Gonzalo M A, Grant C, Moreno I, Garcia F J, Suárez A I, Herrera-Pombo J L, Rovira A
Department of Endocrinology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain.
Clin Endocrinol (Oxf). 1996 Dec;45(6):689-97. doi: 10.1046/j.1365-2265.1996.8500860.x.
Inter-relationships between insulin sensitivity and body weight in patients with hyperthyroidism remain incompletely understood. We have examined whether a mild excess of body weight exacerbates the metabolic abnormalities of spontaneous hyperthyroidism.
Insulin-modified intravenous glucose tolerance tests were performed on 14 hyperthyroid women with body mass indices (BMI) ranging from 21 to 31 kg/m2. A control group of 19 healthy women matched for age and BMI was also studied.
Intravenous glucose tolerance (KG), first and second-phase integrated insulin responses to glucose, the integrated glucose area under the curve (AUC), and minimal model parameters of insulin sensitivity (SI) and glucose effectiveness (SG) were determined.
Hyperthyroid women had mean KG, glucose-induced insulin secretion and SG values similar to those in control women. The mean glucose AUC was higher in hyperthyroid patients (P < 0.05). Lower insulin sensitivity was observed in hyperthyroid patients than in control women (SI = 0.38 +/- 0.07 vs 0.59 +/- 0.07 l/min pmol 10(4) (mean +/- SEM), P < 0.05). A steeper decline in insulin sensitivity with increase in body mass index was found in hyperthyroid women when compared with the control group, after adjusting for age. When groups were compared according to their BMI, hyperthyroid women with normal weight (BMI < or = 25 kg/m2, n = 8) had mean KG, insulin response to glucose, glucose AUC, SG and SI values similar to those in normal weight control women (n = 11). Overweight hyperthyroid patients (BMI > 25 kg/m2, n = 6) had a higher (P < 0.05) second-phase insulin response to glucose than normal weight patients, a higher glucose AUC (P < 0.05) than normal weight patients and overweight controls (n = 8), and a lower SI (P < 0.05) than normal weight patients and overweight controls. SG was not influenced by BMI in hyperthyroid patients.
These results suggest that overall glucose tolerance was not significantly affected in normal weight hyperthyroid women. However, when a moderate excess of weight is also present, a state of clear insulin resistance occurs.
甲状腺功能亢进症患者胰岛素敏感性与体重之间的相互关系仍未完全明确。我们研究了轻度体重超标是否会加剧自发性甲状腺功能亢进症的代谢异常。
对14名体重指数（BMI）在21至31kg/m²之间的甲状腺功能亢进女性进行了胰岛素改良静脉葡萄糖耐量试验。还研究了19名年龄和BMI相匹配的健康女性组成的对照组。
测定静脉葡萄糖耐量（KG）、葡萄糖刺激后的第一和第二阶段胰岛素综合反应、曲线下葡萄糖综合面积（AUC）以及胰岛素敏感性（SI）和葡萄糖效能（SG）的最小模型参数。
甲状腺功能亢进女性的平均KG、葡萄糖诱导的胰岛素分泌和SG值与对照女性相似。甲状腺功能亢进患者的平均葡萄糖AUC较高（P<0.05）。与对照女性相比，甲状腺功能亢进患者的胰岛素敏感性较低（SI = 0.38±0.07对0.59±0.07 l/min pmol 10⁴（平均值±标准误），P<0.05）。在调整年龄后，与对照组相比，甲状腺功能亢进女性中胰岛素敏感性随体重指数增加而下降得更陡峭。根据BMI对各组进行比较时，体重正常的甲状腺功能亢进女性（BMI≤25kg/m²，n = 8）的平均KG、葡萄糖刺激后的胰岛素反应、葡萄糖AUC、SG和SI值与体重正常的对照女性（n = 11）相似。超重的甲状腺功能亢进患者（BMI>25kg/m²，n = 6）葡萄糖刺激后的第二阶段胰岛素反应高于体重正常的患者（P<0.05），葡萄糖AUC高于体重正常的患者和超重对照组（n = 8）（P<0.05），且SI低于体重正常的患者和超重对照组（P<0.05）。甲状腺功能亢进患者的SG不受BMI影响。
这些结果表明，体重正常的甲状腺功能亢进女性的总体葡萄糖耐量未受到显著影响。然而，当同时存在适度超重时，会出现明显的胰岛素抵抗状态。
