Department of Internal Medicine, Taipei Medical University Hospital, Taiwan.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taiwan.
Medicine (Baltimore). 2022 Aug 26;101(34):e30092. doi: 10.1097/MD.0000000000030092.
Graves disease (GD) and type 2 diabetes mellitus (T2DM) both impair liver function; we therefore explored the possibility of a relationship among diabetic control, thyroid function, and liver function. This retrospective, cross-sectional study compared serum liver function biomarkers of primary GD patients in a single center between 2016 and 2020, derived from clinical databases, and clarified the correlation of liver function in GD patients with or without T2DM. Furthermore, the diabetes mellitus group was divided into glycated hemoglobin A1C (HbA1C) <6.5% group and ≥6.5% group to further analyze the effect by disease control in patients. Statistical differences between groups were assessed using independent t tests to clarify the association of serum biomarkers between GD with T2DM. Pearson test was applied to assess within-group statistical correlation of serum biomarkers. The correlation of factors in each group was demonstrated by using the Kendall tau-b method and stepwise regression analysis. A total of 77 patients were included in the study. In the study population, glutamate pyruvate transaminase (GPT) was significantly correlated with thyroid-stimulating hormone, and HbA1C was significantly correlated with alkaline phosphatase (ALK-P), glutamate oxaloacetate transaminase (GOT), and GPT. An examination of GOT, GPT, free thyroxine (FT4), and HbA1C levels revealed a significant difference between the non-T2DM and T2DM groups. GPT also exhibited a significant correlation with triiodothyronine in the T2DM group. The T2DM group was further divided into groups: HbA1C <6.5% and ≥6.5%. The results demonstrated that ALK-P, GOT, GPT, and FT4 levels were significantly different between the groups. A significant correlation between ALK-P and thyroid-stimulating hormone and between GOT and FT4 was also identified in the HbA1C <6.5% group. Our single-center study revealed that diabetes affects liver function in patients with GD. For patients with T2DM, when liver function becomes impaired, thyroid function control deteriorates. GPT was correlated with triiodothyronine but not with FT4, which indicated the impairment of deiodination in the liver. This phenomenon was not observed in the non-T2DM population. The early detection of abnormal liver function in patients with GD and T2DM may help limit the development of comorbidities and improve disease management.
格雷夫斯病（GD）和 2 型糖尿病（T2DM）均会损害肝功能；因此，我们探讨了糖尿病控制、甲状腺功能和肝功能之间关系的可能性。这项回顾性、横断面研究比较了 2016 年至 2020 年期间单中心原发性 GD 患者的血清肝功能生物标志物，这些数据来源于临床数据库，并阐明了 GD 患者中 T2DM 与肝功能之间的相关性。此外，糖尿病组根据糖化血红蛋白（HbA1C）<6.5%和≥6.5%进一步分为两组，以进一步分析患者疾病控制对肝功能的影响。采用独立 t 检验评估组间差异，以阐明 GD 合并 T2DM 患者血清生物标志物的相关性。采用 Pearson 检验评估组内血清生物标志物的统计学相关性。应用 Kendall tau-b 法和逐步回归分析显示各组间各因素的相关性。研究共纳入 77 例患者。在研究人群中，谷氨酸丙酮酸转氨酶（GPT）与促甲状腺激素显著相关，HbA1C 与碱性磷酸酶（ALKP）、谷氨酸草酰乙酸转氨酶（GOT）和 GPT 显著相关。非 T2DM 组和 T2DM 组 GOT、GPT、游离甲状腺素（FT4）和 HbA1C 水平检查结果有显著差异。T2DM 组中 GPT 也与三碘甲状腺原氨酸显著相关。T2DM 组进一步分为 HbA1C<6.5%和≥6.5%两组。结果显示，两组间 ALK-P、GOT、GPT 和 FT4 水平有显著差异。HbA1C<6.5%组中 ALK-P 与促甲状腺激素和 GOT 与 FT4 之间也存在显著相关性。我们的单中心研究表明，糖尿病会影响 GD 患者的肝功能。对于 T2DM 患者，当肝功能受损时，甲状腺功能控制会恶化。GPT 与三碘甲状腺原氨酸相关，但与 FT4 无关，这表明肝脏脱碘功能受损。这种现象在非 T2DM 人群中并未观察到。早期发现 GD 和 T2DM 患者的肝功能异常可能有助于限制并发症的发生并改善疾病管理。
