1
|
Lee J, Baek HS, Jo K, Kim MH, Lee JM, Chang SA, Lim DJ. The Impact of Physical Activity on Thyroid Health: Insights From Representative Data in Korea. J Clin Endocrinol Metab 2024:dgae178. [PMID: 38620035 DOI: 10.1210/clinem/dgae178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Indexed: 04/17/2024]
Abstract
CONTEXT Thyroid hormones are essential for energy metabolism related to thermogenesis and oxygen consumption. OBJECTIVE This study evaluated the potential association of thyroid function including thyroid peroxidase antibodies (TPOAb) with physical activity in nationally representative data. DESIGN/SETTING/PARTICIPANTS This retrospective cohort study used data from the Korean National Health and Nutrition Examination Survey between 2013 and 2015. Physical activity (PA) was assessed using metabolic equivalents based on the validated Korean version of the International Physical Activity Questionnaire Short Form. PA level was categorized into 3 groups of high, moderate, and low. Participants with abnormal thyroid function test, restricted activity, or previous history of thyroid disease were excluded in the study. RESULTS A total of 5372 participants was finally selected. The free T4 level was lowest in the low PA group, while TSH was not significantly different among the groups. TPOAb titers increased in the following order: moderate PA, low PA, and high PA. After adjustment for confounding factors, moderate PA was associated with a high T4 level and a decrease in TSH and TPOAb with significance. However, there were no significant changes in free T4, TSH, or TPOAb titer in the high PA group. In a subanalysis, females with moderate PA showed a significant decrease in TSH and TPOAb. In both males and females, insulin sensitivity was increased with moderate PA. In obese participants, TSH negatively correlated with PA, and free T4 levels decreased in the low PA. The sensitivity to thyroid hormone did not differ in our study. CONCLUSION The present study found an association between thyroid function and moderate PA. Therefore, moderate-intensity PA should be recommended to improve thyroid function.
Collapse
Affiliation(s)
- Jeongmin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, Republic of Korea
| | - Han-Sang Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Kwanhoon Jo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, 21431, Republic of Korea
| | - Min-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, Republic of Korea
| | - Jung Min Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, Republic of Korea
| | - Sang Ah Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, Republic of Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| |
Collapse
|
2
|
Darouei B, Amani-Beni R, Abhari AP, Fakhrolmobasheri M, Shafie D, Heidarpour M. Systematic review and meta-analysis of levothyroxine effect on blood pressure in patients with subclinical hypothyroidism. Curr Probl Cardiol 2024; 49:102204. [PMID: 37967804 DOI: 10.1016/j.cpcardiol.2023.102204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/17/2023]
Abstract
This study aims to evaluate the effect of levothyroxine therapy on blood pressure (BP) in patients with subclinical hypothyroidism (SCH). Were searched Six databases, and randomized controlled trials (RCT) and prospective cohort studies evaluating the effect of levothyroxine therapy on BP in patients with SCH were included. 37 articles (9 RCTs and 28 prospective cohorts) were included in this meta-analysis. Pooled analysis of RCT studies was insignificant; however, pooled analysis of 28 prospective cohort studies showed a significant difference before and after the therapy, reducing both systolic blood pressure (SBP) and diastolic blood pressure (DBP) (MD=-4.02 [-6.45, -4.58] and MD=-2.13 [-3.69, -0.56], both P-values<0.05). Levothyroxine therapy can play a role in lowering BP in patients with SCH. However, this effect is more observed in Caucasians, SCH patients with higher initial TSH followed by more remarkable TSH change to normal levels, and SCH patients with hypertension.
Collapse
Affiliation(s)
- Bahar Darouei
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Amani-Beni
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Parsa Abhari
- Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Fakhrolmobasheri
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Heidarpour
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
3
|
Ramzy A, Saber N, Bruin JE, Thompson DM, Kim PTW, Warnock GL, Kieffer TJ. Thyroid Hormone Levels Correlate With the Maturation of Implanted Pancreatic Endoderm Cells in Patients With Type 1 Diabetes. J Clin Endocrinol Metab 2024; 109:413-423. [PMID: 37671625 PMCID: PMC10795919 DOI: 10.1210/clinem/dgad499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Macroencapsulated pancreatic endoderm cells (PECs) can reverse diabetes in rodents and preclinical studies revealed that thyroid hormones in vitro and in vivo bias PECs to differentiate into insulin-producing cells. In an ongoing clinical trial, PECs implanted in macroencapsulation devices into patients with type 1 diabetes were safe but yielded heterogeneous outcomes. Though most patients developed meal responsive C-peptide, levels were heterogeneous and explanted grafts had variable numbers of surviving cells with variable distribution of endocrine cells. METHODS We measured circulating triiodothyronine and thyroxine levels in all patients treated at 1 of the 7 sites of the ongoing clinical trial and determined if thyroid hormone levels were associated with the C-peptide or glucagon levels and cell fate of implanted PECs. RESULTS Both triiodothyronine and thyroxine levels were significantly associated with the proportion of cells that adopted an insulin-producing fate with a mature phenotype. Thyroid hormone levels were inversely correlated to circulating glucagon levels after implantation, suggesting that thyroid hormones lead PECs to favor an insulin-producing fate over a glucagon-producing fate. In mice, hyperthyroidism led to more rapid maturation of PECs into insulin-producing cells similar in phenotype to PECs in euthyroid mice. CONCLUSION These data highlight the relevance of thyroid hormones in the context of PEC therapy in patients with type 1 diabetes and suggest that a thyroid hormone adjuvant therapy may optimize cell outcomes in some PEC recipients.
Collapse
Affiliation(s)
- Adam Ramzy
- Laboratory of Molecular and Cellular Medicine, Department of Cellular and Physiological Sciences, Life Sciences Institute, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Nelly Saber
- Laboratory of Molecular and Cellular Medicine, Department of Cellular and Physiological Sciences, Life Sciences Institute, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jennifer E Bruin
- Department of Biology, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - David M Thompson
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Peter T W Kim
- Department of Surgery, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Garth L Warnock
- Department of Surgery, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Timothy J Kieffer
- Laboratory of Molecular and Cellular Medicine, Department of Cellular and Physiological Sciences, Life Sciences Institute, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Department of Surgery, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| |
Collapse
|
4
|
Sakyi SA, Ameyaw B, Laing EF, Anthony R, Ephraim RKD, Effah A, Kwayie AA, Senu E, Anto EO, Acheampong E, Afranie BO, Amoani B, Opoku S. Thyroid dysfunction and glycaemic control among Type 2 diabetes mellitus patients in Ghana: A comparative cross-sectional study. Endocrinol Diabetes Metab 2023; 6:e447. [PMID: 37621219 PMCID: PMC10638622 DOI: 10.1002/edm2.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/06/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Thyroid disorders and diabetes mellitus coexist and are prevalent endocrinopathies among adult population. Thyroid dysfunction contributes to metabolic imbalances, increase beta-cell apoptosis and glucose intolerance. There is paucity of data and contradicting findings on how thyroid dysfunction influence glycaemic control. Therefore, we evaluated thyroid dysfunction and glycaemic control among Type 2 diabetes mellitus (T2DM) patients in Ghana. METHODS A comparative cross-sectional study was conducted among 192 T2DM patients from Effia Nkwanta Regional Hospital. Three consecutive monthly fasting plasma glucose (FBG) and glycated haemoglobin (HbA1c) were analysed and the results were classified as, moderate hyperglycaemia (MH) (FBG = 6.1-12.0 mmol/L, HbA1c < 7%), severe hyperglycaemia (SH) (FBG ≥ 12.1 mmol/L, HbA1c > 7%) and good glycaemic controls (GC) (FBG = 4.1-6.0 mmol/L, HbA1c < 7%). Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4), body mass index (BMI) and other clinical parameters were measured. Data analysis was done using R language version 4.0.2 and p < .05 was considered statistically significant. RESULTS There were no significant differences in age (years) between patients in the various glycaemic groups (p = .9053). The overall prevalence of thyroid disorders was 7.8% among T2DM patients. The prevalence of thyroid disorders was higher in patients with SH (11.7%) followed by those with MH (7.5%) and then those with GC (5.4%). Serum levels of TSH and FT3/FT4 ratio were significantly lower in T2DM patients with SH compared to those with MH and the GC (p < .0001). However, FT4 was significantly higher in SH patients compared to the good glycaemic controls (p < .01). The first tertiles of TSH [aOR = 10.51, 95% CI (4.04-17.36), p < .0001] and FT3 [aOR = 2.77, 95% CI (1.11-6.92), p = .0290] were significantly and independently associated with increased odds of hyperglycaemia. CONCLUSION The prevalence of thyroid dysfunction is high in T2DM and increases with hyperglycaemia. Reduced TSH and T3 may worsen glycaemic control. Periodic monitoring of thyroid function should be incorporated into management guidelines among T2DM patients in Ghana.
