糖尿病与甲状腺疾病

糖尿病和甲状腺疾病是常见的累及能量和物质代谢的内分泌疾病.流行病学研究结果显示,与普通人群相比,糖尿病患者中甲状腺功能异常发生率明显增高.甲状腺激素与糖代谢的多个环节关系密切,甲状腺功能异常可伴发各种不同程度的糖代谢异常.糖尿病患者合并甲状腺功能异常时不仅加重机体代谢异常,而且还可以放大患者心血管疾病患病风险.早期发现糖尿病患者潜在的甲状腺功能异常,关注甲状腺疾病人群中糖代谢状况,有利于控制血糖,减轻心血管疾病风险,改善总体预后.现将糖尿病与甲状腺疾病的关系作一综述.     

糖尿病合并甲状腺异常的研究进展

糖尿病常合并甲状腺异常,主要表现为糖尿病患者甲状腺功能[主要是促甲状腺激素水平的升高和（或）三碘甲状腺原氨酸的降低]、甲状腺自身抗体（多表现为甲状腺球蛋白抗体及甲状腺过氧化物酶抗体阳性率增高）及甲状腺形态（体积多有增大）、基因（多与白细胞相关抗原相关）等方面的变化.糖尿病合并甲状腺异常的发病机制尚不完全清楚,有待于进一步研究.     

2型糖尿病合并甲状腺功能异常的诊治分析

目的探讨2型糖尿病合并甲状腺功能异常类型及治疗经验,提高临床诊治率。方法回顾性分析20例2型糖尿病合并甲状腺功能异常患者临床诊治资料,分析类型差异,经降糖治疗及甲状腺疾病对症处理后,观察患者血糖与甲状腺激素水平。结果本组2型糖尿病合并甲状腺功能亢进患者20.0%(4/20)明显低于甲状腺功能减退患者80.0%(16/20),两组疗效比较,差异有统计学意义(P<0.05)。经全面治疗后,全部患者甲状腺功能均恢复正常,无病死患者。结论 2型糖尿病合并甲状腺功能异常的临床表现易混淆,重视2型糖尿病患者存在甲状腺功能异常的筛查,是提高临床疗效的重要保证。     

老年2型糖尿病合并甲状腺功能异常的危险因素

目的探讨老年2型糖尿病(T2DM)患者合并甲状腺功能异常的危险因素。方法回顾性分析柳州市人民医院内分泌科2014年6月至2015年6月250例老年T2DM患者,观察T2DM患者甲状腺功能异常的患病情况和分布特点,T2DM合并甲状腺功能异常患者为研究组102例,不合并甲状腺功能异常为对照组148例,采用Logistic回归分析方法,对T2DM患者合并甲状腺功能异常的相关危险因素进行探讨。结果 102例T2DM合并甲状腺功能异常患者中甲状腺功能减低74例(72.55%),女54例(52.94%)、男20例(19.61%),甲状腺功能亢进28例(27.45%),女17例(16.67%),男11例(10.78%),女性甲状腺功能异常的患病率明显高于男性(P0.05)。与对照组相比较,研究组的体重指数(BMI)、甘油三酯(TG)、空腹C肽(CP)、糖化血红蛋白(Hb A1c),低密度脂蛋白胆固醇(LDL-C)均增高(P0.05),游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)及促甲状腺素(TSH)均有明显变化(P0.05)。Logistic回归分析显示:病程、Hb A1c是T2DM患者合并甲状腺功能异常的影响因素(P0.05)。结论 T2DM患者合并甲状腺功能异常较常见,应筛查和随访糖尿病患者的甲状腺功能,对指导糖尿病治疗有重要意义。     

亚临床甲状腺功能减退症对糖尿病血管并发症的影响

糖尿病和甲状腺功能障碍是常见的内分泌代谢疾病,糖尿病患者中合并甲状腺功能异常者越来越多,其中以亚临床甲状腺功能减退症居多.目前大多数研究认为,亚临床甲状腺功能减退症可通过引起血脂紊乱、血流动力学异常及内皮功能紊乱等机制,参与并加重糖尿病微血管及大血管并发症.     

