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The effects of pathophysiological changes in Type-2 diabetic patients on thyroid dysfunction and nodular goiter development in Turkey

Yıl 2023, Cilt: 15 Sayı: 1, 86 - 90, 15.03.2023

Zeynep Ergenç Özlem Karaca Ocak Erkan Aksoy Hasan Ergenç

https://doi.org/10.18521/ktd.1159387

Öz

Objective: The prevalence of thyroid dysfunction is higher in patients with diabetes, and its diagnosis could cause better diabetes management. The purpose of the present study is to examine the impact of pathophysiological changes in patients with Type-2 diabetes on the frequency of thyroid dysfunction, thyroid autoimmunity, thyroid nodule, and thyroid cancer in Turkey.
Methods: The study was conducted on a total of 3.276 patients with Type-2 diabetes who underwent thyroid tests and thyroid ultrasonography (US). The demographic characteristics, biochemical and hormonal values, thyroid US reports, and histopathology reports were collected from the patient's electronic records.
Results: Thyroid autoimmunity positive TPOab 15.9% (n = 524) and/or positive TGab 9.9% (n = 327), the rate of positivity of both antibodies (TPOab + TGab) in the same patient, and total thyroid autoimmunity was found to be 32.57% (n=1067) in Type-2 diabetic patients. Thyroid dysfunction was detected in 18.3% (n = 602) of these patients. The distribution of thyroid dysfunction was 9.09% (n = 298) subclinical hypothyroidism, 4.1% (n = 135) clinical hypothyroidism, 3.1% (n = 102) subclinical hyperthyroidism, 2.0% (n = 67) clinical hyperthyroidism. Also, 67.9% (n = 2225) thyroid nodules, and 5% (n = 164) thyroid cancer were detected.
Conclusion: Thyroid dysfunction was found to have increased in patients with Type-2 diabetes at significant levels.

