Kabadi U M
J Clin Endocrinol Metab. 1984 Sep;59(3):521-5. doi: 10.1210/jcem-59-3-521.
Altered thyroid hormone metabolism with decreased serum T3 and increased rT3 concentrations in patients with uncontrolled diabetes mellitus has been well documented. However, data regarding TSH secretion are sparse, especially the influence of glycemic control. Therefore, we examined serum T4, free T4, T3, rT3, T3 resin uptake, and TSH as well as the TSH response to TRH administration [expressed as TSH increment (delta TSH) and area under the curve (theta TSH)] in 29 newly discovered type II diabetic patients (DM) before treatment and in 12 normal subjects. The study was repeated in the DM patients after attainment of euglycemia and normalization of glycosylated hemoglobin (HbA1C) following therapy with diet and tolazamide for 8-12 weeks. Serum T4, free T4, and T3 resin uptake were not significantly different in DM compared to those in normal subjects. Serum T3 was low and rT3 was high in DM before treatment, and both normalized on achieving the euglycemic state. Basal TSH in uncontrolled DM was not significantly different from that in normal subjects and remained unchanged during treatment. However, delta TSH and theta TSH were significantly reduced (P less than 0.01) in uncontrolled DM. Both fasting plasma glucose (FBS) and HbA1C levels correlated inversely with delta TSH as well as theta TSH (FBS vs. delta TSH, r = -0.42; FBS vs. theta TSH, r = -0.38; HbA1C vs. delta TSH, r = -0.40; HbA1C vs. theta TSH, r = -0.42; P less than 0.05 for all correlations). Finally, TSH responses returned to normal on attainment of euglycemia and normal HbA1C concentrations. These studies indicate that regulation of TSH secretion is altered in DM during the decompensated state and normalizes when euglycemia is achieved.
糖尿病控制不佳患者甲状腺激素代谢改变，血清总三碘甲状腺原氨酸（T3）降低，反三碘甲状腺原氨酸（rT3）浓度升高，这一点已有充分记录。然而，关于促甲状腺激素（TSH）分泌的数据稀少，尤其是血糖控制的影响。因此，我们检测了29例新发现的未经治疗的II型糖尿病患者（DM）以及12名正常受试者的血清总甲状腺素（T4）、游离甲状腺素（FT4）、T3、rT3、T3树脂摄取率和TSH，以及TSH对促甲状腺激素释放激素（TRH）给药的反应[表示为TSH增加值（△TSH）和曲线下面积（θTSH）]。在29例新发现的II型糖尿病患者接受饮食和甲苯磺丁脲治疗8 - 12周达到血糖正常且糖化血红蛋白（HbA1C）正常后，重复该研究。与正常受试者相比，DM患者的血清T4、FT4和T3树脂摄取率无显著差异。治疗前DM患者血清T3降低，rT3升高，血糖正常后两者均恢复正常。未控制的DM患者基础TSH与正常受试者无显著差异，且在治疗期间保持不变。然而，未控制的DM患者△TSH和θTSH显著降低（P < 0.01）。空腹血糖（FBS）和HbA1C水平与△TSH以及θTSH均呈负相关（FBS与△TSH，r = -0.42；FBS与θTSH，r = -0.38；HbA1C与△TSH，r = -0.40；HbA1C与θTSH，r = -0.42；所有相关性P < 0.05）。最后，血糖正常且HbA1C浓度正常时，TSH反应恢复正常。这些研究表明，DM失代偿期TSH分泌调节发生改变，血糖正常时恢复正常。
