The First Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
Wakayama City Medical Association Seijinbyo Center, 2-1-2 Tebira, Wakayama, Wakayama, 640-8319, Japan.
BMC Endocr Disord. 2023 Jul 10;23(1):146. doi: 10.1186/s12902-023-01393-4.
The higher prevalence of thyroid dysfunction in type 1 diabetes patients has been well established, whereas it is a matter of debate whether that is also observed in type 2 diabetes patients. This study was conducted to reveal whether higher prevalence of thyroid dysfunction is observed in patients with type 2 diabetes.
We examined thyroid functions and thyroid autoantibodies in 200 patients with type 2 diabetes and 225 controls, with 24 months follow up for those with type 2 diabetes.
Serum free triiodothyronine (fT3) levels and fT3/free thyroxine (fT4) ratio were significantly lower, while fT4 levels were significantly higher in patients with type 2 diabetes. The number of patients with thyroid dysfunction or patients positive for thyroid autoantibodies were not different between the two groups. The fT3/fT4 ratio was positively and negatively correlated with serum c-peptide and HbA1c levels, respectively, suggesting that the difference can be attributable to insulin resistance and diabetic control. In the follow-up observation, we found no significant correlation between basal thyrotropin (TSH), fT3, fT4 or fT3/fT4 ratio with the amounts of changes of HbA1c levels at 12 or 24 months after the basal measurements. There was a negative relationship between TSH levels and eGFR at baseline measurements, but TSH levels did not seem to predict future decline of eGFR levels. No relationship was observed between urine albumin/ g‧cre levels and thyroid function.
Thyroid dysfunction and thyroid autoantibodies were not different in prevalence between patients with type 2 diabetes and controls, although in patients with type 2 diabetes, the fT3/fT4 ratio was decreased. Basal thyroid function did not predict future diabetes control or renal function within 24 months of follow-up.
1 型糖尿病患者甲状腺功能障碍的患病率较高已得到充分证实，而 2 型糖尿病患者是否也存在这种情况则存在争议。本研究旨在揭示 2 型糖尿病患者中是否存在更高的甲状腺功能障碍患病率。
我们检查了 200 例 2 型糖尿病患者和 225 名对照者的甲状腺功能和甲状腺自身抗体，并对 2 型糖尿病患者进行了 24 个月的随访。
2 型糖尿病患者的血清游离三碘甲状腺原氨酸（fT3）水平和 fT3/游离甲状腺素（fT4）比值显著降低，而 fT4 水平显著升高。两组患者的甲状腺功能障碍患者或甲状腺自身抗体阳性患者数量无差异。fT3/fT4 比值与血清 C 肽和 HbA1c 水平呈正相关和负相关，提示这种差异可能与胰岛素抵抗和糖尿病控制有关。在随访观察中，我们发现基础促甲状腺激素（TSH）、fT3、fT4 或 fT3/fT4 比值与基础测量后 12 或 24 个月 HbA1c 水平变化量之间无显著相关性。基础测量时 TSH 水平与 eGFR 呈负相关，但 TSH 水平似乎不能预测未来 eGFR 水平的下降。TSH 水平与尿白蛋白/肌酐比值之间无相关性。
2 型糖尿病患者与对照组之间甲状腺功能障碍和甲状腺自身抗体的患病率无差异，尽管 2 型糖尿病患者的 fT3/fT4 比值降低。基础甲状腺功能不能预测未来 24 个月随访期间的糖尿病控制或肾功能。