Anahtar Kelimeler

Type-2 diabetes thyroid dysfunction nodular goiter thyroid autoimmunity

Destekleyen Kurum

None

Proje Numarası

None

Kaynakça

  • 1) Gierach M, Gierach J, Junik R. Insulin resistance and thyroid disorders. Endokrynol Pol. 2014;65(1):70-6. doi: 10.5603/EP.2014.0010. PMID: 24549605.
  • 2) Roubsanthisuk W, Watanakejorn P, Tunlakit M, Sriussadaporn S. Hyperthyroidism induces glucose intolerance by lowering both insulin secretion and peripheral insulin sensitivity. J Med Assoc Thai. 2006 Nov;89 Suppl 5:S133-40. PMID: 17718254.
  • 3) Maratou E, Hadjidakis DJ, Kollias A, Tsegka K, Peppa M, Alevizaki M, Mitrou P, Lambadiari V, Boutati E, Nikzas D, Tountas N, Economopoulos T, Raptis SA, Dimitriadis G. Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. Eur J
  • 4) Chen RH, Chen HY, Man KM, Chen SJ, Chen W, Liu PL, Chen YH, Chen WC. Thyroid diseases increased the risk of type 2 diabetes mellitus: A nation-wide cohort study. Medicine (Baltimore). 2019 May;98(20):e15631. doi: 10.1097/MD.0000000000015631. PMID:
  • 5) Palma CC, Pavesi M, Nogueira VG, Clemente EL, Vasconcellos Mde F, Pereira LC Júnior, Pacheco FF, Braga TG, Bello Lde F, Soares JO, Dos Santos SC, Campos VP, Gomes MB. Prevalence of thyroid dysfunction in patients with diabetes mellitus. Diabetol Metab Syndr.
  • 6) Jali MV, Kambar S, Jali SM, Pawar N, Nalawade P. Prevalence of thyroid dysfunction among type 2 diabetes mellitus patients. Diabetes Metab Syndr. 2017 Nov;11 Suppl 1:S105-S108. doi: 10.1016/j.dsx.2016.12.017. Epub 2016 Dec 19. PMID: 28057505.
  • 7) Tang Y, Yan T, Wang G, Chen Y, Zhu Y, Jiang Z, Yang M, Li C, Li Z, Yu P, Wang S, Zhu N, Ren Q, Ni C. Correlation between Insulin Resistance and Thyroid Nodule in Type 2 Diabetes Mellitus. Int J Endocrinol. 2017;2017:1617458. doi: 10.1155/2017/1617458. Epub 2017 Oct
  • 8) Papazafiropoulou A, Sotiropoulos A, Kokolaki A, Kardara M, Stamataki P, Pappas S. Prevalence of thyroid dysfunction among greek type 2 diabetic patients attending an outpatient clinic. J Clin Med Res. 2010 Mar 20;2(2):75-8. doi: 10.4021/jocmr2010.03.281w. Epub 2010
  • 9) Radaideh AR, Nusier MK, Amari FL, Bateiha AE, El-Khateeb MS, Naser AS, Ajlouni KM. Thyroid dysfunction in patients with type 2 diabetes mellitus in Jordan. Saudi Med J. 2004 Aug;25(8):1046-50. PMID: 15322596.
  • 10) Akbar DH, Ahmed MM, Al-Mughales J. Thyroid dysfunction and thyroid autoimmunity in Saudi type 2 diabetics. Acta Diabetol. 2006 May;43(1):14-8. doi: 10.1007/s00592-006-0204-8. PMID: 16710644.
  • 11) Biondi B, Kahaly GJ, Robertson RP. Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders. Endocr Rev. 2019 Jun 1;40(3):789-824. doi: 10.1210/er.2018-00163. PMID: 30649221; PMCID: PMC6507635.
  • 12) Khassawneh AH, Al-Mistarehi AH, Zein Alaabdin AM, Khasawneh L, AlQuran TM, Kheirallah KA, Saadeh NA, Beni Yonis O, Shawkat M, Obeidat N. Prevalence and Predictors of Thyroid Dysfunction Among Type 2 Diabetic Patients: A Case-Control Study. Int J Gen Med.
  • 13) Kordonouri O, Klinghammer A, Lang EB, Grüters-Kieslich A, Grabert M, Holl RW. Thyroid autoimmunity in children and adolescents with type 1 diabetes: a multicenter survey. Diabetes Care. 2002 Aug;25(8):1346-50. doi: 10.2337/diacare.25.8.1346. PMID: 12145233.
  • 14) Perros P, McCrimmon RJ, Shaw G, Frier BM. Frequency of thyroid dysfunction in diabetic patients: value of annual screening. Diabet Med. 1995 Jul;12(7):622-7. doi: 10.1111/j.1464-5491.1995.tb00553.x. PMID: 7554786.
  • 15) Zhu Y, Xu F, Shen J, Liu Y, Bi C, Liu J, Li Y, Wang X, Gao Z, Liang L, Chen Y, Sun W, Guan Q, Zhang J, Luo Z, Guo L, Cai X, Li L, Xiu L, Yan L, Li C, Shi X, Zhu M, Kuang J, Li G, Ji L. Prevalence of thyroid dysfunction in older Chinese patients with type 2 diabetes-A multicenter cross-
  • 16) Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin
  • 17) Bjoro T, Holmen J, Krüger O, Midthjell K, Hunstad K, Schreiner T, Sandnes L, Brochmann H. Prevalence of thyroid disease, thyroid dysfunction and thyroid peroxidase antibodies in a large, unselected population. The Health Study of Nord-Trondelag (HUNT). Eur J
  • 18) Duntas LH, Orgiazzi J, Brabant G. The interface between thyroid and diabetes mellitus. Clin Endocrinol (Oxf). 2011 Jul;75(1):1-9. doi: 10.1111/j.1365-2265.2011.04029.x. PMID: 21521298.
  • 19) Díez JJ, Sánchez P, Iglesias P. Prevalence of thyroid dysfunction in patients with type 2 diabetes. Exp Clin Endocrinol Diabetes. 2011 Apr;119(4):201-7. doi: 10.1055/s-0031-1271691. Epub 2011 Apr 4. PMID: 21465427.
  • 20) Al-Geffari M, Ahmad NA, Al-Sharqawi AH, Youssef AM, Alnaqeb D, Al-Rubeaan K. Risk Factors for Thyroid Dysfunction among Type 2 Diabetic Patients in a Highly Diabetes Mellitus Prevalent Society. Int J Endocrinol. 2013;2013:417920. doi: 10.1155/2013/417920. Epub 2013
  • 21) Demitrost L, Ranabir S. Thyroid dysfunction in type 2 diabetes mellitus: A retrospective study. Indian J Endocrinol Metab. 2012 Dec;16(Suppl 2):S334-5. doi: 10.4103/2230-8210.104080. PMID: 23565418; PMCID: PMC3603066.
  • 22) Centeno Maxzud M, Gómez Rasjido L, Fregenal M, Arias Calafiore F, Córdoba Lanus M, D'Urso M, Luciardi H. Prevalencia de disfunción tiroidea en pacientes con diabetes mellitus tipo 2 [Prevalence of thyroid dysfunction in patients with type 2 diabetes
  • 23) Sarfo-Kantanka O, Sarfo FS, Ansah EO, Yorke E, Akpalu J, Nkum BC, Eghan B. Frequency and determinants of thyroid autoimmunity in Ghanaian type 2 diabetes patients: a case-control study. BMC Endocr Disord. 2017 Jan 17;17(1):2. doi: 10.1186/s12902-016-0152-4.
  • 24) Zhang HM, Feng QW, Niu YX, Su Q, Wang X. Thyroid Nodules in Type 2 Diabetes Mellitus. Curr Med Sci. 2019 Aug;39(4):576-581. doi: 10.1007/s11596-019-2076-5. Epub 2019 Jul 25. PMID: 31346993.
  • 25) Kang HW, No JH, Chung JH, Min YK, Lee MS, Lee MK, Yang JH, Kim KW. Prevalence, clinical and ultrasonographic characteristics of thyroid incidentalomas. Thyroid. 2004 Jan;14(1):29-33. doi: 10.1089/105072504322783812. PMID: 15009911.
  • 26) Kitahara CM, Platz EA, Beane Freeman LE, Black A, Hsing AW, Linet MS, Park Y, Schairer C, Berrington de González A. Physical activity, diabetes, and thyroid cancer risk: a pooled analysis of five prospective studies. Cancer Causes Control. 2012 Mar;23(3):463-471. doi:
  • 27) Chodick G, Heymann AD, Rosenmann L, Green MS, Flash S, Porath A, Kokia E, Shalev V. Diabetes and risk of incident cancer: a large population-based cohort study in Israel. Cancer Causes Control. 2010 Jun;21(6):879-87. doi: 10.1007/s10552-010-9515-8. Epub 2010 Feb 11. PMID: 20148361.

