Skip to main content

Advertisement

SpringerLink
Log in

Subclinical hyperthyroidism in patients with type 2 diabetes

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Both subclinical hyperthyroidism and type 2 diabetes (T2D) have been associated with an increase in cardiovascular disease risk and mortality. We aimed to assess the prevalence of newly diagnosed subclinical hyperthyroidism in a cohort of patients with T2D, and also to analyse the relationships between diabetes-related characteristics and the presence of subclinical hyperthyroidism. 933 diabetic patients without previous history of thyroid disease (45.4% females, mean age 66.3 years, median duration of diabetes 10 years) were evaluated. A sample of 911 non-diabetic subjects without known thyroid dysfunction was studied as control group. Serum concentrations of thyrotropin were measured in all subjects. Subclinical hyperthyroidism was present in 4.3% of female and 3.5% of male diabetic patients. Relative risk was significant only for the female gender (OR 3.69, 95% CI 1.56–8.71). In comparison with diabetic patients without thyroid hyperfunction, patients with subclinical hyperthyroidism were older, had longer duration of diabetes, showed lower fasting glucose levels, had greater proportion of goitre and diet therapy, and had lower proportion of treatment with oral agents. Logistic regression analysis showed that age and the presence of goitre were significantly related to subclinical hyperthyroidism in patients with T2D. The risk for subclinical hyperthyroidism is increased in women with T2D. Advanced age and the presence of goitre are significantly and independently related with the presence of subclinical hyperthyroidism in diabetic population.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

CI:

Confidence interval

OR:

Odds ratio

RAS:

Renin-angiotensin system

T2D:

Type 2 diabetes

TGAb:

Thyroglobulin autoantibodies

TPOAb:

Thyroid peroxidase autoantibodies

References

  1. J.G. Hollowell, N.W. Staehling, W.D. Flanders et al., Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J. Clin. Endocrinol. Metab. 87, 489–499 (2002)

    Article  PubMed  CAS  Google Scholar 

  2. J. Gussekloo, E. van Exel, A.J. de Craen, A.E. Meinders, M. Frölich, R.G. Westendorp, Thyroid status, disability and cognitive function, and survival in old age. JAMA 292, 2491–2499 (2004)

    Article  Google Scholar 

  3. G. Iervasi, S. Molinaro, P. Landi et al., Association between increased mortality and mild thyroid dysfunction in cardiac patients. Arch. Intern. Med. 167, 1526–1532 (2007)

    Article  PubMed  Google Scholar 

  4. J.A. Sgarbi, L.K. Matsumura, T.S. Kasamatsu, S.R. Ferreira, R.M. Maciel, Subclinical thyroid dysfunctions are independent risk factors for mortality in a 7.5-year follow-up: the Japanese-Brazilian thyroid study. Eur. J. Endocrinol. 162, 569–577 (2010)

    Article  PubMed  CAS  Google Scholar 

  5. Emerging Risk Factors Collaboration, S.R. Seshasai, S. Kaptoge et al., Diabetes mellitus, fasting glucose, and risk of cause-specific death. N. Engl. J. Med. 364, 829–841 (2011)

    Article  PubMed  CAS  Google Scholar 

  6. A.M. Michalek, M.C. Mahoney, D. Calebaugh, Hypothyroidism and diabetes mellitus in an American Indian population. J. Fam. Pract. 49, 638–640 (2000)

    PubMed  CAS  Google Scholar 

  7. R.E. Warren, P. Perros, M.J. Nyirenda, B.M. Frier, Serum thyrotropin is a better predictor of future thyroid dysfunction than thyroid autoantibody status in biochemically euthyroid patients with diabetes: implications for screening. Thyroid 14, 853–857 (2004)

    Article  PubMed  CAS  Google Scholar 

  8. P. Perros, R.J. McCrimmon, G. Shaw, B.M. Frier, Frequency of thyroid dysfunction in diabetic patients: value of annual screening. Diabet. Med. 12, 622–627 (1995)

    Article  PubMed  CAS  Google Scholar 

  9. M.J. Smithson, Screening for thyroid dysfunction in a community population of diabetic patients. Diabet. Med. 15, 148–150 (1998)

    Article  PubMed  CAS  Google Scholar 

  10. M. Matejkova-Behanova, V. Zamrazil, K. Vondra et al., Autoimmune thyroiditis in non-obese subjects with initial diagnosis of type 2 diabetes mellitus. J. Endocrinol. Invest. 25, 779–784 (2002)

    PubMed  CAS  Google Scholar 

  11. A.R.M. Radaideh, M.K. Nusier, F.L. Amari et al., Thyroid dysfunction in patients with type 2 diabetes mellitus in Jordan. Saudi Med. J. 25, 1046–1050 (2004)

    PubMed  Google Scholar 

  12. S.A.P. Chubb, W.A. Davis, Z. Inman, T.M.E. Davis, Prevalence and progression of subclinical hypothyroidism in women with type 2 diabetes: the Freemantle diabetes study. Clin. Endocrinol. 62, 480–486 (2005)

    Article  CAS  Google Scholar 

  13. A. Ishay, I. Chertok-Shaham, I. Lavi, R. Luboshitzky, Prevalence of subclinical hypothyroidism in women with type 2 diabetes. Med. Sci. Monit. 15, CR151–CR155 (2009)