Collapse
Affiliation(s)
- Samuel Asamoah Sakyi
- Department of Molecular Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Bright Ameyaw
- Department of Molecular Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
- Laboratory DepartmentEffia Nkwanta Regional HospitalWestern RegionGhana
| | - Edwin Ferguson Laing
- Department of Molecular Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Richard Anthony
- Department of Internal MedicineEffia Nkwanta Regional HospitalWestern RegionGhana
| | | | - Alfred Effah
- Department of Molecular Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Afia Agyapomaa Kwayie
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ebenezer Senu
- Department of Molecular Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Enoch Odame Anto
- School of Medical and Health ScienceEdith Cowan UniversityJoondalupAustralia
| | - Emmanuel Acheampong
- Department of Molecular Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
- School of Medical and Health ScienceEdith Cowan UniversityJoondalupAustralia
| | - Bright Oppong Afranie
- Department of Molecular Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Benjamin Amoani
- Department of Medical Laboratory TechnologyUniversity of Cape CoastCape CoastGhana
| | - Stephen Opoku
- Department of Molecular Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| |
Collapse
|
5
|
Lee YW, Yang TT, Lin YY, Hsieh YS. Elevated Free Thyroxine Levels Might Alter the Effect of the Lipid Profile on Insulin Resistance in Type 2 Diabetes Mellitus. Diagnostics (Basel) 2023; 13:2656. [PMID: 37627914 PMCID: PMC10453194 DOI: 10.3390/diagnostics13162656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Previous studies have shown that hyperthyroidism is associated with heightened insulin resistance and dyslipidemia. Therefore, in this study, we aim to explore the relationship between elevated thyroid hormone levels and the lipid profile in insulin resistance in patients with type 2 diabetes mellitus (T2DM) with hyperthyroidism. A total of 177 participants were included and grouped according to diagnosis. The serum test results demonstrated that free thyroxine (FT4) increased the insulin resistance index (HOMA-IR) by positively correlating with triglyceride (TG) levels (p = 0.005, r2 = 0.35). In patients with T2DM with hyperthyroidism, the decreasing high-density lipoprotein levels showed an association with HOMA-IR (p = 0.005). Among all the patients, with different levels of FT4, the areas under the ROC curve (AUCs) of the TG level, TG/high-density lipoprotein ratio, and HOMA-IR were 0.620 (95% CI: 0.536 to 0.698), 0.614 (95% CI: 0.530 to 0.692), and 0.722 (95% CI: 0.645 to 0.791), respectively. Our results suggest that elevated FT4 levels due to hyperthyroidism could alter the association with the lipid profile and insulin resistance in patients with T2DM. We also suggest that among all the included patients with T2DM, irrespective of the presence of hyperthyroidism, FT4 levels are positively correlated with insulin resistance.
Collapse
Affiliation(s)
- Yi-Wei Lee
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei City 11030, Taiwan
| | - Ting-Teng Yang
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei City 11030, Taiwan
| | - Yan-Yu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City 11030, Taiwan
| | - Yu-Shan Hsieh
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City 11230, Taiwan
- Department of Research, Taipei Medical University Hospital, Taipei City 11030, Taiwan
| |
Collapse
|
6
|
Pujia R, Mazza E, Montalcini T, Arturi F, Brunetti A, Aversa A, Romeo S, Perticone M, Sciacqua A, Pujia A. Liver Stiffness in Obese Hypothyroid Patients Taking Levothyroxine. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070946. [PMID: 35888665 PMCID: PMC9316150 DOI: 10.3390/medicina58070946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Thyroid dysfunction is associated with non-alcoholic fatty liver disease, but its role in the progression of liver damage in obese patients remains unclear. In addition, several case reports have suggested the existence of a levothyroxine-induced liver injury, which has been poorly investigated. Our aim was to verify whether a difference in the prevalence of liver fibrosis exists in a population of obese individuals taking Levothyroxine. Materials and Methods: We conducted a cross-sectional study on a population of 137 obese individuals, of which 49 were on replacement therapy with Levothyroxine. We excluded those who had hypertriglyceridemia and diabetes mellitus. All participants underwent a liver stiffness assessment by transient elastography as well as biochemical measurements. In subjects with liver fibrosis, other cause of liver fibrosis were ruled out. Results: Participants taking Levothyroxine had a higher prevalence of liver fibrosis than those not taking Levothyroxine (30.6% vs. 2.3%; p < 0.001), and these results were obtained after we made an adjustment for age (Exp(B) = 18.9; 95% CI = 4.1−87.4; p < 0.001). The liver stiffness value differed significantly between groups (6.0 ± 3.6 and 5.1 ± 1.2, p = 0.033). Of those subjects taking Levothyroxine, there were no significant differences in the dose of medication (1.21 ± 0.36 vs. 1.07 ± 0.42; p = 0.240) and treatment duration (13.7 ± 7.43 vs. 11.13 ± 6.23; p = 0.380) between those with and without liver fibrosis. Conclusions: We found, for the first time, a greater prevalence of liver fibrosis in obese individuals taking Levothyroxine than in those not taking this medication. This finding needs to be confirmed by longitudinal population studies as well as by cellular studies.
Collapse
Affiliation(s)
- Roberta Pujia
- Department of Medical and Surgical Science, University Magna Grecia of Catanzaro, 88100 Catanzaro, Italy; (R.P.); (E.M.); (F.A.); (S.R.); (M.P.); (A.S.); (A.P.)
| | - Elisa Mazza
- Department of Medical and Surgical Science, University Magna Grecia of Catanzaro, 88100 Catanzaro, Italy; (R.P.); (E.M.); (F.A.); (S.R.); (M.P.); (A.S.); (A.P.)