糖尿病住院患者434例甲状腺疾病患病率分析

目的 探讨江苏地区糖尿病患者中甲状腺疾病的现患情况.方法 横向断面调查2006年10月至2007年6月于南京医科大学第一附属医院就诊的长期居住于江苏地区的434例糖尿病患者的甲状腺功能,其中109例患者作了甲状腺超声检查.结果 (1)糖尿病患者合并甲状腺疾病的患病率为23.27%,女性多见(P＜0.05),其中甲状腺功能减退者占16.36%(临床甲减4.15%,亚临床甲减12.21%),明显高于甲状腺功能亢进者6.91%(临床甲亢4.61%,亚临床甲亢2.30%),两者差异有统计学意义.(2)糖尿病患者中,甲状腺功能减退的患病率随患者年龄和糖尿病病程的增加而增加(P＜0.01);甲状腺功能亢进的患病率随糖尿病痛程的增加而降低(P＜0.05),随年龄的增加患病率改变无统计学意义.(3)糖尿病患者中甲状腺结节患病率为40.37%,性别差异无统计学意义,患病率随年龄的增加而增加(P＜0.05),不随糖尿病痛程的增加而增加.结论 糖尿病患者合并甲状腺疾病较常见,可能影响糖尿病患者的病情和预后,筛查和随访糖尿病患者的甲状腺功能及形态学状态具有重要的临床意义.     

住院2型糖尿病患者甲状腺功能状态的分析

目的分析2型糖尿病患者甲状腺功能状态。方法检测120例住院2型糖尿病患者血清游离T3（FT3）、游离T4（FT4）、促甲状腺激素（TSH），设正常对照组48例。结果2型糖尿病患者TSH水平显著高于正常对照组（P=0．000），FT3水平显著低于正常对照组（P=0．038）。2型糖尿病患者甲状腺功能异常者占40％，其中16．67％呈功能亢进，23．33％呈功能减退，其中女性2型糖尿病患者亚临床甲状腺功能减退达14．80％，显著高于男性（OR=5．565，95％CI：1．129～27．431）。男性2型糖尿病患者甲状腺功能减退的年龄显著高于功能亢进者（P=0．030），糖尿病病程有延长趋势（P=0．079）。而不同甲状腺功能状态的女性2型糖尿病患者的年龄、糖尿病病程无统计学差异。结论2型糖尿病患者甲状腺功能异常的发生率高，其中女性2型糖尿病患者亚临床甲状腺功能减退的患病率更高。     

宁波市某石油化工企业退休老年人甲状腺功能异常患病率调查

目的 调查宁波市某石油化工企业全体老年退休员工甲状腺功能异常的患病情况.方法 采用普查方法 ,调查了该企业1709例60岁以上退休员工的甲状腺疾病史和甲状腺功能状况.结果在该老年人群中,已知甲状腺疾病的患病率为3.8%,女性6.7%,男性2.3%;否认有甲状腺疾病史者中,甲状腺功能异常的患病率为6.7%,女性9.7%,男性5.2%;该老年人群已知与新发现甲状腺功能异常的总患病率达10.2%.女性15.8%,男性7.4%.亚临床甲状腺功能减退症占新发现甲状腺功能异常者的87.3%. 结论 宁波市老年石化退休员工甲状腺功能异常患病率高达10.2%.以亚临床甲状腺功能减退最为多见,女性患病率高于男性.     

糖尿病患者合并甲状腺功能障碍84例临床分析

在同一个体或家庭中糖尿病与自身免疫性甲状腺疾病会同时存在,两者同属内分泌系统疾病,多存在自身免疫功能异常.通常自身免疫性甲状腺疾病在女性和高龄人群发病率较高,甲状腺功能异常引起代谢紊乱从而影响1型糖尿病.合并有自身免疫性甲状腺疾病的糖尿病患者病情会加重'<[1]>.国内对这两种疾病合并发生也有关注,但多是针对病例的报道'<2-4>.本研究通过比较正常人群与糖尿病患者中甲状腺疾病的发病情况,以期了解1型糖尿病与甲状腺疾病的关系.     

