Objective : Graves’ disease (GD) causes significant weight loss due to a hypercatabolic state (HS). The raised appetite rarely normalizes even after clinical & biochemical control which leads to some metabolic derangements and may cause metabolic syndrome (MS). Our current obesogenic environment (OE) further worsens this risk. Since India has a high morbidity burden from MS, and such area hasn’t been previously looked into, aims of the study were to find the incidence and determinants of MS in these patients.
Methods : A descriptive observational longitudinal study was done, where data needed to diagnose MS were collected - at the diagnosis of GD and after maintaining control for a minimum of 1 month, from 86 patients with GD. IDF criteria (2006) were used to diagnose MS.
Results : 36.05% of 86 patients developed MS on follow up, of which 90.32% had normal BMI at presentation. In those who developed MS, the mean BMI were 20.6±2.8 & 25.5±2.6kg/m2, mean FPG were 86.6±5.3 & 105.5±19.9mg/dL, mean Triglyceride were 101.9±17.3 & 173.8±43.6mg/dL, mean HDL were 63.8±7.2 & 42.9±6.9mg/dL, mean SBP were 122.52±4.5 & 139.8±17.2mm of Hg, mean DBP were 75.42±4.8 & 85.55±9.9mm of Hg & mean waist circumferences were 54.6±5.9 & 88±5.8cm at diagnosis of GD & end of the study respectively. The parameters needed to diagnose MS showed significant worsening (p<0.05) with a weak insignificant correlation with duration of therapy. Occurrence of metabolic syndrome had insignificant correlation with sex (p=0.09), duration of therapy (p=0.096), age (p=0.073) and severity at presentation (p=0.75).
Discussion : The study confirmed our initial hypothesis of occurrence of MS in GD patients under control. Thus patients need to be counselled about the risk of MS with disease control and the need for adopting lifestyle measures. This study sets the stage for larger studies to help identify the complex interplay between appetite, HS and its control in patients with treated GD in the face of our OE. Our hospital caters to populations that are economically weaker where under nutrition is fairly common, and in spite of that a significant percentage developed MS. Therefore, populations with exposure to calorie rich diet might show higher incidence of MS.
Conclusion : Remission of GD was found to significantly worsen the parameters pertaining to MS. Incidence of MS was found to be 36.05% in the study population, which was independent of the patients’ age, sex, and initial disease severity. Patients should be informed about this risk so that lifestyle measures may be undertaken from the start.
Jinesh Sengupta– 3rd YEAR POST GRADUATE TRAINEE (JUNIOR RESIDENT), R. G. KAR MEDICAL COLLEGE AND HOSPITAL, MIDNAPORE, West Bengal, India
Indira Maisnam– FACULTY, DEPARTMENT OF ENDOCRINOLOGY, R. G. KAR MEDICAL COLLEGE AND HOSPITAL, KOLKATA, INDIA, Kolkata, West Bengal, India
Manidipa Majumdar– Independant physician ( General Medicine), West Bengal University of Health Sciences, Kolkata, India
Apurba Mukherjee– PROFESSOR AND HEAD, DEPARTMENT OF GENERAL MEDICINE; PROFESSOR AND HEAD, DEPARTMENT OF ENDOCRINOLOGY, R. G. KAR MEDICAL COLLEGE AND HOSPITAL, India
3rd YEAR POST GRADUATE TRAINEE (JUNIOR RESIDENT)
R. G. KAR MEDICAL COLLEGE AND HOSPITAL
MIDNAPORE, West Bengal, India
After completing my MBBS, compulsory 1 year rotational internship and 1 year Housestaffship from Medical College and Hospital Kolkata, I am currently pursuing my MD (General Medicine) degree as a 3rd Year Post-Graduate Trainee (Junior Resident) in R. G. Kar Medical College and Hospital, with future plans of pursuing a superspeciality degree in Endocrinology.
FACULTY, DEPARTMENT OF ENDOCRINOLOGY
R. G. KAR MEDICAL COLLEGE AND HOSPITAL, KOLKATA, INDIA
Kolkata, West Bengal, India
DR. INDIRA MAISNAM, MBBS, MD, DM (ENDOCRINOLOGY), is a Faculty at the Department of Endocrinology, R. G. Kar Medical College and Hospital. With multiple national and international publications to her name, she has guided many of her students to add various publications to their name. She has delivered invited lectures in many conferences of repute. She is a reviewer in many international and national journals of repute.
Independant physician ( General Medicine)
West Bengal University of Health Sciences
I am from kolkata, born, raised and schooled in the same city. Being brought up in a family of doctors, the idea of being one always fascinated me. I was trained for my primary medical qualification (MBBS) in N.R.S. Medical College and completed my MD (residency) in General (Internal) Medicine in R.G. Kar Medical College and Hospital. I'm currently working as an independant physician in private capacity.
PROFESSOR AND HEAD, DEPARTMENT OF GENERAL MEDICINE; PROFESSOR AND HEAD, DEPARTMENT OF ENDOCRINOLOGY
R. G. KAR MEDICAL COLLEGE AND HOSPITAL, India
Dr. APURBA KUMAR MUKHERJEE passed his MBBS from Burdwan Medical College, West Bengal, India and completed his MD from IPGMER, Kolkata, India. He completed his FICP in 2015 and FRCP (Glasgow) in 2017. A stalwart in the management of Diabetes, he is currently Head of the Departments of General Medicine and Endocrinology in R G. Kar Medical College and Hospital. He has guided many students to success in a career spanning decades and himself is widely known in the fields of Medicine and Endocrinology.