Analysis Of Thyroid Disease In Patients With Type 2 Diabetes Mellitus And Its Relationship With Thyroid Function And Related Indicators

Objective:To observe and analyze the prevalence of thyroid disease in patients with T2DM;To study the relationship between thyroid function and blood glucose levels,vascular disease,and osteoporosis in T2DM.Research objects:The clinical data of 677 patients with T2DM mellitus（including 395 males and 282 females）admitted to the Department of Endocrinology of the First Affiliated Hospital of Guangxi Medical University between April 2016 and February 2017 were collected:Age,height,weight,female years of menopause,hypertension,stroke,coronary heart disease,carotid atherosclerosis,retinopathy,diabetic nephropathy,thyroid disease and other medical history;Serum TT3,TT4,FT3,FT4,TSH;venous plasma FPG,2hPG;whole blood HbA1C;American Hologic dual-energy X-ray absorptiometry was used to determine the bone mineral density T value of each lumbar spine and hip.Methods 1.Statistical analysis of the overall prevalence of thyroid disease in all T2DM patients enrolled in the study.Comparative analysis of prevalence of thyroid disease in patients with T2DM aged 60 years or older and comparison of men and women with T2DM Patients with thyroid disease were included in this study.The prevalence of thyroid disease in T2DM with HbA1c≤9%and HbA1c>9%was compared.2.All selected patients with T2DM compared TT₃,TT₄,FT₃,FT₄,and TSH levels by HbA_1c≤9%and HbA_1c>9%,respectively,and performed FPG,2hPG,HbA1c,and TT₃,TT₄,FT₃,FT₄,and TSH levels,respectively.Single factor correlation analysis;3.TT₃,TT₄,FT₃,FT₄,and TSH levels were compared between the macrovascular disease group and the non-macrovascular disease group in all selected T2DM patients,and the gender,age,BMI,hypertension,etc.were corrected.After the factors,whether the macroangiopathy or microangiopathy was used as the dependent variable,and the TT₃,TT₄,FT₃,FT₄,and TSH levels were used as independent variables to perform the two-class logistic regression analysis.4.To compare the levels of TT₃,TT₄,FT₃,FT₄,and TSH in patients with T2DM of age≥50 years and menopausal women with osteoporosis and without osteoporosis,and further to determine if osteoporosis occurred.Variables,age,BMI,and other factors were adjusted,and TT₃,TT₄,FT₃,FT₄,and TSH were used as independent variables to perform logistic regression analysis.Results:1.The detection rate of T2DM with thyroid diseases:hyperthyroidism 2.8%,subclinical hyperthyroidism 0.4%,hypothyroidism 1.3%,subclinical hypothyroidism 1.3%,thyroid nodules 9.9%,ESS0.6%,thyroid cancer 0.3%,and thyroiditis 0.3%.The detection rate of thyroid nodules in patients aged 60 and above was higher than that of patients under 60 years of age（P=0.004）,and the rate of female hyperthyroidism and thyroid nodules was higher than that of men（P<0.05）.2.The levels of TT₃ and TSH in the HbA_1c>9%group were lower than those in the HbA_1c≤9%group.The FT₄ levels in the HbA_1c>9%group were significantly higher than those in the HbA_1c≤9%group（P=0.002）.There was a negative correlation between serum TT₃ and HbA_1cc levels（r_s=-0.163,P=0.000）.FT₃ levels were positively correlated with 2hPG（r_s=0.094,P=0.021）.FT₄ levels were positively correlated with HbA_1c,FPG,and2hPG（r_s=0.134,0.084,0.123;P=0.001,0.030,0.003）,TSH levels were negatively correlated with HbA_1c,FPG,and 2hPG（r_s=-0.174,-0.104,-0.122;P=0.000,0.010,0.002）.3.The levels of TT₃ and FT₄ in patients with macroangiopathy were lower than those in patients without macrovascular disease（P=0.003,0.024）.Logistic regression analysis of two groups did not find that TT₃,TT₄,FT₃,FT₄,and TSH were Major risk factors for macrovascular disease.Serum TT₃ levels were lower in the microangiopathy group than in the non-microvascular disease group（P=0.002）.Logistic regression analysis showed that the lower the TT₃ level,the higher the risk of microangiopathy（β=-0.618,P=0.012）.4.Serum T₄ levels in T2DM patients with osteoporosis were higher than those in the non-osteoporotic group（P=0.030）.The serum TSH levels in patients with osteoporosis were lower than those in non-osteoporosis group.In the osteoporosis group,the difference was statistically significant（P=0.001）.The results of binary logistic regression analysis showed that the lower the level of TSH,the higher the risk of osteoporosis（β=-0.148,OR=0.862,P=0.038）.The level of FT₄ in the osteoporotic group of postmenopausal women with T2DM was lower than that in the non-osteoporotic group（P=0.028）.The results of binary logistic regression analysis did not reveal that TT₃,TT₄,FT₃,FT₄,and TSH were postmenopausal Risk Factors for Osteoporosis in Women with T2DM.Conclusions:1.The highest rate of thyroid nodules was detected in hospitalized T2DM patients（9.9%）.The detection rate of thyroid nodules was higher in patients older than 60 years old and in T2DM,and the combined hyperthyroidism and thyroid nodules were found in women with T2DM.The detection rate is higher than that of men.2.Patients with poorly controlled glycaemic of T2DM may have low levels of T₃.and FT₃,FT₄,and TSH may participate in the regulation of blood glucose.3.The lower T₃ level may be one of the risk factors for T2DM combined with large vessels and microangiopathy.4.For male T2DM older than 50 years of age and above,higher levels of TSH within the normal range may play a protective role in bone mass;In the postmenopausal women with type 2 diabetes,this protective effect of TSH is not obvious.