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, University Magna Grecia of Catanzaro, 88100 Catanzaro, Italy;
- Correspondence:
| | - Franco Arturi
- Department of Medical and Surgical Science, University Magna Grecia of Catanzaro, 88100 Catanzaro, Italy; (R.P.); (E.M.); (F.A.); (S.R.); (M.P.); (A.S.); (A.P.)
| | - Antonio Brunetti
- Department of Health Science, University Magna Grecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Antonio Aversa
- Department of Clinical and Experimental Medicine, University Magna Grecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Stefano Romeo
- Department of Medical and Surgical Science, University Magna Grecia of Catanzaro, 88100 Catanzaro, Italy; (R.P.); (E.M.); (F.A.); (S.R.); (M.P.); (A.S.); (A.P.)
- Department of Molecular and Clinical Medicine, The University of Gothenburg, 40530 Gothenburg, Sweden
| | - Maria Perticone
- Department of Medical and Surgical Science, University Magna Grecia of Catanzaro, 88100 Catanzaro, Italy; (R.P.); (E.M.); (F.A.); (S.R.); (M.P.); (A.S.); (A.P.)
| | - Angela Sciacqua
- Department of Medical and Surgical Science, University Magna Grecia of Catanzaro, 88100 Catanzaro, Italy; (R.P.); (E.M.); (F.A.); (S.R.); (M.P.); (A.S.); (A.P.)
| | - Arturo Pujia
- Department of Medical and Surgical Science, University Magna Grecia of Catanzaro, 88100 Catanzaro, Italy; (R.P.); (E.M.); (F.A.); (S.R.); (M.P.); (A.S.); (A.P.)
| |
Collapse
|
7
|
Abeer Cheaid Yousif Al-Fatlawi. An evaluation of blood glucose and lipid profile in female hypothyroidism patients in Kerbala province, Iraq. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i3.1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction and Aim: Hypothyroidism is a common metabolic disorder caused by inadequate secretion of the thyroid hormone by the thyroid glands. The condition impacts various metabolic processes including glucose synthesis, lipid synthesis, mobilization and metabolic rate. This study aimed to evaluate the physiological factors associated with female hypothyroidism patients of Kerbala province of Iraq.
Materials and Methods: Fifty females (35 with hypothyroidism and 15 normal) aged between 20-49 years were included in the study. Blood sample was collected from each individual and subjected to thyroid function test (TFT), lipid profile test (LPT) and fasting blood glucose (FBG).
Results: The study showed a significant (P?0.001) increase in thyroid stimulating hormone (TSH) levels as compared to control. While a significant decrease was seen in thyroxin (T4) levels in comparison to controls, no significant difference was seen for triiodothyronine (T3) levels in both groups. Low?density lipoprotein (LDL), Triglycerides (TG), total cholesterol (TC) was significantly increased (P?0.001) while high density lipoprotein (HDL) was observed to significantly decrease as compared to control group. High significant elevation (P?0.001) in fasting blood glucose (FBG) was seen in patients with hypothyroidism as compared to control.
Conclusion: The results obtained in this study show that hypothyroidism in females to be significantly associated with increase in dyslipidemia and blood glucose levels.
Collapse
|
8
|
Arterial Stiffness in Thyroid and Parathyroid Disease: A Review of Clinical Studies. J Clin Med 2022; 11:jcm11113146. [PMID: 35683533 PMCID: PMC9180991 DOI: 10.3390/jcm11113146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 01/27/2023] Open
Abstract
Growing evidence shows that arterial stiffness measurement provides important prognostic information and improves clinical stratification of cardiovascular risk. Thyroid and parathyroid diseases are endocrine diseases with a relevant cardiovascular burden. The objective of this review was to consider the relationship between arterial stiffness and thyroid and parathyroid diseases in human clinical studies. We performed a systematic literature review of articles published in PubMed/MEDLINE from inception to December 2021, restricted to English languages and to human adults. We selected relevant articles about the relationship between arterial stiffness and thyroid and parathyroid diseases. For each selected article, data on arterial stiffness were extracted and factors that may have an impact on arterial stiffness were identified. We considered 24 papers concerning hypothyroidism, 9 hyperthyroidism and 16 primary hyperparathyroidism and hypoparathyroidism. Most studies evidenced an increase in arterial stiffness biomarkers in hypothyroidism, hyperthyroidism and primary hyperparathyroidism, even in subclinical and mild forms, although heterogeneity of measurement methods and of study designs prevented a definitive conclusion, suggesting that the assessment of arterial stiffness may be considered in the clinical evaluation of cardiovascular risk in these diseases.
Collapse
|
9
|
Eom YS, Wilson JR, Bernet VJ. Links between Thyroid Disorders and Glucose Homeostasis. Diabetes Metab J 2022; 46:239-256. [PMID: 35385635 PMCID: PMC8987680 DOI: 10.4093/dmj.2022.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/21/2022] [Indexed: 12/13/2022] Open
Abstract
Thyroid disorders and diabetes mellitus often coexist and are closely related. Several studies have shown a higher prevalence of thyroid disorders in patients with diabetes mellitus and vice versa. Thyroid hormone affects glucose homeostasis by impacting pancreatic β-cell development and glucose metabolism through several organs such as the liver, gastrointestinal tract, pancreas, adipose tissue, skeletal muscles, and the central nervous system. The present review discusses the effect of thyroid hormone on glucose homeostasis. We also review the relationship between thyroid disease and diabetes mellitus: type 1, type 2, and gestational diabetes, as well as guidelines for screening thyroid function with each disorder. Finally, we provide an overview of the effects of antidiabetic drugs on thyroid hormone and thyroid disorders.
Collapse
Affiliation(s)
- Young Sil Eom
- Division of Endocrinology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jessica R. Wilson
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Jacksonville, FL, USA
| | - Victor J. Bernet
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Jacksonville, FL, USA
- Corresponding author: Victor J. Bernet https://orcid.org/0000-0002-2477-5631 Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA E-mail:
| |
Collapse
|
10
|
Bernardi S, Grillo A, Antonello RM, Cola MF, Dobrinja C, Fabris B, Giudici F. Meta-analysis on the association between thyroid hormone disorders and arterial stiffness. J Endocr Soc 2022; 6:bvac016. [PMID: 35284772 PMCID: PMC8907416 DOI: 10.1210/jendso/bvac016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Indexed: 11/23/2022] Open
Abstract
Context Aortic stiffness is an emerging predictor of cardiovascular morbidity and mortality. Current data about the effect of subclinical and overt thyroid hormone disorders on aortic stiffness are often conflicting. Objective Primary outcome was to investigate if subclinical and overt thyroid hormone disorders were associated with aortic stiffness. Secondary outcome was to identify disease effect modifiers. Methods Data sources were PubMed, Google Scholar, SCOPUS, Web of Sciences, and the Cochrane Library. Eligible studies included reports of pulse wave velocity (PWV), which is the gold standard method for measuring aortic stiffness, in patients with subclinical and overt thyroid disorders. Two investigators independently identified eligible studies and extracted data. Pooled mean difference was the summary effect measure. Data were presented in forest plots with outlier and influential case diagnostics. Univariate meta-regression analysis was used to identify effect modifiers. Results Eleven observational studies were selected, including 1239 patients with subclinical hypothyroidism, 81 patients with overt hypothyroidism, 338 patients with thyrotoxicosis, and 12 715 controls. PWV was significantly higher in subclinical (P < .001) and overt hypothyroidism (P < .001), as well as in patients with thyrotoxicosis (P = .027) compared with controls. Age was an effect modifier in hypothyroid patients. Conclusion This study shows that both overt and subclinical hypothyroidism as well as thyrotoxicosis were associated with an increase of aortic stiffness. The impact of treatment of these conditions on aortic stiffness should be assessed in clinical trials.