Türkiye'de Tip-2 diyabetli hastalarda patofizyolojik değişikliklerin tiroid disfonksiyonu ve nodüler guatr gelişimi üzerine etkileri

Yıl 2023, Cilt: 15 Sayı: 1, 86 - 90, 15.03.2023

Zeynep Ergenç Özlem Karaca Ocak Erkan Aksoy Hasan Ergenç

https://doi.org/10.18521/ktd.1159387

Öz

Amaç: Bu çalışmanın amacı, Türkiye'de Tip 2 diyabetli hastalardaki patofizyolojik değişikliklerin tiroid disfonksiyonu, tiroid otoimmünitesi, tiroid nodülü ve tiroid kanseri sıklığına etkisini incelemektir.
Gereç ve Yöntem: Çalışma, tiroid testleri ve tiroid ultrasonografisi (US) yapılan toplam 3.276 Tip-2 diyabetli hasta üzerinde yapıldı. Demografik özellikler, biyokimyasal ve hormonal değerler, tiroid US raporları ve histopatoloji raporları hastaların elektronik kayıtlarından toplandı.
Bulgular:Tiroid otoimmünite pozitif TPOab %15.9 (n = 524) ve/veya pozitif TGab %9.9 (n=327), aynı hastada her iki antikorun (TPOab + TGab) pozitiflik oranı ve total tiroid otoimmünitesi Tip-2 diyabetli hastalarda %32,57 (n=1067) olabilir. Bu hastaların %18,3'ünde (n=602) tiroid disfonksiyonu saptandı. Tiroid disfonksiyonu dağılımı %9.09 (n=298) subklinik hipotiroidi, %4.1 (n=135) klinik hipotiroidi, %3.1 (n=102) subklinik hipertiroidi, %2.0 (n=67) klinik hipertiroidi idi. Ayrıca %67.9 (n=2225) tiroid nodülü ve %5 (n=164) tiroid kanseri tespit edildi.
Sonuç: Tip-2 diyabetli hastalarda tiroid disfonksiyonunun anlamlı düzeyde arttığı bulundu.

