بررسی فراوانی اختلالات عملکرد تیروئید در بیماران دیابت تیپ 2 مراجعه کننده به کلینیک داخلی بیمارستان 22 بهمن مشهد، بین سالهای 1392 تا 1393

Subject Areas : علوم پزشکی

Sahar Ghare ¹ , Golnaz Latifian ² , Vahid Pooresmaeel ³

1 - متخصص غدد، استادیار دانشکده پزشکی دانشگاه آزاد اسلامی واحد مشهد
2 - دانشجوی پزشکی دانشگاه آزاد اسلامی واحد مشهد
3 - نویسنده پاسخگو، PhD ، استادیار گروه بیوشیمی دانشکده پزشکی دانشگاه آزاد اسلامی واحد مشهد

Received: 2017-02-22 Accepted : 2017-02-22 Published : 2016-09-22

Keywords: frequency, Diabetes mellitus, Thyroid dysfunction,

Abstract :

Background: Thyroid diseases are common in public population. New methods of evaluation have made it efficient and cheap to detect these diseases in special groups. According to previous studies the prevalence of thyroid dysfunction is higher in diabetic patients compare to normal population. Moreover, poor control of metabolism is associated with increased rate of thyroid dysfunction. In this study we decided to evaluate the frequency of thyroid dysfunction in type 2 diabetic patients.   Methods: This is a cross sectional study in which patients visited the internal medicine clinic at 22 Bahman hospital in Mashhad from 2013 till 2014 were evaluated. 524 type 2 diabetic adult patients (over 18 years old) were included (184 males and 340 females). Exclusion criteria were pregnancy, acute and severe disease during the last 3 months, using any of the following medicines: glucocorticoids, amiodarone, interferon, iodide and lithium. TSH, FT4, Age, gender and existence of goiter were compared among all the patients. Results: From all 524 type 2 diabetic patients with the mean age of 56 years, 28.2% suffered from thyroid dysfunction. 20.2% had clinical hypothyroidism, 3.8% had subclinical hypothyroidism, 1.9% had clinical hyperthyroidism, 1.3% had subclinical hyperthyroidism and 1% had goiter. There was a statistically meaningful association between age and clinical hyperthyroidism (p=0.012), that shows the frequency was higher in younger than 50 years and also between subclinical hypothyroidism and existence of goiter (p= 0.013). Conclusion: The Frequency of thyroid dysfunction in type 2 diabetic patients is clearly higher than overall prevalence reported in the country (10.5%). According to this significant differences and also effects of thyroid function in glucose and lipid metabolism, so it seems logical to evaluate thyroid function in diabetic patients.

References:

1) Duntas L,Orgiazzi J , Brabant G.The interface between Thyroid and Diabetes mellitus.clinical Endocrinology.2011;75:1-9.

2) Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care.2004;27:1047-1053.

3) Estegamati A,Gouya MM,Abbasi M,Delavari A,Alikhani S,Alaedini F, et al. Prevalence of Diabetes and Impaired Fasting Glucose in the Adult Population of Iran:National survey of risk factor of non communicable disease of Iran. Diabetes Care.2008 Jan;31(1):96-8.

4) Fauci AS,Braunwald E,Kasper DL,Jameson JL,Hauser SL,Longo DL,et al.Harrison's principles of internal medicine, 18^th Edition.New York: The McGraw-Hill Companies; 2012.

5) Mohn A, Di Michele S, Di Luzio R, Tumini S, Chiarelli F. The effect of subclinical hypothyroidism on metabolic control in children and adolescents with Type 1 diabetes mellitus. Diabet Med. 2002; 19: 70-3.

6) Franzese A, Buono P, Mascolo M, Leo AL, Valerio G. Thyroid autoimmunity starting during the course of type 1 diabetes denotes a subgroup of children with more severe diabetes. Diabetes Care.2000;23:1201-1102.

7) Hak AE,Poles HA,Visser TJ,Drexhege HA,Hofman A,et al.subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women:the Rotterdam study. Ann Intern Med.2000;132(4): 270-278.

8) اسدی.م،دلشاد.ح،توحیدی.م، عزیزی. ف. میزان بروز اختلال عملکرد و سیر طبیعی اختلال های زیربالینی تیروئید در بزرگسالان تهرانی.مجله غدد متابولیسم ایران.1388؛11(6):673-679.

9) The Expert Committee on theDiagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26(1):3160–3167.

10) David M , John B , Mayer B , Ele Ferrannini,  Rury R,  Sherwin R,  et  al .Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care. 2009;32(1):193-94.

11) Diabetes Prevention Program Research Group. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab. 2008 JAN; 93:4774–4779.

12) Singer PA, Cooper DS, Levy EG. Treatment guidelines for patients

with hyperthyroidism and hypothyroidism. JAMA. 1995;273:808-812.

13 ) Klee GG, Hay ID. Biochemical testing of thyroid function. Endocrinol Metab Clin North Am. 1997; 26:763-775.

14) Ladenson P, Singer P, Kenneth B Bagchi N, Bigos T,Elliot G, et al. American Thyroid Association Guidelines for Detection of Thyroid Dysfunctio. Arch Intern Med. 2000;160:1573-1575.

15) Díez J , Sánchez P, Iglesias P. Prevalence of Thyroid Dysfunction in Patients with Type 2 Diabetes. Exp Clin Endocrinol Diabetes .2011; 119: 201 – 207.

16) Smithson MJ. Screening for thyroid dysfunction in a community population of diabetic patients. Diabet Med .1998; 15(2): 148–50.

17) Pasupathi P,Baktharathsalam G,Saravanan G,Sundaramoorthi R. Screening for Thyroid Dysfunction in the Diabetic/Non-Diabetic Population. Thyroid Science.2008;3(8):1-6.

18) Gopinath B,wang J,Kiflev A,Wall J,Leadear S. Type 2 diabetes does not predict incident thyroid dysfunction in the elderly. Diabetes research and clinical practice.2008;82:11-13.

19) Perros P , McCrimmon RJ , Shaw G,Frier BM. Frequency of thyroid dysfunction in diabetic patients: value of annual screening . Diabet Med. 1995; 12(7) : 622 – 627.

20) D.H Akbar,M.M Ahmed,J.Al-Mughales.Thyroid Dysfunction and thyroid autoimmunity in Saudi type 2 diabetics.Acta Diabetol. 2006;43:14-18

21) Abdel-Rahman M,Mohammad K,Fawaz L,Kamel M. Thyroid Dysfunction in patients wiyh type 2 diabetes mellitus in Jordan.Saudi Med .2004; 25 (8): 1046-1050.

22) Palma CC,Paveci M,Nogueira VG,Clemente E,Guedes V,Gomes MB,et al.Prevalence of thyroid disfunction in patients with diabetes mellitus.Diabetology & Metabolic syndrome. 2013;5:58.

23) بذرافشان. ح، رمضانی.م، صالحی.ع، عزیزی.ف، شیرافکن.الف. رابطه ی اختلال عملکرد تیروئید با دیابت نوع 2. مجله علمی دانشگاه علوم پزشکی گرگان. 1379؛2(5):6-11.

24) Celani MF, Bonati ME, Stucci N. Prevalence of abnormal thyrotropin concentrations measured by a sensitive assay in patients with type 2 Diabetes mellitus. Diabetes Research. 1994; 27(1): 15-25.