Rohini N S

Abstract

Introduction: Cardiovascular diseases (CVDs) are one of the leading causes of death in women across the globe. CVD is more prevalent in women after menopause due to the lack of estrogens which have a cardioprotective effect Menopause and diabetes mellitus are individually high risk for cardiovascular autonomic neuropathy which in turn results in CV accidents and deaths. Aims and Objectives: The aim of this study was to evaluate the Autonomic Nervous System dysfunctions in post menopausal women with diabetes mellitus, to grade the severity of dysfunctions and to compare the severity of the ANS dysfunction with age matched healthy controls. Materials and Methods: This observational study was conducted in the department of Obstetrics and Gynecology, Akash Institute of Medical Sciences & Research Centre, Devanahalli, Bengaluru, Karnataka, India. A total of 120 postmenopausal women were examined for the study. They were divided into two equal groups (60 women in each group) as menopausal women with diabetes and without diabetes. The ANS dysfunctions were evaluated based on symptoms and also specific tests like heart rate response to Valsalva maneuver, heart rate response to standing up from supine position, blood pressure response to sustained handgrip, blood pressure response to standing up from supine position. The ANS dysfunctions were categorized into mild, moderate and severe dysfunctions. Results: Of the 60 postmenopausal women without diabetes, 20 women had symptoms of autonomic dysfunction in the form of hot flushes, giddiness and palpitations, (33%) and they also tested positive for ANS dysfunction. Though the remaining 40 women did not have any symptoms, they tested positive for ANS dysfunction. 40 women had mild ANS dysfunctions, 12 had moderate dysfunctions and 8 had severe dysfunctions. In the other group of postmenopausal women with diabetes, 30 women had symptoms of ANS dysfunction (50%) and also tested positive for ANS dysfunction. The remaining 30 women, though did not have any symptoms, they also tested positive for ANS dysfunctions. 30 of them had mild dysfunctions, 18 had moderate dysfunctions and 12 had severe dysfunctions. Conclusion: Our study has broadly shown that postmenopausal women suffer from autonomic derangements, and degree and severity of such derangements are much higher in post menopausal women with diabetes mellitus and are possibly at an increased risk of developing heart disease. Hence early detection, good control of diabetes and early detection of autonomic dysfunction and management is important in these women. Keywords: Post-menopausal women, Diabetes, Autonomic function tests, Cardiovascular disease.

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Abstract

Aims and Objectives: The study was undertaken in pregnant women to understand and analyze the obstetric and fetal outcomes of thyroid disorders. Materials and Methods: TSH estimation was used as universal screening in their first visit to our hospital. Those patients with abnormal TSH values, i.e. above 2.5mIU/ml in first trimester and above 3mIU/ml in second and third trimesters were evaluated for freeT3, freeT4 and TPO Abs. They were treated accordingly and dosage adjustments made and the tests repeated once in 4-6 weeks. They were followed throughout pregnancy and delivery. Results: Total no of pregnant women screened were 860, of which 130 had abnormal thyroid functions, thereby the prevalence of thyroid dis­orders being 15.11%. Of the 130 patients with thyroid disorders, 126 were hypothyroid and 4 were hyperthyroid. Among the 126 hypothy­roid cases, 48 were known cases and 78 were new cases. The total cases of subclinical hypothyroidism were 91, prevalence being 10.58% and overt cases were 35, prevalence being 4.06%; 4 cases were overt hyperthyroid, prevalence being 0.4%. 60.3% of subclinical hypothy­roidism were TPO positive and 39.6% of overt hypothyroidism were TPO positive (p value-<0.05). Out of 130 abnormal thyroid function patients, 98 patients delivered in our hospital. There were 16 abor­tions, 14 spontaneous and 2 terminations of pregnancies; 6 patients were lost for follow up, 7 patients have delivered outside and 1 patient lost follow up. Conclusions: The prevalence of thyroid disorders during pregnancy was significantly more in our study, hypothyroidism being the commonest. Significant numbers of cases were newly diagnosed on universal screening. The commonest disorder was subclinical hypothyroidism. Adverse maternal and fetal outcomes were almost similar in both subclinical and overt hypothyroidism. The common adverse outcomes noted were abortions, pre-eclampsia, gestational diabetes mellitus, preterm births and increased rates of caesarean sections. The adverse outcomes were significantly more in autoimmune antibody positive patients. Keywords: Sub-clinical hypothyroidism, Overt hypothyroidism, Thyro ­peroxidase antibody (TPO Abs), Hyperthyroidism, preterm abortions, IUGR, Eclampsia.

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