Endocrine Abstracts

Objective

To establish the association of the dynamic changes in carbohydrate, lipid metabolism parameters and blood pressure (BP) profile in patients with combined course of arterial hypertension (AH), type 2 diabetes mellitus (DM) and subclinical hypothyroidism (SH) and to determine the efficacy of the applied scheme. We examined 106 patients – 45 women and 61 men aged 45–55 years with AH stage II grade 2 and type 2 DM which were divided on SH presence into two groups: gr.1 – with SH which additionaly to the main antihypertensive scheme received levothyroxine (n = 47) and without SH (n = 59) – gr.2. Levothyroxine was administered in an individually selected dosage by titration in accordance with the obtained laboratory parameters.

Methods

BP profile, HOMA-insulin resistance (IR), glycated hemoglobin (HbA1c), lipid metabolism parameters (LDL-C, HDL, TG), thyroid-stimulating hormone (TSH) levels.

Results

Analysis of patients monitored during the year with multimorbid pathology – gr. 2 showed more expressed disorders of carbohydrate metabolism – fasting glucose, HbA1c, compared with similar indicators in gr.1, which demonstrates more significant metabolic changes, and subjectively indicates an increase in cardiovascular risk. Patients of gr. 2 are characterized by more pronounced manifestations of dyslipoproteinemia in the form of increased LDL-C (P<0.05) and hypertriglyceridemia and lower levels of HDL. In the dynamics of combined antihypertensive treatment in patients from gr. 1 and gr. 2, a sufficient antihypertensive effect was found, which was to achieve the target BP levels of 76.43 % and 69.27 % of those surveyed, respectively. Significant differences after 12 months of therapy were reached by the value of systolic BP in all examined groups (P<0.05). Diastolic BP was significantly reduced in all groups compared to the initial values (P <0.05). Administration of levothyroxine led to a significant reduction in proatherogenic lipids, in group 2, where LDL-C from (3.6 ± 0.33) mmol/l to (2.5 ± 0.27) mmol/l, P <0.05, and TG from (3.3 ± 0.44) mmol/l to (1.85 ± 0.31) mmol/l, P <0.05, whereas SH promotes the development and progression of atherosclerosis despite hypolipidemic therapy.

Conclusions

Additional administration of levothyroxine to the standard combined scheme in patients with AH, type 2 DM and SH improve lipid, carbohydrate metabolism and hemodynamics in the form of a significant reduction in dyslipidemia, normalization of fasting glucose levels and HbA1c which definitely reduces the risk of cardiovascular events in this category of patients.