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Krysiak R, Kowalcze K, Okopień B. Subclinical Hyperthyroidism Enhances Gonadotropin-Lowering Effects of Metformin in Postmenopausal Women. J Clin Pharmacol 2025; 65:318-327. [PMID: 39363530 DOI: 10.1002/jcph.6144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 09/07/2024] [Accepted: 09/17/2024] [Indexed: 10/05/2024]
Abstract
Metformin treatment decreases elevated concentrations of anterior pituitary hormones. The aim of this prospective, cohort study was to investigate whether hyperthyroidism modulates the impact of metformin on gonadotroph secretory function. The study population included 48 postmenopausal women with untreated type 2 diabetes or prediabetes, 24 of whom had coexisting grade 1 subclinical hyperthyroidism. Both groups were matched for age, insulin sensitivity, and gonadotropin levels. Over the entire study period, all participants were treated with metformin (2.55-3 g daily). Plasma glucose, insulin, thyroid-stimulating hormone (TSH), total and free thyroid hormones, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, adrenocorticotropic hormone (ACTH), and insulin-like growth factor-1 (IGF-1) were assayed at entry and 6 months later. At baseline, the study groups differed in levels of TSH and thyroid hormones but not in body mass index, blood pressure, glucose homeostasis markers (fasting glucose, homeostatic model assessment 1 of insulin resistance ratio [HOMA1-IR], and glycated hemoglobin [HbA1c]), and the remaining hormones. There were no differences between both groups in the degree of reduction in plasma glucose and HbA1c in response to metformin treatment. Although metformin decreased HOMA1-IR in both groups, this effect was stronger in women with hyperthyroidism than with normal thyroid function (-50 ± 20% vs -30 ± 15%). Similar relationships were observed for FSH (-43 ± 21% vs -21 ± 12%). Only in hyperthyroid women did the drug reduce LH concentration (by 35 ± 17%). Metformin did not affect circulating levels of TSH, total and free thyroxine, total and free triiodothyronine, estradiol, prolactin, ACTH, and IGF-1. The obtained results indicate that hyperthyroidism enhances the gonadotropin-lowering effects of metformin, as well as the fact that this agent has a neutral effect on the hypothalamic-pituitary-thyroid axis in case of its overactivity.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Karolina Kowalcze
- Department of Pediatrics in Bytom, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
- Department of Pathophysiology, Faculty of Medicine, Academy of Silesia, Katowice, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
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2
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Wang Y, Zhang C, Zhao S, Xu J, Han J. Predictive Effect of FT3 Within the Euthyroid Range on LDL-C in Patients With Type 2 Diabetes: A Cross-Sectional Analysis of Inpatients in China. Clin Exp Pharmacol Physiol 2025; 52:e70021. [PMID: 39787620 DOI: 10.1111/1440-1681.70021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 12/06/2024] [Accepted: 12/16/2024] [Indexed: 01/12/2025]
Abstract
Evidence regarding the relationship between free triiodothyronine (FT3) and low-density lipoprotein cholesterol (LDL-C) remains limited. This study aimed to evaluate the association between FT3 and LDL-C levels in patients with type 2 diabetes mellitus (T2DM) who exhibit normal thyroid function. Between June 2022 and October 2023, a total of 3011 inpatients with T2DM and euthyroid status were continuously and non-selectively recruited from a Chinese hospital. The average age of the included individuals was 56.92 ± 12.56 years, with 1430 (47.49%) males. The mean FT3 concentration was 4.35 ± 0.56 pmol/L. A logistic regression model was applied to analyse the relationship between the FT3 and LDL-C levels, while smooth curve fitting was employed to investigate potential nonlinear associations between these variables. This study demonstrated a positive correlation (0.05 [95% CI: 0.02-0.07; p = 0.0018]) and nonlinear relationship (p = 0.0014) between FT3 and LDL-C levels in Chinese patients with diabetes. Specifically, when FT3 was below 4.28 pmol/L, LDL-C levels increased alongside rising FT3 concentration. However, when FT3 reached or exceeded 4.28 pmol/L, LDL-C levels plateaued and tended to stabilise. These findings suggest that maintaining FT3 within the range of 2.76 to 4.28 pmol/L may be most beneficial for mitigating the progression of cardiovascular disease in patients with T2DM. Our research is important for identifying the optimal FT3 range to delay the progression of cardiovascular disease in patients with T2DM. These findings provide valuable insights to guide clinicians in preventing and managing cardiovascular disease in this population.
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Affiliation(s)
- Yujue Wang
- Department of Research, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Chi Zhang
- Department of Medical Insurance, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Shangshuang Zhao
- Department of Endocrinology and Metabolism, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Jinmei Xu
- Department of Endocrinology and Metabolism, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Jun Han
- Department of Endocrinology and Metabolism, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
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AlMoosa ES, Al Ghadeer HA, Alatiya JE, Aldairam WH, Alhamrani AM, Alarbash AA, Alamer AT, AlHelal MT, Alkhawajah AM, AlDaif ZY, Alarab YA, Al Hani MF, Alhamdan AY, AlWassel AI, Alshabaan AA. The Prevalence of Autoimmune Diseases Among Children With Type I Diabetes Mellitus. Cureus 2024; 16:e76272. [PMID: 39845243 PMCID: PMC11753791 DOI: 10.7759/cureus.76272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2024] [Indexed: 01/24/2025] Open
Abstract
Background Type I diabetes mellitus (T1DM) is a prevalent chronic illness that typically manifests in childhood. In patients who are genetically predisposed to diabetes, complex interactions between environmental and genetic factors play a role in the development of type 1 diabetes. There is proof that the onset of type 1 diabetes raises the possibility of developing additional autoimmune conditions. This has to do with the hereditary predisposition to these illnesses. As the autoimmune process in pancreatic beta cells advances, it may also impact other organs, leading to the emergence of autoimmune diseases that are either organ-specific or organ-nonspecific. Purpose The purpose of this study is to determine the prevalence of autoimmune disorders among children who are diagnosed with T1DM in Al-Ahsa, Saudi Arabia, and assess the potential impact of these conditions on other comorbidities. Methods Over the course of three years, from 2020 to 2023, children with T1DM were the subjects of this descriptive retrospective cross-sectional study conducted in the Endocrinology and Diabetes Unit of the Maternity and Children's Hospital in Al-Ahsa, Saudi Arabia. There were 281 participants in total. Clinical and laboratory research was conducted on autoimmune T1DM. Results A total of 281 T1DM children were investigated, with 59.9% being female and 43.1% being male. The mean age was 12.8 ± 3.3 years, and the mean disease duration at the end of follow-up was 6.6 ± 2.9 years. Among these participants, 5.3% were diagnosed with at least one autoimmune disease (AID). Celiac disease is the most commonly reported AID, accounting for 56.3%, followed by hypothyroidism (31.3%). An increased risk of developing AIDs was linked to significant associations between older age (>10 years old) and longer duration of DM (p<0.05). Conclusion The data show a high prevalence of autoimmune comorbidities among pediatric T1DM patients treated at our department. The findings highlight the importance of regular screenings in facilitating timely diagnosis and intervention, which is critical in promoting the well-being and normative development of pediatric patients.
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Affiliation(s)
- Eman S AlMoosa
- Paediatrics, Maternity and Children Hospital, Al-Ahsa, SAU
| | | | | | | | | | | | - Ali T Alamer
- Paediatrics, Maternity and Children Hospital, Al-Ahsa, SAU
| | | | | | | | - Yaser A Alarab
- Paediatrics, Maternity and Children Hospital, Al-Ahsa, SAU
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Pavan Kumar JTVK, A UM. Comparison of Thyroid Function Tests Among Type 2 Diabetes Patients With and Without Diabetic Nephropathy and Controls. Cureus 2024; 16:e70462. [PMID: 39479143 PMCID: PMC11521962 DOI: 10.7759/cureus.70462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2024] [Indexed: 11/02/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with hyperglycemia and impaired insulin function. Diabetic nephropathy (DN) is a common complication of T2DM, characterized by progressive kidney damage. Thyroid dysfunction, particularly hypothyroidism, has been increasingly recognised as a significant factor influencing the progression of DN. OBJECTIVE To compare thyroid function tests in patients with T2DM with and without diabetic nephropathy and non-diabetic controls, and to assess the role of thyroid dysfunction in DN progression. METHODS A hospital-based cross-sectional study was conducted among 225 participants. Patients were divided into three groups: T2DM with DN, T2DM without DN, and controls, with 75 participants in each group. Data collection included demographic details, comorbidities, and clinical assessments such as blood pressure, thyroid function tests, urinary albumin levels, glycated hemoglobin (HbA1c), renal function tests, serum electrolytes, and estimated glomerular filtration rate (eGFR). Statistical analyses were conducted using SPSS version 20.0 (IBM Corp., Armonk, NY, USA). Results: The most common DN stage among T2DM patients was stage 4 (29, 38.7%), followed by stages 2 and 5 (19, 25.3% each). The T2DM with DN (47, 62.7%) group had a higher prevalence of overweight and obesity compared to the T2DM without DN group (38, 51.5%) and controls (24, 32%) (p value<0.001). Abnormal cardiovascular, respiratory, and abdominal examinations were most prevalent in the T2DM with DN group. Hypothyroidism was more prevalent in both T2DM groups (14, 18.7% each) compared to controls (2, 2.7%) (p value<0.004). Conclusion: Our findings strengthen the evidence of an important link between T2DM and thyroid disorders. The high prevalence of thyroid dysfunction among T2DM patients highlights the critical need for routine screening and integrated management of both conditions to enhance patient outcomes.
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Affiliation(s)
| | - Uma M A
- General Medicine, PES Institute of Medical Sciences and Research, Kuppam, IND
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Moosazadeh M, Khakhki S, Bahar A, Hedayatizadeh-Omran A, Kheradmand M, Alizadeh-Navaei R, Ghadirzadeh E. The prevalence and determinants of diabetes mellitus and thyroid disorder comorbidity in Tabari cohort population. Sci Rep 2024; 14:17577. [PMID: 39080342 PMCID: PMC11289382 DOI: 10.1038/s41598-024-68569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024] Open
Abstract
Studies have shown that the co-occurrence of diabetes mellitus (DM) and thyroid dysfunction (TD) exacerbates diabetes complications and imposes a financial burden on the healthcare system. Therefore, this study aimed to investigate the prevalence of TD-DM comorbidity and its associated risk factors. This cross-sectional study was conducted on enrollment phase data of the TABARI cohort population which consisted of 10,255 adults aged between 35 to 70 years old residing in Sari, Mazandaran, Iran from 2015 to 2017. A total of 9939 out of 10,255 individuals (96.92%) entered the study. The prevalence of TD among T2DM patients was 13.2%. The prevalence of T2DM among patients with TD was 9.2%. Furthermore, the prevalence of TD-DM comorbidity in the overall population was 2.2%. Logistic regression analysis revealed that the odds of TD-DM comorbidity was significantly higher in women (OR 2.85; 95% CI 1.58-5.11), in the age group of 60-70 years (OR 9.62; 95% CI 3.69-25.10), in smokers (OR 2.32; 95% CI 1.19-4.52), in individuals with high waist circumference (WC) (OR 2.22; 95% CI 1.32-3.75), in individuals with low high-density lipoprotein (HDL) (OR 1.60; 95% CI 1.20-2.14), in individuals with high total cholesterol (TC) (OR 1.71; 95% CI 1.21-2.41), in individuals with high triglycerides (TG) (OR 1.79; 95% CI 1.27-2.51), and significantly lower in individuals with higher physical activity (PA) (OR 0.67; 95% CI 0.49-0.93). The present study demonstrated a prevalence of 2.2% in patients with both TD and T2DM. Additionally, female gender, older age, smoking, high WC, low HDL, high TC, high TG, and low PA were predictors of TD-DM comorbidity.
