Journal of Diabetes and Endocrinology Association of Nepal

Meeting Report: 9th Annual Diabetes Nepal Conference

Satyan Rajbhandari — Sun, 26 May 2019 03:42:38 +0000

DOI: https://doi.org/10.3126/jdean.v3i1.24057

9th Annual Diabetes Nepal Conference and Indo-Nepal-UK Diabetes Meeting was held in Kathmandu on 23rd February 2019.

Keywords: Diabetes Nepal Conference

Thyroid function status in patients with thyroid associated ophthalmopathy: a study for Nepal

Saurav Piya, Jeena Gurung, Anadi Khatri — Sun, 26 May 2019 03:44:10 +0000

DOI: https://doi.org/10.3126/jdean.v3i1.24058

Introduction: Thyroid Eye Disease (TED) is an organ-specific autoimmune inflammatory incapacitating eye disorder usually associated with Graves’ disease affecting the orbit. Objectives: To determine thyroid function status in patients with thyroid-associated Ophthalmopathy.

Methods: This is a hospital-based cross-sectional study of sixty three clinically diagnosed new cases of thyroid-associated ophthalmopathy done at Nepal Eye Hospital, Kathmandu from February 2012 to January 2013. Detailed history, systemic & ocular examination with special emphasis on evaluation of extraocular movement, lid signs, exophthalmos with Hertel's exophthalmometer was done. Thyroid function test and endocrine consultation were also done in all cases.

Results: There were an equal distribution of TED with hyperthyroid (34.95%) and euthyroid status (34.95%). The most common presentation of both euthyroid and hypothyroid patient was tremor (13.4%) and palpitation (13.45%). The most common symptom of TED was foreign body sensation (54 %) but in TED with euthyroid and hypothyroid status, redness (22.2 %) and diminution of vision (20.6 %) were more frequent symptoms respectively. The most common presenting sign was Von Graefe’s sign (69 %). Among TED with hyperthyroid and hypothyroid status, Dalrymple's sign (29.3%) and Mobius sign (17.4%) were most common respectively.

Conclusion: Thyroid-associated ophthalmopathy is an important health concern among patients with a thyroid disorder. TED with hyperthyroid states present more severely than hypothyroid and euthyroid states. As TED occurred with a high prevalence in all thyroid states, a close collaboration between endocrinologists and ophthalmologists along with timely referrals of patients with any eye complaint is mandated.

Keywords: Graves Opthalmopathy, Thyroid Function Tests, Hyperthyroidism, Thyroid Diseases, Hypothyroidism

Cause of Hypothyroidism in Post Iniversal Salt Iodization era in Nepal

Sunil Pokharel — Sun, 26 May 2019 03:44:59 +0000

DOI: https://doi.org/10.3126/jdean.v3i1.24059

Introduction: Iodine deficiency remains the most common cause of hypothyroidism worldwide, but in areas of iodine sufficiency autoimmune disease (Hashimoto’s thyroiditis) is most common. After implementation of Universal Salt Iodization (USI) to control Iodine Deficiency Disorder(IDD), Nepal is heading towards iodine sufficiency but the prevalence of clinical and subclinical hypothyroidism is still high. So this study was done to find out either chronic autoimmune thyroiditis is the cause of clinical hypothyroidism in post universal salt iodization era of Nepal by measuring Anti-TPO antibody.

Method: Newly diagnosed patients with Clinical or Sub clinical hypothyroidism by thyroid function test were included in this study. Anti-TPO antibody was measured by Elisa method, Anti-TPO >34 was considered positive. All the data’s were analyzed using SPSS software.

Result: In this study 1000 patients were included, male to female ratio was 5:1. 270 patients had clinical hypothyroidism among which 230(85.1%) patients had Anti-TPO antibody positive. Among 730 patients with subclinical hypothyroidism only 220(30.1%) patients had antibody positive. Our result showed that TPO antibody was positive in clinical hypothyroidism compared to subclinical hypothyroidism with statistical significance (p<0.001). Our result also showed that clinical hypothyroidism had higher TPO value (mean 225.14) compared to subclinical hypothyroidism (74.34) with statistical significance p<0.001.

Conclusion: The cause of hypothyroidism in present day Nepal is chronic autoimmune thyroiditis (Hashimoto’s thyroiditis). As we are moving from iodine deficiency status to iodine adequate or iodine excess status there might be an increased burden of thyroid disorders in Nepal due to the increased prevalence of autoimmune thyroiditis.

Keywords: Universal Salt Iodization (UI), Iodine Deficiency Disorder (IDD), Clinical Hypothyrodism, Sub-clinical Hypothyroidism, Anti-TPO antibody

Cost of Illness Study of Regular Out Patient Department Diabetic in a Low Income Country: A Cross Sectional Study

Sun, 26 May 2019 03:45:49 +0000

DOI: https://doi.org/10.3126/jdean.v3i1.24060

Background: The burden of Diabetes in South Asia is alarming as the prevalence is higher compared to other region, living cost is low after Sub Saharan Africa and health care system are in state of expanding to be more accessible and adequate.

