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维生素D状态与二甲双胍对亚临床甲状腺功能减退女性下丘脑-垂体-甲状腺轴活性影响之间的关联

The Association between Vitamin D Status and the Impact of Metformin on Hypothalamic-Pituitary-Thyroid Axis Activity in Women with Subclinical Hypothyroidism.

作者信息

Krysiak Robert, Kowalcze Karolina, Szkróbka Witold, Okopień Bogusław

机构信息

Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland.

Department of Pediatrics in Bytom, Faculty of Health Sciences in Katowice, Medical University of Silesia, Stefana Batorego 15, 41-902 Bytom, Poland.

出版信息

Pharmaceutics. 2024 Aug 20;16(8):1093. doi: 10.3390/pharmaceutics16081093.

Abstract

Metformin inhibits enhanced secretion of anterior pituitary hormones. Its impact on prolactin and gonadotropin concentrations is absent in individuals with hypovitaminosis D. The aim of this prospective cohort study was to investigate whether vitamin D status determines the effect of metformin on hypothalamic-pituitary-thyroid axis activity in levothyroxine-naïve women. The study included three groups of women of reproductive age with subclinical non-autoimmune hypothyroidism, which were matched for age, thyroid-stimulating hormone (TSH) concentration, and insulin sensitivity: untreated women with vitamin D deficiency/insufficiency (group A), women effectively supplemented with exogenous calciferol (group B), and untreated women with normal 25-hydroxyvitamin D concentrations (25OHD) (group C). Owing to concomitant type 2 diabetes or prediabetes, all subjects were treated with metformin. Concentrations of 25OHD, TSH, total and free thyroid hormones, glucose, insulin, glycated hemoglobin (HbA), prolactin, and peripheral markers of thyroid hormone action were assayed before metformin treatment and six months later. Based on hormone concentration, structure parameters of thyroid homeostasis were calculated. Except for 25OHD concentrations, there were no between-group differences in baseline values of the measured variables. Metformin reduced glucose, the homeostatic model assessment 1 of insulin resistance ratio (HOMA1-IR), and HbA in all study group, but these effects were less pronounced in group A than in the remaining groups. The reduction in TSH and Jostel's index was observed only in groups B and C, and its degree correlated with baseline TSH concentrations, baseline 25OHD concentrations, and the degree of improvement in HOMA1-IR. The drug did not affect circulating levels of 25OHD, free and total thyroid hormones, prolactin, other structure parameters of thyroid homeostasis, and markers of thyroid hormone action. The obtained results allow us to conclude that low vitamin D status in young women mitigates the impact of metformin on thyrotroph secretory function.

摘要

二甲双胍可抑制垂体前叶激素分泌增加。维生素D缺乏的个体中,二甲双胍对催乳素和促性腺激素浓度无影响。这项前瞻性队列研究的目的是调查维生素D状态是否决定二甲双胍对未服用左甲状腺素的女性下丘脑-垂体-甲状腺轴活性的影响。该研究纳入了三组患有亚临床非自身免疫性甲状腺功能减退的育龄女性,她们在年龄、促甲状腺激素(TSH)浓度和胰岛素敏感性方面相匹配:维生素D缺乏/不足的未治疗女性(A组)、有效补充外源性骨化醇的女性(B组)以及25-羟维生素D浓度(25OHD)正常的未治疗女性(C组)。由于合并2型糖尿病或糖尿病前期,所有受试者均接受二甲双胍治疗。在二甲双胍治疗前及治疗六个月后,检测25OHD、TSH、总甲状腺激素和游离甲状腺激素、血糖、胰岛素、糖化血红蛋白(HbA)、催乳素以及甲状腺激素作用的外周标志物浓度。根据激素浓度计算甲状腺稳态的结构参数。除25OHD浓度外,各测量变量的基线值在组间无差异。二甲双胍降低了所有研究组的血糖、胰岛素抵抗稳态模型评估1比值(HOMA1-IR)和HbA,但这些作用在A组不如其余组明显。仅在B组和C组观察到TSH和乔斯特尔指数降低,其降低程度与基线TSH浓度、基线25OHD浓度以及HOMA1-IR的改善程度相关。该药物不影响25OHD、游离和总甲状腺激素、催乳素的循环水平、甲状腺稳态的其他结构参数以及甲状腺激素作用的标志物。所得结果使我们得出结论,年轻女性维生素D水平低会减轻二甲双胍对促甲状腺细胞分泌功能的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08e4/11360748/1afd212c51fd/pharmaceutics-16-01093-g001.jpg

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