Deciphering the prolactin-thyroid-lipid nexus in type 2 diabetes and hypothyroidism: insights into metabolic interactions and dysregulation
DOI:
https://doi.org/10.18203/2320-6012.ijrms20251291Keywords:
Hypothyroidism, Prolactin, Thyroid hormones, Lipid metabolism, Type 2 diabetes, Glycemic control, Metabolic dysregulationAbstract
Background: Prolactin, thyroid hormones, and lipid metabolism play critical roles in maintaining metabolic homeostasis. Their dysregulation in type 2 diabetes and hypothyroidism may contribute to disease progression and complications. This study investigates the associations between prolactin, thyroid function, lipid metabolism, and glycemic parameters in individuals with type 2 diabetes and hypothyroidism.
Methods: A cross-sectional study was conducted on patients diagnosed with type 2 diabetes and hypothyroidism. Serum levels of fasting blood glucose (FBS), postprandial blood sugar (PPBS), glycated hemoglobin (HbA1c), thyroid hormones [free T3 (FT3), free T4 (FT4), and thyroid stimulating hormone (TSH)], lipid parameters, and prolactin were measured. Correlation analyses were performed to determine associations between prolactin, thyroid function, lipid profile, and glycemic markers.
Results: Significant alterations were observed in metabolic parameters among diabetic and hypothyroid patients. Prolactin levels showed a significant negative correlation with HbA1c (r=-0.42, p<0.05) and triglycerides (TG) (r=-0.38, p<0.05), suggesting a potential role in metabolic regulation. A positive correlation was found between prolactin and thyroid hormones FT3 (r=0.44, p<0.05) and FT4 (r=0.39, p<0.05), highlighting the interplay between the pituitary-thyroid axis and metabolism.
Conclusions: The findings emphasize the need for routine screening of thyroid function in diabetic patients and lipid profile monitoring in individuals with thyroid dysfunction to prevent metabolic complications. Prolactin may serve as a potential biomarker for metabolic dysregulation, warranting further investigation into its diagnostic and prognostic significance.
Metrics
References
Melmed S, Koenig RJ, Rosen CJ, Auchus RJ. Williams Textbook of Endocrinology. 14th ed. Philadelphia: Elsevier. 2022.
Sinha RA, Singh BK, Yen PM. Thyroid hormone regulation of hepatic lipid and carbohydrate metabolism. Trend Endocrinol Metabol. 2021;32(8):551-62.
Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. The Lancet. 2017;390(10101):1550-62.
Mendoza A, Hollenberg AN. New insights into thyroid hormone action. Pharmacological Rev. 2018;70(1):55-80.
Sharma MD, Mohan V, Joseph F. Dyslipidemia in hypothyroidism: Clinical implications and management strategies. J Clin Lipidol. 2020;14(6):687-95.
Ben-Jonathan N, Hugo ER, Brandebourg TD. Prolactin as a metabolic hormone. Annual Rev Physiol. 2017;79:503-6.
Newey PJ, Gorvin CM, Cleland SJ, Willberg CB, Bridge M, Azharuddin M, et al. Hyperprolactinaemia: Pathophysiology and clinical approach. Clin Endocrinol. 2018;89(3):291-302.
López-Vicchi F, De Winne C, Brie B, Eleonora S, Sharon RL, Damasia B-V. Metabolic functions of prolactin: Physiological and pathological aspects. Trend Endocrinol Metabol. 2017;28(10):819-34.
Mancini A, Di Segni C, Bruno C. Thyroid, prolactin and metabolic disorders: An unresolved puzzle. J Endocrinological Investigat. 2021;44(4):713-.30.
Duntas LH, Brenta G. Thyroid hormones: Functional relevance in the cardiovascular system and therapeutic implications for cardiovascular risk in hypothyroidism and subclinical hypothyroidism. J Clin Endocrinol Metabol. 2018;103(5):1838-50.
American Diabetes Association. Standards of Medical Care in Diabetes-2024. Diabetes Care. 2024;47(1):S1-220.
Kaplan LA, Pesce AJ, Kazmierczak SC. Clinical Chemistry: Theory, Analysis, Correlation. 6th ed. Elsevier. 2020.
Rifai N, Warnick GR, Dominiczak MH. Handbook of Lipoprotein Testing. 2nd ed. AACC Press. 2019.
Stone NJ, Robinson JG, Lichtenstein AH, Merz CNB, Blum CB, Eckel RH, et al. 2023 ACC/AHA Guideline on the Management of Blood Cholesterol. Circulation. 2023;147(25ptB):37-70.
Grundy SM, Stone NJ, Bailey AL, Craig B, Kim KB, Roger SB, et al. 2018 AHA/ACC Multi-Society Guideline on the Management of Blood Cholesterol. J Am Coll Cardiol. 2019;73(24):285-350. DOI: https://doi.org/10.1016/j.jacc.2018.11.003
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502. DOI: https://doi.org/10.1093/clinchem/18.6.499
Kratzsch J, Fiedler GM, Leichtle AB. The laboratory diagnosis of thyroid disorders. Dtsch Arztebl Int. 2018;115(12):213-22..
