Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany.
Endocr Rev. 2019 Jun 1;40(3):789-824. doi: 10.1210/er.2018-00163.
Thyroid dysfunction and diabetes mellitus are closely linked. Several studies have documented the increased prevalence of thyroid disorders in patients with diabetes mellitus and vice versa. This review critically discusses the different underlying mechanisms linking type 1 and 2 diabetes and thyroid dysfunction to demonstrate that the association of these two common disorders is unlikely a simple coincidence. We assess the current state of knowledge on the central and peripheral control of thyroid hormone on food intake and glucose and lipid metabolism in target tissues (such as liver, white and brown adipose tissue, pancreatic β cells, and skeletal muscle) to explain the mechanism linking overt and subclinical hypothyroidism to type 2 diabetes and metabolic syndrome. We also elucidate the common susceptibility genes and the pathogenetic mechanisms contributing to the autoimmune mechanism involved in the onset of type 1 diabetes mellitus and autoimmune thyroid disorders. An untreated thyroid dysfunction can impair the metabolic control of diabetic patients, and this association can have important repercussions on the outcome of both of these disorders. Therefore, we offer recommendations for the diagnosis, management, and screening of thyroid disorders in patients with diabetes mellitus, including the treatment of diabetic patients planning a pregnancy. We also discuss the major causes of failure to achieve an optimal management of thyroid dysfunction in diabetic patients and provide recommendations for assessing and treating these disorders during therapy with antidiabetic drugs. An algorithm for a correct approach of these disorders when linked is also provided.
甲状腺功能障碍与糖尿病密切相关。有几项研究记录了糖尿病患者甲状腺疾病患病率的增加，反之亦然。这篇综述批判性地讨论了将 1 型和 2 型糖尿病与甲状腺功能障碍联系起来的不同潜在机制，以证明这两种常见疾病的关联不太可能仅仅是巧合。我们评估了目前关于甲状腺激素对食物摄入以及葡萄糖和脂质代谢在靶组织（如肝脏、白色和棕色脂肪组织、胰岛β细胞和骨骼肌）中的中央和外周控制的知识状态，以解释显性和亚临床甲状腺功能减退与 2 型糖尿病和代谢综合征之间的联系机制。我们还阐明了常见的易感基因和导致 1 型糖尿病和自身免疫性甲状腺疾病发病机制的致病机制。未经治疗的甲状腺功能障碍可损害糖尿病患者的代谢控制，这种关联对这两种疾病的结局都有重要影响。因此，我们为糖尿病患者的甲状腺功能障碍的诊断、管理和筛查提供了建议，包括计划怀孕的糖尿病患者的治疗。我们还讨论了未能实现糖尿病患者甲状腺功能障碍最佳管理的主要原因，并为在抗糖尿病药物治疗期间评估和治疗这些疾病提供了建议。还提供了一种正确处理这些相关疾病的算法。