    PubMed  CAS  Google Scholar 

  14. V. Lambadiari, P. Mitrou, E. Maratou, A.E. Raptis, N. Tountas, S.A. Raptis et al., Thyroid hormones are positively associated with insulin resistance early in the development of type 2 diabetes. Endocrine 39, 28–32 (2011)

    Article  PubMed  CAS  Google Scholar 

  15. J.M. Dora, W.E. Machado, J. Rheinheimer, D. Crispim, A.L. Maia, Association of the type 2 deiodinase Thr92Ala polymorphism with type 2 diabetes: case-control study and meta-analysis. Eur. J. Endocrinol. 163, 427–434 (2010)

    Article  PubMed  CAS  Google Scholar 

  16. H.S. Chen, T.E.J. Wu, T.S. Jap et al., Subclinical hypothyroidism is a risk factor for nephropathy and cardiovascular diseases in type 2 diabetic patients. Diabet. Med. 24, 1336–1344 (2007)

    Article  PubMed  CAS  Google Scholar 

  17. S.H. Wang, Z.L. Sun, Y.J. Guo, Q. Wei, Y. Yuan, Prevalence of subclinical hypothyroidism in older patients with diabetes mellitus with poorly controlled dyslipidemia in China. J. Am. Geriatr. Soc. 57, 1506–1507 (2009)

    Article  PubMed  Google Scholar 

  18. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 20, 1183–1197 (1997)

    Google Scholar 

  19. J.J. Díez, P. Sánchez, P. Iglesias, Prevalence of thyroid dysfunction in patients with type 2 diabetes. Exp. Clin. Endocrinol. Diabetes 119, 201–207 (2011)

    Article  PubMed  Google Scholar 

  20. P. Iglesias, J. Lázaro, G. Velasco, J.J. Díez, Disfunción tiroidea en población laboral hospitalaria. Rev. Clin. Esp. 210, 505–508 (2010)

    Article  PubMed  CAS  Google Scholar 

  21. G. Morreale de Escobar, F. Escobar del Rey, Consequences of iodine deficiency for brain development, in Thyroid and Brain, ed. by J. De Vilder, G. Morreale de Escobar, S. Butz, V. Hostalek (Schattauer Verlag, Stuttgart, 2003), pp. 33–56

    Google Scholar 

  22. P. Iglesias, A. Muñoz, F. Prado, M.T. Guerrero, M.C. Macías, E. Ridruejo, P. Tajada, J.J. Díez, Alterations in thyroid function tests in aged hospitalized patients: prevalence, aetiology and clinical outcome. Clin. Endocrinol. 70, 961–967 (2009)

    Article  CAS  Google Scholar 

  23. D.H. Akbar, M.M. Ahmed, J. Al-Mughales, Thyroid dysfunction and thyroid autoimmunity in Saudi type 2 diabetics. Acta. Diabetol. 43, 14–18 (2006)

    Article  PubMed  CAS  Google Scholar 

  24. B. Gopinath, J.J. Wang, A. Kifley, J.R. Wall, S.R. Leeder, P. Mitchell, Type 2 diabetes does not predict incident thyroid dysfunction in the elderly. Diabetes Res. Clin. Pract. 82, e11–e13 (2008)

    Article  PubMed  Google Scholar 

  25. C. Cappelli, M. Rotondi, I. Pirola et al., TSH-lowering effect of metformin in type 2 diabetic patients. Diabetes Care 32, 1589–1590 (2009)

    Article  PubMed  CAS  Google Scholar 

  26. M. Potenza, M.A. Via, R.T. Yanagisawa, Excess thyroid hormone and carbohydrate metabolism. Endocr. Pract. 15, 254–262 (2009)

    PubMed  Google Scholar 

  27. C.T. Sawin, A. Geller, P.A. Wolf et al., Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N. Engl. J. Med. 331, 1249–1252 (1994)

    Article  PubMed  CAS  Google Scholar 

  28. B. Biondi, E.A. Palmieri, G. Lombardi, S. Fazio, Effects of subclinical thyroid dysfunction on the heart. Ann. Intern. Med. 137, 904–914 (2002)

    PubMed  Google Scholar 

  29. A. Radácsi, G. Kovács, W. Bernard, J. Feldkamp, F.A. Horster, I. Szabolcs, Mortality rate of chronically ill geriatric patients with subnormal serum thyrotropin concentration: a 2-year follow-up study. Endocrine 21, 133–136 (2003)

    Article  PubMed  Google Scholar 

  30. J.V. Parle, P. Maisonneuve, M.C. Sheppard, P. Boyle, J.A. Franklyn, Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet 358, 861–865 (2001)

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest in relation to this article.

Ethical standards

The experiments comply with the current laws of the country in which they were performed.

Author information

Authors and Affiliations

  1. Department of Endocrinology, Hospital Ramón y Cajal, Carretera de Colmenar Km 9, 28034, Madrid, Spain

    Juan J. Díez & Pedro Iglesias

Authors
  1. Juan J. Díez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pedro Iglesias
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juan J. Díez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Díez, J.J., Iglesias, P. Subclinical hyperthyroidism in patients with type 2 diabetes. Endocrine 42, 157–163 (2012). https://doi.org/10.1007/s12020-012-9621-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-012-9621-3

Keywords

Search

Navigation