Hypothyroid are the two major endocrine disorders which influence each other and tend to coexist. The objective of the present study is to assess the prevalence of thyroid dysfunction among Type-2 diabetics. Materials & methods: The present study carried was carried out in 100 known cases of Diabetes mellitus attending to medical OP department of GGH. Ananthapur medical college.Ananthapur, A.P,were screened for Thyroid dysfunction by doing Thyroid profile. Results: It was confirmed that 11 cases of hypothyroidism among 100 diabetic patients which is a significant association. Conclusion: When these two endocrinopathies coexist the patients are more prone for cardiac complications. So it is advised to screen every diabetic patient for the occurrence of hypothyroidism.

Santosh University Journal of Health Sciences, 2020

Two endocrinopathies namely diabetes and thyroid disorders are most often encountered in general population either individually or together mutually influencing one another. Both the disorders have complex biochemical pathophysiology along with hormonal and genetic malfunctions. Thyroid hormones are important regulators of carbohydrate and lipid metabolism, pancreatic function while diabetes affects functioning of thyroid hormones to a variable extent. The main underlying basis of such link could be the interconnections between common signalling pathways among these disorders. Thyroid dysfunctions that are also associated with insulin resistance, when present in diabetic individuals can impair metabolic control. Both hyperthyroidism and hypothyroidism are reported to be associated diabetes mellitus. Researches that investigated the potentiality of thyroid hormone analogues to alleviate obesity, diabetes, and atherosclerosis are also being conducted in clinical practice. This requires a vivid knowledge of this multifarious and complex relationship between diabetes and thyroid hormone so that it can aid in optimisation of treatment modalities in diabetic patients. Thus, in this review article we emphasized on the incidence of thyroid disorders in diabetes and possible links between the two disorders.

This study was carried out to estimate thyroid hormones (T3, T4 and TSH) level in diabetic patients and to compare it with normal controls in an attempt to find out the importance of thyroid hormone estimation in diabetic cases. Fifty cases of diabetes mellitus who attended Diabetic Clinic, J.L.N.M.CH , Bhagalpur during the period from October 2016 to March 2017 were taken as the cases and 50 healthy individuals were selected as control group. Serum total Tri-iodothyronine (T3), Thyroxine (T4), Thyroid stimulating hormone and blood sugar were estimated in both the cases and controls. The study showed that diabetes was more prevalent in the age group of 51-65 years, and more in males (52%). The mean fasting blood sugar (182.12 ± 30.28mg%) and serum TSH level (8.54 ± 1.07mIU/L) were increased significantly (r=0.884, p>0.05) whereas serum T4 level (2.21± 0.55µg/dl) was decreased in diabetic cases when compared with controls.Mean T3 level of diabetic cases was higher than controls but it was insignificant. Diabetes mellitus cases with statistically significant higher TSH value have more prevalence of complications like hypertension, retinopathy, nephropathy etc. A statistically significant, negative correlation (r=-0.942, p<0.05) was seen between Serum T4 and blood sugar in the cases.Therefore routine screening of thyroid hormone level in addition to other biochemical tests in the early stage of diabetes will help better in the management of thease patients.

Zahedan Journal of Research in Medical Sciences

Background: The close physiological and biochemical relationships between insulin/thyroid hormones and intermediary metabolism, as well as hepatic homeostasis, are well documented. Apart from significant changes in thyroid hormones levels and altered insulin secretion or resistance, there is no consistency regarding the presence of hepatic storage diseases and fatty liver in hypothyroid patients. Objectives: The main objective of the current study was to evaluate the effect of experimental hypothyroidism on insulin level and histological alterations in the liver such as changes in lipid and glycogen reservoirs. Methods: In this study, 20 adult male Wistar rats were assigned to two similar groups including control and hypothyroid. Experimental hypothyroidism was induced by 0.02% propylthiouracil (PTU) administered to rats via drinking water for two months. The rates were then killed and blood samples were assayed for TSH, T4, T3, insulin hormones, and lipid profile. The left lobes of rats' livers were also used for the histological study. Results: Our results indicated that the two-month administration of 0.02% PTU induced mild hypothyroidism associated with about a 50% reduction in the insulin level. The examination of liver samples showed that there were no significant changes in the overall architecture of liver tissue as compared to normal controls; that is, hepatocytes morphology, appearance, and position of the core, as well as glycogen content, were the same. The main finding of the current work was that in the hypothyroid group, the mild steatosis was accompanied by dyslipidemia. Conclusions: Based on our findings, a two-month administration of 0.02% PTU induces mild hypothyroidism in rates associated with a 50% decrease in the insulin level and mild steatosis in liver hepatocytes. This condition in long period may predispose hypothyroid individuals to develop diabetes mellitus and fatty liver simultaneously.

European Journal of Pharmacology, 2007

An investigation was made to reveal the possible involvement of thyroid hormones in the progression of diabetes mellitus in response to an atherogenic diet; CCT (4% cholesterol, 1% cholic acid and 0.5% 2-thiouracil). Following the intake of CCT diet for 14 consecutive days a decrease in the serum levels of insulin, both the thyroid hormones, triiodothyronine (T 3 ) and thyroxine (T 4 ); hepatic glycogen content, hepatic type-1 iodothyronine 5′-mono-deiodinase (5′D) and serum α-amylase activities were observed, while there was an increase in the levels of serum glucose and nitrite and in lipid peroxidation of heart, liver and kidney tissues as well as in serum. However, simultaneous administration of Lthyroxine (500 μg/kg/day, s.c.) to CCT-diet fed animals resulted in the amelioration of all the aforesaid adverse changes including that of serum glucose, insulin, α-amylase, hepatic glycogen content and nitrite levels, suggesting the involvement of thyroid hormones in the progression of CCT-diet induced diabetes mellitus.

Medicina clínica, 2012

The aim of our study was to identify the rate of diabetic patients treated for hypothyroidism and compare them with a group without type 2 diabetes mellitus (T2DM).

Biochemical Journal, 1989

The effects of hypothyroidism on the sensitivity of glycolysis and glycogen synthesis to insulin were investigated in the isolated, incubated soleus muscle of the rat. 2. Hypothyroidism, which was induced by administration of propylthiouracil to the rats, decreased fasting plasma levels of free fatty acids and increased plasma levels of glucose but did not significantly change plasma levels of insulin. 3. The sensitivity of the rates of glycogen synthesis to insulin was increased at physiological, but decreased at supraphysiological, concentrations of insulin. 4. The rates of glycolysis in the hypothyroid muscles were decreased at all insulin concentrations studied and the EC50 for insulin was increased more than 8-fold; the latter indicates decreased sensitivity of this process to insulin. However, at physiological concentrations of insulin, the rates of glucose phosphorylation in the soleus muscles of hypothyroid rats were not different from controls. This suggests that hypothyroidism affects glucose metabolism in muscle not by affecting glucose transport but by decreasing the rate of glucose 6-phosphate conversion to lactate and increasing the rate of conversion of glucose 6-phosphate to glycogen. 5. The rates of glucose oxidation were decreased in the hypothyroid muscles at all insulin concentrations. * To whom correspondence and reprint requests should be addressed.

Diabetologia, 2005

Aims/hypothesis The aims of this work were to determine the effect of hypothyroidism on insulin-stimulated glucose turnover and to unravel the potential mechanisms involved in such an effect. Methods Hypothyroidism was induced by administration of propylthiouracil, with partial T4 substitution. Euglycaemic–hyperinsulinaemic clamps, associated with the labelled 2-deoxy-d-glucose technique for measuring tissue-specific glucose utilisation, were used. To assess a possible involvement of leptin in the modulation of glucose metabolism by hypothyroidism, leptin was infused intracerebroventricularly for 6 days. A group of leptin-infused rats was treated with rT3 to determine a potential role of T3 in mediating the leptin effects. Results Compared with euthyroid rats, hypothyroid animals exhibited decreased overall glucose turnover and decreased glucose utilisation indices in skeletal muscle and adipose tissue. Leptinaemia in hypothyroid rats was lower while resistin mRNA expression in adipose tissue was higher than in euthyroid animals. Intracerebroventricular leptin infusion in hypothyroid rats partially restored overall, muscle and adipose tissue insulin-stimulated glucose utilisation and improved the reduced glycaemic response observed during insulin tolerance tests. The leptin effects were due neither to the observed increase in plasma T3 levels nor to changes in the high adipose tissue resistin expression of hypothyroid rats. The administration of leptin to hypothyroid animals was accompanied by increased expression of muscle and adipose tissue carnitine palmitoyl transferases, decreased plasma NEFA levels and reduced muscle triglyceride content. Conclusions/interpretation Hypothyroidism is characterised by decreased insulin responsiveness, partly mediated by an exaggerated glucose–fatty acid cycle that is partly alleviated by intracerebroventricular leptin administration.