The Retrospective Analysis Of Clinical Characteristics Of Diabetic Patients With Thyroid Dysfunction

Background:Diabetes Mellitus(DM),one of the metabolic diseasescharacterized by increased chronic blood level, is mainly caused byinsulin secretary defect and insulin resistance. DM can be divided into4categories clinically: type1diabetes mellitus(T1DM),type2diabetesmellitus(T2DM),specific type of diabetes and gestational diabetesmellitus. The basic clinical symptoms include polydipsia, polyphagia, andpolyuria.It can be developed with a variety of acute and chroniccomplications.Thyroid dysfunction mainly includes hyperthyroidism,hypothyroidism, sub-clinical hyperthyroidism, and sub-clinicalhypothyroidism. When thyroid gland secrete excess thyroxine,it maycause hyperthyroidism which can lead to hyper-metabolism andsympathetic nervous excitement. It can caused patients feel heartpalpitations, sweating, polyphagia and lossing weight. Most patients arealso accompanied by special symptoms such as exophthalmos, palpebraledema and hypopsia. Hyperthyroidism mainly effects respiratory system,circulatory system, digestive system, hemopoietic system andneuro-muscular system. Hypothyroidism is a kind of systemic diseasecaused by synthetic and secretory deficiency of thyroxine and disorder ofthyroxine’s physiological effects. It is divided into3types according tothe onset age: Cretinism, Juvenile hypothyroidism and Adulthypothyroidism. The experiment object in this test is mainly for adultonset hypothyroidism patients. Sub-clinical hypothyroidism is defined as:the upper limit of TSH level is more than the normal reference range ofstatistics,however,FT4is in normal reference value range.It’s must be rule out the conditions caused by the rise of TSH levels. The definition ofSun-clinical hyperthyroidism is: TSH levels must below the lower limitof normal reference value, however, the blood concentrations of FT3andFT4are within their own reference. The conditions caused by the declineof TSH levels are must be excluded at the same time. A variety ofdomestic and overseas literature shows that there is a certain correlationbetween thyroid disease and diabetes, and the main mechanism may berelated to the same susceptibility genes. With the same genes, diabetesand autoimmune thyroid disease(AITD) can cause the imbalance ofbody’s immune system to some extent. Then, it can influence theoccurrence and development of disease finally.Objective: To compare the clinical characteristics between diabeticpatients with abnormal thyroid function and diabetes alone, which mayprovide new clinical clues for the early detection of thyroid diseasesamong diabetes patients.Methods: Collecting the laboratory results of diabetes patients(withT1DM and T2DM) with abnormal thyroid function(includeshyperthyroidism, sub-clinical hyperthyroidism, hypothyroidism andsub-clinical hypothyroidism)from the inpatients database ofEndocrinology Department of the2ndAffiliated Hospital of JilinUniversity from Jan1,2010to Dec31,2013.152diabetes patientswithout abnormal thyroid function were also recruited as control group.The clinical and labortory examination results(include BMI, TT3, TT4,FT3,FT4,TSH,TRAb,TPOAb,TMAb,FBG,TG,TC,HDL,LDL-C,uric acid,GAD,IA-2,IAA,HbA1C,and MA)of these subjects were collectedanalyzed retrospectively. Results:1.Among329cases of diabetes patients, there are151males(59cases with thyroid dysfunction,92cases without thyroiddysfunction)and178females(59cases with thyroid dysfunction,92caseswithout thyroid dysfunction).The gender difference was statisticallysignificant(t=5.043， p<0.01).After having Chi-square test betweenexperimental and control group, the results suggest that diabetes have asignificant correlation with thyroid diseases(χ2（1，N=329）=5.93，p=0.015).which means that individuals with T1DM are more likely todevelopment thyroid diseases.2.Between the experimental group andcontrol group, the difference of TG（t=3.264，p=0.001）,FPG(t=5.184，p<0.001)and uric acid（t=4.308，p<0.001）are statistically significant.3.Indiabetic patients with thyroid dysfunction, the level of FT4issignificantly related to TG（r=0.574；P=0.031）、LDL（r=0.767；P=0.016）、FBG（r=0.550；P=0.033）、HbA1C（r=0.925；P=0.025）、uric acid（r=0.514；P=0.036）and age(r=0.863；P=0.010）.4.The average ages ofdiabetic patients with hyperthyroidism or hypothyroidism are higher thancontrol group.5.To diabetic patients with hypothyroidism, the averageconcentrations of uric acid and TC are higher than control group.Conclusion:1.In patients with diabetes mellitus,more female thanmale have thyroid disorder;2.Patients with T1DM are more likely tocome down with thyroid disorder compared with those with T2DM;3.Thelevel of Fast plasma glucose(FPG) and uric acid in treatment group are lower than control group.However triglyceride(TG) is higher than control groupon the contrary;4.The concentration of FT4is directly connected withTC,LDL,FPG,HbA1C,uric acid,BMI,gender and age;5.There is nostatistical significance except FT3,FT4between the hyperthyroidism andthe sub-clinical hyperthyroidism group,and the same with thehypothyroidism and the sub-clinical hypothyroidism group;6.The averageages of diabetic patients with hyperthyroidism or hypothyroidism areboth higher than control group.In other words,with the increase ofage,diabetic patients have a high-risk of thyroid disease.7.To diabeticpatients with hypothyroidism,there are higher levels of TC and uric acidcompared with control group,namely,hypothyroidism takes a part inmetabolism disorder.