Features of Type 2 Diabetes Mellitus in Combination with Hypothyroidism
Background. The last decades are characterized by the considerable increase in the prevalence of endocrine disorders with the change of the structure, and first of all cases of polyendocrinopathy, the special place among which is occupied by combination of diabetes mellitus (DM) and thyroid diseases. Increase in the incidence of DM type 2 associated with hypothyroidism affects the clinical course of this pathology, remains topical problem of modern medical science. The objective: to study the prevalence of hypothyroidism in patients with type 2 DM and to establish clinical features of DM type 2 in combination with hypothyroidism. Materials and methods. We have examined 179 patients with DM associated with primary hypothyroidism, including 64 patients with DM type 1 and 115 patients with type 2 DM. Comparison group consisted of 62 patients with DM without hypothyroidism (27 of them — with DM type 1, 35 — with DM type 2). Thyroid function was assessed by determining the basal concentrations of thyroid stimulating hormone and free thyroxine fraction. Results. It was found that patients with DM type 2 and hypothyroidism belonged to an older age group than patients with DM type 1 and hypothyroidism. Thus, the age of patients with DM type 1 and hypothyroidism was 35.3 ± 9.5 years, and in patients with type 2 DM and hypothyroidism — 47.6 ± 11.0 years. In all groups of patients, the percentage of women was much higher than men. The significant differences were detected in terms of the amplitude of glycemic index, namely its increase in patients with DM type 1 and hypothyroidism. When DM type 2 was combined with hypothyroidism, lipid metabolism indices were higher than in DM type 2 without thyroid disease. This confirms the effect of hypothyroidism on lipid metabolism and causes increased risk of progression of cardiovascular events at the presence of two diseases. Conclusions. Among examined patients, hypothyroidism occurred 2.4 times more often in DM type 2, than in DM type 1, indicating a greater presence of risk factors of concomitant autoimmune pathology in conditions of metabolic disorders at DM type 2. Insulin resistance and hyperinsulinemia, which are marked with DM type 2, promote proliferative processes, in particular in thyroid tissue, and older age of patients with type 2 DM contributes to the progression of involutional changes and further development of hypothyroidism. Obligatory comprehensive examination of patients with type 2 DM is recommended in the presence of concomitant thyroid pathology.
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