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Affiliation(s)
- Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeedeh Khakhki
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Adele Bahar
- Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Akbar Hedayatizadeh-Omran
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Motahareh Kheradmand
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Erfan Ghadirzadeh
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
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Adelson RP, Garikipati A, Zhou Y, Ciobanu M, Tawara K, Barnes G, Singh NP, Mao Q, Das R. Machine Learning Approach with Harmonized Multinational Datasets for Enhanced Prediction of Hypothyroidism in Patients with Type 2 Diabetes. Diagnostics (Basel) 2024; 14:1152. [PMID: 38893680 PMCID: PMC11172278 DOI: 10.3390/diagnostics14111152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Type 2 diabetes (T2D) is a global health concern with increasing prevalence. Comorbid hypothyroidism (HT) exacerbates kidney, cardiac, neurological and other complications of T2D; these risks can be mitigated pharmacologically upon detecting HT. The current HT standard of care (SOC) screening in T2D is infrequent, delaying HT diagnosis and treatment. We present a first-to-date machine learning algorithm (MLA) clinical decision tool to classify patients as low vs. high risk for developing HT comorbid with T2D; the MLA was developed using readily available patient data from harmonized multinational datasets. The MLA was trained on data from NIH All of US (AoU) and UK Biobank (UKBB) (Combined dataset) and achieved a high negative predictive value (NPV) of 0.989 and an AUROC of 0.762 in the Combined dataset, exceeding AUROCs for the models trained on AoU or UKBB alone (0.666 and 0.622, respectively), indicating that increasing dataset diversity for MLA training improves performance. This high-NPV automated tool can supplement SOC screening and rule out T2D patients with low HT risk, allowing for the prioritization of lab-based testing for at-risk patients. Conversely, an MLA output that designates a patient to be at risk of developing HT allows for tailored clinical management and thereby promotes improved patient outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Qingqing Mao
- Montera, Inc. dba Forta, 548 Market St, PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (A.G.); (Y.Z.); (M.C.); (K.T.); (G.B.); (N.P.S.); (R.D.)
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Florido Neto AR, Agostini L, Silva LPD, Nunes MT. Therapeutical Potential of T3 as Adjuvant Therapy in Male Alloxan-induced Diabetic Rats. Endocrinology 2024; 165:bqae066. [PMID: 38862394 DOI: 10.1210/endocr/bqae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/13/2024]
Abstract
Alloxan-induced diabetic rats present with hypothyroidism. When treated with triiodothyronine (T3), glycemia and proinflammatory cytokine expression are downregulated, improving insulin sensitivity. The effectiveness of associating T3 with insulin (replacement dose [6 U] and [3 U]) in controlling glycemia was investigated in this experimental model. Male Wistar rats were made diabetic by alloxan injection and sorted into groups treated or not with insulin (3 or 6 U) associated or not with T3 (1.5 µg 100 g-1 BW) for 28 days. Nondiabetic rats constituted the control group. Fasting glycemia, glucose decay rate, and thyrotropin (TSH) were measured in the blood/serum of all animals. Immunoblotting was used to assess total GLUT4 expression in skeletal muscles and epididymal white adipose tissue. Cytokine and nuclear factor-κB (NF-κB) expression were measured in these tissues and liver. Diabetic rats presented with increased fasting glycemia, inflammatory cytokines, and NF-κB expression, TSH levels, and insulin resistance. In diabetic rats treated with T3 and/or insulin, these parameters were decreased, whereas GLUT4 and anti-inflammatory cytokine expression were increased. T3 combined with 3-U insulin restored the parameters to values of the control group and was more effective at controlling glycemia than 6-U insulin. Thus, a combination of T3 and insulin might represent a promising strategy for diabetes management since it reduces the insulin requirement by half and improves glycemic control of diabetic rats, which could postpone insulin resistance that develops with chronic insulin administration. These findings open a perspective for using thyroid analogues that provide tissue-specific effects, which might result in a potentially more effective treatment of diabetes.
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Affiliation(s)
- Armando Ribeiro Florido Neto
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, 05508-000, São Paulo, SP, Brazil
| | - Lucas Agostini
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, 05508-000, São Paulo, SP, Brazil
| | - Luciano Pedro da Silva
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, 05508-000, São Paulo, SP, Brazil
| | - Maria Tereza Nunes
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, 05508-000, São Paulo, SP, Brazil
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Makunts T, Joulfayan H, Abagyan R. Thyroid Hyperplasia and Neoplasm Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists in the Food and Drug Administration Adverse Event Reporting System: Retrospective Analysis. JMIRX MED 2024; 5:e55976. [PMID: 38738836 DOI: 10.2196/55976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/03/2024] [Accepted: 03/10/2024] [Indexed: 05/14/2024]
Abstract
Background Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) are one of the most commonly used drugs for type 2 diabetes mellitus. Clinical guidelines recommend GLP-1 RAs as an adjunct to diabetes therapy in patients with chronic kidney disease, presence or risk of atherosclerotic cardiovascular disease, and obesity. The weight loss observed in clinical trials has been explored further in healthy individuals, putting GLP-1 RAs on track to be the next weight loss treatment. Objective Although the adverse event profile is relatively safe, most GLP-1 RAs come with a labeled boxed warning for the risk of thyroid cancers, based on animal models and some postmarketing case reports in humans. Considering the increasing popularity of this drug class and its expansion into a new popular indication, a further review of the most recent postmarketing safety data was warranted to quantify thyroid hyperplasia and neoplasm instances. Methods GLP-1 RA patient reports from the US Food and Drug Administration (FDA) Adverse Event Reporting System database were analyzed using reporting odds ratios and 95% CIs. Results In this study, we analyzed over 18 million reports from the US FDA Adverse Event Reporting System and provided evidence of significantly increased propensity for thyroid hyperplasias and neoplasms in patients taking GLP-1 RA monotherapy when compared to patients taking sodium-glucose cotransporter-2 (SGLT-2) inhibitor monotherapy. Conclusions GLP-1 RAs, regardless of indication, are associated with an over 10-fold increase in thyroid neoplasm and hyperplasia adverse event reporting when compared to SGLT-2 inhibitors.
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Affiliation(s)
- Tigran Makunts
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, United States
| | | | - Ruben Abagyan
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, United States
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González-Flores D, Márquez A, Casimiro I. Oxidative Effects in Early Stages of Embryo Development Due to Alcohol Consumption. Int J Mol Sci 2024; 25:4100. [PMID: 38612908 PMCID: PMC11012856 DOI: 10.3390/ijms25074100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Alcohol, a widely consumed drug, exerts significant toxic effects on the human organism. This review focuses on its impact during fetal development, when it leads to a spectrum of disorders collectively termed Fetal Alcohol Spectrum Disorders (FASD). Children afflicted by FASD exhibit distinct clinical manifestations, including facial dysmorphism, delayed growth, and neurological and behavioral disorders. These behavioral issues encompass diminished intellectual capacity, memory impairment, and heightened impulsiveness. While the precise mechanisms underlying alcohol-induced fetal damage remain incompletely understood, research indicates a pivotal role for reactive oxygen species (ROS) that are released during alcohol metabolism, inciting inflammation at the cerebral level. Ethanol metabolism amplifies the generation of oxidant molecules, inducing through alterations in enzymatic and non-enzymatic systems responsible for cellular homeostasis. Alcohol consumption disrupts endogenous enzyme activity and fosters lipid peroxidation in consumers, potentially affecting the developing fetus. Addressing this concern, administration of metformin during the prenatal period, corresponding to the third trimester of human pregnancy, emerges as a potential therapeutic intervention for mitigating FASD. This proposed approach holds promise for ameliorating the adverse effects of alcohol exposure on fetal development and warrants further investigation.
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Affiliation(s)
- David González-Flores
- Department of Anatomy, Cell Biology and Zoology, Faculty of Medicine and Health Sciences, University of Extremadura, 06006 Badajoz, Spain
| | - Antonia Márquez
- Department of Anatomy, Cell Biology and Zoology, Faculty of Medicine and Health Sciences, University of Extremadura, 06006 Badajoz, Spain
| | - Ilda Casimiro
- Department of Anatomy, Cell Biology and Zoology, Faculty of Sciences, University of Extremadura, 06006 Badajoz, Spain;
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10
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Makunts T, Joulfayan H, Abagyan R. Thyroid hyperplasia and neoplasm adverse events associated with GLP-1 receptor agonists in FDA Adverse Event Reporting System. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.19.23298750. [PMID: 38045343 PMCID: PMC10690345 DOI: 10.1101/2023.11.19.23298750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Glucagon receptor-like peptide receptor agonists, GLP-1 RAs, are one of the most commonly used drugs for type-2 diabetes mellitus. The clinical guidelines recommend GLP-1 RAs as adjunct to diabetes therapy in patients with chronic kidney disease, presence or risk of atherosclerotic cardiovascular disease, obesity, and other cardiometabolic conditions. The weight loss seen in clinical trials has been explored further in healthy individuals, putting GLP-1 RAs on track to be the next weight loss treatment. Although the adverse event profile is relatively safe, most GLP-1 RAs come with a labeled black boxed warning of the risk of thyroid cancers, based on animal models and some postmarketing case reports in humans. Considering the increasing popularity of this drug class and its expansion into a new popular indication, a further review of most recent postmarketing safety data is warranted to quantify thyroid hyperplasia and neoplasms instances. In this study we analyzed over eighteen million reports from United States Food and Drug Administration Adverse Event Reporting System and identified 17,653 relevant GLP-1 RA monotherapy reports to provide the evidence of significantly increased propensity for thyroid hyperplasias and neoplasms in patients taking GLP-1 RA as monotherapy when compared to patients taking sodium-glucose cotransporter-2 inhibitor monotherapy.
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11
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Li W, He Q, Zhang H, Shu S, Wang L, Wu Y, Yuan Z, Zhou J. Thyroid-stimulating hormone within the normal reference range has a U-shaped association with the severity of coronary artery disease in nondiabetic patients but is diluted in diabetic patients. J Investig Med 2023; 71:350-360. [PMID: 36680358 DOI: 10.1177/10815589221149187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Too high or too low thyroid-stimulating hormone (TSH) has been associated with the progress and prognosis of coronary artery disease (CAD). However, whether TSH within its normal reference range plays a role in the severity of CAD remains unclear. In this observational study, we explored the potential relationship of hypersensitive TSH (hs-TSH) with the severity of CAD in euthyroid patients with or without diabetes mellitus. A total of 7357 CAD patients with euthyroidism were enrolled in this study. Of those, 1997 had diabetes mellitus. The severity of CAD was evaluated through the presence of myocardial infarction (MI) and the severity of coronary lesions, which was calculated using the Gensini score (GS). Logistic regression models treating hs-TSH as a categorical variable and restricted cubic spline analyses treating it as a continuous variable were used to evaluate the associations of hs-TSH with the severity of CAD. The propensity score matching method was used to further validate the differences between diabetic and nondiabetic patients. CAD patients with diabetes mellitus had lower levels of hs-TSH (1.6 (0.97-2.53) vs 1.67 (1.00-2.64)) in serum compared with CAD patients without diabetes mellitus. Meanwhile, hs-TSH was independently related to the severity of CAD. In CAD patients with vs without diabetes mellitus, the U-shaped relationship between hs-TSH and MI was more prominent in patients without diabetes mellitus, and the significant U-shaped association between higher GS and hs-TSH remained only in nondiabetes. Therefore, hs-TSH within the normal reference range has a U-shaped association with the severity of CAD in nondiabetic patients, which is markedly diluted in diabetic patients.
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Affiliation(s)
- Wenyuan Li
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qingyuan He
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Haoxuan Zhang
- Department of Bioengineering, Southwest Jiaotong University, Chengdu, Sichuan, China
- Department of Biological Science, Georgia State University, Atlanta, GA, USA
| | - Shan Shu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lijun Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yue Wu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China
| | - Juan Zhou
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Key Laboratory of Molecular Cardiology of Shannxi Province, Xi'an, Shaanxi, China
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Popoviciu MS, Kaka N, Sethi Y, Patel N, Chopra H, Cavalu S. Type 1 Diabetes Mellitus and Autoimmune Diseases: A Critical Review of the Association and the Application of Personalized Medicine. J Pers Med 2023; 13:jpm13030422. [PMID: 36983604 PMCID: PMC10056161 DOI: 10.3390/jpm13030422] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/17/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
Type 1 Diabetes Mellitus (T1DM) is a common hyperglycemic disease characterized by the autoimmune destruction of insulin-producing beta cells of the pancreas. Various attempts have been made to understand the complex interplay of genetic and environmental factors which lead to the development of the autoimmune response in an individual. T1DM is frequently associated with other autoimmune illnesses, the most common being autoimmune thyroid disorders affecting more than 90% of people with T1D and autoimmune disorders. Antithyroid antibodies are present in around 20% of children with T1D at the start of the illness and are more frequent in girls. Patients with T1DM often have various other co-existing multi-system autoimmune disorders including but not limited to thyroid diseases, parathyroid diseases, celiac disease, vitiligo, gastritis, skin diseases, and rheumatic diseases. It is a consistent observation in clinics that T1DM patients have other autoimmune disorders which in turn affect their prognosis. Concomitant autoimmune illness might affect diabetes care and manifest itself clinically in a variety of ways. A thorough understanding of the complex pathogenesis of this modern-day epidemic and its association with other autoimmune disorders has been attempted in this review in order to delineate the measures to prevent the development of these conditions and limit the morbidity of the afflicted individuals as well. The measures including antibody screening in susceptible individuals, early identification and management of other autoimmune disorders, and adoption of personalized medicine can significantly enhance the quality of life of these patients. Personalized medicine has recently gained favor in the scientific, medical, and public domains, and is frequently heralded as the future paradigm of healthcare delivery. With the evolution of the ‘omics’, the individualization of therapy is not only closer to reality but also the need of the hour.
