Endocrine Abstracts

Introduction: Pathological features of T2DM – change in β–cell mass, increased intestinal glucose absorption, glucagon secretion, gluconeogenesis, enhanced catecholamines, insulin resistance – features of hyperthyroidism as well. It is known that Insulin Like Growth Factor Binding Protein (ILGFBP) is related to high insulin (possible asymptomatic hypoglycemia) as well to function and growth of the thyroid, that’s why there is increased risk that patients with T2DM will develop goiter and its associaed osteopenia/osteoporosis. It’s evident that TSH effects directly on bone formation and bone resorption, via the TSH receptor on osteoblast and osteoclast precursors. Association of T2DM and thyroid dysfunction is a less explored area, which may answer to various mysteries of metabolic diseases.

Methods: Retrospective cohort study.

We have studied 51 T2DM patients with nontoxic multinodular goiter and osteoporosis/osteopenia – to understand development in time and analyse possible outcomes. Age (yrs) – 63.53 ± 9.16; 30–60 = 15 (29.5 %); 60 ≤ 36 (70.5%); Sex– F = 42 (82.5%); M = 9 (17.5%); Duration: Diabetes – 10.69 ± 6.405; <6 yrs = 16 (31.3%); ≥6 yrs = 35 (68.7%); Nontoxic Multinodular Goiter – 4.41 ± 3.56; <6 yrs = 11 (21.5%); ≥6 yrs = 40 (78.5%); Osteoporosis (n20) ; 1.4 ± 0.59; < 6 yrs = 20 (100%); Osteopenia (n31)– 1.25 ± 0.85; <6 yrs = 31 (100%); HbA1c(%) – 7.76 ± 2.26; < 7.5% = 30 (58.8%); > 7.5% = 21 (41.2%); TSH (µIU/ml) – 0.74 ± 0.45; < 0.4 = 14 (24.5%); > 0.4 = 37 (75.5%) ; vit.D3 (OH25) (ng/ml) = 14.42 ± 7.88; i–Ca(mmol/l) = 1.2 ± 0.14; BMI (kg/m²) –30.61 ± 5.40; Therapy– oral anti–diabetic drugs– 39(76.5%), combined (oral + insulin) anti–diabetic therapy – 12 (23.5%).

Results: Linear regression showed correlation between HbA1c and TSH (Goodness of Fit – R square– 0.3826, P value – <0.0001, 95% confidence interval – 0.07906 to 0.1700) ; Duration of T2DM and nontoxic multinodular goiter (Goodness of Fit – R square– 0.2125, P value – 0.0007, 95% confidence interval – 0.1147 to 0.3988) Duration of goiter and osteoporosis/osteopenia (Goodness of Fit – R square– 0.08001, P value – 0.0443, 95% confidence interval – 0.001542 to 0.1192).

Conclusion: Current study shows that there is significat correlation between duration of T2DM and development of Thyroid Dysfunction and association between HbA1c levels and TSH is evident. We consider patients with T2DM as a high risk to Thyroid Dysfunctions, especially patients with possible asymptomatic hypoglycemic events and recommend to screen frequently. Thyroid Dysfunction itself effects bone health. The interface between Thyroid malfunction owing to diabetes is a matter of further investigation.