الفهرس 
THYROID-STIMULATING-H ORMONEOnly 14 pages are availabe for public view
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Abstract
Abstract
Background: The problem of obesity and diabetes mellitus is growing in many developing countries, rates have been tripled in the last 20 years in the developing world with 10% of world nearly currently overweight or obese. The Middle East, Pacific Islands, Southeast Asia and China are facing the greatest challenges. TSH (thyroid stimulating hormone) secretion shows a diurnal rhythm with a surge late in the evening (10.00 pm - 2.00 am) in healthy subjects. This pattern seems to be under hypothalamic control and disappears in patients with central hypothyroidism. Nocturnal TSH surge is essential to thyroid function regulation, The TSH surge test is the most sensitive test available for confirming the diagnosis of isolated central hypothyroidism. Aim of the Work: The aim of the present study to evaluate nocturnal TSH surge, leptin levels and their relationship to obesity, patients with pre-diabetes and patients with type 2 diabetes mellitus on metformin therapy. Patients and Methods: This comparative study was carried out in El Demerdash hospital (Endocrine outpatient clinic and inpatients). Informed consent (oral and written) for participation in the study was obtained. The study included 3 groups: group 1: 20 healthy obese people with BMI ≥ 30 (grade 1 & 2 obesity). group 2: 20 obese patients (BMI ≥ 30) with pre-diabetes as confirmed by FBS and OGTT & HbA1c according to ADA 2014: IFG: FBS ≥ 5.6 mmol / L (100 mg/dl) and < 7 mmol / L (126 mg/dl). IGT: FBS <7 mmol / L (126 mg/dl) and 2h PP ≥ 7.8 mmol / L (140 mg/dl) and < 11 mmol / L (200 mg/dl). group 3: 20 obese patients (BMI ≥ 30) with type 2 diabetes mellitus as confirmed by FBS, HbA1c and on metformin therapy. Results: The current study showed a high statistical significant difference between TSH surge and Negative correlation with HbA1C with p-value 0.010 in blunted group (patients with central hypothyroidism). There was a positive significant correlation between serum Leptin and HbA1C with p-value 0.002. There was a non significance positive correlation between serum leptin, TSH surge. Conclusion: Patients with thyroid dysfunction (blunted thyroid response; Central hypothyroidism) tends to have more liability for diabetes, uncontrolled blood sugar and atherogenic lipid profile, thus, estimation of thyroid functions in every diabetic patients is essential. Leptin resistance still has a role in correlation with diabetes as it was found the highest among the diabetic patients rather than normal healthy or prediabetics. However, its correlation with thyroid function is questionable as it was found non significant correlation in the present study. Recommendations: Patients with thyroid dysfunction (blunted thyroid response; Central hypothyroidism) tends to have more liability for diabetes, uncontrolled blood sugar and atherogenic lipid profile, thus, estimation of thyroid functions in every diabetic patients is essential. In patients with uncontrolled blood sugar with up to normal primary thyroid profile (normal TSH, normal or low normal FT4), Central hypothyroidism should be excluded as a cause for blood sugar deregulation. The same as well in patients with hypercholesterolemia, where no obvious cause and negative family history with up to normal thyroid profile ((normal TSH, normal or low normal FT4), Central hypothyroidism should be excluded. Larger scales of studies are needed to evaluate the benefit of treatment of such patients with blunted Nocturnal TSH surge response for lipid and blood sugar control.