Objectives: The objective of the study was to assess the direct cost of illness among diabetic patient regularly visiting at outpatient department (OPD) in BPKIHS.

Methods: This was a cross sectional study done in year 2018. 142 patients with at least nine visit per year were enrolled. The direct cost were calculated from the pattern of prescription of medications and laboratory investigations carried out over a year of the individual patient. The data were tabulated and analyzed.

Results: Among the 142 patients on 37.5% were in mono-therapy and 62.5% were in poly-therapy. The direct cost of illness was USD 103 per annum that includes drug and investigation cost expensed at OPD visit. The average indirect cost was USD 102 per annum including travel and food. Among 142 patient the cost of illness on inpatient due to DM was USD 85.47 per event.

Conclusion: The financial burden of being a diabetic in Nepal is high. Comprehensive quality care by expansion of health system and service with nominal charges to patient seems to be one of the challenges in Nepal.

Keywords: Burden, Cost of illness, Diabetes, Nepal

Pattern of thyroid disorders in ENT OPD of Nobel Medical College in Eastern Nepal

Sanjeev Kumar Thakur, Manish Agrawal, Nisha Ghimire, R.K. Bedajit, Pratap Roy — Sun, 26 May 2019 03:46:41 +0000

DOI: https://doi.org/10.3126/jdean.v3i1.24061

Background: Thyroid dysfunction is a major health problem in eastern Nepal with a high prevalence and the pattern of thyroid disorders. Previous studies have shown the tendency of hypothyroidism to increase with the age and being more common in women.

Objective: this study was undertaken to study the various possible manifestations of thyroid disorders and their relation to age in female population in eastern Nepal.

Methods: This was a hospital based study, conducted in the Department of ENT of Nobel Medical College and teaching hospital in eastern Nepal. A total of 153 female subjects, who attended the outpatients department (OPD) for thyroid screening were enrolled in the study. Blood samples were collected and thyroid assay was done (fT3, fT4, and TSH). Data was tabulated and analysed.

Results: On analyzing the Thyroid profile of 153 subjects, 107 (69.93%) of them were found to be of euthyroid status. Rest of them had abnormal status. Subclinical hypothyroidism status was found in 31 (20.26%) subjects, while frank hypothyroidism was found in 9 (5.88%) cases. Subclinical hyperthyroidism and frank hyperthyroidism was found in 3 (1.96%) cases each. The fT3 level was of high normal level in the less than 40 years age group, while it was low normal in the above 40 years age group. On analysis, with ANOVA, there was significant difference in fT3 values among three age groups. But, no significant difference was found for fT4 level among age groups. The TSH level was shown to differ significantly among three different age groups. The normal range of TSH increased with increasing age. On analyzing the correlation of Thyroid function parameters, fT3 and fT4 values did not correlate with age, but, TSH was positively correlated with age. This signifies that TSH increases with increasing age, which is also similar to the ANOVA results.

Conclusion: the prevalence of thyroid disorder in the studied sample of eastern Nepal is found to be 30.07% and hypothyroidism was the commonest disorder in this study. There is a tendency of fT3 to decrease and TSH to increase with increasing age. However no definite pattern was found for fT4.

Keywords: Thyroid stimulating hormone, Thyroid disorders, Hypothyroidism, Hyperthyroidism, Nepal

Neonatal thyroid screening for congential hypothyroidism

Luna Bajracharya — Sun, 26 May 2019 03:47:33 +0000

DOI: https://doi.org/10.3126/jdean.v3i1.24070

No abstract available.

Keywords: hypothyroidism, neonatal thyroid screening

Undetectable TSH could be a TSH variant; case of a young asymptomatic Nepalese male

Santosh Pradhan, Vivek Pant, Keyoor Gautam, Devish Pyakurel, Abha Shrestha — Sun, 26 May 2019 03:48:43 +0000

DOI: https://doi.org/10.3126/jdean.v3i1.24071

Thyroid function tests are frequently ordered test. Infrequently, the automated thyroid hormone assay system is subjected to interference which may yield false results, thus leading to inappropriate diagnosis and management. We report an unusual case of clinically misdiagnosed subclinical hyperthyroidism with undetectable TSH due to negative interference in particular TSH assay platforms in a young Nepalese male.

Keywords: Thyroid stimulating hormone, TSH, TSH variant, Immunoassay

National Consensus Statement on the Management of Type 2 Diabetes Mellitus in Nepal

Sun, 26 May 2019 03:49:30 +0000

DOI: https://doi.org/10.3126/jdean.v3i1.24072

The full National Consensus Statement on the Management of Type 2 Diabetes Mellitus in Nepal is included here.

Keywords: Diabetes Mellitus, Consensus Statement