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Affiliation(s)
| | - Nirja Kaka
- PearResearch, Dehradun 248001, India
- Department of Medicine, GMERS Medical College, Himmatnagar 383001, India
| | - Yashendra Sethi
- PearResearch, Dehradun 248001, India
- Department of Medicine, Government Doon Medical College, HNB Uttarakhand Medical Education University, Dehradun 248001, India
| | - Neil Patel
- PearResearch, Dehradun 248001, India
- Department of Medicine, GMERS Medical College, Himmatnagar 383001, India
| | - Hitesh Chopra
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | - Simona Cavalu
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
- Correspondence:
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Zhang X, Ardeshirrouhanifard S, Li J, Li M, Dai H, Song Y. Associations of Nutritional, Environmental, and Metabolic Biomarkers with Diabetes-Related Mortality in U.S. Adults: The Third National Health and Nutrition Examination Surveys between 1988-1994 and 2016. Nutrients 2022; 14:nu14132629. [PMID: 35807807 PMCID: PMC9268621 DOI: 10.3390/nu14132629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Nutritional, environmental, and metabolic status may play a role in affecting the progression and prognosis of type 2 diabetes. However, results in identifying prognostic biomarkers among diabetic patients have been inconsistent and inconclusive. We aimed to evaluate the associations of nutritional, environmental, and metabolic status with disease progression and prognosis among diabetic patients. Methods: In a nationally representative sample in the NHANES III (The Third National Health and Nutrition Examination Survey, 1988−1994), we analyzed available data on 44 biomarkers among 2113 diabetic patients aged 20 to 90 years (mean age: 58.2 years) with mortality data followed up through 2016. A panel of 44 biomarkers from blood and urine specimens available from NHANES III were included in this study and the main outcomes as well as the measures are mortalities from all-causes. We performed weighted logistic regression analyses after controlling potential confounders. To assess incremental prognostic values of promising biomarkers beyond traditional risk factors, we compared c-statistics of the adjusted models with and without biomarkers, separately. Results: In total, 1387 (65.2%) deaths were documented between 1988 and 2016. We observed an increased risk of all-cause mortality associated with higher levels of serum C-reactive protein (p for trend = 0.0004), thyroid stimulating hormone (p for trend = 0.04), lactate dehydrogenase (p for trend = 0.02), gamma glutamyl transferase (p for trend = 0.02), and plasma fibrinogen (p for trend = 0.03), and urine albumin (p for trend < 0.0001). In contrast, higher levels of serum sodium (p for trend = 0.005), alpha carotene (p for trend = 0.006), and albumin (p for trend = 0.005) were associated with a decreased risk of all-cause mortality. In addition, these significant associations were not modified by age, sex, or race. Inclusion of thyroid stimulating hormone (p = 0.03), fibrinogen (p = 0.01), and urine albumin (p < 0.0001), separately, modestly improved the discriminatory ability for predicting all-cause mortality among diabetic patients. Conclusions: Our nationwide study findings provide strong evidence that some nutritional, environmental, and metabolic biomarkers were significant predictors of all-cause mortality among diabetic patients and may have potential clinical value for improving stratification of mortality risk.
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Affiliation(s)
- Xi Zhang
- Clinical Research Unit, Department of Pediatrics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China;
| | - Shirin Ardeshirrouhanifard
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA; (S.A.); (M.L.)
| | - Jing Li
- Department of Biostatistics, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA;
| | - Mingyue Li
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA; (S.A.); (M.L.)
| | - Hongji Dai
- Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Tianjin 300060, China
- Correspondence: (H.D.); (Y.S.); Tel.: +86-22-2337-2231 (H.D.); +1-317-274-3833 (Y.S.); Fax: +86-22-2337-2231 (H.D.); +1-317-274-3443 (Y.S.)
| | - Yiqing Song
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA; (S.A.); (M.L.)
- Correspondence: (H.D.); (Y.S.); Tel.: +86-22-2337-2231 (H.D.); +1-317-274-3833 (Y.S.); Fax: +86-22-2337-2231 (H.D.); +1-317-274-3443 (Y.S.)
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Eom YS, Wilson JR, Bernet VJ. Links between Thyroid Disorders and Glucose Homeostasis. Diabetes Metab J 2022; 46:239-256. [PMID: 35385635 PMCID: PMC8987680 DOI: 10.4093/dmj.2022.0013] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/21/2022] [Indexed: 12/13/2022] Open
Abstract
Thyroid disorders and diabetes mellitus often coexist and are closely related. Several studies have shown a higher prevalence of thyroid disorders in patients with diabetes mellitus and vice versa. Thyroid hormone affects glucose homeostasis by impacting pancreatic β-cell development and glucose metabolism through several organs such as the liver, gastrointestinal tract, pancreas, adipose tissue, skeletal muscles, and the central nervous system. The present review discusses the effect of thyroid hormone on glucose homeostasis. We also review the relationship between thyroid disease and diabetes mellitus: type 1, type 2, and gestational diabetes, as well as guidelines for screening thyroid function with each disorder. Finally, we provide an overview of the effects of antidiabetic drugs on thyroid hormone and thyroid disorders.
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Affiliation(s)
- Young Sil Eom
- Division of Endocrinology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jessica R. Wilson
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Jacksonville, FL, USA
| | - Victor J. Bernet
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Jacksonville, FL, USA
- Corresponding author: Victor J. Bernet https://orcid.org/0000-0002-2477-5631 Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA E-mail:
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Saboo B, Seshadri K, Agarwal S, Sahay R, Ghosh S, Joshi S. RSSDI guidelines on thyroid dysfunction and diabetes. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01030-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Ibrahim SH. Impact of Quercus infectoria Galls Extract on Thyroid Gland and Testicular Functions in Diabetic Rats. THE IRAQI JOURNAL OF VETERINARY MEDICINE 2021. [DOI: 10.30539/ijvm.v45i2.1268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Diabetes mellitus has been reported to be accompanied by thyroid and testicular dysfunctions. The objective of this study was to investigate the effect of Quercus infectoria galls (QIg) extract on the thyroid gland and testicular functions in diabetic rats. Sixteen rats were randomly divided into four equal groups, consisting of normal control, diabetic untreated control, diabetic treated with oral administration of 500 mg/kg BW and 1000 mg/kg BW, respectively for 15 days. Serum blood glucose, thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), testosterone (T), and luteinizing hormone (LH) were assessed. At the end of the experimental period, the rats were euthanized for histopathological analysis of thyroid gland and testis. Furthermore, immunohistochemistry was used to assess the expression of thyroid transcription factor-1 (TTF-1) in the thyroid gland of rats. The significant increase in serum blood glucose level in diabetic rats (DC) was markedly decreased by treatment with QIg extract (500 mg and 100 mg/kg BW) almost to the normal level. The reduced thyroid hormones, both the T3 and T4 were significantly recovered after 15 days of treatment with QIg extract (500 mg and 100 mg/kg BW). Whereas serum concentration of testosterone was significantly reduced in diabetic rats with QIg extract (500 mg and 100 mg/kg BW) treatment. Histopathological analysis of diabetic rats showed a wide range of morphological alterations in thyroid gland and testicular structures, which were almost completely, restored back to normal by treatment of rats with QIg extract. Furthermore, results showed overexpression of TTF-1 in the thyroid gland of diabetic rats, which was recovered back to normal expression after 15 days of treatment with QIg extract. These findings may provide new insights into the potential role of QIg extract as a promising therapeutic agent against diabetic complications in thyroid gland and testicular functions.
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Song E, Koo MJ, Noh E, Hwang SY, Park MJ, Kim JA, Roh E, Choi KM, Baik SH, Cho GJ, Yoo HJ. Risk of Diabetes in Patients with Long-Standing Graves' Disease: A Longitudinal Study. Endocrinol Metab (Seoul) 2021; 36:1277-1286. [PMID: 34915605 PMCID: PMC8743588 DOI: 10.3803/enm.2021.1251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/04/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The detrimental effects of excessive thyroid hormone on glucose metabolism have been widely investigated. However, the risk of diabetes in patients with long-standing hyperthyroidism, especially according to treatment modality, remains uncertain, with few longitudinal studies. METHODS The risk of diabetes in patients with Graves' disease treated with antithyroid drugs (ATDs) for longer than the conventional duration (≥2 years) was compared with that in age-and sex-matched controls. The risk was further compared according to subsequent treatment modalities after a 24-month course of ATD: continuation of ATD (ATD group) vs. radioactive iodine ablation (RIA) group. RESULTS A total of 4,593 patients were included. Diabetes was diagnosed in 751 (16.3%) patients over a follow-up of 7.3 years. The hazard ratio (HR) for diabetes, after adjusting for various known risk factors, was 1.18 (95% confidence interval [CI], 1.10 to 1.28) in patients with hyperthyroidism. Among the treatment modality groups, the RIA group (n=102) had a higher risk of diabetes than the ATD group (n=4,491) with HR of 1.56 (95% CI, 1.01 to 2.42). Further, the risk of diabetes increased with an increase in the ATD treatment duration (P for trend=0.019). CONCLUSION The risk of diabetes was significantly higher in patients with long-standing Graves' disease than in the general population, especially in patients who underwent RIA and prolonged ATD treatment. Special attention to hyperglycemia during follow-up along with effective control of hyperthyroidism may be necessary to reduce the risk of diabetes in these patients.
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Affiliation(s)
- Eyun Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Min Ji Koo
- Smart Healthcare Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Eunjin Noh
- Smart Healthcare Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Soon Young Hwang
- Department of Biostatistics, Korea University College of Medicine, Seoul,
Korea
| | - Min Jeong Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Jung A Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul,
Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
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Mohammed Hussein SM, AbdElmageed RM. The Relationship Between Type 2 Diabetes Mellitus and Related Thyroid Diseases. Cureus 2021; 13:e20697. [PMID: 35106234 PMCID: PMC8787293 DOI: 10.7759/cureus.20697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2021] [Indexed: 01/25/2023] Open
Abstract
Diabetes and thyroid diseases are caused by endocrine dysfunction and both have been demonstrated to mutually impact each other. Variation in thyroid hormone levels, even within the normal range, can trigger the onset of type 2 diabetes mellitus (T2DM), particularly in people with prediabetes. However, the available evidence is contradictory. The purpose of this review is to understand the pathological relationship between thyroid-related disorders and T2DM. T2DM in thyroid dysfunction is thought to be caused by altered gene expression of a group of genes, as well as physiological abnormalities that result in decreased glucose uptake increased, splanchnic glucose absorption, disposal in muscles, increased hepatic glucose output. Additionally, both hyperthyroidism and hypothyroidism can cause insulin resistance. Insulin resistance can develop in subclinical hypothyroidism as a result of a reduced rate of insulin-stimulated glucose transfer caused by a translocation of the glucose transporter type 2 (GLUT 2) gene. On the other hand, novel missense variations in (Thr92Ala) can cause insulin resistance. Furthermore insulin resistance and hyperinsulinemia resulting from diabetes can cause culminate in goitrous transformation of the thyroid gland. Thyroid-related diseases and T2DM are closely linked. Type 2 diabetes can be exacerbated by thyroid disorders, and diabetes can worsen thyroid dysfunction. Insulin resistance has been found to play a crucial role in both T2DM and thyroid dysfunction. Therefore, failure to recognize inadequate thyroid hormone levels in diabetes and insulin resistance in both conditions can lead to poor management of patients.