Collapse
Affiliation(s)
- Stella Bernardi
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Operative Unit of Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, Trieste, Italy
| | - Andrea Grillo
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Operative Unit of Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, Trieste, Italy
| | | | - Marco Fabio Cola
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Chiara Dobrinja
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Operative Unit of Chirurgia Generale, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, Trieste, Italy
| | - Bruno Fabris
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Operative Unit of Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, Trieste, Italy
| | - Fabiola Giudici
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| |
Collapse
|
11
|
Rong F, Dai H, Wu Y, Li J, Liu G, Chen H, Zhang X. Association between thyroid dysfunction and type 2 diabetes: a meta-analysis of prospective observational studies. BMC Med 2021; 19:257. [PMID: 34670571 PMCID: PMC8529738 DOI: 10.1186/s12916-021-02121-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Diabetes mellitus and thyroid disease are two areas of broad interest in the field of endocrinology and metabolism. Variation of thyroid hormone concentration, even within the normal range, may portend the onset of type 2 diabetes mellitus (T2DM), especially among those with prediabetes. However, current evidence is mixed. METHODS Prospective studies which assessed diabetes incidence were identified using a database search of MEDLINE and Embase through May 1, 2021. The Sidik-Jonkman random-effects model and cubic spline model were used to evaluate the associations and dose-response relationships between thyroid function/hormone levels and risk of T2DM and cardiovascular disease (CVD) risk among T2DM patients. RESULTS A total of 12 prospective studies were included. We found that high baseline TSH levels were related to a 17% higher risk of T2DM (RR 1.17, 95% CI 1.01, 1.36; I2=78%, P<0.01), compared with normal TSH levels. Low FT3 (RR 1.40, 95% CI 1.09, 1.80; I2=59%, P=0.03) and low FT4 (RR 1.33, 95% CI 1.04, 1.71; I2=62%, P=0.02) levels were significantly associated with risk of T2DM. The cubic spline model indicated a J-shaped relationship with TSH, but inverted-J-shaped relationships with FT3 and FT4. CVD events and all-cause deaths were prospectively evaluated in four studies, but were not associated with abnormal thyroid function. CONCLUSIONS Our meta-analysis determined that abnormal thyroid hormone level is associated with an increased risk of T2DM, showing a J-shaped relationship with TSH and inverted-J-shaped relationships with FT3 and FT4. TRIAL REGISTRATION Registered number in PROSPERO: CRD42021225695 .
Collapse
Affiliation(s)
- Fen Rong
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongji Dai
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Yuwan Wu
- Department of Pediatrics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jibin Li
- Department of Clinical Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guoping Liu
- School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, 201203, Shanghai, China.
| | - Hanbei Chen
- Department of Endocrinology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Xi Zhang
- Clinical Research Unit, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China.
| |
Collapse
|
12
|
Blaslov K, Gajski D, Vucelić V, Gaćina P, Mirošević G, Marinković J, Vrkljan M, Rotim K. THE ASSOCIATION OF SUBCLINICAL INSULIN RESISTANCE WITH THYROID AUTOIMMUNITY IN EUTHYROID INDIVIDUALS. Acta Clin Croat 2020; 59:696-702. [PMID: 34285440 PMCID: PMC8253084 DOI: 10.20471/acc.2020.59.04.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
Hashimoto thyroiditis is characterized by anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies that gradually lead to thyroid cell destruction. As hypothyroidism has been associated with insulin resistance (IR), we aimed to investigate whether IR is associated with thyroid antibody presence and whether the degree of IR correlates with their concentration in euthyroid individuals. A total of 164 non-diabetic, euthyroid individuals, average age 34 years, were included in the study, divided into two groups according to Hashimoto thyroiditis and underwent 5-hour oral glucose tolerance test. The degree of IR was evaluated by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). The Hashimoto thyroiditis group had higher HOMA-IR (p=0.003) and lower glucose levels (p=0.04). HOMA-IR correlated positively with anti-TPO (p<0.001). Linear logistic regression revealed that anti-TPO concentration increased by 18.13 (p=0.001) with each HOMA-IR unit. IR might trigger thyroid antibody production and Hashimoto thyroiditis development, which needs to be evaluated in further larger scale follow up studies.
Collapse
Affiliation(s)
| | - Domagoj Gajski
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Vesna Vucelić
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Petar Gaćina
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Gorana Mirošević
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Jelena Marinković
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Milan Vrkljan
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Krešimir Rotim
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| |
Collapse
|
13
|
Huang Y, Cai L, Zheng Y, Pan J, Li L, Zong L, Lin W, Liang J, Huang H, Wen J, Chen G. Association between lifestyle and thyroid dysfunction: a cross-sectional epidemiologic study in the She ethnic minority group of Fujian Province in China. BMC Endocr Disord 2019; 19:83. [PMID: 31362731 PMCID: PMC6668292 DOI: 10.1186/s12902-019-0414-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/12/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Thyroid dysfunction is one of the prevalent endocrine disorders. The relationship between lifestyle factors and thyroid dysfunction was not clear and some of the factors seemed paradoxical. METHODS We conducted this population-based study using data from 5154 She ethnic minority people who had entered into the epidemic survey of diabetes between July 2007 to September 2009. Life style information was collected using a standard questionnaire. Body mass index (BMI), Blood pressure and serum TSH, TPOAb, triglycerides (TG), total cholesterol (TC) and high-density lipoprotein cholesterol (HDL) were collected. RESULTS The study showed that people who drank, had higher education or suffered from insomnia have lower incidence of hyperthyroidism. On the other hand, smoking, alcohol consumption, exercise, undergoing weight watch and chronic headache were associated with decreased incidence of hypothyroidism. Using multivariable logistic regression analysis, we found that alcohol consumption was associated with decreased probability of hyperthyroidism, hypothyroidism, as well as positive TPOAb. The amounts of cigarettes smoked daily displayed a positive correlation with hyperthyroidism among smokers. Accordingly, smoking seemed to be associated with decreased risk for hypothyroidism and positive TPOAb. Exercise and maintaining a healthy weight might have a beneficial effect on thyroid health. Interestingly, daily staple amount showed an inverse correlation with incidence of positive TPOAb. CONCLUSIONS Within the Chinese She ethnic minority, we found associations between different lifestyle factors and the incidence of different thyroid diseases. Understanding the nature of these associations requires further investigations.
