ACTA ENDOCRINOLOGICA (BUC)

Diabetes Mellitus is a huge syndrome which can be detected from the first day of life until the last year of life of a centenarian. In the current classification of diabetes among the so-called “idiopathic phenotypes”, apart Type 1 Diabetes (T1D) and Type 2 Diabetes (T2D) has been included provisionally term “Latent Autoimmune Diabetes in Adults” (LADA). This has unclear characterization regarding the age at onset, the presence of anti-β-cell antibodies and the level of insulin secretory function, in conformity with C-peptide levels. According to several recent publications, there are no specific biochemical or genetic markers for Latent Autoimmune Diabetes in Adults (LADA), but only a gradual transition from T1D to T2D. In addition, the word “latent” in the construction of “LADA” term is inaccurate because in this phenotype nothing is latent: both the autoimmunity and diabetes are present and are even parts of the diagnosis. So that, the best term should be what in reality this subphenotype is: an Intermediary Diabetes Mellitus (IDM). Some recent genetic data strongly support this designation.

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More than one century passed from the first proposed classification of diabetes in two phenotypes which survived in all the official classifications of WHO, despite the repeated suggestion that, in the light of the new biochemical, immunological and genetic data, the old black and white view on diabetes must be challenged. The time for a reclassification is now!

Background. The modifications of blood pressure and lipid metabolism, the decrease of heart contractility and the increase of systemic vascular resistance that accompany hypothyroidism are caused by the decreased action of thyroid hormones. Objective. The purpose of this study is to evaluate, using echocardiography, the changes of the heart functional parameters in patients with untreated thyroid dysfunctions. Pacients and Methods. Study group included 348 patients for an evaluation of cardiovascular and thyroid status. The control of the thyroid condition was conducted using measurements of the FT3, FT4 and TSH levels, echocardiographic measurements defining the parameters of the function of the left ventricle. Results. The study group was divided into subclinical hypothyroidism (SH, 75 cases), overt hypothyroidism (OH, 123 patients) and normal thyroid function (C, 150 patients). TSH values decreased (from 5.8±15 mUI/L to 2.28±0.63 mUI/L in SH and from 20.23±17.33 mUI/L to 4.24±0.24 mUI/L in OH) after one year of treatment while fT4 and fT3 increased. The parameters obtained revealed significant decreases of the E/A ratio in both groups with hypothyroidism. The isovolumetric relaxation time was significantly higher in SH and OH as compared to the control group (C: 112.50±35.45 msec, SH: 118.75±16.52 msec p<0.05, OH: 130±41.83 msec p<0.001). In addition, the tissue Doppler revealed significant decreases of the E’/A’ ratio, measured septally and laterally in the group with overt and subclinical hypothyroidism. Conclusion. In hypothyroidism the systolic and predominantly diastolic function of the left ventricle are impaired. These dysfunctions are reversible under L-T4 substitutive treatment.