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Salman A, Aon M, Hussein A, Salman M, Tourky M, Mahmoud A, Aljarad F, Elkaseer M, Shaaban HED, Moustafa A, El-Mikkawy A, Gaballa N, Abdallah H, Zaky Rashed ZF, Elkassar H. Impact of Hypothyroidism on Patients with Hepatocellular Carcinoma Undergoing Liver Transplantation. Int J Gen Med 2021; 14:5711-5718. [PMID: 34557025 PMCID: PMC8455075 DOI: 10.2147/ijgm.s326315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/31/2021] [Indexed: 12/23/2022] Open
Abstract
Background This work endeavored to explore the effect of hypothyroidism on mortality in subjects with HCC who underwent living-donor liver transplantation (LDLT). Methods This prospective study included 107 patients with HCC subjected to LDLT, divided into hypothyroid group (n=53) and euthyroid group (n=54). The primary objectives were overall and disease-free survival (DFS). Results Euthyroid and hypothyroid groups were comparable in all baseline characteristics except the age of patients. Overall survival (OS) of the whole group at 48 months was 68.8%, while the DFS was 60.2%. On univariate analysis, OS was negatively affected by the older age of the patients (p<0.001) or the donor (p<0.001), hypothyroidism (p=0.008), HBV (p=0.029), larger tumor size (p=0.023), and defective Milan criteria (p=0.022). On multivariate analysis, the age of the patients and donors was the independent factor affecting OS. On univariate analysis, DFS was negatively affected by older age of the patients (p < 0.001) or the donor (p=0.005), hypothyroidism (p=0.005), HBV (p=0.019), larger tumor size (p=0.023), and defective Milan criteria (p=0.020). On multivariate analysis, the age of the patients, thyroid status, and Milan criteria were the independent factors affecting DFS. Conclusion Hypothyroidism is a risk factor for worse outcomes in HCC patients after liver transplantation.
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Affiliation(s)
- Ahmed Salman
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Aon
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amr Hussein
- Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Salman
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Tourky
- Department of Surgery, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Ahmed Mahmoud
- Senior Clinical Fellow, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Feras Aljarad
- Lewisham and Greenwich NHS Trust, Lewisham, London, UK
| | - Mohamed Elkaseer
- General Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hossam El-Din Shaaban
- Hepatology and Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Ahmed Moustafa
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed El-Mikkawy
- Hepatology and Gastroenterology Department, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Nahla Gaballa
- Anesthesiology and Intensive Care Department, National Liver Institute, Menoufia University, Shibin El Kom, Egypt
| | - Heba Abdallah
- Clinical Pathology Department, National Liver Institute, Menoufia University, Shibin El Kom, Egypt
| | - Zaky Ftouh Zaky Rashed
- Anesthesiology and Intensive Care Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.,Department of Anesthesia, College of Applied Sciences, Almaarefa university, Ad Diriyah, Riyadh, Saudi Arabia
| | - Hesham Elkassar
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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GURZĂU DA, CALOIAN B, COMŞA H, SITAR-TĂUT A, ZDRENGHEA D, POP D. The importance of stratifying ischemic risk by using the Duke score in women with ischemic heart disease and hypothyroidism before inclusion in cardiovascular rehabilitation programs. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The relationship between abnormal thyroid function and coronary heart disease has been known for a long time, and particularly, hypothyroidism is associated with an increased risk of cardiovascular disease. The aim of this study was to evaluate the ischemic risk by using the Duke score in women with ischemic heart disease and associated hypothyroidism before inclusion in cardiovascular rehabilitation program.
Materials and methods: We included in the study 150 female patients admitted to the Cardiology Department of the Clinical Rehabilitation Hospital Cluj-Napoca. All the patients included had ischemic heart disease and performed an exercise stress testing to evaluate the effort capacity and also to stratify the ischemic risk by calculating the Duke Score. After dosing the thyroid stimulating hormone (TSH) we divided the patients in two groups: with hypothyroidism and a control group.
Results: Patients with hypothyroidism were more frequently hypertensive, (98% vs 87%, p-0.035), and they had diabetes mellitus in a higher proportion (51% vs 22%, p-0.005). HDL cholesterol was significantly decreased in the group of patients with hypothyroidism: 40.36±10.39mg/dl vs 44.85±10.29mg/dl (p-0.01). Regarding the ischemic risk assessed by the Duke score, the statistically significant differences between the two groups were registered only for the category of high-risk patients, 5.55% vs 18% (p-0.048). Also, the TSH value was higher in the group with high-risk Duke score, 4.21±3.73µIU/ml, compared to the moderate-risk score group, 1.95±1.12µIU/ml(p-0.05).
Conclusion: In women with ischemic heart disease, assessing thyroid function can be useful to identify patients at high risk of ischemia. Patients with hypothyroidism tend to have a higher prevalence of cardiovascular risk factors, a higher ischemic risk objectified by the Duke score and more commonly multivascular coronary lesions. For these patients, the inclusion in cardiovascular rehabilitation programs is essential, but it is very important that the programs to be customized for each patient.
Keywords: coronary heart disease in women, exercise ECG, Duke score, ischemic risk, hypothyroidism, cardiovascular rehabilitation programs
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Affiliation(s)
| | - Bogdan CALOIAN
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horaţiu COMŞA
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adela SITAR-TĂUT
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dumitru ZDRENGHEA
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana POP
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
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21
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Sight-Threatening Thyroid Eye Disease: Role of Diabetes Mellitus and Interaction with Other Risk Factors. Ophthalmic Plast Reconstr Surg 2021; 37:352-360. [PMID: 33060509 DOI: 10.1097/iop.0000000000001871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the study was to investigate whether diabetes mellitus (DM) is an independent risk factor in sight-threatening thyroid eye disease (ST-TED) and explore the interaction of DM with other known risk factors in TED. METHODS This was a retrospective cohort study and included 202 consecutive TED patients presenting between 2013 and 2019. Data collected included demography, history of smoking, thyroid dysmetabolism, and presence of DM, TED-duration, activity and severity, best-corrected visual acuity (BCVA), and follow-up. Primary outcome measure was development of ST-TED and secondary outcome measures included change in BCVA, activity, and bilateral ST-TED. RESULTS Mean age of the cohort was 52.14 + 9.14 years and 74 (36%) were male. DM was present in 49 (24%) and a positive history of smoking in 65 (32%) TED patients. Cox's proportional hazards showed the presence of DM (hazard ratio [HR] 2.22; P = 0.02) and a positive history of smoking (HR 3.62; P = 0.003) were significant risk factors for development of ST-TED and dysthyroid optic neuropathy (DON). Older age was a risk factor (HR 1.05; P = 0.02) for DON. DM increased the risk of developing bilateral ST-TED (OR 4.14; P = 0.004). Median follow-up was 4 months (range 0.1-96 months). A linear mixed model to predict longitudinal interaction between risk factors, found TED patients in DM group were likely to have worsening of visual function and a positive history of smoking accentuated this adverse outcome. CONCLUSION DM and smoking are major independent risk factors predictive of ST-TED. Coexisting DM either singularly or in combination with smoking may predict worsening of visual function in TED patients.
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Correlations between FTO Gene Polymorphisms and TSH Level in Uyghur Chinese Patients with Type 2 Diabetes. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6646750. [PMID: 34258276 PMCID: PMC8257352 DOI: 10.1155/2021/6646750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
Objective The aim of this study was to investigate the correlation between polymorphisms in the FTO gene and TSH level in Uyghur patients with type 2 diabetes in the Xinjiang region. Material and Methods. This cohort was made up of 498 Uyghur patients with type 2 diabetes who underwent genotype screening for rs8050136 and rs9939609 using the Sequenom MassARRAY system. The distribution frequencies of the genotypes and alleles at rs8050136 and rs993960 were compared between two patient groups, those with TSH < 2.5 mU/L and those with TSH ≥ 2.5 mU/L group. We further evaluated the relationships between these different genotypes and FT3, FT4, TSH, FPG, and HbA1c expression. Results The results suggested the TSH level was 2.281 times higher in rs8050136 CC+CA carriers than in AA genotype (95%CI = 1.024~5.080, P = 0.044) and was 2.417 times higher in rs9939609 TT+TA carriers than in AA genotype (95%CI = 1.257~4.649, P = 0.008) after adjusting for age, sex, and BMI under the recessive model. TSH levels were significantly different between T2DM patients with different FTO genotypes, rs8050136 (P = 0.008) and rs9939609 (P = 0.003), with TSH levels in rs8050136 CC genotype carriers showing a significant increase compared to those in the AA genotype carriers (P = 0.005). Additionally, rs9939609 TT and TA genotype carriers had a significant increase in the TSH level when compared to AA genotype carriers (P = 0.001 and P = 0.031, respectively). The TSH level was also significantly different in these male patients with different genotypes of rs8050136 (P = 0.026) and rs9939609 (P = 0.019). And TSH levels in rs8050136 CC genotype male carriers showing a significant increase compared to those in the AA genotype carriers (P = 0.013) and rs9939609 TT genotype male carriers had a significant increase in TSH level when compared to AA genotype carriers (P = 0.004). Conclusion The polymorphisms at rs8050136 and rs9939609 are associated with changes in the TSH level with rs8050136 CC and rs9939609 TT genotypes identified as potential risk factors for increased TSH levels in these male patients.
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Gardas BB, Ghongade NP, Jagtap AH. Application of multi‐criteria decision‐making approach in healthcare surgical management. JOURNAL OF MULTI-CRITERIA DECISION ANALYSIS 2021. [DOI: 10.1002/mcda.1753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Bhaskar B. Gardas
- Department of Mechanical Engineering M.H. Saboo Siddik College of Engineering Mumbai Maharashtra India
| | - Nilesh P. Ghongade
- Department of Mechanical Engineering M.H. Saboo Siddik College of Engineering Mumbai Maharashtra India
| | - Annasaheb H. Jagtap
- Department of Mechanical Engineering M.H. Saboo Siddik College of Engineering Mumbai Maharashtra India
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Kalra S, Aggarwal S, Khandelwal D. Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies. Int J Endocrinol 2021; 2021:9641846. [PMID: 33859689 PMCID: PMC8024090 DOI: 10.1155/2021/9641846] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 02/26/2021] [Accepted: 03/19/2021] [Indexed: 12/25/2022] Open
Abstract
Thyroid dysfunction (TD) is common in metabolic disorders such as diabetes mellitus (DM), cardiovascular disease (CVD), obesity, dyslipidemia, hyperuricemia, kidney and liver dysfunctions, and polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SHypo) worsens glycemic control in patients with DM, and these patients, especially those with Type-1DM, have higher prevalence of TD. Both TD and DM increase CVD risk. Even minor alteration in thyroid hormone (TH) levels can alter cardiovascular function. While hyperthyroidism increases systolic blood pressure and leads to high-output heart failure, hypothyroidism increases diastolic blood pressure and leads to low-output heart failure. Chronic subclinical hyperthyroidism (SHyper) and SHypo both increase the risk of hypertension, coronary artery disease (CAD) events, CAD deaths, and total deaths. SHyper alters cardiac morphology and function. SHypo causes dyslipidemia and endothelial dysfunction and increases the risk for weight gain and obesity. Overweight and obese patients often have hyperleptinemia, which increases the secretion of thyroid stimulating hormone (TSH) and induces TD. Dyslipidemia associated with TD can increase serum uric acid levels. Hyperuricemia promotes inflammation and may increase the risk for dyslipidemia, atherosclerosis, and CVD. TD increases the risk for developing chronic kidney disease. In nephrotic syndrome, proteinuria is associated with urinary loss of TH leading to TD. Some correlation between TD and severity of liver disease is also seen. TD and PCOS have common risk factors and pathophysiological abnormalities. Hypothyroidism must be excluded before diagnosing PCOS. Current guidelines do not strongly recommend thyroid screening in the presence of all metabolic disorders. However, pragmatic thyrovigilance is required. Clinicians must stay alert to signs and symptoms of TD, maintain high clinical suspicion, and investigate thoroughly. Drug-induced TD should be considered when TH levels do not match clinical findings or when patients are on medications that can alter thyroid function.
