دانلود کتاب تیروئید، دیابت و پوکی استخوان

Considering together the overt clinical conditions and the preclinical stages of hypothyroidism, type 2 diabetes mellitus, and osteoporosis, between 50% and 70% of the general population, may have one single disease, or the overlapping of two and three diseases.
In Italy, 10 million people (out of 60 million) have prediabetes or diabetes; approximately 50% of the population (30 million people) have osteopenia or osteoporosis (more women than men are affected), and up to 10% of the population (mainly females) is affected by hypothyroidism (clinical and subclinical). Worldwide, over 537 million adults (20–79 years) were living with diabetes in 2021 (expected to rise to 783 million by 2045). Approximately 500 million people worldwide are estimated to have osteoporosis, with 1 in 3 women and 1 in 5 men over 50 experiencing osteoporotic fractures. The global prevalence of hypothyroidism varies, but estimates suggest around 5% of the population has clinical hypothyroidism, with subclinical cases pushing overall prevalence to 10% or more in many regions.
Although with different pathogenesis, all three conditions induce an increase in morbidity and mortality. All three conditions in different stages of the natural history of the disease may induce accelerated aging and invalidity, causing a dramatic impairment of quality of life.
Among all noncommunicable diseases, thyroid dysfunction, diabetes mellitus, and osteoporosis with their complications (cardiovascular events, cognitive impairment, and fractures) are likely to be the most relevant chronic diseases to determine the increase of Health Organizations costs worldwide.
Whether the three clinical conditions share a common pathogenic pathway is unlikely. Nonetheless, there are many overlapping factors leading to the same potential complications. Firstly, diabetes mellitus and hypo- or hyperthyroid function are common causes of cardiovascular disease. Secondly, hyperthyroid function increases bone fragility. Thirdly, osteoporosis itself is listed today among the complications of type 1 and type 2 diabetes. Lastly, hypothyroidism may increase obesity prevalence and conversely induce type 2 diabetes increment in the general population. All those aspects will undergo an in-depth analysis in the present book.
From all these considerations derives the subtitle of this book: The Bermuda Triangle. Like the geographic triangle constituted by Bermuda, Puerto Rico, and Florida, the three clinical conditions may interact in determining life-threatening complications, increasing the overall mortality. Like in the Bermuda Triangle myth, overlapping, confusing, and contrasting clinical pictures may be present, probably related to the preclinical stages of the three diseases (hypothyroid function, prediabetes, osteopenia) which may be as dangerous and as lethal as the related overt diseases, although often asymptomatic and invisible.
A thorough analysis of existing medical evidence as presented herein will help
to unravel the real impact of thyroid dysfunction, diabetes, and altered bone metabolism on morbidity and mortality, similarly to what was done in recent years to disprove the Bermuda Triangle myth. No alien entities in the Bermuda were causing the naval and aircraft disasters, but adverse physical and weather conditions. Similarly, strict attention to virtuous life style, the application of precision medicine principles, and a gender-related approach will succeed in understanding, preventing, and treating better thyroid dysfunction, diabetes, and osteoporosis.
Finally, I wish to dedicate this book to the two souls—never friends—of the Endocrinology science, namely, the Diabetologist and the Endocrinologist. In the old days, I began my medical career as a “pure diabetologist” considering the other endocrine diseases secondary—if not boring. In my “physiological academic aging process,” I realized that the close interrelationship between diabetes and most other endocrine diseases makes it impossible to treat diabetes without a profound knowledge of all endocrine disease spectrum. Thus, the present work is a mature fruit of my academic career and is mainly dedicated to young professionals working in the area, urging them to span from metabolic to endocrine diseases without close compartmentalization but, in contrast, considering them as a unity. This professional behavior will help them (and their patients) to pass through the Bermuda Triangle unharmed!