الفهرس 
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Abstract
Dissertation Abstract Fibroblast growth factor 21 (FGF21) is considered one of the most important global marker. Typically, Thyroid hormone (TH) regulates fibroblast growth factor 21 (FGF21) levels within the liver and the adipose tissue. On the contrary, peripheral FGF21 dispensation results in deficient circulating levels of TH. These data propose that FGF21 and TH could interact to systematize metabolism, thyroid hormone regulates FGF21 expression in the liver and adipose tissue; however, until now, few reports regarding the correlation of thyroid function and FGF21 levels in humans have been generated. The goalmouth of this thesis is to investigate if the selected FGF21 could be used as novel biomarkers for early diagnosis and prognosis of several stages of hypothyroidism-associated DM diseases as an alternative to existing biomarkers. The specific objectives are: (1) collect clinical specimens from healthy control, Diabetic patients along with hypothyroidism. (2) Develop ELISA technique for detection of FGF21 in patient’s serum. (3) Study the correlation between some clinical data and FGF21 expression. So, to achieve the study intended to assess serum FGF21 levels in type 2 diabetic patients with or without hypothyroidism, 100 Egyptian individuals were enrolled in the study and divided into groups, each group consists of 25 patients to study the association between insulin resistance, hypothyroidism, and FGF21. All patients were selected based on one of the following: Age > 18, disease history, age at diagnosis of diabetes was collected for each subject. The inclusion criterion for diabetic subjects was levels of FPG more than 110 mg/dl with type 2 only at more than two occasions. All the diagnoses were made by physicians. Healthy subjects were selected by random selective sampling from different subjects. None of them were complaining of any acute or chronic illness as confirmed by physical examination and laboratory testing results. The duration of diabetes ranges from a few months to many years. The materials and methods are summarized in collecting 95 samples for FGF21 and collected from different Egyptian subjects and all the patients who were diagnosed with the DM and Thyroid diseases did not have any common infection with other viruses such as the hepatitis C virus or delta virus or HIV, and was saved The samples are then divided and stored at -50 ° C until the analysis is performed. After obtaining the results, they were organized, scheduled, and statistically analyzed using appropriate statistical methods and tests via the computer programs Diabetic subjects with hypothyroidism having abnormal thyroid profile and significant effect on HDL-C lipid and thyroid stimulating hormones as compared to control subjects. A significant difference in the levels of lipid, ACR and liver functioning is observed in diabetic compared to control subjects. An ultrasensitive serum TSH assay is better screening test for the determination of thyroid dysfunction as compared to FT3, and FT4. There were highly significant differences between all groups regarding control group, and the Mann– Whitney U test was used to authenticate these differences in the group 3 of hypothyroidism group and group 4 T2DM with hypothyroidism. The test results showed that the mean level of FG21 in patients without diabetes was significantly higher than those in patients with well- diabetes and in group 4 of DM with hypothyroidism.