Anahtar Kelimeler

Tip-2 diyabet Tiroid disfonksiyonu Nodüler guatr Tiroid otoimmünitesi

Proje Numarası

None

Kaynakça

  • 1) Gierach M, Gierach J, Junik R. Insulin resistance and thyroid disorders. Endokrynol Pol. 2014;65(1):70-6. doi: 10.5603/EP.2014.0010. PMID: 24549605.
  • 2) Roubsanthisuk W, Watanakejorn P, Tunlakit M, Sriussadaporn S. Hyperthyroidism induces glucose intolerance by lowering both insulin secretion and peripheral insulin sensitivity. J Med Assoc Thai. 2006 Nov;89 Suppl 5:S133-40. PMID: 17718254.
  • 3) Maratou E, Hadjidakis DJ, Kollias A, Tsegka K, Peppa M, Alevizaki M, Mitrou P, Lambadiari V, Boutati E, Nikzas D, Tountas N, Economopoulos T, Raptis SA, Dimitriadis G. Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. Eur J
  • 4) Chen RH, Chen HY, Man KM, Chen SJ, Chen W, Liu PL, Chen YH, Chen WC. Thyroid diseases increased the risk of type 2 diabetes mellitus: A nation-wide cohort study. Medicine (Baltimore). 2019 May;98(20):e15631. doi: 10.1097/MD.0000000000015631. PMID:
  • 5) Palma CC, Pavesi M, Nogueira VG, Clemente EL, Vasconcellos Mde F, Pereira LC Júnior, Pacheco FF, Braga TG, Bello Lde F, Soares JO, Dos Santos SC, Campos VP, Gomes MB. Prevalence of thyroid dysfunction in patients with diabetes mellitus. Diabetol Metab Syndr.
  • 6) Jali MV, Kambar S, Jali SM, Pawar N, Nalawade P. Prevalence of thyroid dysfunction among type 2 diabetes mellitus patients. Diabetes Metab Syndr. 2017 Nov;11 Suppl 1:S105-S108. doi: 10.1016/j.dsx.2016.12.017. Epub 2016 Dec 19. PMID: 28057505.
  • 7) Tang Y, Yan T, Wang G, Chen Y, Zhu Y, Jiang Z, Yang M, Li C, Li Z, Yu P, Wang S, Zhu N, Ren Q, Ni C. Correlation between Insulin Resistance and Thyroid Nodule in Type 2 Diabetes Mellitus. Int J Endocrinol. 2017;2017:1617458. doi: 10.1155/2017/1617458. Epub 2017 Oct
  • 8) Papazafiropoulou A, Sotiropoulos A, Kokolaki A, Kardara M, Stamataki P, Pappas S. Prevalence of thyroid dysfunction among greek type 2 diabetic patients attending an outpatient clinic. J Clin Med Res. 2010 Mar 20;2(2):75-8. doi: 10.4021/jocmr2010.03.281w. Epub 2010
  • 9) Radaideh AR, Nusier MK, Amari FL, Bateiha AE, El-Khateeb MS, Naser AS, Ajlouni KM. Thyroid dysfunction in patients with type 2 diabetes mellitus in Jordan. Saudi Med J. 2004 Aug;25(8):1046-50. PMID: 15322596.
  • 10) Akbar DH, Ahmed MM, Al-Mughales J. Thyroid dysfunction and thyroid autoimmunity in Saudi type 2 diabetics. Acta Diabetol. 2006 May;43(1):14-8. doi: 10.1007/s00592-006-0204-8. PMID: 16710644.
  • 11) Biondi B, Kahaly GJ, Robertson RP. Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders. Endocr Rev. 2019 Jun 1;40(3):789-824. doi: 10.1210/er.2018-00163. PMID: 30649221; PMCID: PMC6507635.
  • 12) Khassawneh AH, Al-Mistarehi AH, Zein Alaabdin AM, Khasawneh L, AlQuran TM, Kheirallah KA, Saadeh NA, Beni Yonis O, Shawkat M, Obeidat N. Prevalence and Predictors of Thyroid Dysfunction Among Type 2 Diabetic Patients: A Case-Control Study. Int J Gen Med.
  • 13) Kordonouri O, Klinghammer A, Lang EB, Grüters-Kieslich A, Grabert M, Holl RW. Thyroid autoimmunity in children and adolescents with type 1 diabetes: a multicenter survey. Diabetes Care. 2002 Aug;25(8):1346-50. doi: 10.2337/diacare.25.8.1346. PMID: 12145233.