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Aravinda Swami P, T. Saravana Kumar R, Babu Sitty M. KAP of Metabolic Disorders in South Indian Population. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2021. [DOI: 10.18311/ajprhc/2021/26382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Awad AS, Alshahrni FMM, Alhawyan FS, Ghazwani EY, Alasmary MY, Alshahrani MY, Tobaiqi MAA, Alshahrani SSM, Alghamdi SSA, Bakri STH, Ayed AA. Inference of link among diabetes, obesity, and thyroid dysfunction in data from a clinic at Saudi Arabia. Bioinformation 2021; 17:119-125. [PMID: 34393426 PMCID: PMC8340702 DOI: 10.6026/97320630017119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/31/2020] [Accepted: 01/26/2021] [Indexed: 01/04/2023] Open
Abstract
The clinical link among diabetes, obesity, and thyroid dysfunction is of interest. Hence, medical records of 601 patients with diabetes, obesity, and thyroid dysfunctions at the Abha Specialist Center and Military Diabetic Endocrine Center we used in this analysis. Approximately 28% of diabetic patients had thyroid dysfunction, and 12.4% were vitamin D deficient. The patients with thyroid dysfunction had significantly elevated triglyceride levels compared to the patients without thyroid dysfunction (173.6 vs. 128. p=0.009). Vitamin D deficient obese patients were significantly younger (33.99±10.69 vs. 43.68±14.42; p<0.001) and had significantly lower levels of HbA1c (5.73±1.16 vs. 6.83±2.08; p=0.014) and lower systolic BP (120.26±11.75 vs. 124.58±13.63; p=0.049) than non-vitamin D deficient obese patients. Vitamin D deficient thyroid patients had significantly lower diastolic BP (71.4±9.9 vs. 74.9±9.7; p=0.040) and higher HbA1c (8.7±3.6 vs. 6.4±1.7; p=0.003) in comparison to non-vitamin D deficient thyroid patients. Hence, analysis of metabolic disorders in these patients will help combat complications in these cases.
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Affiliation(s)
- Alsamghan S Awad
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, KSA-61421
| | | | - Fatmah Salem Alhawyan
- Diabetes and Metabolism, Armed Forces Hospitals Southern Region, Khamis Mushait, Aseer, Kingdom of Saudi Arabia
| | - Eisa Yazeed Ghazwani
- Family and Palliative Medicine, Department of Family & Community Medicine, Faculty of Medicine, Najran University, Najran, Kingdom of Saudi Arabia
| | - Mohammed Yahia Alasmary
- Department of Medicine,Faculty of Medicine, Najran University, Najran, Kingdom of Saudi Arabia
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Faddladdeen K, Ali SS, Bahshwan S, Ayuob N. Thymoquinone Preserves Pancreatic Islets Structure Through Upregulation of Pancreatic β-Catenin in Hypothyroid Rats. Diabetes Metab Syndr Obes 2021; 14:2913-2924. [PMID: 34234489 PMCID: PMC8254558 DOI: 10.2147/dmso.s317417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Altered status of thyroid hormones, which have a key role in regulating metabolism, was reported to affect glucose homeostasis and insulin secretion. OBJECTIVE This study was designed to assess the impact of propylthiouracil (PTU)-induced hypothyroidism on the pancreatic islet cells and the efficacy of thymoquinone (TQ) in alleviating this impact and explore the mechanism behind it alleviating oxidative stress and affecting β-catenin expression. MATERIALS AND METHODS PTU (6 mg/kg/body weight) was used to induce hypothyroidism in Wistar rats. Four groups of rats (n=6 each) were utilized in this study. Untreated hypothyroid and TQ-treated hypothyroid groups (50 mg/kg/body weight for 4 weeks) were included. Thyroid functions, antioxidant profile and pancreatic β-catenin and IL-10 mRNA were measured. Histopathological and immunohistochemical assessment of the pancreas was performed. RESULTS PTU administration induced a hypothyroid status that was associated with a marked disturbed oxidant/antioxidant status and a significant hyperglycemia (p<0:001), hypoinsulinemia (p=0.01) and decreased HOMA-β-cell (p<0.001). Islet cells of hypothyroid pancreas showed many degenerative changes with increased apoptosis, reduced insulin β-catenin immunoexpression. Administration of TQ alleviated these effects on the thyroid function, antioxidants, structure of pancreatic islet cells. Up-regulation of β-catenin, IL-10 and CAT gene expression in pancreatic islets after treatment with TQ supported its antioxidant and preserving β-cell function and viability mechanistic action. CONCLUSION TQ alleviated PTU-induced hypothyroidism changes in insulin homeostasis and pancreatic β cells mostly through its antioxidant effect as well as up-regulation of pancreatic β-catenin expression.
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Affiliation(s)
- Khadija Faddladdeen
- Biology Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Soad Shaker Ali
- Anatomy Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Histology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Safia Bahshwan
- Biology Department, College of Science and Arts in Al-Makhwah, Al-Baha University, Al-Baha, Saudi Arabia
| | - Nasra Ayuob
- Medical Histology and Cell Biology Department, Faculty of Medicine, Damietta University, Damietta, Egypt
- Yousef Abdullatif Jameel, Chair of Prophetic Medical Applications (YAJCPMA), Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Correspondence: Nasra Ayuob Medical Histology and Cell Biology Department, Faculty of Medicine, Damietta University, Damietta, EgyptTel +201066513745 Email
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Kumari K, Chainy GB, Subudhi U. Prospective role of thyroid disorders in monitoring COVID-19 pandemic. Heliyon 2020; 6:e05712. [PMID: 33344794 PMCID: PMC7733548 DOI: 10.1016/j.heliyon.2020.e05712] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/01/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 pandemic has affected more than 200 countries and 1.3 million individuals have deceased within eleven months. Intense research on COVID-19 occurrence and prevalence enable us to understand that comorbidities play a crucial role in spread and severity of SARS-CoV-2 infection. Chronic kidney disease, diabetes, respiratory diseases and hypertension are among the various morbidities that are prevalent in symptomatic COVID-19 patients. However, the effect of altered thyroid-driven disorders cannot be ignored. Since thyroid hormone critically coordinate and regulate the major metabolism and biochemical pathways, this review is on the potential role of prevailing thyroid disorders in SARS-CoV-2 infection. Direct link of thyroid hormone with several disorders such as diabetes, vitamin D deficiency, obesity, kidney and liver disorders etc. suggests that the prevailing thyroid conditions may affect SARS-CoV-2 infection. Further, we discuss the oxidative stress-induced aging is associated with the degree of SARS-CoV-2 infection. Importantly, ACE2 protein which facilitates the host-cell entry of SARS-CoV-2 using the spike protein, are highly expressed in individuals with abnormal level of thyroid hormone. Altogether, we report that the malfunction of thyroid hormone synthesis may aggravate SARS-CoV-2 infection and thus monitoring the thyroid hormone may help in understanding the pathogenesis of COVID-19.
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Affiliation(s)
- Kanchan Kumari
- CSIR-Institute of Minerals & Materials Technology, Bhubaneswar 751013, Odisha, India
- Department of Molecular Biology, Umea University, Sweden
| | - Gagan B.N. Chainy
- Post Graduate Department of Biotechnology, Utkal University, Bhubaneswar 751004, Odisha, India
| | - Umakanta Subudhi
- CSIR-Institute of Minerals & Materials Technology, Bhubaneswar 751013, Odisha, India
- Academy of Scientific & Innovative Research (AcSIR), New Delhi 110025, India
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Elwenspoek MMC, Scott LJ, Alsop K, Patel R, Watson JC, Mann E, Whiting P. What methods are being used to create an evidence base on the use of laboratory tests to monitor long-term conditions in primary care? A scoping review. Fam Pract 2020; 37:845-853. [PMID: 32820328 PMCID: PMC7759753 DOI: 10.1093/fampra/cmaa074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Studies have shown unwarranted variation in test ordering among GP practices and regions, which may lead to patient harm and increased health care costs. There is currently no robust evidence base to inform guidelines on monitoring long-term conditions. OBJECTIVES To map the extent and nature of research that provides evidence on the use of laboratory tests to monitor long-term conditions in primary care, and to identify gaps in existing research. METHODS We performed a scoping review-a relatively new approach for mapping research evidence across broad topics-using data abstraction forms and charting data according to a scoping framework. We searched CINAHL, EMBASE and MEDLINE to April 2019. We included studies that aimed to optimize the use of laboratory tests and determine costs, patient harm or variation related to testing in a primary care population with long-term conditions. RESULTS Ninety-four studies were included. Forty percent aimed to describe variation in test ordering and 36% to investigate test performance. Renal function tests (35%), HbA1c (23%) and lipids (17%) were the most studied laboratory tests. Most studies applied a cohort design using routinely collected health care data (49%). We found gaps in research on strategies to optimize test use to improve patient outcomes, optimal testing intervals and patient harms caused by over-testing. CONCLUSIONS Future research needs to address these gaps in evidence. High-level evidence is missing, i.e. randomized controlled trials comparing one monitoring strategy to another or quasi-experimental designs such as interrupted time series analysis if trials are not feasible.
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Affiliation(s)
- Martha M C Elwenspoek
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lauren J Scott
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katharine Alsop
- Nightingale Valley Practice, Bristol, UK
- Brisdoc Healthcare Services, Bristol, UK
| | - Rita Patel
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jessica C Watson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ed Mann
- Tyntesfield Medical Group, Bristol, UK
| | - Penny Whiting
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Huang X, Zhang X, Zhou X, Han X, Fu Z, Li Y, Ji L. Prevalence of Thyroid Dysfunction in a Chinese Population with Different Glucose Intolerance Status: A Community-Based Cross-Sectional Study. Diabetes Metab Syndr Obes 2020; 13:4361-4368. [PMID: 33235476 PMCID: PMC7678694 DOI: 10.2147/dmso.s271328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022] Open
Abstract
AIM Impaired glucose metabolism and thyroid dysfunction (TD) are the two most common chronic metabolic disorders. This study aimed to investigate the epidemiological characteristics of TD in different status of glucose tolerance in a community-based Chinese population and to understand the association between TD and glucose metabolism. METHODS A community-based population study of metabolic disease was conducted from June 2013 to September 2014 in Beijing, China. Residents aged 26-76 years were selected according to gender and age composition using multi-stage stratified random sampling process. All participants underwent serum thyroid function and thyroid-associated antibody tests. The status of glucose tolerance was determined using 75g-oral glucose tolerance test. Chi-square test was used to compare the differences in prevalence. Multivariate logistic regression analysis was used to determine the impact of insulin resistance (IR) on thyroid function. RESULTS By analyzing 3986 participants who were included in the survey, the prevalence of type 2 diabetes (T2DM) and pre-diabetes (pre-DM) was 18.59% and 26.79%, respectively. The prevalence of TD was 8.81%, with overt hyperthyroidism accounting for 0.38%; subclinical hyperthyroidism, 1.86%; overt hypothyroidism, 0.70%; and subclinical hypothyroidism, 5.87%. The prevalence of TD increased with gradually deteriorated glucose tolerance (7.63% in those with normal glucose tolerance, 9.27% in pre-DM, and 11.61% in T2DM) in both men and women. Each unit of higher HOMA-IR was associated with 7% higher likelihood of having subclinical hypothyroidism. CONCLUSION The coexisting of TD with T2DM and pre-DM is high in this community-based Chinese population, suggesting a close relationship between TD and glucose metabolism.
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Affiliation(s)
- Xiuting Huang
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Peking University Diabetes Center, Beijing100044, People’s Republic of China
| | - Xiuying Zhang
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Peking University Diabetes Center, Beijing100044, People’s Republic of China
| | - Xianghai Zhou
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Peking University Diabetes Center, Beijing100044, People’s Republic of China
| | - Xueyao Han
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Peking University Diabetes Center, Beijing100044, People’s Republic of China
| | - Zuodi Fu
- Department of Endocrinology and Metabolism, Capital Medical University Pinggu Teaching Hospital, Beijing101200, People’s Republic of China
| | - Yufeng Li
- Department of Endocrinology and Metabolism, Capital Medical University Pinggu Teaching Hospital, Beijing101200, People’s Republic of China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Peking University Diabetes Center, Beijing100044, People’s Republic of China
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Frommer L, Kahaly GJ. Type 1 diabetes and associated autoimmune diseases. World J Diabetes 2020; 11:527-539. [PMID: 33269064 PMCID: PMC7672792 DOI: 10.4239/wjd.v11.i11.527] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/27/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Common autoimmune diseases (AID) tend to occur together in the same individual and families. Type 1 diabetes (T1D) is caused by an autoimmune-induced inflammatory destruction of the pancreatic tissue and clusters with several other AID. AIM To compare the demographic, clinical, and serological features of patients with single T1D vs those with T1D and associated AID. METHODS From October 1999 to February 2020, a total of 665 patients with T1D and their first-degree relatives were evaluated. RESULTS Compared to patients with isolated T1D, those with T1D + AID were older and had a higher female: male ratio. Average patient age and age at disease onset were higher in T1D + AID vs T1D only. The average time interval between T1D onset and the onset of a second glandular AID was markedly shorter than the time interval between T1D and the occurrence of a non-endocrine AID. T1D-specific autoantibodies were more frequent in patients with T1D + AID and relatives vs those with T1D only. However, the prevalence of AID and autoantibodies against various tissues were found to be higher in relatives of patients with T1D only compared to relatives of patients with T1D + AID. CONCLUSION Annual serological and subsequent functional screening for AID in patients with T1D and their first-degree relatives is recommended.
