Thyroid dysfunction in patients with diabetes: clinical implications and screening strategies

被引:143
作者
Kadiyala, R. [1 ]
Peter, R. [2 ]
Okosieme, O. E.
机构
[1] Prince Charles Hosp, Cwm Taf Local Hlth Board, MRCP Endocrinol & Diabet Dept, Merthyr Tydfil CF47 9DT, M Glam, Wales
[2] Abertawe Bro Morgannwg Univ Hlth Board, Neath Port Talbot Hosp, Port Talbot, England
关键词
20-YEAR FOLLOW-UP; BODY-MASS INDEX; INSULIN SENSITIVITY; SERUM THYROTROPIN; SUBCLINICAL HYPOTHYROIDISM; NATURAL-HISTORY; FUNCTION TESTS; HEART-DISEASE; AUTOIMMUNITY; COMMUNITY;
D O I
10.1111/j.1742-1241.2010.02376.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
P>Background: Patients with diabetes mellitus are at an increased risk of thyroid disease. The frequency of thyroid dysfunction in diabetic patients is higher than that of the general population and up to a third of patients with type-1 diabetes (T1DM) ultimately develop thyroid dysfunction. Unrecognised thyroid dysfunction may impair metabolic control and add to cardiovascular disease risk in diabetic patients. Aims: Our aims were to review the current literature on the association between thyroid dysfunction and diabetes mellitus, to highlight relevant clinical implications, and to examine present thyroid disease screening strategies in routine diabetes care. Results: The pleiotropic effects of thyroid hormones on various metabolic processes are now better understood. Uncontrolled hyperthyroidism in diabetic patients may trigger hyperglycaemic emergencies while recurrent hypoglycaemic episodes have been reported in diabetic patients with hypothyroidism. Furthermore, thyroid dysfunction may amplify cardiovascular disease risk in diabetic patients through inter-relationships with dyslipidaemia, insulin resistance and vascular endothelial dysfunction. However, the significance of subclinical degrees of thyroid dysfunction remains to be clarified. While these developments have implications for diabetic patients a consensus is yet to be reached on optimal thyroid screening strategies in diabetes management. Conclusions: The increased frequency of thyroid dysfunction in diabetic patients and its likely deleterious effects on cardiovascular and metabolic function calls for a systematic approach to thyroid disease screening in diabetes. Routine annual thyroid testing should be targeted at diabetic patients at risk of thyroid dysfunction such as patients with T1DM, positive thyroid autoantibodies or high-normal TSH concentrations.
引用
收藏
页码:1130 / 1139
页数:10
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