  • 14) Perros P, McCrimmon RJ, Shaw G, Frier BM. Frequency of thyroid dysfunction in diabetic patients: value of annual screening. Diabet Med. 1995 Jul;12(7):622-7. doi: 10.1111/j.1464-5491.1995.tb00553.x. PMID: 7554786.
  • 15) Zhu Y, Xu F, Shen J, Liu Y, Bi C, Liu J, Li Y, Wang X, Gao Z, Liang L, Chen Y, Sun W, Guan Q, Zhang J, Luo Z, Guo L, Cai X, Li L, Xiu L, Yan L, Li C, Shi X, Zhu M, Kuang J, Li G, Ji L. Prevalence of thyroid dysfunction in older Chinese patients with type 2 diabetes-A multicenter cross-
  • 16) Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin
  • 17) Bjoro T, Holmen J, Krüger O, Midthjell K, Hunstad K, Schreiner T, Sandnes L, Brochmann H. Prevalence of thyroid disease, thyroid dysfunction and thyroid peroxidase antibodies in a large, unselected population. The Health Study of Nord-Trondelag (HUNT). Eur J
  • 18) Duntas LH, Orgiazzi J, Brabant G. The interface between thyroid and diabetes mellitus. Clin Endocrinol (Oxf). 2011 Jul;75(1):1-9. doi: 10.1111/j.1365-2265.2011.04029.x. PMID: 21521298.
  • 19) Díez JJ, Sánchez P, Iglesias P. Prevalence of thyroid dysfunction in patients with type 2 diabetes. Exp Clin Endocrinol Diabetes. 2011 Apr;119(4):201-7. doi: 10.1055/s-0031-1271691. Epub 2011 Apr 4. PMID: 21465427.
  • 20) Al-Geffari M, Ahmad NA, Al-Sharqawi AH, Youssef AM, Alnaqeb D, Al-Rubeaan K. Risk Factors for Thyroid Dysfunction among Type 2 Diabetic Patients in a Highly Diabetes Mellitus Prevalent Society. Int J Endocrinol. 2013;2013:417920. doi: 10.1155/2013/417920. Epub 2013
  • 21) Demitrost L, Ranabir S. Thyroid dysfunction in type 2 diabetes mellitus: A retrospective study. Indian J Endocrinol Metab. 2012 Dec;16(Suppl 2):S334-5. doi: 10.4103/2230-8210.104080. PMID: 23565418; PMCID: PMC3603066.
  • 22) Centeno Maxzud M, Gómez Rasjido L, Fregenal M, Arias Calafiore F, Córdoba Lanus M, D'Urso M, Luciardi H. Prevalencia de disfunción tiroidea en pacientes con diabetes mellitus tipo 2 [Prevalence of thyroid dysfunction in patients with type 2 diabetes
  • 23) Sarfo-Kantanka O, Sarfo FS, Ansah EO, Yorke E, Akpalu J, Nkum BC, Eghan B. Frequency and determinants of thyroid autoimmunity in Ghanaian type 2 diabetes patients: a case-control study. BMC Endocr Disord. 2017 Jan 17;17(1):2. doi: 10.1186/s12902-016-0152-4.
  • 24) Zhang HM, Feng QW, Niu YX, Su Q, Wang X. Thyroid Nodules in Type 2 Diabetes Mellitus. Curr Med Sci. 2019 Aug;39(4):576-581. doi: 10.1007/s11596-019-2076-5. Epub 2019 Jul 25. PMID: 31346993.
  • 25) Kang HW, No JH, Chung JH, Min YK, Lee MS, Lee MK, Yang JH, Kim KW. Prevalence, clinical and ultrasonographic characteristics of thyroid incidentalomas. Thyroid. 2004 Jan;14(1):29-33. doi: 10.1089/105072504322783812. PMID: 15009911.
  • 26) Kitahara CM, Platz EA, Beane Freeman LE, Black A, Hsing AW, Linet MS, Park Y, Schairer C, Berrington de González A. Physical activity, diabetes, and thyroid cancer risk: a pooled analysis of five prospective studies. Cancer Causes Control. 2012 Mar;23(3):463-471. doi:
  • 27) Chodick G, Heymann AD, Rosenmann L, Green MS, Flash S, Porath A, Kokia E, Shalev V. Diabetes and risk of incident cancer: a large population-based cohort study in Israel. Cancer Causes Control. 2010 Jun;21(6):879-87. doi: 10.1007/s10552-010-9515-8. Epub 2010 Feb 11. PMID: 20148361.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Zeynep Ergenç 0000-0001-7598-4508