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Affiliation(s)
- Lara Frommer
- Department of Medicine I, Johannes Gutenberg Medical Center, Mainz 55131, Germany
| | - George J Kahaly
- Department of Medicine I, Johannes Gutenberg Medical Center, Mainz 55131, Germany
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Pillay S, Pillay D, Singh D, Pillay R. Human immunodeficiency virus, diabetes mellitus and thyroid abnormalities: Should we be screening? South Afr J HIV Med 2020; 21:1116. [PMID: 33240534 PMCID: PMC7670034 DOI: 10.4102/sajhivmed.v21i1.1116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) and human immunodeficiency virus (HIV) are associated with thyroid abnormalities. Scarce literature exists on the prevalence of thyroid abnormalities in people living with HIV (PLWH) and DM (PLWHD). Guidelines vary regarding thyroid-stimulating hormone (TSH) screening in PLWH and/or DM. OBJECTIVES This study describes thyroid abnormalities in PLWHD and HIV-uninfected people living with DM (PLWD). METHOD This was a cross-sectional analysis of demographic, clinical and biochemical data including TSH results of first-visit patients to the Edendale Hospital diabetes clinic between January 2016 and December 2017. RESULTS A total of 915 patients were enrolled: 165 PLWHD and 750 PLWD. Overall prevalence of thyroid disorders in PLWD was 8.53% (64/750). The occurrence of 'total' thyroid disorders and of 'subclinical-hypothyroidism' (SCH) was higher in PLWHD than PLWD (23.03% vs. 8.53% and 20.61% vs. 4%, p < 0.001; respectively). People living with HIV and diabetes with thyroid disorders had lower CD4 counts than PLWHD without thyroid disorders (376.08 ± 333.30 vs. 509 ± 341.7 cells/mm3; p = 0.004). Subclinical-hypothyroidism was more common in patients on antiretroviral therapy [ART] (27/136 [19.85%] vs. 4/27 [14.81%], p < 0.001). A significant number of PLWHD acquired HIV before the onset of DM (107/165 [64.85%] vs. 58/165 [35.15%], p < 0.001). Patients on ART were more likely to develop DM, OR 2.66 (95% CI 1.11-6.38). CONCLUSION Our study showed an increased prevalence of thyroid disorders (especially SCH) in PLWD and a higher prevalence in PLWHD. Young, overweight, female PLWHD were at risk of SCH. People living with HIV and DM on ART demonstrated an increased prevalence of thyroid dysfunction and poor lipaemic control. The introduction of combined communicable-non-communicable disease clinics might provide an integrated patient screening option.
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Affiliation(s)
- Somasundram Pillay
- Department of Internal Medicine, King Edward VIII Hospital, Durban, South Africa
- Department of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Deepak Singh
- Department of Physics, Durban University of Technology, Durban, South Africa
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Khassawneh AH, Al-Mistarehi AH, Zein Alaabdin AM, Khasawneh L, AlQuran TM, Kheirallah KA, Saadeh NA, Beni Yonis O, Shawkat M, Obeidat N. Prevalence and Predictors of Thyroid Dysfunction Among Type 2 Diabetic Patients: A Case-Control Study. Int J Gen Med 2020; 13:803-816. [PMID: 33116772 PMCID: PMC7568427 DOI: 10.2147/ijgm.s273900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/14/2020] [Indexed: 01/22/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) and thyroid disorders are common endocrine disorders. This case–control study aims to determine the prevalence and predictors of thyroid disorders in T2DM patients. Methods A total of 998 T2DM patients attending a tertiary hospital were included and underwent investigations for thyroid function: thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3); and glycated hemoglobin (HbA1c). They were compared with 343 non-diabetic subjects as controls. Results A total of 1341 participants were included in the study. The mean age ± SD was 60.14 ± 12.21, and 47.9% were females. Among T2DM patients, 140 (14%) were known to have thyroid disorders; and as a direct result of screening, 126 (12.6%) new cases of thyroid disorder were diagnosed. Thus, the overall prevalence of thyroid disorders was found to be 26.7% in T2DM patients which significantly higher than the controls (13.7%), (p˂0.001). Subclinical hypothyroidism was the most common one. Using logistic regression, after adjusting for age, gender, obesity, smoking, anemia, presence of goiter, disease duration, and poorly controlled, the risk factors for thyroid dysfunction among T2DM patients were an age of ≥50 years with an adjusted OR of 3.895 (95% CI 2.151–7.052, p<0.001); female gender (OR 1.757, 95% CI 1.123–2.747, p=0.013); goiter (OR 2.904, 95% CI 1.118–7.547, p=0.029), and HbA1c>7% (OR 2.553, 95% CI 1.472–4.429, p=0.001). However, there were no significant associations between thyroid disorders and complications or duration of diabetes (p>0.050). Conclusion A high prevalence of thyroid disorders was reported in T2DM patients. Therefore, we suggest that diabetic patients should be routinely screened for thyroid dysfunction. Old age, female gender, goiter, and poorly controlled diabetes found to be risk factors for thyroid dysfunction among T2DM patients. Consequently, appropriate management and control of diabetes may lower the risk of thyroid dysfunction and vice versa.
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Affiliation(s)
- Adi H Khassawneh
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Anas M Zein Alaabdin
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Laith Khasawneh
- Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Thekraiat M AlQuran
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid A Kheirallah
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nesreen A Saadeh
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Othman Beni Yonis
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohamid Shawkat
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nail Obeidat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Vamshidhar IS, Rani SSS. A Study of Association of Thyroid Dysfunctions in Patients with Type 2 Diabetes Mellitus. MAEDICA 2020; 15:169-173. [PMID: 32952680 PMCID: PMC7482697 DOI: 10.26574/maedica.2020.15.2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background: Type 2 diabetes mellitus is known to be associated with other endocrine dysfunctions and thyroid is one of them. In the current study we tried to evaluate the frequency of thyroid dysfunctions in patients with type 2 diabetes mellitus and compare them with a normal control population. Methods: This cross-sectional study was carried out in the Department of Physiology and Department of General Medicine, Kakatiya Medical College, and MGM Hospital, Warangal, India. A total of 50 consecutive patients with diabetes mellitus type 2 were selected as cases, and an equal number of age- and sex-matched individuals with normoglycemia as controls. Laboratory investigations included measurements of fasting blood sugar [FBS] and HbA1c values after overnight fasting for eight hours, serum triglycerides, along with serum TSH, FT3, and FT4, which were measured by chemiluminescence immunoassay. Results: Among all cases of type 2 diabetes mellitus, eight (16%) presented thyroid disorders, with 10% in male patients and 6% in female patients. The overall frequency of thyroid disorders was found in four (8%) cases, of which two (4%) in males and two in females. The values of TSH μIU/ml and FBS mg/dl in type 2 diabetes mellitus cases were plotted and a Pearson correlation coefficient of +0.70 was calculated, indicating a positive correlation between the TSH and FBS. Along with TSH levels, the values of HbA1c were plotted in patients with type 2 diabetes mellitus and a Pearson correlation coefficient of +0.76 was calculated. Conclusion: Within the limitations of the present study, it can be concluded that the prevalence of thyroid dysfunctions is more common in patients with type 2 diabetes mellitus. Also, a continuous positive correlation of TSH with FBS and HbA1c was found. Hence, a periodic screening for their coexistence in thyroid dysfunctions among diabetic patients is advisable.
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Affiliation(s)
- I S Vamshidhar
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bibinagar-508126, Telangana State, India
| | - S S Sabitha Rani
- Department of Pathology, Kamineni Institute of Medical Sciences (KIMS), Sreepuram, Narketpally, Telangana-508254, India
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Peters KE, Chubb SAP, Bruce DG, Davis WA, Davis TME. Prevalence and incidence of thyroid dysfunction in type 1 diabetes, type 2 diabetes and latent autoimmune diabetes of adults: The Fremantle Diabetes Study Phase II. Clin Endocrinol (Oxf) 2020; 92:373-382. [PMID: 31984536 DOI: 10.1111/cen.14164] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/02/2020] [Accepted: 01/22/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Since the results of published studies assessing thyroid dysfunction complicating diabetes have been variable in quality, inconsistent and may not reflect contemporary clinical care, the aim of this study was to determine its prevalence and incidence in a large, well-characterized, representative cohort. DESIGN Community-based, longitudinal, observational study. PATIENTS A total of 1617 participants from the Fremantle Diabetes Study Phase II (FDS2), including 130 (8.0%) with type 1 diabetes, 1408 (87.1%) with type 2 diabetes, and 79 (4.9%) with latent autoimmune diabetes of adults (LADA). MEASUREMENTS Serum thyrotropin (TSH) and free thyroxine (FT4) at baseline between 2008 and 2011 and in those attending Year 4 follow-up. RESULTS The prevalence of known thyroid disease (ascertained from baseline self-reported thyroid medication use or hospitalization data) was 11.7% (189/1617). Of the remaining 1428 participants, 5.1% (73/1428) had biochemical evidence of subclinical hypothyroidism, 1.1% (15/1428) overt hypothyroidism, 0.1% (2/1428) subclinical hyperthyroidism and 0.2% (3/1428) overt hyperthyroidism, representing an overall baseline prevalence of thyroid disease of 17.4% (282/1617). During 5694 patient-years of follow-up, 25 (3.0%) of the 844 with a normal baseline TSH and follow-up data developed known thyroid disease. Of the remaining 819, 3.4% developed subclinical hypothyroidism, 0.2% overt hypothyroidism and 0.5% subclinical hyperthyroidism. There were no statistically significant differences in the prevalence or incidence of thyroid dysfunction by diabetes type. CONCLUSIONS Thyroid dysfunction, known or detected through screening, is common in diabetes. These data suggest the need for periodic clinical and biochemical screening for thyroid disease in all types of diabetes.
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Affiliation(s)
- Kirsten E Peters
- Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Fremantle, WA, Australia
| | - Stephen A Paul Chubb
- Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Fremantle, WA, Australia
- PathWest Laboratory Medicine Western Australia, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - David G Bruce
- Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Fremantle, WA, Australia
| | - Wendy A Davis
- Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Fremantle, WA, Australia
| | - Timothy M E Davis
- Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Fremantle, WA, Australia
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Ala M, Jafari RM, Dehpour AR. Diabetes Mellitus and Osteoporosis Correlation: Challenges and Hopes. Curr Diabetes Rev 2020; 16:984-1001. [PMID: 32208120 DOI: 10.2174/1573399816666200324152517] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/02/2020] [Accepted: 02/24/2020] [Indexed: 01/14/2023]
Abstract
Diabetes and osteoporosis are two common diseases with different complications. Despite different therapeutic strategies, managing these diseases and reducing their burden have not been satisfactory, especially when they appear one after the other. In this review, we aimed to clarify the similarity, common etiology and possible common adjunctive therapies of these two major diseases and designate the known molecular pattern observed in them. Based on different experimental findings, we want to illuminate that interestingly similar pathways lead to diabetes and osteoporosis. Meanwhile, there are a few drugs involved in the treatment of both diseases, which most of the time act in the same line but sometimes with opposing results. Considering the correlation between diabetes and osteoporosis, more efficient management of both diseases, in conditions of concomitant incidence or cause and effect condition, is required.
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Affiliation(s)
- Moein Ala
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, 13145-784, Tehran, Iran
| | - Razieh Mohammad Jafari
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Dehpour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, 13145-784, Tehran, Iran
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Kalra S, Aggarwal S, Khandelwal D. Thyroid Dysfunction and Type 2 Diabetes Mellitus: Screening Strategies and Implications for Management. Diabetes Ther 2019; 10:2035-2044. [PMID: 31583645 PMCID: PMC6848627 DOI: 10.1007/s13300-019-00700-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Indexed: 12/20/2022] Open
Abstract
Diabetes mellitus (DM) and thyroid dysfunction (TD) often tend to coexist in patients. Both hypothyroidism and hyperthyroidism are more common in type 2 diabetes mellitus (T2DM) patients than in their nondiabetic counterparts. Current guidelines are neither clear nor specific about the frequency of thyroid function monitoring in T2DM patients. Circulating thyroid hormones affect several different organs and cells, have a major impact on glucose, lipid, and protein metabolism, and can worsen glycaemic control in T2DM. Hyperthyroidism and thyrotoxicosis can worsen subclinical DM and cause hyperglycaemia in T2DM patients, increasing the risk of diabetic complications. T2DM reduces thyroid-stimulating hormone levels and impairs the conversion of thyroxine (T4) to triiodothyronine (T3) in the peripheral tissues. Poorly managed T2DM can lead to insulin resistance and hyperinsulinaemia, which causes thyroid tissue proliferation and increases nodule formation and goitre size. In addition, while metformin can be beneficial in both T2DM and TD patients, other antidiabetics such as sulfonylureas, pioglitazone, and thiazolidinediones can negatively impact TD. Antithyroid drugs such as methimazole can impair glycaemic control in T2DM patients. Thyrovigilance in T2DM patients and diabetovigilance in TD patients may therefore be necessary to facilitate individualized care and management.Funding: Abbott India Ltd.