Sapin R, Gasser F. Progress in the immunoassays of thyroid hormones and TSH. Ann Biol Clin (Paris). 2009;67(5):513-27.
Sturgeon CM, Sprague S, Viljoen A. Guidelines for the analytical performance of immunoassays for Free Thyroxine and Free Triiodothyronine. Clin Chem. 2016;62(8):1022-9.
Sturgeon CM, Vesper HW, Bunker AM. Advances in prolactin immunoassays: Clinical applications and challenges. Clin Chem. 2017;63(9):1522-30.
Sapin R, Gasser F. Prolactin assays: Standardization and analytical performance. Ann Biol Clin (Paris). 2019;77(4):413-21.
Fisher RA. Statistical Methods for Research Workers. Edinburgh: Oliver and Boyd. 1925;66-70. DOI: https://doi.org/10.1007/978-1-4612-4380-9_6
Tukey JW. Comparing Individual Means in the Analysis of Variance. Biometrics. 1949;5(2):99-114. DOI: https://doi.org/10.2307/3001913
Pearson K. Notes on Regression and Inheritance in the Case of Two Parents. Proc R Soc Lond. 1895;58:240-2. DOI: https://doi.org/10.1098/rspl.1895.0041
Brenta G. Why can insulin resistance be a natural consequence of thyroid dysfunction? J Thyroid Res. 2011;2011:152850. DOI: https://doi.org/10.4061/2011/152850
Duntas LH, Orgiazzi J, Brabant G. The interface between thyroid and diabetes mellitus. Clin Endocrinol (Oxf). 2011;75(1):1-9. DOI: https://doi.org/10.1111/j.1365-2265.2011.04029.x
Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550-62. DOI: https://doi.org/10.1016/S0140-6736(17)30703-1
Jabbar A, Pingitore A, Pearce SH, Zaman A, Iervasi G, Razvi S. Thyroid hormones and cardiovascular disease. Nat Rev Cardiol. 2017;14(1):39-55. DOI: https://doi.org/10.1038/nrcardio.2016.174
Bernard V, Young J, Chanson P. Corticotroph, somatotroph, and lactotroph pituitary tumors: Physiopathology, clinical consequences, and management. Nat Rev Endocrinol. 2022;18(6):341-54.
Grattan DR, Ladyman SR, Augustine RA. Hormonal induction of leptin resistance during pregnancy. Physiol Behav. 2007;91(4):366-74. DOI: https://doi.org/10.1016/j.physbeh.2007.04.005
Pritchard J, Birchall D, Hussain A, Riley P, Wilson R, Peters M, et al. Prolactin levels in type 2 diabetes: A potential marker of insulin resistance? Diabetes Res Clin Pract. 2021;178:108992.
Gaitan JM, Cabrera C, Mehta A, Ananth CV, Vahratian A, Simhan HN, et al. Thyroid dysfunction in pregnancy and lactation. J Clin Endocrinol Metab. 2013;98(11):4295-303.
Biondi B, Kahaly GJ. Cardiovascular involvement in patients with different causes of hyperthyroidism. Nat Rev Endocrinol. 2010;6(8):431-43. DOI: https://doi.org/10.1038/nrendo.2010.105
Pijl H, Meinders AE. Hypothyroidism and statin intolerance: What to do? J Clin Endocrinol Metab. 2019;104(7):3083-5.
Fisher FM, Maratos-Flier E. Understanding the physiology of FGF21. Annu Rev Physiol. 2016;78:223-41. DOI: https://doi.org/10.1146/annurev-physiol-021115-105339
O'Shea PJ, Harvey CB, Suzuki H, Kaneshige M, Kaneshige K, Cheng SY, et al. A role for thyroid hormone in developmental and adult erythropoiesis. J Endocrinol. 2002;173(3):357-65.
Melmed S, Koenig RJ, Rosen CJ. Williams Textbook of Endocrinology. 14th ed. Elsevier. 2021. DOI: https://doi.org/10.33029/9704-4951-6-PEND-1-848
Bernichtein S, Jeay S, Vandewalle B, Touraine P. New insights in prolactin: Pathological implications. Nat Rev Endocrinol. 2020;16(5):276-86.
Khan A, Malik R, Khan M. Role of prolactin in thyroid dysfunction: A clinical perspective. J Endocrinol Invest. 2019;42(3):289-95.
Shibli-Rahhal A, Van Beek AP, Schlechte JA. Hyperprolactinemia and prolactinomas. Endocrinol Metab Clin North Am. 2020;49(1):153-64.
Cabrera-Reyes EA, Camacho-Arroyo I, Cerbón M. Prolactin function and its role in metabolic homeostasis: A review. Endocr Metab Immune Disord Drug Targets. 2021;21(4):603-12.