Duntas Leonidas H, Orgiazzi Jacques, Brabant Georg
Endocrine Unit, Evgenidion Hospital, University of Athens Medical School, Athens, GreeceService d' Endocrinologie-Diabète-Maladies Métaboliques, Centre Hospitalier, Lyon-Sud, FranceDepartment of Endocrinology, The Christie, Manchester Academic Health Science Centre, Manchester, UK.
Clin Endocrinol (Oxf). 2011 Jul;75(1):1-9. doi: 10.1111/j.1365-2265.2011.04029.x.
Thyroid disease and type 1 but also type 2 diabetes mellitus (DM) are strongly associated, and this has important clinical implications for insulin sensitivity and treatment requirements. The pathophysiological basis of this association has only recently been better elucidated. It rests on a complex interaction of common signalling pathways and, in the case of type 1 diabetes and autoimmune thyroid disease, on a linked genetic susceptibility. The pathophysiological mechanisms underlying this linked regulation are increasingly being unravelled. They are exemplified in the regulation of 5' adenosine monophosphate-activated protein kinase (AMPK), a central target not only for the modulation of insulin sensitivity but also for the feedback of thyroid hormones on appetite and energy expenditure. The present review will discuss these concepts and their consequences for the clinical care of patients with DM and thyroid disorders. Moreover, it makes reference to the added effect of metformin in suppressing TSH.
甲状腺疾病与1型糖尿病以及2型糖尿病（DM）都密切相关，这对胰岛素敏感性和治疗需求具有重要的临床意义。这种关联的病理生理基础直到最近才得到更好的阐明。它基于常见信号通路的复杂相互作用，对于1型糖尿病和自身免疫性甲状腺疾病而言，还基于相关的遗传易感性。这种关联调节背后的病理生理机制正越来越多地被揭示出来。5' 腺苷单磷酸激活蛋白激酶（AMPK）的调节就是例证，AMPK不仅是调节胰岛素敏感性的核心靶点，也是甲状腺激素对食欲和能量消耗进行反馈的核心靶点。本综述将讨论这些概念及其对糖尿病和甲状腺疾病患者临床护理的影响。此外，还提及了二甲双胍在抑制促甲状腺激素方面的附加作用。