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Abstract
The present analysis aims to investigate the prevalence of thyroid nodules in type 2 diabetes mellitus (T2DM) population. We searched PubMed, EMBASE, and Web of Science from inception to the March 1, 2018. The studies were selected to estimate the prevalence of thyroid nodules in T2DM subjects and to compare the prevalence of thyroid nodules in different glucose tolerance status. The random effects model was used, and the outcome was presented as a pooled prevalence proportion with 95% confidence interval (95% CI) or a summary odds ratio (OR) with 95% CI. In the end, 9 studies met the inclusion criteria and were included in the analysis. The pooled prevalence of thyroid nodules was 60% (95% CI: 0.52, 0.68) for T2DM 2 diabetes patients, 50% (95% CI: 0.48, 0.51) for pre-diabetes, and 43% (95% CI: 0.34, 0.52) for normal glucose tolerance population. Compared with patients without diabetes, diabetes subjects are more likely to develop thyroid nodules, adjusted OR for thyroid nodule was 1.78 (95% CI: 1.25, 2.55). Insulin resistance might be involved in thyroid nodule development.
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Zhu Y, Xu F, Shen J, Liu Y, Bi C, Liu J, Li Y, Wang X, Gao Z, Liang L, Chen Y, Sun W, Guan Q, Zhang J, Luo Z, Guo L, Cai X, Li L, Xiu L, Yan L, Li C, Shi X, Zhu M, Kuang J, Li G, Ji L. Prevalence of thyroid dysfunction in older Chinese patients with type 2 diabetes-A multicenter cross-sectional observational study across China. PLoS One 2019; 14:e0216151. [PMID: 31048873 PMCID: PMC6497275 DOI: 10.1371/journal.pone.0216151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/15/2019] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes [T2D] and thyroid dysfunction [TD] often co-occur, have overlapping pathologies, and their risk increases with age. Since 1995, universal salt iodization has been implemented in China to prevent disorders caused by iodine deficiency. However, after two decades of implementation of universal salt iodization, the prevalence of TD in elderly Chinese patients with T2D is not well described and may have been underestimated. We conducted a questionnaire-based survey across 24 endocrinology centers in China between December 2015 and July 2016. Demographic and clinical data from 1677 patients with T2D were obtained and analyzed to examine the prevalence of TD along with T2D in these patients. We assessed TD prevalence according to the four TD subtypes [subclinical hypothyroidism, clinical hypothyroidism, subclinical hyperthyroidism, and clinical hyperthyroidism], TD history, gender, and age. The diagnosis rates were calculated for TD and also for the TD subtype. The number of patients reaching treatment goals for T2D [hemoglobin A1c <7%] and TD [normal free thyroxine and thyroid-stimulating hormone [TSH]] and the incidences of complications and comorbidities were recorded. Among the enrolled patients with T2D [N = 1677], TD was diagnosed in 23.79% [399/1677] out of which 61% (245/399) were previously diagnosed and 38.59% (154/399) were newly diagnosed cases. Subclinical hypothyroidism, clinical hypothyroidism, subclinical hyperthyroidism, and clinical hyperthyroidism were reported in 4.89%, 9.3%, 1.13%, and 3.16% of the total population, respectively. Among patients previously diagnosed with TD, the incidence in women [166/795; 20.88%] was higher than in men [79/882; 8.96%]. The treatment goals for TD and T2D were attained in 39.6% [97/245] and 34.41% [577/1677] of the cases, respectively. Diabetic complications and comorbidities were reported in 99.7% of patients, with peripheral neuropathy being the most common [43.46%] followed by cataract [24.73%]. We had found that the incidences of dyslipidemia, elevated LDL levels, and osteoporosis were significantly higher in patients with TD than those without TD. TD is underdiagnosed in elderly Chinese patients with T2D.
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Affiliation(s)
- Yu Zhu
- Peking University People’s Hospital, Beijing, China
| | - Fengmei Xu
- General Hospital of Hebi Coal Industry [Group] Co., Ltd., Hebi, China
| | - Jie Shen
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Youshuo Liu
- The Second Xiangya Hospital of Central South University, Changsha, China
| | | | - Jing Liu
- Gansu Provincial Hospital, Lanzhou, China
| | - Yufeng Li
- Beijing Pinggu Hospital, Beijing, China
| | - Xueqin Wang
- Beijing Huairou Hospital of University of Chinese Academy Sciences, Beijing, China
| | - Zhengnan Gao
- Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian, China
| | - Linlang Liang
- The General Hospital of Shenyang Military Region, Shenyang, China
| | - Yanyan Chen
- Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Weiping Sun
- The First People’s Hospital of Xiangtan City, Xiangtan, China
| | - Qingbo Guan
- Shandong Provincial Hospital, Shandong, China
| | | | - Zuojie Luo
- The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | | | - Xiaopin Cai
- China-Japan Friendship Hospital, Beijing, China
| | - Ling Li
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Lingling Xiu
- First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Yan
- Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chunlin Li
- The General Hospital of the People's Liberation Army [301 Hospital], Beijing, China
| | - Xiaoyun Shi
- The General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Mei Zhu
- General Hospital, Tianjin Medical University, Tianjin, China
| | - Jian Kuang
- Guangdong General Hospital, Guangzhou, China
| | - Guangwei Li
- Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Linong Ji
- Peking University People’s Hospital, Beijing, China
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Arafa MAA, Gouda ZA, El-Naseery NI, Abdel-Nour HM, Hanafy SM, Mohamed AF, Abo-Ouf AM. Bone Marrow-Derived Mesenchymal Stem Cells Ameliorate the Pancreatic Changes of Chemically Induced Hypothyroidism by Carbimazole in Male Rats. Cells Tissues Organs 2019; 206:144-156. [PMID: 30921798 DOI: 10.1159/000497297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/25/2019] [Indexed: 11/19/2022] Open
Abstract
We induced hypothyroidism (HT) in male rats through chronic oral administration of carbimazole and then tested whether an i.v. injection of rat bone marrow-derived mesenchymal stem cells (BM-MSCs) could ameliorate the HT-induced changes in pancreatic structure and function. The thyroid and pancreatic function tests, as well as total antioxidant capacity (TAC) and malondialdehyde (MDA) were estimated. The pancreatic structure was evaluated by hematoxylin and eosin (H&E) stain. Insulin protein and cleaved caspase-3 were detected immunohistochemically. The degree of apoptosis was assessed by TUNEL assay. The morphometric measurements were done by an image analyzer system and the obtained data were statistically analyzed. HT rats showed hyperglycemia associated with insulin deficiency, decreased TAC and increased MDA levels. H&E-stained sections showed that the pancreatic septa were infiltrated with acidophilic material. Some acini were vacuolated while others showed depleted acidophilia and dilated lumina. Spindle-shaped cells were accumulated within deformed islets in HT rats. The positive reaction with anti-cleaved caspase-3 was exclusively noted in the cytoplasm of islet cells with no immunostaining reaction in the acinar and ductal cells, whereas the positively stained nuclei with TUNEL were demonstrated in the islet and acinar cells. A significant increase in the apoptotic index % of both markers was detected. Injection of BM-MSCs in HT rats restored all biochemical indicators of disturbed pancreatic function to normal level and improved pancreatic structure, resulting in a clear septa and normal appearance of acini and islets. In conclusion, many of the significant structural and func tional pancreatic alterations detected in HT rats were ameliorated after the injection of BM-MSCs. These data demonstrate the ability of BM-MSCs to repair pancreatic disturbances. Further studies on humans are necessary to determine the potential clinical applications of BM-MSCs.
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Affiliation(s)
- Mona A A Arafa
- Department of Anatomy, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Zienab A Gouda
- Department of Histology and Cell Biology, Faculty of Medicine, Zagazig University, Zagazig, Egypt,
| | - Nesma I El-Naseery
- Department of Histology and Cytology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Hanim M Abdel-Nour
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Safaa M Hanafy
- Department of Anatomy, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Amany F Mohamed
- Department of Anatomy, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Amany M Abo-Ouf
- Department of Anatomy, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
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Talwalkar P, Deshmukh V, Bhole M. Prevalence of hypothyroidism in patients with type 2 diabetes mellitus and hypertension in India: a cross-sectional observational study. Diabetes Metab Syndr Obes 2019; 12:369-376. [PMID: 30936734 PMCID: PMC6431000 DOI: 10.2147/dmso.s181470] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the prevalence of hypothyroidism in patients with type 2 diabetes mel-litus (T2DM), hypertension, and both T2DM and hypertension (T2DM + hypertension) in India. PATIENTS AND METHODS In this cross-sectional observational study, adult patients with an established or newly diagnosed T2DM, hypertension, and T2DM + hypertension who were visiting their physicians for a routine clinical checkup were enrolled across 29 sites in India. All the patient-related data were extracted from their medical records. The prevalence of hypothyroidism was evaluated by thyroid function test (levels of serum free thyroxine, free triiodothyronine, and thyroid-stimulating hormone [TSH]). The proportion of obese and overweight hypothyroid patients and dose of thyroxine in overt and subclinical hypothyroidism (SCH) cases (as per TSH values) were assessed during the study. The results were summarized by descriptive statistics. RESULTS A total of 1,508 patients (T2DM: 504; hypertension: 501; T2DM + hypertension: 503) were enrolled in the study. The prevalence of hypothyroidism in patients with T2DM, hypertension, and T2DM + hypertension was 24.8%, 33.5%, and 28.9%, respectively. The overall prevalence of hypothyroidism in T2DM (n=1,002) and hypertension (n=1,001) was 26.9% and 31.2%, respectively. The proportion of obese against overweight hypothyroid patients was higher in all indications (T2DM: 16.5% vs 3.4%; hypertension: 23.8% vs 5.4%; T2DM + hypertension: 21.5% vs 3.8%). A considerable proportion of patients with SCH was prescribed thyroxine in T2DM (61.5%), hypertension (61%), and T2DM + hypertension (62.5%) cases. The most commonly prescribed dose (mean) of thyroxine was 50 and 25 µg for overt hypothyroidism and SCH cases, respectively, in all cohorts. CONCLUSION There is a high (>20%) prevalence of hypothyroidism in patients with T2DM, hypertension, and T2DM + hypertension. Screening for hypothyroidism should be routinely considered for early diagnosis and effective management.
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Affiliation(s)
| | | | - Milind Bhole
- Medical Affairs, Abbott India Ltd, Mumbai, India,
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Association between Continuity of Care and the Onset of Thyroid Disorder among Diabetes Patients in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020233. [PMID: 30650629 PMCID: PMC6352198 DOI: 10.3390/ijerph16020233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/27/2018] [Accepted: 01/09/2019] [Indexed: 12/15/2022]
Abstract
Objectives: As the relationship between diabetes mellitus and thyroid dysfunction is well known, it is important to investigate the factors influencing this association. Continuity of care is associated with better quality of care and outcomes, such as reduced complications, among diabetes patients. Therefore, the purpose of this study was to investigate the association between continuity of care and the onset of thyroid dysfunction among diabetes patients. Methods: We used Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013. Our final study population included 16,806 newly diagnosed diabetes patients who were older than 45 years of age. Continuity of care was measured using the Continuity of Care index. The dependent variable was the onset of thyroid disorder. Cox proportional hazard regression models were used for statistical analyses. Results: Diabetes patients with low continuity of care were at increased risk of the onset of thyroid disorder compared with those with high continuity of care (hazard ratio (HR): 1.28, 95% confidence interval (CI): 1.07–1.54). Subgroup analyses showed that this association was significant within patients with type 2 diabetes (HR: 1.24, 95% CI: 1.01–1.52) or whose main attending site was a local clinic (HR: 1.32, 95% CI: 1.07–1.64). Conclusions: Our results show that diabetes patients with low continuity of care are more likely to experience the onset of thyroid disorder. Therefore, improving continuity of care could be a reasonable method of preventing complications or comorbidities, including thyroid disorder, among diabetes patients.
