This original research from Jothydev's Diabetes Research Centre was presented at the 50th European Association for the Study of Diabetes(EASD) Annual Meeting in September 2014. The research was headed by Dr. Jothydev Kesavadev.

Thyroid function test is not a part of routine diabetes practice in India, due to the extra cost involved and the lack of time for the physician to convince the patient on the requirement of an extra expensive investigation. Many a time, symptoms of hypothyroidism in diabetes patients are mistaken for hypoglycaemia and associated metabolic syndrome and hence goes grossly undetected. We screened T2DM patients, presenting at our comprehensive diabetes speciality clinic for the first time, to evaluate the prevalence of thyroid disorders. Screening was done during the past 5 years, using the 'sensitive TSH test' in Cobas E411 Elecsys. Patients with undetected hypothyroidism reported mood changes, anxiety, anger, memory loss etc. which were corrected with thyroid supplementation.

During selection of 7402 consecutive T2DM subjects aged ≥ 21yrs (62.48% male), 5.83% self reported hypothyroidism; 29.67% showed abnormal TSH values, comprising of 10.42% with TSH values suggestive of subclinical hypothyroidism((3.04-10 μIU/mL); 17.09% overt hypothyroidism (>10 μIU/mL) and 2.16% with low TSH values suggestive of hyperthyroidism((<0.05 μIU/mL). Abnormal TSH values showed significant association with female sex and >60yrs age group; whereas distribution of other subgroups were not statistically significantly different.

Among females, 9.09% had mildly increased TSH levels (3.04-10μIU/mL), 22.14% had high TSH levels (>10μIU/mL) and 1.45% had low TSH levels (<0.05 μIU/mL). Overall, subjects with newly detected hypothyroidism showed a trend of higher BMI (1.7 kg/m2) compared to others, but this was not statistically significant (p>0.05). The level of diabetes control was possibly confounded by treatment received and HbA1c did not significantly differ among hyperthyroid, euthyroid & sub-clinically hypothyroid patients (mean HbA1c=8.9%).

Overall, subjects with newly detected hypothyroidism showed a trend of higher BMI (1.7 kg/m2) compared to others, but this was not statistically significant (p>0.05). The level of diabetes control was possibly confounded by treatment received and HbA1c did not significantly differ among hyperthyroid, euthyroid & sub-clinically hypothyroid patients (mean HbA1c=8.9%).

Overall, subjects with newly detected hypothyroidism showed a trend of higher BMI (1.7 kg/m2) compared to others, but this was not statistically significant (p>0.05). The level of diabetes control was possibly confounded by treatment received and HbA1c did not significantly differ among hyperthyroid, euthyroid & sub-clinically hypothyroid patients (mean HbA1c=8.9%).

Considering the negligible extra cost of 1.26Euros for 90 tablets (presuming an average 50mcg/day dosage) of thyroid supplementation, diabetes patients will tremendously benefit from early detection of thyroid disorders. The very high prevalence of hypothyroidism in diabetes, significantly higher than in the general population, makes it imperative to include TSH test in routine diabetes evaluation in developing countries like India.

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