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.
Ashrafuzzaman SM, Taib AN, Rahman R, Latif ZA. Prevalence of diabetes among hypothyroid subjects. Mymensingh Med J. 2012 Jan;21(1):129-32.
Fleiner HF, Bjøro T, Midthjell K, Grill V, Åsvold BO. Prevalence of thyroid dysfunction in autoimmune and type 2 diabetes. The population-based HUNT Study in Norway. J Clin Endocrinol Metab. 2015 Nov 19:jc20153235.
Han C, He X, Xia X, Li Y, Shi X, Shan Z, Teng W. Subclinical Hypothyroidism and Type 2 Diabetes: A Systematic Review and Meta-Analysis. PLoS One. 2015 Aug 13;10(8):e0135233. doi: 10.1371/journal.pone.0135233. eCollection 2015.
Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004;291(2):228-38. doi: 10.1001/jama.291.2.228291/2/228 [pii].
Sawin CT, Castelli WP, Hershman JM, McNamara P, Bacharach P. The aging thyroid. Thyroid deficiency in the Framingham Study. Arch Intern Med. 1985;145(8):1386-8.
Distiller LA, Polakow ES, Joffe BI. Type 2 diabetes mellitus and hypothyroidism: the possible influence of metformin therapy. Diabet Med. 2014;31(2):172-5. doi: 10.1111/ dme.12342 .
Pearce SH, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J. 2013;2(4):215-28. doi:10.1159/000356507 etj-0002-0215 [pii].
Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22(12):1200-35. doi:10.1089/thy.2012.0205 .
Zhao W, Han C, Shi X, Xiong C, Sun J, Shan Z, et al. Prevalence of goiter and thyroid nodules before and after implementation of the universal salt iodization program in mainland China from 1985 to 2014: a systematic review and meta-analysis. PLoS One. 2014; 9(10):e109549 doi:10.1371/journal.pone.0109549 PONE-D-14-20444 [pii].
Liu W, Yang J, Yu M, Pan S. Screening for subclinical hypothyroidism in type 2 diabetes mellitus patients in Beijing (Article in Chinese). Clinical Focus. 2007;22(21):1558-60.
Zhang N, Tang W, Lu W, Xu K, Bo L, Liu C, et al. Study on type 2 diabetes mellitus with subclinical hypothyroidism in Jiangsu (Article in Chinese). Chinese Journal of Practical Internal Medicine. 2009;29(12):1106-8.
Diez JJ, Sanchez P, Iglesias P. Prevalence of thyroid dysfunction in patients with type 2 diabetes. Exp Clin Endocrinol Diabetes. 2011;119(4):201-7. doi: 10.1055/s-0031-1271691.
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