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Jinlida Granules Improve Dysfunction of Hypothalamic-Pituitary-Thyroid Axis in Diabetic Rats Induced by STZ. BIOMED RESEARCH INTERNATIONAL 2019; 2018:4764030. [PMID: 29984235 PMCID: PMC6011157 DOI: 10.1155/2018/4764030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/02/2018] [Indexed: 01/08/2023]
Abstract
Objective We aim to explore the effects and mechanisms of Jinlida granules on the dysfunction of hypothalamic-pituitary-thyroid (HPT) axis in diabetic rats induced by streptozotocin. Methods A total of 48 SD rats were randomized into normal control group (NC, n = 6) and diabetic group (n = 42). Rats in diabetic group were randomly divided into diabetes mellitus (DM) control group, low, medium, and high doses of Jinlida group (JL, JM, and JH), medium dose of Jinlida plus Tongxinluo group (JM + T), metformin group (Met), and Saxagliptin group (Sax) (n = 6 in each group). Diabetic rats were obtained by intraperitoneal injection of streptozotocin and sacrificed at 8 weeks to examine the function of HPT axis. Results Levels of fasting blood glucose (P < 0.05), pIκB, TNFα (P < 0.05), pNF-κB, and IL-6 (P < 0.01) in liver tissue and TSHR mRNA expression (P < 0.01) in diabetic group were significantly increased, while levels of serum T3 and T4, thyroid hormone receptor (TR) mRNA and Dio1 mRNA in liver tissue, and sodium iodide symporter (NIS) mRNA in thyroid tissue in diabetic group were significantly decreased compared with those in NC group (P < 0.01). Among diabetic groups, level of fasting blood glucose in JH, JM + T and Met group was lower (P < 0.05) compared with DM group. However, levels of serum T3 and T4, TR mRNA in liver tissue, TSHR, and NIS mRNA in thyroid tissue in JH, JM + T, Met, and Sax group were significantly increased (P < 0.01) compared to DM group. In contrast, levels of Dio1 mRNA, pI-κB in Met and JM + T groups, pNF-κB in JH, JM + T, and Met group, and TNFα and IL-6 in JM, JH, JM + T, and Met group were significantly decreased (P < 0.05). HE staining showed reduced thyroid follicular epithelium and follicular area, as well as increased colloid area in DM group, indicating impaired synthesis, reabsorption, and secretory of TH in diabetes, which was significantly improved in JH, JM + T, and Met groups. Conclusion HPT axis dysfunction in DM could be significantly improved by Jinlida granules. The mechanism might be associated with the anti-inflammatory effects involving NF-κB pathway. Our findings suggested the potential benefit of Jinlida granules for patients with HPT axis dysfunction and DM, which was to be verified by more experimental and clinical studies.
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Mignogna MD, Leuci S. Interface Between Oral and Systemic Disease. CONTEMPORARY ORAL MEDICINE 2019:67-136. [DOI: 10.1007/978-3-319-72303-7_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Du W, Wang F, Zhao M, Zhang H, Zhang X, Zhao J, Gao L. Prevalence of thyroid disorders and associated risk factors with various glycemic status in North China. BIOTECHNOL BIOTEC EQ 2019. [DOI: 10.1080/13102818.2019.1656106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Wenhua Du
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
- Department of Endocrinology, Linyi People’s Hospital, Linyi, Shandong, PR China
| | - Fei Wang
- Department of Endocrinology, Weifang People’s Hospital, Weifang, Shandong, PR China
| | - Meng Zhao
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
- Scientific Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
| | - Haiqing Zhang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
- Scientific Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
| | - Xu Zhang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Jiajun Zhao
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
- Scientific Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
| | - Ling Gao
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
- Scientific Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China
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Alsolami AA, Alshali KZ, Albeshri MA, Alhassan SH, Qazli AM, Almalki AS, Bakarman MA, Mukhtar AM. Association between type 2 diabetes mellitus and hypothyroidism: a case-control study. Int J Gen Med 2018; 11:457-461. [PMID: 30584348 PMCID: PMC6287518 DOI: 10.2147/ijgm.s179205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Type 2 diabetes mellitus (DM-II) is highly prevalent in Saudi Arabia and only few studies have assessed it as a risk factor for hypothyroidism. This study aimed to examine the association between DM-II and hypothyroidism. Subjects and methods We conducted a hospital-based case-control study. As cases, we included all adults admitted to King Abdulaziz University Hospital (KAUH) with laboratory-confirmed hypothyroidism. As controls, we drew a random sample of patients admitted to the orthopedic clinic at KAUH with laboratory-confirmed absence of hypothyroidism. We extracted data from the medical records regarding age, sex, presence of DM-II, HbA1c, comorbidities, treatment, and complications. We used multivariate logistic regression to identify factors associated with hypothyroidism. Results We included 121 cases and 121 controls. In comparison to controls, cases were older (P=0.005), had higher prevalence of DM-II (P<0.001), had higher levels of HbA1c (P=0.03), used insulin (P<0.001) and oral hypoglycemic drugs (P<0.001) more often, and suffered more often from hypertension (P<0.001), coronary artery disease (CAD) (P<0.001), stroke (P=0.04), diabetic foot (P<0.001), and nephropathy (P<0.001). According to multivariate regression, the risk of hypothyroidism was significantly increased among patients with DM-II (OR=4.14; 95% CI=20.20-7.80; P<0.001) and CAD (OR=14.15; 95% CI=1.80-111.43; P=0.01). Conclusion Patients with DM-II were at increased risk of developing hypothyroidism. Adequate management and control of DM-II might reduce the risk of developing hypothyroidism. Further research using a prospective cohort study design is needed to confirm these findings. Key messages Patients with DM-II had an increased risk of developing hypothyroidism.
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Affiliation(s)
- Anas Awad Alsolami
- Faculty of Medicine, Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Khalid Z Alshali
- Faculty of Medicine, Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Marwan Ahmad Albeshri
- Faculty of Medicine, Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Shikih Hussain Alhassan
- Faculty of Medicine, Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Abdalrhman Mohammed Qazli
- Faculty of Medicine, Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Ahmed Saad Almalki
- Faculty of Medicine, Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Marwan A Bakarman
- Department of Family and Community Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdel Moniem Mukhtar
- Faculty of Medicine, Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
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Leng L, Zhang C, Ren L, Li Q. Construction of a long non‑coding RNA-mediated competitive endogenous RNA network reveals global patterns and regulatory markers in gestational diabetes. Int J Mol Med 2018; 43:927-935. [PMID: 30569156 PMCID: PMC6317690 DOI: 10.3892/ijmm.2018.4026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/27/2018] [Indexed: 12/14/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a common disease affecting pregnant women. Recent studies have suggested that competing endogenous RNAs (ceRNAs), which compete with long non‑coding RNAs (lncRNAs) for microRNA (miRNA or miR) binding and indirectly regulate miRNA targets through competing interactions, play a critical role in disease. In this study, we present a computationally integrated approach with which to construct a lncRNA‑mediated ceRNA network (LCEN) in GDM by integrating RNA interactions and expression data. lncRNAs exhibited specific features and played critical roles in GDM‑associated LCEN. The construction of a global functional score profile revealed that ceRNAs had a high activity in GDM. We extracted several ceRNA modules and demonstrated that these modules had increased close interactions. We further discovered that these ceRNA modules may be utilized as specific and effective circulating biomarkers for GDM. Finally, functional analyses demonstrated that the GDM‑associated ceRNAs participated in the regulation of irisin and the thyroid hormone signaling pathway. It was suggested that there were close associations between the thyroid hormone and GDM. Collectively, ceRNAs may accelerate biomarker discovery and therapeutic development in GDM.
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Affiliation(s)
- Lei Leng
- Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150006, P.R. China
| | - Chengwei Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150006, P.R. China
| | - Lihong Ren
- Department of Endocrinology, The Second Hospital of Harbin, Harbin, Heilongjiang 150006, P.R. China
| | - Qiang Li
- Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150006, P.R. China
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Sriphrapradang C, Pinyopodjanard S, Suntornlohanakul O, Nimitphong H, Chirakalwasan N, Saetang S, Anothaisintawee T, Siwasaranond N, Manodpitipong A, Chailurkit LO, Reutrakul S. Lack of associations between thyroid function and obstructive sleep apnea severity in adults with prediabetes and diabetes mellitus. Sleep Breath 2018; 23:963-967. [PMID: 30456738 DOI: 10.1007/s11325-018-1756-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/18/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Hypothyroidism is associated with a high frequency of obstructive sleep apnea (OSA). However, the prevalence of OSA in hypothyroid patients is not different from the general population in many reports. The importance of thyroid function screening in sleep-disordered breathing is still controversial. This study aimed to explore the association between thyroid dysfunction and OSA in the adults with prediabetes or diabetes mellitus type 2, who have very high prevalence of OSA. METHODS OSA was assessed using an in-home monitoring device, WatchPAT200. OSA severity was measured using apnea-hypopnea index (AHI), oxygen desaturation index (ODI), minimum oxygen saturation (minO2), and time spent under oxygen saturation < 90% (T90). Patients with pre-existing thyroid dysfunction were excluded. RESULTS Participants included 70 men and 118 women with mean age 52.8 ± 10.9 years and body mass index 28.2 ± 4.9 kg/m2. One hundred forty participants (75%) had OSA, with a median AHI of 10.1 (interquartile range 4.8, 18.3). The percentage of positive thyroid autoantibody (thyroperoxidase and thyroglobulin antibody) was similar among the subjects with and without OSA. There was no correlation between the levels of thyroid function (TSH, FT3, FT4, TSH/FT3, and TSH/FT4 ratio) and the severity indices of OSA (AHI, ODI, minO2, and T90). CONCLUSIONS These data do not support universal screening for thyroid dysfunction in OSA patients with diabetes or prediabetes.
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Affiliation(s)
- Chutintorn Sriphrapradang
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand.
| | - Sittichai Pinyopodjanard
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Onnicha Suntornlohanakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Hataikarn Nimitphong
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sunee Saetang
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nantaporn Siwasaranond
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Areesa Manodpitipong
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - La-Or Chailurkit
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Sirimon Reutrakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand.,Division of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, IL, USA
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49
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Shpakov AO. Molecular Mechanisms of the Relationship between Thyroid Dysfunctions and Diabetes Mellitus. J EVOL BIOCHEM PHYS+ 2018. [DOI: 10.1134/s0022093018040014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chutia H, Bhattacharyya H, Ruram AA, Bora K, Chakraborty M. Evaluation of thyroid function in type 2 diabetes in north-eastern part of India: A hospital-based study. J Family Med Prim Care 2018; 7:752-755. [PMID: 30234048 PMCID: PMC6132016 DOI: 10.4103/jfmpc.jfmpc_292_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Diabetes mellitus (DM) and thyroid dysfunctions are the two most common endocrine disorders to come across in any clinical practice. Both thyroid hormones and insulin act antagonistically in metabolic pathways or cycles of cells. The aim of our study is to look for thyroid dysfunction in patients with type 2 DM and its correlation with insulin resistance (IR). Methods A cross-sectional study was carried out among 80 newly diagnosed type 2 diabetic patients. Thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, and insulin were measured in fasting serum sample. Homeostasis model assessment for IR was calculated as per formula. Results Among 80 diabetic patients, 20 were hypothyroid, 4 were hyperthyroid, and 56 were found to be euthyroid. IR was found to be significantly higher in hypothyroid as compared to euthyroid patients. A positive association was found between TSH and IR (r = 0.230) among hypothyroid patients though association was not significant. In hyperthyroid patients, a strong negative correlation (r = -0.94933) was found between TSH and IR, but no association was found among euthyroid patients. Conclusion The inability to recognize the presence of thyroid hormone dysfunction may be one of the important causes of poor management of type 2 DM. Therefore, there is a need for routine assay of thyroid hormones in type 2 diabetic patients to improve the medical management as well as to reduce the morbidity in them.
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Affiliation(s)
- Happy Chutia
- Department of Biochemistry, NEIGRIHMS, Shillong, Meghalaya, India
| | | | | | - Kaustubh Bora
- Regional Medical Research Centre, Dibrugarh, Assam, India
| | - Montosh Chakraborty
- Deparment of Biochemistry, Andaman and Nicober Islands Institute of Medical Sciences, Port Blair, Andaman Nicober, India
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