Collapse
Affiliation(s)
- Yanling Huang
- Department of Endocrinology and Metabolism, Zhongshan Hospital Xiamen University, 201-209 Hubin South Road, Xiamen, 361004, China
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Liangchun Cai
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Yuanyuan Zheng
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Jinxing Pan
- Department of Geriatrics, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Liantao Li
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Liyao Zong
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Wei Lin
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Jixing Liang
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Huibin Huang
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Junping Wen
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Gang Chen
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
- Department of Endocrinology, Fujian Provincial Hospital, Fujian Academy of Medical Sciences, Fuzhou, 350001, China.
| |
Collapse
|
14
|
Biondi B, Kahaly GJ, Robertson RP. Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders. Endocr Rev 2019; 40:789-824. [PMID: 30649221 PMCID: PMC6507635 DOI: 10.1210/er.2018-00163] [Citation(s) in RCA: 232] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
Thyroid dysfunction and diabetes mellitus are closely linked. Several studies have documented the increased prevalence of thyroid disorders in patients with diabetes mellitus and vice versa. This review critically discusses the different underlying mechanisms linking type 1 and 2 diabetes and thyroid dysfunction to demonstrate that the association of these two common disorders is unlikely a simple coincidence. We assess the current state of knowledge on the central and peripheral control of thyroid hormone on food intake and glucose and lipid metabolism in target tissues (such as liver, white and brown adipose tissue, pancreatic β cells, and skeletal muscle) to explain the mechanism linking overt and subclinical hypothyroidism to type 2 diabetes and metabolic syndrome. We also elucidate the common susceptibility genes and the pathogenetic mechanisms contributing to the autoimmune mechanism involved in the onset of type 1 diabetes mellitus and autoimmune thyroid disorders. An untreated thyroid dysfunction can impair the metabolic control of diabetic patients, and this association can have important repercussions on the outcome of both of these disorders. Therefore, we offer recommendations for the diagnosis, management, and screening of thyroid disorders in patients with diabetes mellitus, including the treatment of diabetic patients planning a pregnancy. We also discuss the major causes of failure to achieve an optimal management of thyroid dysfunction in diabetic patients and provide recommendations for assessing and treating these disorders during therapy with antidiabetic drugs. An algorithm for a correct approach of these disorders when linked is also provided.
Collapse
Affiliation(s)
- Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - George J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - R Paul Robertson
- Department of Medicine, Division of Endocrinology and Metabolism, University of Washington School of Medicine, Seattle, Washington.,Department of Pharmacology, University of Washington, Seattle, Washington
| |
Collapse
|
15
|
Jayanthi R, Srinivasan AR. Biochemical isthmus [nexus] between type 2 diabetes mellitus and thyroid status-an update. Diabetes Metab Syndr 2019; 13:1173-1177. [PMID: 31336461 DOI: 10.1016/j.dsx.2019.01.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/18/2019] [Indexed: 11/29/2022]
Abstract
Both Type 1 [T1DM] and Type 2 diabetes mellitus [T2DM] share a nexus with altered thyroid status. In recent times, evidences point to the link between thyroid hormones andT2DM in particular. Several lines of evidences suggest an array of biochemical and molecular events. Gene polymorphism, disturbances in gene expression and regulation, enhanced and bizarre absorption of dietary glucose from intestine, decreased utilization of glucose by tissues and aberrations in hepatic handling of glucose with the onus on Gluconeogenesis are some of the projected mechanisms. Insulin resistance, a progressive condition is the hallmark in T2DM. Hypothyroidism as well as hyperthyroidism have been associated with insulin resistance which are synonymous with impaired glucose metabolism in T2DM. A multitude of basic, clinical and molecular studies provide an insight into thyroid comorbidity in T2DM, though there are a few instances to suggest equivocal link denoting cause-effect relationship. In biochemical pharmacology, as fortified by pharmacogenomics, modalities have now been proposed, through drug trials, to underline the utility of specifically designed thyroid hormone analogues in addressing metabolic syndrome, DM and associated cardiovascular pathology. A thorough understanding of the physiological, biochemical and molecular mechanisms would certainly open newer vistas in the perspectives of T2DM with special reference to alterations in thyroid status.
Collapse
Affiliation(s)
- Rajendran Jayanthi
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pillaiyarkuppam, Pondicherry, 607 402, India
| | - Abu Raghavan Srinivasan
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pillaiyarkuppam, Pondicherry, 607 402, India.
| |
Collapse
|
16
|
Xiao Y, Sun H, Li C, Li Y, Peng S, Fan C, Teng W, Shan Z. Effect of Iodine Nutrition on Pregnancy Outcomes in an Iodine-Sufficient Area in China. Biol Trace Elem Res 2018; 182:231-237. [PMID: 28770411 DOI: 10.1007/s12011-017-1101-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
Many studies focused on the association between thyroid disease and pregnancy outcomes. The present study explored the effect of iodine nutrition during the first trimester on pregnancy outcomes. One thousand five hundred sixty-nine pregnant, euthyroid women at ≤12 weeks of gestation in an iodine-sufficient area in China were recruited. According to the World Health Organization (WHO) criteria for iodine nutrition during pregnancy, participants were divided into four groups: adequate iodine (median urinary iodine concentration (UIC), 150-249 μg/L), mild deficiency (UIC, 100-150 μg/L), moderate and severe deficiency (UIC, <100 μg/L), and more than adequate and excessive (UIC, ≥250 μg/L) groups. Pregnancy outcomes, including abortion, gestational hypertension, pre-eclampsia, gestational diabetes mellitus (GDM), placenta previa, placental abruption, preterm labor, low birth weight infants, macrosomia, breech presentation, and cord entanglement, were obtained during follow-up. The results showed that there was no significant difference in general characteristics, including age, body mass index, abdominal circumference, systolic blood pressure, diastolic blood pressure, heart rate, smoking rate, and drinking rate, among the four groups. In the more than adequate and excessive group, thyroid-stimulating hormone (TSH) was greater and free thyroxine (FT4) was lower than any other groups but still within normal range. The thyroglobulin (Tg) level was greater in the moderate and severe deficiency group. The incidence of GDM was significantly greater in women with mild iodine deficiency than in women with adequate iodine nutriture (18.38 vs. 13.70%, p < 0.05). Compared with the adequate group, incidence of macrosomia was significantly greater in the more than adequate and excessive group (12.42 vs. 9.79%, p < 0.05). Mild iodine deficiency was an independent risk factor for GDM (odds ratio = 1.566, 95% confidence interval = 1.060-2.313, p = 0.024); more than adequate and excessive iodine was an independent risk factor for macrosomia (OR = 1.917, CI = 1.128-3.256, p = 0.016). In summary, during 1st trimester, both mild iodine deficiency and excessive iodine intake had adverse impacts on pregnancy outcomes in an iodine-sufficient area.
Collapse
Affiliation(s)
- Yue Xiao
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Huakun Sun
- Department of Rheumatism and Hematology, First Hospital of Dandong, Dandong, Liaoning Province, People's Republic of China
| | - Chenyan Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Yongze Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Shiqiao Peng
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Chenling Fan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
- , NO.155 Nanjing North Street, Heping District, Shenyang, Liaoning Province, 110001, China.
| |
Collapse
|
17
|
Song F, Bao C, Deng M, Xu H, Fan M, Paillard-Borg S, Xu W, Qi X. The prevalence and determinants of hypothyroidism in hospitalized patients with type 2 diabetes mellitus. Endocrine 2017; 55:179-185. [PMID: 27605039 DOI: 10.1007/s12020-016-1095-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/13/2016] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to investigate the prevalence of hypothyroidism among hospitalized patients with type 2 diabetes mellitus and its related factors, and to assess the prevalence of macrovascular and microvascular diseases among type 2 diabetes mellitus inpatients with hypothyroidism and euthyroidism. A total of 1662 type 2 diabetes mellitus inpatients hospitalized at the Metabolic Diseases Hospital, Tianjin Medical University from 1 January 2008 to 1 March 2013 were included in this study. Information on demographic and anthropometric factors and additional variables related to hypothyroidism were collected from medical records. Prevalence rates were calculated and standardized using direct method based on the age-specific and sex-specific structure of all participants. Data were analyzed using binary logistic regression with adjustment for potential confounders. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and 77.0 % of the patients with hypothyroidism had subclinical hypothyroidism. The prevalence of hypothyroidism increased with age, and was higher in women (10.8 %) than in men (3.4 %). Older age (odds ratio, 1.74; 95 % confidence interval, 1. 05 to 2.89), female gender (odds ratio, 2.02; 95 % confidence interval, 1.05 to 3.87), and positive thyroid peroxidase antibody (odds ratio, 4.99; 95 % confidence interval, 2.83 to 8.79) were associated with higher odds of hypothyroidism among type 2 diabetes mellitus inpatients. The type 2 diabetes mellitus inpatients with hypothyroidism had higher prevalence of cerebrovascular diseases than those with euthyroidism after adjustment for age and gender. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and most patients had subclinical hypothyroidism. Older age, female gender, and positive thyroid peroxidase antibody could be indicators for detecting hypothyroidism in type 2 diabetes mellitus inpatients.
Collapse
Affiliation(s)
- Fei Song
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China
| | - Cuiping Bao
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China
| | - Meiyu Deng
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China
| | - Hui Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China
| | - Meijuan Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China
| | - Stéphanie Paillard-Borg
- Department of Medicine and Public Health, The Swedish Red Cross University College, Stockholm, Sweden
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China
- Aging Research Center (ARC), Department Neurobiology, Health Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China.
| |
Collapse
|
18
|
Moon MK, Kang GH, Kim HH, Han SK, Koo YD, Cho SW, Kim YA, Oh BC, Park DJ, Chung SS, Park KS, Park YJ. Thyroid-stimulating hormone improves insulin sensitivity in skeletal muscle cells via cAMP/PKA/CREB pathway-dependent upregulation of insulin receptor substrate-1 expression. Mol Cell Endocrinol 2016; 436:50-8. [PMID: 27452800 DOI: 10.1016/j.mce.2016.07.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/13/2016] [Accepted: 07/16/2016] [Indexed: 11/21/2022]
Abstract
Thyroid-stimulating hormone (TSH) receptor is expressed in extrathyroidal tissues such as hepatocytes, adipocytes, and skeletal muscle, which suggests a possible novel role of TSH in various metabolic processes in extrathyroidal tissues independent of thyroid hormones. We investigated whether TSH has any effects on glucose tolerance and insulin sensitivity in the skeletal muscle using diet-induced obesity (DIO) mouse models and rodent skeletal muscle cells. TSH improved glucose tolerance in DIO mice and this was associated with an improvement of skeletal muscle insulin sensitivity resulting from the increased expression of insulin receptor substrate (IRS)-1 protein and mRNA therein. TSH significantly increased both basal and insulin-stimulated glucose transport in rat L6 myotubes and increased the expression of IRS-1 protein and mRNA in these cells as well. TSH also stimulated Irs1 promoter activation; this stimulation was abolished by protein kinase A (PKA) inhibition using H89 or by mutation of the cAMP-response element site located at -1155 to -875 bp of the Irs1 promoter region, supporting a novel role of TSH activated-cAMP/PKA/CREB signaling in the regulation of Irs1 expression. In conclusion, TSH improves insulin sensitivity in skeletal muscle by increasing Irs1 gene expression. This regulatory effect is mediated by a PKA-CREB-dependent pathway.
Collapse
Affiliation(s)
- Min Kyong Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea; Department of Internal Medicine, Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Geun Hyung Kang
- Seoul National University Hospital Biomedical Research Institute, Seoul, 03080, Republic of Korea
| | - Hwan Hee Kim
- Seoul National University Hospital Biomedical Research Institute, Seoul, 03080, Republic of Korea
| | - Sun Kyoung Han
- Seoul National University Hospital Biomedical Research Institute, Seoul, 03080, Republic of Korea
| | - Young Do Koo
- Seoul National University Hospital Biomedical Research Institute, Seoul, 03080, Republic of Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea; Seoul National University Hospital Biomedical Research Institute, Seoul, 03080, Republic of Korea
| | - Ye An Kim
- Seoul National University Hospital Biomedical Research Institute, Seoul, 03080, Republic of Korea; Seoul National University Hospital Healthcare System Gangnam Center, Seoul, 06236, Republic of Korea
| | - Byung-Chul Oh
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University Graduate School of Medicine, Incheon, 21999, Republic of Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea; Seoul National University Hospital Biomedical Research Institute, Seoul, 03080, Republic of Korea
| | - Sung Soo Chung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea; Seoul National University Hospital Biomedical Research Institute, Seoul, 03080, Republic of Korea
| | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea; Seoul National University Hospital Biomedical Research Institute, Seoul, 03080, Republic of Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea; Seoul National University Hospital Biomedical Research Institute, Seoul, 03080, Republic of Korea.
| |
Collapse
|
19
|
Mazaheri T, Sharifi F, Kamali K. Insulin resistance in hypothyroid patients under Levothyroxine therapy: a comparison between those with and without thyroid autoimmunity. J Diabetes Metab Disord 2014; 13:103. [PMID: 25364704 PMCID: PMC4216656 DOI: 10.1186/s40200-014-0103-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 10/21/2014] [Indexed: 01/21/2023]
Abstract
Background A chronic inflammation resulting from an imbalance between pro-inflammatory and anti-inflammatory cytokines in Hashimoto’s thyroiditis (HT) might be responsible for IR in hypothyroidism. This study was performed to investigate a probable association between autoimmune background of hypothyroidism and IR. Methods In this clinical study, 63 subjects with Hashimoto’s thyroiditis and 49 subjects with post-ablation hypothyroidism were enrolled. All the participants were euthyroid for more than one year through Levothyroxine therapy. Serum concentrations of Thyroid-stimulating Hormone (TSH), Free Thyroxin (FT4, FT3), Anti-Thyroid Peroxidase Antibodies (Anti-TPO Abs), Total Cholesterol (TC), HDL-Cholesterol (HDL-C), Triglyceride (TG), Fasting Blood Glucose (FBG), and insulin levels were measured and Oral Glucose Tolerance Test (OGTT) was performed for all of the subjects. Participants with anti TPO levels more than 1000 IU /ml were classified as having highly positive antibodies. Results No significant differences regarding to plasma insulin, glucose and lipid concentration, were detected between subjects with and without Hashimoto’s thyroiditis. However, subjects with highly positive Anti TPO Abs had higher prevalence of elevated fasting insulin level than those with lower titers of Anti TPO Abs and subjects without autoimmune background (94.1% vs. 62.8% and 71.4% respectively, P = 0.05). Subjects with highly positive titers of Abs also had a lower serum HDL-c levels than the rest of the subjects (40.6 ± 2.1 vs. 47.2 ± 1.7 and 47.4 ± 1.4, P = 0.04). Conclusions There is no obvious association between thyroid autoimmunity and metabolic indexes of hypothyroid patients. Only patients with Ani TPO antibody levels more than 1000 IU/ml may experience higher insulin level and less HDL-c with the same BMI.