马鞍山地区糖尿病患者合并甲状腺疾病的调查

调查2009年10月至2011年6月于十七冶医院就诊的423例糖尿病患者的甲状腺功能,其中299例患者作了甲状腺超声检查。结果 (1)糖尿病患者合并甲状腺疾病的患病率为43.27%,其中甲状腺功能减退者占26.36%(临床甲减8.55%,亚临床甲减18.11%),甲状腺功能亢进者16.91%(临床甲亢10.61%,亚临床甲亢6.30%),低T3综合征者6.11%。(2)糖尿病患者中甲状腺疾病患病率女性高于男性,差异有统计学意义(P<0.05)。结论糖尿病与甲状腺疾病均是常见的内分泌代谢性疾病,二者并存并非少见,有时症状叠加互相影响,甲状腺疾病可加速糖尿病的进程,促进某些慢性并发症的发生;对于糖尿病合并甲状腺疾病患者应两病兼治。     

Thyroid dysfunction prevalence and relation to glycemic control in patients with type 2 diabetes mellitus

ObjectiveIt is usually difficult to clinically identify thyroid abnormalities in diabetics as features of thyroid dysfunction may simulate diabetes symptoms or complications. So, assessing thyroid dysfunction prevalence in patients with type 2 diabetes mellitus (DM) would help better control of DM and its complications. Several studies reported this prevalence, however, some included small sample size or lacked a control group. We aimed to determine thyroid dysfunction prevalence in diabetic patients as well as its relation to glycemic control.MethodsA cross-sectional study included 200 patients having type 2 DM and 200 apparently healthy controls. Each participant was tested for fasting and 2-h post-prandial blood glucose, glycated haemoglobin (HbA1C), thyroid function tests: thyroid-stimulating hormone (TSH), free tri-iodothyronine (FT3), free thyroxine (FT4), serum total cholesterol and triglycerides and thyroid antibodies; anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) for hypothyroidism only.ResultsThere was a significant increase in serum TSH and T3 levels in diabetics when compared with the controls, (P < 0.001, P = 0.001), respectively. Thyroid dysfunction was significantly more prevalent in patients with HbA1c ≥ 8%, (P = 0.0001), and in those having longer diabetes duration, (P < 0.001).ConclusionThere was a higher prevalence of thyroid dysfunction among patients with type 2 DM. This dysfunction increased with the rise of HbA1c. This could suggest that poor glycemic control may have a role in the development of thyroid dysfunction in type 2 DM patients. Subclinical hypothyroidism was the most prevalent type of thyroid dysfunction in diabetic patients.     

亚临床甲状腺疾病与缺血性卒中的风险和转归

亚临床甲状腺疾病包括亚临床甲状腺功能减退和亚临床甲状腺功能亢进,以后者更常见。亚临床甲状腺疾病可能导致高血压、糖尿病、血脂异常、动脉粥样硬化、心房颤动、高同型半胱氨酸血症等血管危险因素的发生率显著增高,同时与急性缺血性卒中的转归可能有关。     

Thyroid autoantibodies in Thai type 1 diabetic patients: clinical significance and their relationship with glutamic acid decarboxylase antibodies

OBJECTIVE: To study the clinical significance of thyroid autoantibodies in Thai patients with type 1 diabetes and their relationship with glutamic acid decarboxylase antibodies (GAD(65)Ab). METHODS: Thyroglobulin antibodies (TG-Ab) and thyroid peroxidase antibodies (TPO-Ab) were measured in 50 Thai type 1 diabetic patients. Forty-four patients also had GAD(65)Ab measured. Serum thyrotropin (TSH) was measured in all patients who had no history of thyroid disease regardless of thyroid antibody status. Clinical data including sex, age at onset and duration of diabetes, family history of diabetes, fasting c-peptide levels as well as frequencies of GAD(65)Ab were compared between patients with and without thyroid antibodies. GAD(65)Ab was also measured in 29 non-diabetic patients with hyperthyroid Graves' disease or Hashimoto thyroiditis as a control group. RESULTS: TG-Ab and TPO-Ab were positive in nine (18%) and 15 (30%) patients, respectively. Eight patients (16%) were positive for both antibodies. Two of 16 patients who were positive for TG-Ab or TPO-Ab had a previous history of hyperthyroidism prior to diabetes onset. Of the remainder, two were newly diagnosed with hyperthyroidism and one was found to have clinical hypothyroidism at the time of the study. None of 34 patients without thyroid antibodies had thyroid dysfunction. Eight patients with positive thyroid antibodies but without clinical thyroid dysfunction and 21 patients without thyroid antibodies were followed for up to 3 years, two patients of the first group developed hypothyroidism, whereas none of the latter developed thyroid dysfunction. The frequency of thyroid dysfunction at the time of initial study was significantly higher in patients with positive thyroid antibodies (3/14 vs. 0/34; P=0.021) and these patients who were initially euthyroid tended to have a higher risk of developing thyroid dysfunction (2/8 vs. 0/21; P=0.069). The frequency of thyroid antibodies was significantly increased in females and in those who had positive GAD(65)Ab. GAD(65)Ab was negative in all of the non-diabetic patients with autoimmune thyroid disease. CONCLUSIONS: About one-fourth of Thai patients with type 1 diabetes without thyroid disease had thyroid antibodies. The frequency of thyroid antibodies was increased in female and in GAD(65)Ab positive patients. The presence of thyroid antibodies is associated with a higher frequency of and may predict a higher risk for thyroid dysfunction in Thai type 1 diabetic patients.     

