Diagnosis of Diabetic Neuropathy

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In general when someone has hypothyroidism then we have an increase in body weight. The opposite happens in hyperthyroidism. Most of the cases we deal with in daily clinical practice are subclinical, i.e. an increase or decrease in TSH with normal peripheral hormones T3, T4. In these cases, the hormonal disorder hardly contributes to the fluctuations in body weight. In the case of hypothyroidism, the burden is on average 3-4 kg.

Thyroid diseases are distinguished according to the findings of thyroid hormones in hypothyroidism when the thyroid gland does not produce the appropriate amount of thyroid hormones and we should supplement it by administering thyroxine - the well-known tablets T4, Medithyrox, Euthyrox, Tirosint, Thyrohormone-, in hyperthyroidism where the gland produces large amounts of hormones and we should block them by administering antithyroid drugs - Unimazole, Thyrostat, Prothuril - but there are many patients who come to the doctor's office due to findings in tests done for another reason with findings of nodules or positive antithyroid antibodies and normal thyroid hormones. In these cases, the patient is characterized as euthyroid, does not need medication and simply enters a follow-up protocol depending on the damage.

The administration or not of suppression treatment in nodular goitre has been a field of debate in Endocrinology for years. In recent years, the direction is not to administer suppression therapy to the nodules unless there are laboratory indications of hypothyroidism. Administering thyroxine without reason is dangerous and is associated with causing arrhythmias in the heart and deterioration of bone metabolism.

Hashimoto's autoimmune thyroiditis is a thyroid condition in which our body attacks its own thyroid cells and destroys them. The rate of progression to normal hypothyroidism where it usually ends up is 5-6% per year when antithyroid antibodies are positive. There is also a percentage of 10-15% where Hashimoto's disease is present as shown on thyroid ultrasound but we do not have positive antibodies In all cases as long as the thyroid hormone tests are normal we do NOT give thyroxine unnecessarily just by finding an elevated titer of antithyroid antibodies.

Psychological changes are a symptom for which thyroid function must be checked. Also extreme symptomatology such as a severe depression or suicidal tendencies and hyperarousal are conditions in which a thyroid check should be done.

Rate of incidentally discovered of thyroid nodules on imaging tests done for another reason is very high, estimated at 40-60%. These nodules are found incidentally and in most cases do not cause clinical symptoms or are of no clinical significance. What concerns us and needs further control is that some of these nodules are malignant. The malignancy detection rate varies among the different series from 7-15%. In this investigation, critical is the role of ultrasound studies where, depending on the special imaging characteristics of each nodule, we decide whether to proceed with further diagnostic tests.

The T3/T4 combination has been tested in patients who, while treated with thyroxine and whose laboratory tests are normal, report persistence of hypothyroid symptoms. In these cases, after ruling out other causes such as anemia, it makes sense to co-administer a small dose of T3.

Fatigue, loss of energy, lethargy, weight gain, decreased appetite, cold intolerance, dry skin, hair loss, drowsiness, muscle pain, joint pain, lower limb weakness, depression, emotional instability, mental disorders, memory disorders, inability to concentrate, constipation , menstrual disorders, reduced fertility, reduced sweating, hallucinations and nerve entrapment syndromes, blurred vision, hearing loss, feeling of suffocation, hoarseness.

The following symptoms are more specific to Hashimoto's disease: Suffocation in the cervix, painful swelling of the cervix, exhaustion, mild cervical pain or sore throat, or both.

Weight gain, slow speech and movements, dry skin or less often yellow skin, jaundice, pallor, brittle hair growth, eyelid swelling, macroglossia, decreased systolic pressure increased diastolic, hypothermia, bradycardia.

The following symptoms are more specific to Hashimoto's disease: Suffocation in the cervix, painful swelling of the cervix, exhaustion, mild cervical pain or sore throat, or both.

Insulin resistance is a multifactorial clinical entity in which the hereditary factor plays a major role and is a result of obesity. It is mainly a result of the increased weight and not a cause.

The cornerstone of obesity treatment is the adoption of a diet program combined with physical exercise. In the event that efforts fail and given that obesity has now been recognized as a disease, medication has its role. A dominant position in this field is a class of drugs, the GLP-1 agonists, which are available at least in our country in injectable form. The substance which has an official indication for the treatment of obesity is liraglutide - trade name Saxenda - in daily administration with a dosage of 3 mg per day which is not covered by the EOPPY. This substance is available in a smaller dose of up to 1.8 mg and is indicated for the treatment of type 2 diabetes. Another substance with a similar indication and equally good results is semaglutide - trade name Ozempic - which in our country is not yet available in dosage of 2mg per day which has an official indication for obesity. There is now a global trend of uncontrolled administration of the above substances with various gimmicks independently to all obese people by experts and non-specialists as the new "water of Kamateros". I would recommend as a specialist that we follow the official indications of the drugs under the guidance of doctors with knowledge of the subject.

Another myth that is widely circulated. The main, but rare, side effect of statin administration is myopathy. Regarding liver function, the data show that the administration of statins reduces the fatty infiltration of the liver, a very common nosological entity in which we usually have a mild increase in liver enzymes or which is confused with liver damage from the administration of statins.

An elevated morning cortisol value does not indicate increased cortisol production by the body. It simply shows that the adrenal glands are working properly. To document cortisol overproduction we use another approach.

High-intensity exercises such as jumping, intense running, jogging, squats, spins, golf, tennis, bowling are not recommended because they increase the risk of fracture. Even yoga increases the risk of compression fractures of the spine. In contrast, strength exercises with resistance are generally considered beneficial. These exercises include activities that build muscle mass and increase muscle strength. Such exercises are training with free weights or machines, exercises with resistance bands or exercises with only the body such as push-ups, squats. Aerobic weight training including walking, low-intensity aerobics, ellipticals and stair climbing are also beneficial. Activities such as swimming and cycling typically do not contribute to improving bone mass.
In older patients with osteoporosis, agility exercises are of great help to reduce the risk of falls. These can be structured to improve eye-hand-foot coordination, dynamic balance and reaction time. Agility exercises with resistance training are also beneficial.
In conclusion a proper program includes a combination of resistance exercises and strength-aerobic weight training and exercises that improve stability, balance and flexibility.

It is a condition that increases the risk of type 2 diabetes and cardiovascular disease. When someone is diagnosed with insulin resistance their body has trouble using the insulin produced by the pancreas. Over time this results in blood sugar levels rising. The good news is that increasing physical activity and losing weight can reverse insulin resistance and lower the risk.

  • Increased body weight
  • Lack of physical activity
  • First-degree relative—parent, brother, sister—with type 2 diabetes
  • Ethnicity-African American, Hispanic, American Indian, etc.
  • Have polycystic ovary syndrome
  • During your pregnancy you developed gestational diabetes
  • To give birth to a child larger than 4.5 kg
  • Your age must be older than 45
  • Your sugar levels are above normal
  • Have high blood pressure
  • Have low good HDL cholesterol
  • Have high triglycerides
  • Have suffered a heart attack, stroke or blockage of blood vessels in the neck or lower extremities.

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