Abstract
ObjectivesThis study aimed to assess the prevalence and incidence and predictive factors of thyroid disorders (TD) in patients with impaired glucose metabolism.MethodsPrevalence of TD was calculated in patients with impaired glucose metabolism compared to healthy controls, aged over 30 years in phase 1 of the Tehran Thyroid Study (TTS). Follow up assessments were conducted every 3 yrs, after which incidence of TD was calculated and its correlations with age, sex, smoking, blood pressure, body mass index (BMI), thyroid peroxidase antibody (TPOAb), thyrotropin (TSH), insulin resistance index, triglycerides and cholesterol were assessed.ResultsIncidence of TD among 435 diabetics, 286 prediabetics, and 989 healthy controls at baseline was 14, 18, and 21 per 1000 patients per year, respectively, being significantly lower in diabetics than that in healthy controls, a difference however that was not significant after adjusting for the variables mentioned (OR:0.64, 95% CI: 0.39–1.01). The incidence of TD in subjects with baseline serum TSH>1.94 mU/L or TPOAb≥40 IU/ml in all three groups was higher than that in patients with TSH≤1.94 mU/L or TPOAb<40 IU/ml, and remained significant after variable adjustment. Baseline TSH>1.94 mU/L was predictive of TD with 70% sensitivity and specificity. Baseline serum TSH (ROC area: 0.73, 95% CI: 0.68–0.77) had better predictive value than TPOAb (ROC area: 0.65, 95% CI: 0.61–0.69) for developing TD.ConclusionIncidence of TD in type 2 diabetics or prediabetics is not higher than healthy controls. It is however necessary to conduct thyroid tests in patients with TPOAb≥40 IU/ml or TSH>1.94 mU/L.
Highlights
Disorders of the thyroid gland and carbohydrate metabolism such as diabetes mellitus (DM), and prediabetes are among the most common endocrine disorders [1]
Incidence of thyroid disorders (TD) among 435 diabetics, 286 prediabetics, and 989 healthy controls at baseline was 14, 18, and 21 per 1000 patients per year, respectively, being significantly lower in diabetics than that in healthy controls, a difference that was not significant after adjusting for the variables mentioned (OR:0.64, 95% CI: 0.39–1.01)
Baseline thyroid stimulating hormone (TSH)>1.94 mU/L was predictive of TD with 70% sensitivity and specificity
Summary
Disorders of the thyroid gland and carbohydrate metabolism such as diabetes mellitus (DM), and prediabetes are among the most common endocrine disorders [1]. In a study by Wickham et al, the prevalence of thyroid disorders (TD) was reported to be 6.6% in the UK [2]. According to a study conducted by the World Health Organization (WHO), the prevalence of DM in 2000 was 2.2% and is estimated to reach 4.4% by 2030; in other words, the total number of diabetic patients will reach 366 million by 2030 from 171 million in 2000 [8]. Undetected thyroid disorders may compromise metabolic control of patients with diabetes, IGT, or IFG, and may increase the risk of cardiovascular diseases [20,21,22,23]. Considering the fact that thyroid screening tests are currently recommended only for high-risk groups, i.e. infants, pregnant women and the elderly, conducting these tests in diabetics and prediabetics requires further investigation [25,26,27,28,29]. The goal of this study was to assess the prevalence and incidence of TD and their predictive factors in diabetic and prediabetic patients
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