Gholampour Dehaki M, Amouzegar A, Delshad H, Mehrabi Y, Tohidi M, Azizi F
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I.R. Iran.
Department of Internal Medicine, School of Medicine, Aja University of Medical Science, Tehran, I.R. Iran.
PLoS One. 2017 Oct 3;12(10):e0184808. doi: 10.1371/journal.pone.0184808. eCollection 2017.
This study aimed to assess the prevalence and incidence and predictive factors of thyroid disorders (TD) in patients with impaired glucose metabolism.
Prevalence of TD was calculated in patients with impaired glucose metabolism compared to healthy controls, aged over 30 years in phase 1 of the Tehran Thyroid Study (TTS). Follow up assessments were conducted every 3 yrs, after which incidence of TD was calculated and its correlations with age, sex, smoking, blood pressure, body mass index (BMI), thyroid peroxidase antibody (TPOAb), thyrotropin (TSH), insulin resistance index, triglycerides and cholesterol were assessed.
Incidence of TD among 435 diabetics, 286 prediabetics, and 989 healthy controls at baseline was 14, 18, and 21 per 1000 patients per year, respectively, being significantly lower in diabetics than that in healthy controls, a difference however that was not significant after adjusting for the variables mentioned (OR:0.64, 95% CI: 0.39-1.01). The incidence of TD in subjects with baseline serum TSH>1.94 mU/L or TPOAb≥40 IU/ml in all three groups was higher than that in patients with TSH≤1.94 mU/L or TPOAb<40 IU/ml, and remained significant after variable adjustment. Baseline TSH>1.94 mU/L was predictive of TD with 70% sensitivity and specificity. Baseline serum TSH (ROC area: 0.73, 95% CI: 0.68-0.77) had better predictive value than TPOAb (ROC area: 0.65, 95% CI: 0.61-0.69) for developing TD.
Incidence of TD in type 2 diabetics or prediabetics is not higher than healthy controls. It is however necessary to conduct thyroid tests in patients with TPOAb≥40 IU/ml or TSH>1.94 mU/L.
本研究旨在评估糖代谢受损患者甲状腺疾病（TD）的患病率、发病率及预测因素。
在德黑兰甲状腺研究（TTS）第一阶段中，计算30岁以上糖代谢受损患者与健康对照者的TD患病率。每3年进行一次随访评估，之后计算TD发病率，并评估其与年龄、性别、吸烟、血压、体重指数（BMI）、甲状腺过氧化物酶抗体（TPOAb）、促甲状腺激素（TSH）、胰岛素抵抗指数、甘油三酯和胆固醇的相关性。
在基线时，435名糖尿病患者、286名糖尿病前期患者和989名健康对照者中，TD的发病率分别为每年每1000名患者14例、18例和21例，糖尿病患者的发病率显著低于健康对照者，但在对上述变量进行校正后，差异无统计学意义（OR：0.64，95%CI：0.39 - 1.01）。在所有三组中，基线血清TSH>1.94 mU/L或TPOAb≥40 IU/ml的受试者中TD的发病率高于TSH≤1.94 mU/L或TPOAb<40 IU/ml的患者，且在变量校正后仍具有统计学意义。基线TSH>1.94 mU/L对TD的预测敏感性和特异性为70%。对于TD的发生，基线血清TSH（ROC曲线面积：0.73，95%CI：0.68 - 0.77）比TPOAb（ROC曲线面积：0.65，95%CI：0.61 - 0.69）具有更好的预测价值。
2型糖尿病患者或糖尿病前期患者中TD的发病率不高于健康对照者。然而，对于TPOAb≥40 IU/ml或TSH>1.94 mU/L的患者，有必要进行甲状腺检查。
