The prevalence and determinants of hypothyroidism in hospitalized patients with type 2 diabetes mellitus

Abstract

The purpose of this study was to investigate the prevalence of hypothyroidism among hospitalized patients with type 2 diabetes mellitus and its related factors, and to assess the prevalence of macrovascular and microvascular diseases among type 2 diabetes mellitus inpatients with hypothyroidism and euthyroidism. A total of 1662 type 2 diabetes mellitus inpatients hospitalized at the Metabolic Diseases Hospital, Tianjin Medical University from 1 January 2008 to 1 March 2013 were included in this study. Information on demographic and anthropometric factors and additional variables related to hypothyroidism were collected from medical records. Prevalence rates were calculated and standardized using direct method based on the age-specific and sex-specific structure of all participants. Data were analyzed using binary logistic regression with adjustment for potential confounders. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and 77.0 % of the patients with hypothyroidism had subclinical hypothyroidism. The prevalence of hypothyroidism increased with age, and was higher in women (10.8 %) than in men (3.4 %). Older age (odds ratio, 1.74; 95 % confidence interval, 1. 05 to 2.89), female gender (odds ratio, 2.02; 95 % confidence interval, 1.05 to 3.87), and positive thyroid peroxidase antibody (odds ratio, 4.99; 95 % confidence interval, 2.83 to 8.79) were associated with higher odds of hypothyroidism among type 2 diabetes mellitus inpatients. The type 2 diabetes mellitus inpatients with hypothyroidism had higher prevalence of cerebrovascular diseases than those with euthyroidism after adjustment for age and gender. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and most patients had subclinical hypothyroidism. Older age, female gender, and positive thyroid peroxidase antibody could be indicators for detecting hypothyroidism in type 2 diabetes mellitus inpatients.

Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders

“…This wide range could reflect differences in age, gender and iodine intake in the populations surveyed. Female gender, older age, obesity, TPO-Ab positivity and hospitalization are associated with an increased risk of developing hypothyroidism in T2D (98,(100)(101)(102)(103). A significant increased risk of hypothyroidism was observed in patients with T2D over 65 years of age with an odds ratio (OR) of 4.2 and a clear difference between males and females (OR 4.82 vs. 2.60), obese and non-obese patients (OR 2.56 vs. 3.11), and presence or absence of thyroid auto-antibodies (OR 4.26 vs. 2.93) (101).…”

“…A large longitudinal study from Australia in women with T2D reported that SHypo is a common finding in T2D (97). It was the prevalent form of thyroid hormone deficiency in diabetic females (104,105) and patients with positive TPO-Ab (97,(101)(102)(103). In line with these results, a meta-analysis on 36 articles confirmed a higher pooled prevalence of SHypo in patients with T2D when compared with healthy controls (1.93-fold increased risk; 95% CI: 1.66-2.24) (104).…”

Abnormal Glucose Metabolism and Insulin Resistance Are Induced via the IRE1α/XBP-1 Pathway in Subclinical Hypothyroidism

“…Subclinical hypothyroidism (SCH), characterized by elevated serum thyroid stimulating hormone (TSH) and normal serum free thyroxine (FT4) levels, is an independent risk factor for atherosclerosis, myocardial infarction, and non-alcoholic fatty liver disease (NAFLD) (1–4). Notably, emerging evidence shows that SCH and Type 2 diabetes mellitus (T2DM) are closely related and often occur together in individuals (5). We wondered whether SCH is also an independent risk factor for T2DM.…”

Thyroid-stimulating hormone levels in the normal range and incident type 2 diabetes mellitus

“…Type 1 diabetes mellitus and auto-immune thyroid disease are associated through common auto-immune links [5]. The underlying pathophysiological mechanisms of the repeatedly reported association between thyroid dysfunction and type 2 diabetes (T2DM) have not yet been fully elucidated [4, 6, 7]. Thyroid hormones have a large impact on glucose homeostasis [8], and both high and low thyroid hormone levels are associated with peripheral insulin resistance [9–11].…”

“…Besides the association between thyroid dysfunction, in particular hypothyroidism, and T2DM [4, 6, 7], increasing plasma thyroid stimulating hormone (TSH) levels within the normal range are also associated with the prevalence of T2DM in a cross-sectional study in a general adult population in China [16]. Two longitudinal studies, from the Netherlands and Korea, show conflicting results [17–19].…”