The Relationship Between Insulin Resistance And Thyroid Disorders

Year 2018, Volume: 10 Issue: 6, 13 - 17, 28.11.2018

Medine Şişman

Abstract

Abstract

Aim: There are researches that the thyroid disorders effect carbonhydrate metabolizm and the insulin resistance causes impaired glucose tolerance, diabetes, dyslipidemia, obesity, metabolic syndrome and hypertension. The purpose ofthis study is; to investigate whether thyroid disorders are related to insulin resistance and to investigate what family physicians may do before complications develop.

Methods: After the approval of the ethics committee, 2000 patients (age 18-85 years) were evaluated retrospectively and 301 patients were included in the study. According to the diagnosis the patients were grouped as hypothyroid, hyperthyroid and euthyroid. TSH, fT3, fT4, insulin,FPG, HbA1c, anti-TG, anti-TPO were recorded. HOMA-IRs were calculated.

Results: Of the patients, 264 (87.7%) were female and37 (12.3%) were male. 45.8% of the patients were hypothy-roid, 19.6% were hyperthyroid and 34.6% were euthyroid.95.6% of hypothyroid ones and 93.2% of hyperthyroid oneswere receiving treatment. 29.6% of the patients’ FPG were between 100-126 mg/dl. HOMA-IR ≥ 2.5 in 49.6% of thepatients. In 34.9% of patients HBA1C was detected as bet-ween 5.7-6.4%. 48.6% of the hypothyroid group, 52.5% ofthe hyperthyroid group and 48.1% of the euthyroid group had HOMA-IR ≥ 2.5. There were no significant correlation and significant difference between insulin resistance andany of the hypothyroid, hyperthyroid and euthyroid patients.There was a significant difference for anti-TG and anti-TPO in the groups. There was a significant positive correlation between HOMA-IR and TSH, and a negative correlation bet-ween TSH and sT4.

Conclusion: Treatment of thyroid disorders may preventthe development of insulin resistance and / or progressionto diseases such as T2DM, obesity, metabolic syndrome. Monitoring metabolic parameters in thyroid disorders’  follow-up may be clinically important. In this way, a common etio-logical factor such as insulin resistance and many public health problems can be avoided, and / or the course can be slowed down.

Keywords

Diabetes, Insulin Resistance, Metabolic Syndrome, Obesity, Thyroid Di-sorders

Tiroid Bozuklukları İle İnsülin Direnci Arasındaki İlişki

Abstract

Öz

Amaç: Tiroid bozukluklarının glukoz metabolizmasını etkilediği; insülin direncinin,bozulmuş glukoz toleransı, diyabet, dislipidemi, obezite, metabolik sendrom ve hipertansiyona neden olduğu bilinmektedir. Bu çalışmanın amacı, tiroid bozukluklarının insülin direnci ile herhangi bir ilişkisinin olup olmadığını incelemek ve komplikasyonlar gelişmeden önce aile hekimlerinin neler yapabileceğini araştırmaktır.

Yöntem: Bakırköy Dr. Sadi Konuk SUAM etik kurul onayı alınarak, 2015-2017 yıl-ları arasinda takipli, tiroid hastalığı ön tanılı ve kilo verememe yakınması ile başvuran 2000 hasta retrospektif olarak tarandı, 301 hastanın kayıtları incelendi. Hastalar hipotiroid, hipertiroid, ötiroid olarak gruplandırıldı. Tiroid uyarıcı hormon (TSH), serbest triiyodotironin(sT3), serbest tiroksin (sT4), insülin, açlık plazma glukozu (APG), hemog-lobin A1c (HbA1c), anti tiroglobulin antikoru (anti-TG), anti tiroid peroksidaz antikoru (anti-TPO) değerlendirildi. Hastaların Homeostasis Model Assesment-Insulin Resistance (HOMA-IR) değerleri hesaplandı.

Bulgular: Hastaların %87.7’si (264 hasta) kadın, %12.3’ü (37 hasta) ise erkekti. %4.,8’sihipotiroid, %19.6’sı hipertiroid, %34.6’sı ötiroid idi. Hipotiroidlerin %95.6’sı, hipertiroidlerin %93.2’si tedavi almaktaydı. Hastaların %29.6’sında APG 100-126 mg/dl arasında, %49.6’sında HOMA-IR yüksek, %34.9’unda HbA1c %5.7-6.4 olarak saptandı. Hipotiroid grubun %48.6’sında, hipertiroid grubun %52.5’inde, ötirod grubun ise %48.1’in-de HOMA-IR yüksekti. Hasta gruplarının hiçbiriyle HOMA-IR arasında anlamlı ilişkive anlamlı fark saptanmadı. Hasta gruplarında anti-TG ve anti-TPO için ise anlamlı farksaptandı, anlamlı ilişki saptanmadı. HOMA-IR ile TSH arasında pozitif anlamlı ilişki,sT4 ile negatif anlamlı ilişki saptandı.

Sonuç: Tiroid bozukluklarında tedavi, insülin direncinin gelişmesini ve/veya T2DM,obezite, metabolik sendrom gibi hastalıklara ilerlemesini önleyebilir. Tiroid hastalığı olanlar ötiroid halde tutulsalar bile, takiplerinde metabolik parametrelerin izlenmesi klinikaçıdan önemli olabilir.  Bu şekilde insülin direncinin ortak etiyolojik faktör olduğu vehalk sağlığı sorununa dönüşen tip2 diyabet, obezite, metabolik sendrom gibi patolojilerin önüne geçilebilir ve/veya seyri yavaşlatılabilir.

Keywords

Diyabet, İnsülin Direnci, Metabolik Sendrom, Obezite, Tiroid bozuklukları

References

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