Serum thyrotropin is a better predictor of future thyroid dysfunction than thyroid autoantibody status in biochemically euthyroid patients with diabetes: implications for screening.

AIM: To ascertain the predictive values of thyroid autoantibodies and thyrotropin (TSH) levels for subsequent thyroid dysfunction in patients with diabetes. METHODS: Review of records of 467 patients who had attended diabetes clinics for a mean of 6.1 years. Baseline autoantibody and TSH results and thyroid status at annual review were determined. RESULTS: Thyroid disorders were known in 29 patients (6.2%), and newly identified in 32 (6.9%), at presentation. Of 406 patients with normal baseline thyroid status, 24 (5.9%) developed thyroid dysfunction during 6.1 years of mean follow-up. Higher baseline TSH concentration was associated with subsequent hypothyroidism; a threshold of 1.53 mU/L, approximately defining the top quartile, provided 75% sensitivity and specificity. Both TSH greater than 1.53 mU/L and positive autoantibody status predicted thyroid dysfunction, but only TSH was significant in multivariable analysis (odds ratio, 7.74, p < 0.001). No overt thyroid dysfunction developed in 293 patients with baseline TSH levels less than 1.53 mU/l. CONCLUSIONS: Baseline TSH level may be a better predictor of thyroid dysfunction than thyroid autoantibodies in people with diabetes. Patients with TSH levels below the top quartile have a risk of thyroid dysfunction similar to the general population. It may be appropriate to stop annual thyroid screening in this group, although confirmation is required.     

Prevalence of thyroid disorders in North Indian Type 2 diabetic subjects: A cross sectional study

Background

Type 2 diabetes mellitus (T2DM) is a major health burden worldwide with many patients encountering thyroid dysfunction later in their life. Various studies have found that diabetes and thyroid disorders mutually influence each other and both disorders tend to coexists. However, the prevalence of thyroid dysfunction and associated clinical variables in these patients has not been investigated.

Subclinical hyperthyroidism in patients with type 2 diabetes

Both subclinical hyperthyroidism and type 2 diabetes (T2D) have been associated with an increase in cardiovascular disease risk and mortality. We aimed to assess the prevalence of newly diagnosed subclinical hyperthyroidism in a cohort of patients with T2D, and also to analyse the relationships between diabetes-related characteristics and the presence of subclinical hyperthyroidism. 933 diabetic patients without previous history of thyroid disease (45.4% females, mean age 66.3 years, median duration of diabetes 10 years) were evaluated. A sample of 911 non-diabetic subjects without known thyroid dysfunction was studied as control group. Serum concentrations of thyrotropin were measured in all subjects. Subclinical hyperthyroidism was present in 4.3% of female and 3.5% of male diabetic patients. Relative risk was significant only for the female gender (OR 3.69, 95% CI 1.56-8.71). In comparison with diabetic patients without thyroid hyperfunction, patients with subclinical hyperthyroidism were older, had longer duration of diabetes, showed lower fasting glucose levels, had greater proportion of goitre and diet therapy, and had lower proportion of treatment with oral agents. Logistic regression analysis showed that age and the presence of goitre were significantly related to subclinical hyperthyroidism in patients with T2D. The risk for subclinical hyperthyroidism is increased in women with T2D. Advanced age and the presence of goitre are significantly and independently related with the presence of subclinical hyperthyroidism in diabetic population.     

合并2型糖尿病的甲状腺疾病的管理

甲状腺疾病和2型糖尿病是内分泌代谢性疾病中最常见的两种疾病.糖尿病对甲状腺疾病会产生影响,糖尿病急症或严重感染可能会诱发甲状腺危象;甲状腺疾病及抗甲状腺药物或糖皮质激素等另一方面又影响到糖代谢,导致血糖波动甚至心血管风险增加,故合并2型糖尿病的甲状腺疾病患者病情较复杂.文章就合并2型糖尿病的甲状腺疾病包括甲状腺功能亢进...     