Özlem Karaca Ocak 0000-0003-3637-4074

Erkan Aksoy Bu kişi benim 0000-0002-8372-2580

Hasan Ergenç 0000-0003-0519-0264

Proje Numarası None
Yayımlanma Tarihi 15 Mart 2023
Kabul Tarihi 26 Ocak 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 15 Sayı: 1

Kaynak Göster

APA Ergenç, Z., Karaca Ocak, Ö., Aksoy, E., Ergenç, H. (2023). The effects of pathophysiological changes in Type-2 diabetic patients on thyroid dysfunction and nodular goiter development in Turkey. Konuralp Medical Journal, 15(1), 86-90. https://doi.org/10.18521/ktd.1159387
AMA Ergenç Z, Karaca Ocak Ö, Aksoy E, Ergenç H. The effects of pathophysiological changes in Type-2 diabetic patients on thyroid dysfunction and nodular goiter development in Turkey. Konuralp Medical Journal. Mart 2023;15(1):86-90. doi:10.18521/ktd.1159387
Chicago Ergenç, Zeynep, Özlem Karaca Ocak, Erkan Aksoy, ve Hasan Ergenç. “The Effects of Pathophysiological Changes in Type-2 Diabetic Patients on Thyroid Dysfunction and Nodular Goiter Development in Turkey”. Konuralp Medical Journal 15, sy. 1 (Mart 2023): 86-90. https://doi.org/10.18521/ktd.1159387.
EndNote Ergenç Z, Karaca Ocak Ö, Aksoy E, Ergenç H (01 Mart 2023) The effects of pathophysiological changes in Type-2 diabetic patients on thyroid dysfunction and nodular goiter development in Turkey. Konuralp Medical Journal 15 1 86–90.
IEEE Z. Ergenç, Ö. Karaca Ocak, E. Aksoy, ve H. Ergenç, “The effects of pathophysiological changes in Type-2 diabetic patients on thyroid dysfunction and nodular goiter development in Turkey”, Konuralp Medical Journal, c. 15, sy. 1, ss. 86–90, 2023, doi: 10.18521/ktd.1159387.
ISNAD Ergenç, Zeynep vd. “The Effects of Pathophysiological Changes in Type-2 Diabetic Patients on Thyroid Dysfunction and Nodular Goiter Development in Turkey”. Konuralp Medical Journal 15/1 (Mart 2023), 86-90. https://doi.org/10.18521/ktd.1159387.
JAMA Ergenç Z, Karaca Ocak Ö, Aksoy E, Ergenç H. The effects of pathophysiological changes in Type-2 diabetic patients on thyroid dysfunction and nodular goiter development in Turkey. Konuralp Medical Journal. 2023;15:86–90.
MLA Ergenç, Zeynep vd. “The Effects of Pathophysiological Changes in Type-2 Diabetic Patients on Thyroid Dysfunction and Nodular Goiter Development in Turkey”. Konuralp Medical Journal, c. 15, sy. 1, 2023, ss. 86-90, doi:10.18521/ktd.1159387.
Vancouver Ergenç Z, Karaca Ocak Ö, Aksoy E, Ergenç H. The effects of pathophysiological changes in Type-2 diabetic patients on thyroid dysfunction and nodular goiter development in Turkey. Konuralp Medical Journal. 2023;15(1):86-90.
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