Palma Cátia Cristina Silva Sousa Vergara, Pavesi Marco, Nogueira Verônica Guedes, Clemente Eliete Leão Silva, Vasconcellos Maria de Fátima Bevilacqua Motta Pereira, Pereira Luiz Carlos, Pacheco Fernanda Faissol, Braga Tássia Gomide, Bello Ludmila de Faria, Soares Juliana Oliveira, Dos Santos Stefanie Cathren Fenizola, Campos Vinícius Paes Leme Cavalcante, Gomes Marília Brito
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.
Diabetol Metab Syndr. 2013 Oct 9;5(1):58. doi: 10.1186/1758-5996-5-58.
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).
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.
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.
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.
糖尿病（DM）和甲状腺功能障碍（TD）是临床实践中最常见的两种内分泌疾病。未被识别的TD可能会对代谢控制产生不利影响，并给已经存在心血管疾病易患因素的情况增加更多风险。本研究的目的是调查1型和2型糖尿病（T1DM和T2DM）患者中TD的患病率。
这是一项观察性横断面研究。386例定期到佩德罗·埃内斯托大学医院糖尿病科门诊就诊的T1DM或T2DM患者参与了本研究。所有患者均接受了临床和实验室评估。如果促甲状腺激素（TSH）>4.20μUI/mL且游离甲状腺素（FT4）<0.93ng/dL，则甲状腺功能障碍被分类为临床甲状腺功能减退（C-Hypo）；如果TSH>4.20μUI/ml且FT4范围为0.93至1.7ng/dL，则为亚临床甲状腺功能减退（SC-Hypo）；如果TSH<0.27μUI/ml且FT4在正常范围（0.93和1.7ng/dL），则为亚临床甲状腺功能亢进（SC-Hyper），如果TSH<0.27μUI/ml且FT4>1.7μUI/mL，则为临床甲状腺功能亢进（C-Hyper）。当抗甲状腺过氧化物酶（anti-TPO）水平大于34IU/mL时诊断为自身免疫性疾病。自身免疫阳性不作为甲状腺功能障碍的标准。
所有糖尿病患者中TD的患病率为14.7%。在未患或否认既往有TD的患者中，TD的发生率为13%。最常见的TD是亚临床甲状腺功能减退，在13%的T1DM患者和12%的T2DM患者中出现。抗TPO抗体的患病率为10.8%。在临床评估期间诊断出44例（11.2%）新的TD病例。49例既往有TD的患者中，50%的T1DM患者和76%的T2DM患者TSH水平正常。
我们得出结论，鉴于新诊断病例的患病率以及未诊断的甲状腺功能障碍可能加重高血压和血脂异常等经典危险因素，糖尿病患者应常规进行甲状腺疾病筛查。