Newly detected glucose disturbance is associated with a high prevalence of diastolic dysfunction: double risk for the development of heart failure?

Diastolic dysfunction is associated with a high rate of morbidity and mortality and has a high prevalence in patients with diabetes. Aim of the study was to investigate the prevalence of diastolic dysfunction in patients with newly detected glucose metabolism disorder (GMD) submitted for coronary angiography. Oral glucose tolerance test, echocardiography, and tissue Doppler imaging were performed in patients referred to coronary angiography. Prevalence of diastolic dysfunction was 97, 88, and 74% in the known diabetes, newly detected diabetes, and new diagnosed impaired glucose toleranc group, respectively. This is higher than previously reported. Severity of diastolic dysfunction was associated with higher 2-h plasma glucose levels and with new diagnosed diabetes. Screening patients with newly detected GMD for diastolic dysfunction may identify patients with double risk for cardiovascular morbidity and mortality and this group might be a target population to avoid development heart failure.     

Anti-TPO antibodies and screening of thyroid dysfunction in type 1 diabetic patients

The diagnosis of thyroid dysfunction is often late in type 1 diabetic population. So, the aims of this study were 1) to evaluate the prevalences of thyroperoxydase (TPO) and thyroglobulin (Tg) autoantibodies detected by highly sensitive radioimmunological method in a cohort of 258 adult type 1 diabetic patients without evidence of clinical thyroid disease; 2) to determine whether or not measurement of TPO and/or Tg antibodies can identify subjects at risk of clinical or infraclinical thyroid dysfunction by measuring TSH in the entire group. TPO antibodies were found in 45 of the 258 diabetic patients (17%). The prevalence of TPO antibodies was not influenced by the following factors: gender, duration of disease, age at screening and at diabetes diagnosis, positivity of familial history. Tg antibodies were found in 19 patients (7%), including 13 cases with TPO antibodies. All patients without TPO antibody (n=213), including Tg-positive patients displayed TSH values in normal range. Among the 45 TPO-positive patients, 11 patients displayed infraclinical thyroid dysfunction. At the end of the 5-year follow-up, only 2/45 patients became anti-TPO negative. Thirteen of the 45 patients developed subclinical or clinical thyroid diseases (4 Graves'disease and 9 thyroiditis with hypothyroidism). By contrast, none of 45 TPO negative patients, sex and age matched with the TPO-positive patients, developed during follow-up anti-TPO positivity and/or infraclinical thyroid dysfunction. In conclusion, the determination of TPO antibodies by a highly sensitive method allows identifying diabetic patients with thyroid autoimmunity and at risk of subsequent impaired thyroid function, whatever age at diagnosis and diabetes duration. By contrast, anti-Tg determination did not give further information about subsequent thyroid dysfunction. In TPO antibody positive patients repeated thyroid clinical examination and TSH determination could be recommended to detect infraclinical thyroid dysfunction.     

Coexistent insulin dependent diabetes mellitus and hyperthyroidism in a patient with Down's syndrome

The prevalence of thyroid disease is increased in Down's syndrome. Compared with adults, thyroid dysfunction in children with Down's syndrome is less frequently reported. Insulin dependent diabetes mellitus is also uncommon in Down's syndrome children. Coexistent insulin dependent diabetes mellitus and hyperthyroidism in Down's syndrome was only reported once previously in literature. We report an 8-year-old girl with Down's syndrome that had polyuria, polydipsia, abdominal pain and urinary incontinence one and half a month prior to admission. Physical examination revealed typical face of Mongolism and tachycardia. Thyroid glands were not palpable. Laboratory data revealed diabetic ketoacidosis with plasma glucose: 860 mg/dl. She had thyroid hyperfunction with TSH: < 0.1 microU/ml, T3: 219.7 ng/dl, T4: 15 micrograms/dl. Thyroid autoimmune antibodies were also increased. There was markedly increased radiotracer uptake in the bilateral thyroid glands in Tc-99 thyroid scan. We suggest that Down's syndrome children with insulin dependent diabetes mellitus should be evaluated carefully for thyroid function and autoimmune disease.