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Endocrine

, Volume 49, Issue 2, pp 339–352 | Cite as

Italian Association of Clinical Endocrinologists (AME) & Italian Association of Clinical Diabetologists (AMD) Position Statement

Diabetes mellitus and thyroid disorders: recommendations for clinical practice
  • Edoardo Guastamacchia
  • Vincenzo TriggianiEmail author
  • Alberto Aglialoro
  • Antimo Aiello
  • Lucia Ianni
  • Mauro Maccario
  • Michele Zini
  • Carlo Giorda
  • Rinaldo Guglielmi
  • Corrado Betterle
  • Roberto Attanasio
  • Giorgio Borretta
  • Piernicola Garofalo
  • Enrico Papini
  • Roberto Castello
  • Antonio Ceriello
Position Statement/Guideline

Abstract

Thyroid disease and diabetes mellitus, the most common disorders in endocrine practice, are not infrequently associated in the same subject. An altered thyroid function may affect glucose tolerance and worsen metabolic control in patients with diabetes. Thyrotoxicosis increases the risk of hyperglycemic emergencies, while a clinically relevant hypothyroidism may have a detrimental effect on glycemic control in diabetic patients. The association of alterations in thyroid function with diabetes mellitus may adversely affect the risk of cardiovascular and microvascular complications resulting from diabetes. Moreover, the treatments used for both diabetes and thyroid disease, respectively, can impact one other. Finally, multinodular goiter, but not thyroid carcinoma, was shown to be more prevalent in type 2 diabetes mellitus. Aim of the present Position Statement is to focus on the evidence concerning the association of thyroid disease and diabetes mellitus and to provide some practical suggestions for an updated clinical management.

Keywords

Diabetes mellitus Thyroid disorders Hypothyroidism Hyperthyroidism Autoimmune thyroid diseases Glycemic control 

Abbreviations

ADA

American Diabetes Association

AITD

Autoimmune thyroid disease

APS

Autoimmune polyglandular syndrome

BMI

Body mass index

CTLA-4

Cytotoxic T-lymphocyte antigen 4

CV

Cardiovascular

CVD

Cardiovascular diseases

DIO

Deiodinase

DKA

Diabetic ketoacidosis

ELISA

Enzyme-linked immunosorbent assay

FT3

Free tri-iodothyronine

FT4

Free thyroxine

GAD-Abs

Glutamic acid decarboxylase antibodies

GDM

Gestational diabetes mellitus

GLP-1

Glucagon-like peptide 1

GLUT

Glucose transporter

GO

Graves’ orbitopathy

HDL

High-density lipoprotein

IA2

Islet antigen-2

IAA

Insulin antibody

ICA

Islet cell antibody

IGT

Impaired glucose tolerance

LDL

Low-density lipoprotein

LoE

Evels of evidence

MEN

Multiple endocrine neoplasia

OGTT

Oral glucose tolerance test

OR

Odds ratio

PPTD

Post-partum thyroid dysfunction

SU

Sulfonylureas

T1DM

Type 1 diabetes mellitus

T2DM

Type 2 diabetes mellitus

T3

Tri-iodothyronine

TgAb

Anti-thyroglobulin antibodies

TPOAb

Anti-thyroperoxidase antibodies

TRAb

Anti-TSH receptor antibodies

TSH

Thyrotropin

Notes

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Edoardo Guastamacchia
    • 1
  • Vincenzo Triggiani
    • 1
    Email author
  • Alberto Aglialoro
    • 2
  • Antimo Aiello
    • 3
  • Lucia Ianni
    • 4
  • Mauro Maccario
    • 5
  • Michele Zini
    • 6
  • Carlo Giorda
    • 7
  • Rinaldo Guglielmi
    • 8
  • Corrado Betterle
    • 9
  • Roberto Attanasio
    • 10
  • Giorgio Borretta
    • 11
  • Piernicola Garofalo
    • 12
  • Enrico Papini
    • 8
  • Roberto Castello
    • 13
  • Antonio Ceriello
    • 14
  1. 1.Endocrinology and Metabolic Diseases, Interdisciplinary Department of Internal MedicineUniversity of Bari “Aldo Moro”BariItaly
  2. 2.DiabetologyEndocrinology and Metabolic DiseasesGenoaItaly
  3. 3.DiabetologyEndocrinology and Metabolic DiseasesCampobassoItaly
  4. 4.Diabetology and Metabolic DiseasesMisericordia e Dolce Hospital ASL 4 PratoPratoItaly
  5. 5.Department of Medical Science, Endocrinology, Diabetology and MetabolismUniversity of TurinTurinItaly
  6. 6.Endocrinology UnitArcispedale S. Maria Nuova IRCCSReggio EmiliaItaly
  7. 7.Metabolic Diseases and Diabetology, AslTurinItaly
  8. 8.Department of Endocrine, Metabolic and Digestive DiseasesRegina Apostolorum HospitalRomeItaly
  9. 9.Department of Medical and Surgical Science, Endocrinology UnitUniversity of PaduaPaduaItaly
  10. 10.EndocrinologyGaleazzi Institute IRCCSMilanItaly
  11. 11.Endocrinology and Metabolic DiseasesASO S. Croce e CarleCuneoItaly
  12. 12.Endocrinology and Metabolic Diseases A.O. “V Cervello”PalermoItaly
  13. 13.Endocrinology and MetabolismVerona HospitalVeronaItaly
  14. 14.Biomedical Research Center in Diabetes and Associated Metabolic DiseasesBarcelonaSpain

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