Collapse
Affiliation(s)
| | - Faranak Sharifi
- Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Koorosh Kamali
- Department of public health, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
20
|
Posadas-Romero C, Jorge-Galarza E, Posadas-Sánchez R, Acuña-Valerio J, Juárez-Rojas JG, Kimura-Hayama E, Medina-Urrutia A, Cardoso-Saldaña GC. Fatty liver largely explains associations of subclinical hypothyroidism with insulin resistance, metabolic syndrome, and subclinical coronary atherosclerosis. Eur J Endocrinol 2014; 171:319-25. [PMID: 25053728 DOI: 10.1530/eje-14-0150] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The association of subclinical hypothyroidism (SCH) with insulin resistance, metabolic syndrome (MS), and coronary atherosclerosis is uncertain. OBJECTIVE To investigate the role of increased intrahepatic fat in the association of SCH with insulin resistance, MS, and coronary atherosclerosis. DESIGN, PATIENTS, AND METHODS We conducted a cross-sectional study in a sample of 753 subjects (46% males) aged 35-70 years with no history of diabetes, renal, hepatic, thyroid, or coronary heart disease, and were participants of the Genetics of Atherosclerotic Disease study. SCH was defined as a high serum TSH level with normal free thyroxine concentration. Fatty liver (FL), coronary artery calcification (CAC), and abdominal visceral adipose tissue were assessed by computed tomography. Cross-sectional associations of SCH with and without FL, with MS, insulin resistance, and subclinical atherosclerosis defined as a CAC score >0, were examined in logistic regression models. RESULTS SCH was observed in 17.7% of the population studied. The prevalence of FL was similar in both euthyroid and SCH subjects (31.8 vs 27.8%, P=0.371). SCH plus FL subjects were heavier and had more metabolic abnormalities compared with SCH plus normal liver subjects. In multivariate-adjusted logistic regression analyses, SCH plus FL was associated with MS (odds ratio (OR): 2.73, 95% CI: 1.26-5.92), insulin resistance (OR: 4.91, 95% CI: 1.63-14.75), and CAC score >0 (OR: 3.05, 95% CI: 1.20-7.76). SCH without FL showed no associations. CONCLUSION SCH with FL is associated with increased odds of MS, insulin resistance, and CAC, independent of potential confounders.
Collapse
Affiliation(s)
- Carlos Posadas-Romero
- Endocrinology DepartmentInterventional Cardiology DepartmentComputed Tomography DepartmentInstituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Col. Sección XVI, C.P. 14080 Tlalpan, México D.F., Mexico
| | - Esteban Jorge-Galarza
- Endocrinology DepartmentInterventional Cardiology DepartmentComputed Tomography DepartmentInstituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Col. Sección XVI, C.P. 14080 Tlalpan, México D.F., Mexico
| | - Rosalinda Posadas-Sánchez
- Endocrinology DepartmentInterventional Cardiology DepartmentComputed Tomography DepartmentInstituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Col. Sección XVI, C.P. 14080 Tlalpan, México D.F., Mexico
| | - Jorge Acuña-Valerio
- Endocrinology DepartmentInterventional Cardiology DepartmentComputed Tomography DepartmentInstituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Col. Sección XVI, C.P. 14080 Tlalpan, México D.F., Mexico
| | - Juan G Juárez-Rojas
- Endocrinology DepartmentInterventional Cardiology DepartmentComputed Tomography DepartmentInstituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Col. Sección XVI, C.P. 14080 Tlalpan, México D.F., Mexico
| | - Eric Kimura-Hayama
- Endocrinology DepartmentInterventional Cardiology DepartmentComputed Tomography DepartmentInstituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Col. Sección XVI, C.P. 14080 Tlalpan, México D.F., Mexico
| | - Aida Medina-Urrutia
- Endocrinology DepartmentInterventional Cardiology DepartmentComputed Tomography DepartmentInstituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Col. Sección XVI, C.P. 14080 Tlalpan, México D.F., Mexico
| | - Guillermo C Cardoso-Saldaña
- Endocrinology DepartmentInterventional Cardiology DepartmentComputed Tomography DepartmentInstituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Col. Sección XVI, C.P. 14080 Tlalpan, México D.F., Mexico
| |
Collapse
|
21
|
Variation in macro and trace elements in progression of type 2 diabetes. ScientificWorldJournal 2014; 2014:461591. [PMID: 25162051 PMCID: PMC4138889 DOI: 10.1155/2014/461591] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 06/30/2014] [Indexed: 12/12/2022] Open
Abstract
Macro elements are the minerals of which the body needs more amounts and are more important than any other elements. Trace elements constitute a minute part of the living tissues and have various metabolic characteristics and functions. Trace elements participate in tissue and cellular and subcellular functions; these include immune regulation by humoral and cellular mechanisms, nerve conduction, muscle contractions, membrane potential regulations, and mitochondrial activity and enzyme reactions. The status of micronutrients such as iron and vanadium is higher in type 2 diabetes. The calcium, magnesium, sodium, chromium, cobalt, iodine, iron, selenium, manganese, and zinc seem to be low in type 2 diabetes while elements such as potassium and copper have no effect. In this review, we emphasized the status of macro and trace elements in type 2 diabetes and its advantages or disadvantages; this helps to understand the mechanism, progression, and prevention of type 2 diabetes due to the lack and deficiency of different macro and trace elements.
Collapse
|
22
|
Palma CCSSV, Pavesi M, Nogueira VG, Clemente ELS, Vasconcellos MDFBMP, Pereira LC, Pacheco FF, Braga TG, Bello LDF, Soares JO, dos Santos SCF, Campos VPLC, Gomes MB. Prevalence of thyroid dysfunction in patients with diabetes mellitus. Diabetol Metab Syndr 2013; 5:58. [PMID: 24499529 PMCID: PMC3852595 DOI: 10.1186/1758-5996-5-58] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/30/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) and thyroid dysfunction (TD) are the two most common endocrine disorders in clinical practice. The unrecognized TD may adversely affect the metabolic control and add more risk to an already predisposing scenario for cardiovascular diseases. The objective of this study was to investigate the prevalence of TD in patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM). METHODS This is an observational cross-sectional study. Three hundred eighty-six (386) patients with T1DM or T2DM that regularly attended the outpatient clinic of the Diabetes unit, Hospital Universitário Pedro Ernesto, participated in the study. All patients underwent a clinical and laboratory evaluation. Thyroid dysfunction was classified as clinical hypothyroidism (C-Hypo) if TSH > 4.20 μUI/mL and FT4 < 0.93 ng/dL; Subclinical hypothyroidism (SC-Hypo) if TSH > 4.20 μUI/ml and FT4 ranged from 0.93 to 1.7 ng/dL; Subclinical hyperthyroidism (SC-Hyper) if TSH < 0.27 μUI/ml and FT4 in the normal range (0.93 and 1.7 ng/dL) and Clinical hyperthyroidism (C-Hyper) if TSH < 0.27 μUI/ml and FT4 > 1.7 μUI/mL. Autoimmunity were diagnosed when anti-TPO levels were greater than 34 IU/mL. The positive autoimmunity was not considered as a criterion of thyroid dysfunction. RESULTS The prevalence of TD in all diabetic patients was 14,7%. In patients who had not or denied prior TD the frequency of TD was 13%. The most frequently TD was subclinical hypothyroidism, in 13% of patients with T1DM and in 12% of patients with T2DM. The prevalence of anti-TPO antibodies was 10.8%. Forty-four (11.2%) new cases of TD were diagnosed during the clinical evaluation. The forty-nine patients with prior TD, 50% with T1DM and 76% with T2DM were with normal TSH levels. CONCLUSIONS We conclude that screening for thyroid disease among patients with diabetes mellitus should be routinely performed considering the prevalence of new cases diagnosed and the possible aggravation the classical risk factors such as hypertension and dyslipidemia, arising from an undiagnosed thyroid dysfunction.
