Skip to main content


Log in

Does autoimmune hypothyroidism increase the risk of neurovascular complications in type 1 diabetes?

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript



Type 1 diabetes (T1DM) often coexists with other autoimmune diseases, most commonly with hypothyroidism. To date, the influence of coexisting autoimmune hypothyroidism (AHT) on the course of chronic neurovascular complications of autoimmune diabetes has not been established. The aim of the study was to assess the relationship between AHT and the occurrence of chronic T1DM complications.


The study group comprised 332 European Caucasian participants with T1DM [165 (49.7%) men]. AHT was recognized in subclinical and overt hypothyroidism and confirmed by the presence of anti-thyroid autoantibodies: anti-peroxidase (ATPO) and/or anti-thyroglobulin (ATg) and ultrasonography (hypoechogenicity, parenchymal heterogeneity, lymph nodes assessment).


In the analyzed group, 48.5% of patients were diagnosed with at least one neurovascular complication. At the time of enrollment, 16.3% of participants were diagnosed with AHT. Patients with AHT, compared to those without AHT, were characterized by a higher prevalence of neurovascular complications (64.8 vs. 45.3%; P = 0.009) and retinopathy (55.6 vs. 38.9%; P = 0.02). There were significant differences between groups with and without neurovascular complications, with regard to classic risk factors for chronic diabetes complications: age, T1DM duration, SBP, DBP, HbA1c, TG, eGFR and hypertension prevalence. In the multivariate logistic regression analysis, AHT was an independent predictor of neurovascular complications after adjusting for age, DBP, HbA1c and TG (odds ratio, 2.40; 95% confidence interval, 1.17–4.92; P = 0.02).


AHT coexisting with T1DM was associated with a higher incidence of neurovascular complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Chang CC, Huang CN, Chuang LM (1998) Autoantibodies to thyroid peroxidase in patients with type 1 diabetes in Taiwan. Eur J Endocrinol 139(1):44–48

    CAS  PubMed  Google Scholar 

  2. Barker JM et al (2005) Autoantibody “subspecificity” in type 1 diabetes: risk for organ-specific autoimmunity clusters in distinct groups. Diabetes Care 28(4):850–855

    CAS  PubMed  Google Scholar 

  3. Kordonouri O et al (2002) Thyroid autoimmunity in children and adolescents with type 1 diabetes: a multicenter survey. Diabetes Care 25(8):1346–1350

    PubMed  Google Scholar 

  4. ADA (2018) 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care 41(Suppl 1):s13–s27

    Google Scholar 

  5. Huang W et al (1996) Although DR3-DQB1*0201 may be associated with multiple component diseases of the autoimmune polyglandular syndromes, the human leukocyte antigen DR4-DQB1*0302 haplotype is implicated only in beta-cell autoimmunity. J Clin Endocrinol Metab 81(7):2559–2563

    CAS  PubMed  Google Scholar 

  6. Mohn A et al (2002) The effect of subclinical hypothyroidism on metabolic control in children and adolescents with Type 1 diabetes mellitus. Diabet Med 19(1):70–73

    CAS  PubMed  Google Scholar 

  7. Biondi B, Klein I (2004) Hypothyroidism as a risk factor for cardiovascular disease. Endocrine 24(1):1–13

    CAS  PubMed  Google Scholar 

  8. Soedamah-Muthu SS et al (2004) Risk factors for coronary heart disease in type 1 diabetic patients in Europe: the EURODIAB Prospective Complications Study. Diabetes Care 27(2):530–537

    PubMed  Google Scholar 

  9. Araszkiewicz A, Zozulinska-Ziolkiewicz D (2016) Retinal neurodegeneration in the course of diabetes-pathogenesis and clinical perspective. Curr Neuropharmacol 14(8):805–809

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Fong DS et al (2004) Retinopathy in diabetes. Diabetes Care 27(Suppl 1):S84–S87

    PubMed  Google Scholar 

  11. Matsushita K et al (2012) Comparison of risk prediction using the CKD-EPI equation and the MDRD Study equation for estimated glomerular filtration rate. JAMA 307(18):1941–1951

