Thyroid Lesion as a Manifestation of Comorbidity in Patients with Diabetic Polyneyropathy
Keywords:diabetic polyneuropathy, thyroid, body mass index, comorbidities, index of pain rating
The study of clinical and anamnestic and paraclinical characteristics, highlighting their dominant features in patients with DP and existing thyroid diseases occupies an important place in modern neuroendocrinology and requires more focused attention of clinicians.
The objective: to determine the leading clinical and laboratory-instrumental parameters in patients with DP and thyroid pathology, to analyze the mutual influence of neuroendocrine pathology on the patient’s somatoneurological condition.
Materials and methods. Was done a clinical examination of 64 patients with DP , in 27 (42 %) of them was diagnosed the comorbid thyroid pathology, in 37 (58 %) it was absent. All patients were divided into two groups: with DP in the background of type I, II DM and thyroid pathology (A) and with DP in the background of type I, II DM without thyroid pathology (B). During the examination of patients were used clinical-anamnestic, clinical-neurological, laboratory-instrumental, neurophysiological methods of examination. Pain characteristics were assessed using the McGill Pain Questionnaire (MPQ). Statistic calculation was done in MS Excel 2003 and using the package for statistical analysis STATISTICA 10.
Results. In patients of both groups comorbidly were dominated diseases of the cardiovascular system, in group A, increasingly was revealed gastrointestinal pathology. Polyneuritic disorders of sensitivity and autonomic-trophic disorders are more common in persons of group B, they have a higher frequency of comorbid pathology and longer duration of DM. In group A lack of Achilles and knee reflexes was recorded more often than in comparison group. In 18 (65 %) of the examined persons of group A was detected a fatty liver dystrophy by ultrasound scanning of the abdominal organs, which exceeds the number in group B – 13 (35 %). There is an inverse average dependence between the level of TSH and BMI (correlation coefficient = –0,65). The general index of pain rating (Pain Rating Index – PRI) in group A is higher (30,62±2,64 scores).
Conclusions. Among the thyroid diseases in the examined patients of group A hypothyroidism was most often detected, so 30 % of patients had a pronounced violation of lipid metabolism in the form of obesity, besides, in this group the number of people with type II DM was prevailed. The influence of thyroid pathology on the manifestations of DP is reflected in the intensification of neuropathic pain syndrome. There is also a significant effect on the metabolism of fats and carbohydrates, which aggravate and sometimes deepen the somatic condition of the patient.
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