Collapse
Affiliation(s)
- Cátia Cristina Silva Sousa Vergara Palma
- Diabetes Unit, State University Hospital of Rio de Janeiro (UERJ), Avenida 28 de setembro, 77, Serviço de Diabetes, Terceiro andar, Vila Isabel, Rio de Janeiro, Brazil
| | - Marco Pavesi
- CLIF Data Centre, European Consortium on Liver Failure, Hospital Clínic de Barcelona, Barcelona, Espanha
| | - Verônica Guedes Nogueira
- Diabetes Unit, State University Hospital of Rio de Janeiro (UERJ), Avenida 28 de setembro, 77, Serviço de Diabetes, Terceiro andar, Vila Isabel, Rio de Janeiro, Brazil
| | - Eliete Leão Silva Clemente
- Diabetes Unit, State University Hospital of Rio de Janeiro (UERJ), Avenida 28 de setembro, 77, Serviço de Diabetes, Terceiro andar, Vila Isabel, Rio de Janeiro, Brazil
| | | | - Luiz Carlos Pereira
- Diabetes Unit, State University Hospital of Rio de Janeiro (UERJ), Avenida 28 de setembro, 77, Serviço de Diabetes, Terceiro andar, Vila Isabel, Rio de Janeiro, Brazil
| | - Fernanda Faissol Pacheco
- Diabetes Unit, State University Hospital of Rio de Janeiro (UERJ), Avenida 28 de setembro, 77, Serviço de Diabetes, Terceiro andar, Vila Isabel, Rio de Janeiro, Brazil
| | - Tássia Gomide Braga
- Diabetes Unit, State University Hospital of Rio de Janeiro (UERJ), Avenida 28 de setembro, 77, Serviço de Diabetes, Terceiro andar, Vila Isabel, Rio de Janeiro, Brazil
| | - Ludmila de Faria Bello
- Diabetes Unit, State University Hospital of Rio de Janeiro (UERJ), Avenida 28 de setembro, 77, Serviço de Diabetes, Terceiro andar, Vila Isabel, Rio de Janeiro, Brazil
| | - Juliana Oliveira Soares
- Diabetes Unit, State University Hospital of Rio de Janeiro (UERJ), Avenida 28 de setembro, 77, Serviço de Diabetes, Terceiro andar, Vila Isabel, Rio de Janeiro, Brazil
| | - Stefanie Cathren Fenizola dos Santos
- Diabetes Unit, State University Hospital of Rio de Janeiro (UERJ), Avenida 28 de setembro, 77, Serviço de Diabetes, Terceiro andar, Vila Isabel, Rio de Janeiro, Brazil
| | - Vinícius Paes Leme Cavalcante Campos
- Diabetes Unit, State University Hospital of Rio de Janeiro (UERJ), Avenida 28 de setembro, 77, Serviço de Diabetes, Terceiro andar, Vila Isabel, Rio de Janeiro, Brazil
| | - Marília Brito Gomes
- Diabetes Unit, State University Hospital of Rio de Janeiro (UERJ), Avenida 28 de setembro, 77, Serviço de Diabetes, Terceiro andar, Vila Isabel, Rio de Janeiro, Brazil
| |
Collapse
|
23
|
Udupa SV, Manjrekar PA, Udupa VA, Vivian D. Altered fructosamine and lipid fractions in subclinical hypothyroidism. J Clin Diagn Res 2013; 7:18-22. [PMID: 23449765 DOI: 10.7860/jcdr/2012/5011.2660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 11/10/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Thyroid function disorders lead to changes in the lipoprotein metabolism. OBJECTIVES To study the lipid and the glycaemic abnormalities in the subclinical hypothyroidism cases and to compare the same with the euthyroid, overt hypothyroid and the hyperthyroid subjects. METHODOLOGY Four groups, euthyroid (Group-I), hypothyroid (Group-II), subclinical hypothyroid (Group-III) and hyperthyroid (Group-IV), which consisted of 30 subjects each, of either sex, who were aged 25-55 years, underwent Fasting Plasma Glucose (FPG), fructosamine, lipid profile and total T3, T4 and TSH estimations. The subjects who were on lipid lowering or thyroid disorder drugs and known diabetics were excluded from the study. RESULTS In Group-III, all the lipid fractions were comparable to those of Group-II and they were significantly deranged, as compared to those of Group-I. The fructosamine levels were significantly higher in Group-II and Group-III (p<0.05), but the subclinical hypothyroid pool had statistically lower levels than the hypothyroid pool (376.63±54.73, 587.80±65.10). In the Group-IV patients, the LDL-C levels were significantly higher as compared to those in the euthyroid pool. The fructosamine levels were significantly lower in comparison with both the euthyroid and the hypothyroid pools (both in Groups-II and III). The FPG levels were higher in all the classes of the thyroid abnormalities (subclinical hypothyroidnot significant) but within the reference range of 70-100mg/dl. CONCLUSION Since the lipid derangement in subclinical hypothyroidism is on par with that in overt hypothyrodism, the subclinical hypothyroid cases also need to be treated similarly. The fructosamine values which are largely in excess of the FPG values, indicate a higher propensity to glycation and a decreased turnover of the proteins in the hypothyroid and the subclinical hypothyroid pools. Vice versa is true of the hyperthyroid pool. Fructosamine can be included in the thyroid work up of the patients to assess the metabolic function and the subsequent response after the initiation of the therapy.
Collapse
Affiliation(s)
- Sridevi V Udupa
- Assistant Professor, Department of Biochemistry, Tadikela Subbaiah Institute of Medical Sciences and Research Centre , Shivamogga, India
| | | | | | | |
Collapse
|
24
|
Wang C. The Relationship between Type 2 Diabetes Mellitus and Related Thyroid Diseases. J Diabetes Res 2013; 2013:390534. [PMID: 23671867 PMCID: PMC3647563 DOI: 10.1155/2013/390534] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 03/15/2013] [Indexed: 12/12/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) has an intersecting underlying pathology with thyroid dysfunction. The literature is punctuated with evidence indicating a contribution of abnormalities of thyroid hormones to type 2 DM. The most probable mechanism leading to T2DM in thyroid dysfunction could be attributed to perturbed genetic expression of a constellation of genes along with physiological aberrations leading to impaired glucose utilization and disposal in muscles, overproduction of hepatic glucose output, and enhanced absorption of splanchnic glucose. These factors contribute to insulin resistance. Insulin resistance is also associated with thyroid dysfunction. Hyper- and hypothyroidism have been associated with insulin resistance which has been reported to be the major cause of impaired glucose metabolism in T2DM. The state-of-art evidence suggests a pivotal role of insulin resistance in underlining the relation between T2DM and thyroid dysfunction. A plethora of preclinical, molecular, and clinical studies have evidenced an undeniable role of thyroid malfunctioning as a comorbid disorder of T2DM. It has been investigated that specifically designed thyroid hormone analogues can be looked upon as the potential therapeutic strategies to alleviate diabetes, obesity, and atherosclerosis. These molecules are in final stages of preclinical and clinical evaluation and may pave the way to unveil a distinct class of drugs to treat metabolic disorders.
Collapse
Affiliation(s)
- Chaoxun Wang
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai 201399, China
- *Chaoxun Wang:
| |
Collapse
|