    CAS  PubMed  Google Scholar 

  12. Sonne DP, Hemmingsen B (2017) Standards of medical care in diabetes-2017. Diabetes Care 40(Suppl. 1):S1–S135

    Google Scholar 

  13. National Kidney Foundation (2012) KDOQI clinical practice guideline for diabetes and CKD: 2012 update. Am J Kidney Dis 60(5):850–886

    Google Scholar 

  14. Tesfaye S et al (2010) Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 33(10):2285–2293

    PubMed  PubMed Central  Google Scholar 

  15. Rogowicz-Frontczak A et al (2011) Carotid intima-media thickness and arterial stiffness in type 1 diabetic patients are dependent on age and mean blood pressure. Exp Clin Endocrinol Diabetes 119(5):281–285

    CAS  PubMed  Google Scholar 

  16. Spallone V et al (2011) Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev 27(7):639–653

    PubMed  Google Scholar 

  17. Camm AJ et al (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 93(5):1043–1065

    Google Scholar 

  18. Kitahara CM et al (2012) Body fatness and markers of thyroid function among U.S. men and women. PLoS One 7:e34979

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Rogowicz-Frontczak A et al (2016) Patients with diabetes type 1 and thyroid autoimmunity have low prevalence of microangiopathic complications. Endocrine 51(1):185–188

    Article  CAS  PubMed  Google Scholar 

  20. Mancia G et al (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34(28):2159–2219

    PubMed  Google Scholar 

  21. Schalkwijk CG, Stehouwer CD (2005) Vascular complications in diabetes mellitus: the role of endothelial dysfunction. Clin Sci (Lond) 109(2):143–159

    CAS  Google Scholar 

  22. Cebeci E et al (2011) Evaluation of oxidative stress, the activities of paraoxonase and arylesterase in patients with subclinic hypothyroidism. Acta Biomed 82(3):214–222

    PubMed  Google Scholar 

  23. Ates I et al (2015) The relationship between oxidative stress and autoimmunity in Hashimoto’s thyroiditis. Eur J Endocrinol 173(6):791–799

    CAS  PubMed  Google Scholar 

  24. Yang JK et al (2010) An association between subclinical hypothyroidism and sight-threatening diabetic retinopathy in type 2 diabetic patients. Diabetes Care 33(5):1018–1020

    PubMed  PubMed Central  Google Scholar 

  25. Kim BY et al (2011) Association between subclinical hypothyroidism and severe diabetic retinopathy in Korean patients with type 2 diabetes. Endocr J 58(12):1065–1070

    CAS  PubMed  Google Scholar 

  26. Qi Q et al (2017) Association of thyroid-stimulating hormone levels with microvascular complications in type 2 diabetes patients. Med Sci Monit 23:2715–2720

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Yasuda T et al (2011) Subclinical hypothyroidism is independently associated with albuminuria in people with type 2 diabetes. Diabetes Res Clin Pract 94(3):e75–e77

    CAS  PubMed  Google Scholar 

  28. Asvold BO, Bjoro T, Vatten LJ (2011) Association of thyroid function with estimated glomerular filtration rate in a population-based study: the HUNT study. Eur J Endocrinol 164(1):101–105

    PubMed  Google Scholar 

  29. Rodacki M et al (2014) Should thyroid-stimulating hormone goals be reviewed in patients with type 1 diabetes mellitus? Results from the Brazilian Type 1 Diabetes Study Group. Diabet Med 31(12):1665–1672

    CAS  PubMed  Google Scholar 

Download references


We thank Malgorzta Grzelka and Jaroslaw Opiela for language revision of this article.


This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Author information

Authors and Affiliations



ARF and BF planned and designed the study. AGW, AU, AA conducted data acquisition. BF performed the statistical analysis. ARF and BF wrote the manuscript. AGW, AU, AA, DZZ revised the manuscript. All authors approved the submitted version.

Corresponding author

Correspondence to B. Falkowski.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance to the ethical standards of the institutional and/or national research committee (The Bioethical Committee of Poznan University of Medical Sciences; reference numbers: 539/12 and 465/15) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Each enrolled subject delivered a written informed consent for participation in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rogowicz-Frontczak, A., Falkowski, B., Grzelka-Wozniak, A. et al. Does autoimmune hypothyroidism increase the risk of neurovascular complications in type 1 diabetes?. J Endocrinol Invest 43, 833–839 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: