Explore The Relationship Between The Condition And The Changes Of The Thyroid Function In The Diabetic Etoacidosis And Hyperosmolar Hyperglycemic Syndrome Patients

Objective:understand the changes of thyroid function of the patients suffering from diabetic ketoacidosis and (or) hyperglycemic hyperosmolar status, and discuss the relationship between the changes of each indicator of thyroid function and the changes of illness.Method:select 43 patients suffering from diabetic ketoacidosis and hyperglycemic hyperosmolar status confirmed between 2012 and 2015 and call them "severe case group". Randomly select 31 patients suffering from simple diabetic ketoacidosis, hyperglycemic hyperosmolar status and other complications confirmed in the same period as contrast group. Detect the thyroid function and compare both difference.Subgroup analysis of severe case group:according to whether the thyroid function is lower than the normal level, it is divided into the subgroup of abnormal thyroid function and normal thyroid function; according to the severity of ketosis acid (pH value), it is divided into light (pH≥7.3), middle (7.3> pH≥7.2) and severity (pH<7.2); according to the effective osmotic pressure of plasma [(plasma sodium+ serum potassium) ×2+ blood sugar; the unit of serum potassium, plasma sodium and blood sugar is mmol/L], it is divided into Hypertonic group (effective osmotic pressure≥320mOsm/L) and non-hypertonic group (effective osmotic pressure< 320mOsm/L; based on the HbAlc level, it is divided into HbAlc<9.0% and HbAlc≥9.0%. analyze the relationship between changes of thyroid function in each subgroup and illness state.Results:total of 43 patients were enrolled,compare to the diabetics group,the patients who caught ketoacidosis or hyperosmolar hyperglycemic at the same time significantly decreased to a low level thyroid function of T3,T4,FT3,FT4,TSH.(P<0.01).Compared with the control group,although the thyroid function of the patients in the observation group were in normal level,but the T4,FT4 and TSH still showed a significant downward trend.When observation group patients daily blood glucose control is stable (glycated hemoglobin<9%), their thyroid function go with out downward trend, but poor glycemic control (glycated hemoglobin greater than or equal to 9%)take T4 and FT3 decreased statistically significant difference (P<0.01).The decrease of the degree of acid intoxication in patients with thyroid function was more obvious(P<0.01).In observation group patients, the changes of T3, T4, FT4 and FT3 were not significantly correlated with the changes of serum sodium and osmotic pressure (P> 0.05), but there were differences between two groups’ TSH in osmotic pressure. Negative correlation exists between blood osmotic pressure and TSH (P< 0.01). no obvious correlation exists in T3, T4, FT3, FT4.No obvious correlation exists in Glycated hemoglobin level and hydroid function indicator (T3, T4, FT3, FT4 and TSH).Conclusion:(1) The emergency Diabetes (Diabetic ketoacidosis or hyperglycemia hypertonic state) may obviously restrain hypothalamic-pituitary-thyroid axis function, and T3, T4, FT3, FT4 and TSH level tend to normal low limit. The tendency is more obvious with the degree of acidosis. About 40% patients are lower than the normal scope with one or more hydroid function indicators. (2) The rise of effective osmotic pressure of blood un5er Diabetes emergency status may restrain adenohypophysis function and decrease serum TSH. (3) The long-term bad control of diabetes will produce rejection effect on hypothalamic-pituitary-thyroid axis function. HbAlc≥9% may be a boundary line.