Endocr Pract. 2019 Jan;25(1):101-105. doi: 10.4158/EP-2018-0317.
Latin American Thyroid Society (LATS) Hypothyroidism Clinical Practice Guidelines recommend case finding of hypothyroid patients in multiple and different situations that agree with other Society guidelines. However, the detection of hypothyroidism in type 2 diabetes mellitus (T2DM) or metabolic syndrome (MetS) patients is not mentioned in particular. In the recent years, several basic and epidemiologic studies have appeared showing that a lower thyroid function and MetS/T2DM are associated. Hence, the aim of this review is to manifest the LATS position on the diagnosis of hypothyroidism in both MetS and T2DM patients.
A search was made in PubMed using the following terms: "hypothyroidism" AND "diabetes" OR "metabolic syndrome." The most relevant studies describing the prevalence and complications due to hypothyroidism in both MetS and T2DM patients were selected.
The current document reviews new information from studies that have shown that the prevalence of hypothyroidism is higher in T2DM patients (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.5 to 4.7) and that diabetic complications are more prevalent in subclinical hypothyroidism (ScH). The incidence of T2DM is 1.09-fold higher with each doubling of thyroid-stimulating hormone (TSH) mIU/L (95% CI, 1.06 to 1.12), and the incidence of prediabetes increases 15% (hazard ratio, 1.15; 95% CI, 1.04 to 1.26) in patients with TSH >5 mIU/L. Similarly, MetS is more prevalent in ScH compared to euthyroid individuals (OR, 1.31; 95% CI, 1.08 to 1.60).
Thyroid function is affected in MetS and T2DM, and hypothyroidism is more common in these patients. Diabetic complications are more frequent in ScH patients. Therefore, LATS now recommends aggressive case finding of hypothyroidism in both MetS and T2DM patients.
CI = confidence interval; GLUT4 = glucose transporter 4; HOMA-IR = homeostatic model assessment for insulin resistance; HR = hazard ratio; LATS = Latin American Thyroid Society; MetS = metabolic syndrome; OR = odds ratio; ScH = subclinical hypothyroidism; T2DM = type 2 diabetes mellitus; T3 = triiodothyronine; T4 = thyroxine; TSH = thyroid-stimulating hormone.
拉丁美洲甲状腺学会（LATS）的甲状腺功能减退临床实践指南建议在多种不同情况下发现甲状腺功能减退患者，这与其他学会的指南一致。然而，在 2 型糖尿病（T2DM）或代谢综合征（MetS）患者中，并未特别提及甲状腺功能减退的检测。近年来，出现了一些基础和流行病学研究表明，甲状腺功能较低与 MetS/T2DM 相关。因此，本综述旨在阐述 LATS 在 MetS 和 T2DM 患者中诊断甲状腺功能减退的立场。
在 PubMed 中使用以下术语进行搜索：“甲状腺功能减退”和“糖尿病”或“代谢综合征”。选择描述 MetS 和 T2DM 患者中甲状腺功能减退的患病率和并发症的最相关研究。
本文件审查了表明 T2DM 患者甲状腺功能减退患病率较高（比值比[OR]，3.45；95%置信区间[CI]，2.5 至 4.7）和亚临床甲状腺功能减退（ScH）中糖尿病并发症更为普遍的新信息。TSH 每增加 1 mIU/L，T2DM 的发病率增加 1.09 倍（95%CI，1.06 至 1.12），TSH>5 mIU/L 的患者发生糖尿病前期的风险增加 15%（风险比，1.15；95%CI，1.04 至 1.26）。同样，与甲状腺功能正常个体相比，ScH 患者更易患 MetS（OR，1.31；95%CI，1.08 至 1.60）。
甲状腺功能在 MetS 和 T2DM 中受到影响，这些患者中甲状腺功能减退更为常见。ScH 患者的糖尿病并发症更为常见。因此，LATS 现在建议在 MetS 和 T2DM 患者中积极发现甲状腺功能减退。
CI = 置信区间；GLUT4 = 葡萄糖转运蛋白 4；HOMA-IR = 胰岛素抵抗的稳态模型评估；HR = 风险比；LATS = 拉丁美洲甲状腺学会；MetS = 代谢综合征；OR = 比值比；ScH = 亚临床甲状腺功能减退；T2DM = 2 型糖尿病；T3 = 三碘甲状腺原氨酸；T4 = 甲状腺素；TSH = 促甲状腺激素。
