Insulin resistance in sub clinical hypothyroidism
DOI:
https://doi.org/10.18203/2320-6012.ijrms20150159Keywords:
Insulin resistance, Subclinical Hypothyroidism, HOMA-IRAbstract
Background: Insulin resistance (IR) is an established risk factor for cardiovascular diseases. It is an underlying phenomenon in pathogenesis of type 2 Diabetes mellitus. Recent literature proves the development of insulin resistance in Overt hypothyroidism (OH), but there is controversy as to whether this association is also present in sub clinical hypothyroidism (SCH).
Aims: Present study was designed to explore the presence IR in SCH.
Settings & design: The study included 60 hypothyroidism patients and 30 age and sex matched euthyroid controls. Hypothyroidism patients were grouped as SCH (n=30) and OH (n=30).
Methods: We examined total cholesterol levels, fasting blood glucose, fasting serum insulin levels and Insulin resistance (calculated by using HOMA-IR software).
Statistical analysis: All statistical data was analysed by ANOVA using the Graph Pad Prism software, Version 5.01.
Results: HOMA-IR values showed highly significant association between controls and SCH. TSH levels were positively correlated with insulin and HOMA IR in patients with SCH.
Conclusions: Therefore, it will be good practice to screen people &Type 2 DM patients for presence of SCH, so that early detection and prompt intervention can prevent or prolong the appearance of various fatal complications associated with IR & help in managing diabetes holistically.
References
J. Larry Jameson, Antony P. Disorders of the Thyroid Gland. In: Fausi A S, Braunwald E, Kasper D, Hauser S, Longo D, J Jameson et al, editors. Harrison’s principles of internal medicine. 17th ed. New York: McGraw Hill companies; 2008, p.2229-2233.
Fommei E, Iervasi G. The role of thyroid hormone in blood pressure homeostasis: evidence from short-term hypothyroidism in humans. J Clin Endocrinol Metab. 2002; 87:1996-2000.
Maratou E, Hadjidakis D, Kollias A, Tsegka K, Peppa M, Alevizaki M, et al. Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. Eur J Endocrinol. 2009.
Instructions for use of TSH ELISA [package insert]. Am Eichenhain 1, 48531 Nordhorn: Labor Diagnostika Nord GmbH & Co. KG; 2010.
Instructions for use of T3 ELISA [package insert]. Am Eichenhain 1, 48531 Nordhorn: Labor Diagnostika Nord GmbH & Co. KG; 2010.
Instructions for use of T4 ELISA [package insert]. Am Eichenhain 1, 48531 Nordhorn: Labor Diagnostika Nord GmbH & Co. KG; 2010.
Instructions for use of INSULIN ELISA [package insert]. Am Eichenhain 1, 48531 Nordhorn: Labor Diagnostika Nord GmbH & Co. KG; 2009.
Trinder P., Ann. Clin. Biochem. 1969; 6:24-27.
Nader Rifai, G. Russell Warnick. Lipids, lipoproteins, apolipoproteins, and other cardiovascular risk factors. In: Carl Burtis, Edward RA, David EB, editors. Tietz textbook of clinical chemistry and molecular diagnostics, 4th ed.; New Delhi: Elsevier; 2008, p.903-982.
Allain CC, Poon LS, Chan CSG, Richmond W, Fu P. Clin. Chem. 1974; 20:470-475.
Roeschlau P, Bernt E, Gruber WA. Clin. Chem. Clin. Biochem. 1974; 12:226.
HOMA calculator [internet]. 2004 [cited 2004]. Available from: http://www.dtu.ox.ac.uk/ho macalculator/ index.php
Serter R, Demirbas B, Culha C, Cakal E. The effect of L-thyroxine replacement therapy on lipid based cardiovascular risk in sub clinical hypothyroidism. Invest J Endocrinol 2004; 27:897-903.
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract. 2002; 8: 457-69.
Tuzcu A, Bahceci M, Gokalp D, Tuzun Y, Gunes K. Subclinical hypothyroidism may be associated with elevated high-sensitive c-reactive protein (low grade inflammation) and fasting hyperinsulinemia. Endocr. J. 2005 Feb; 52 (1):89-94.
Annemieke R, Stephan JL, Links Thera P, Gans Rijk OB, Wolffenbuttel Bruce HR. Thyroid Function is associated with components of the metabolic syndrome in euthyroid subjects. J Clin Endocrinol Metab 2007; 92:491-6.
Owecki M, El Ali Z, Nikisch E, Sowinski J. Serum insulin levels and the degree of thyroid dysfunction in hypothyroid women. Neuro Endocrinol Lett 2008; 29(1):137-40.
Reaven GM, Banting lecture. Role of insulin resistance in human disease. Diabetes 1988; 37:1595-607
Perros P, McCrimmon R, Shaw G, Frier B. Frequency of thyroid dysfunction in diabetic patients: value of annual screening. Diabet. Med. 1995; 7:622-7.
Dessein PH, Joffe BI, Stanwix AE. Subclinical hypothyroidism is associated with insulin resistance in rheumatoid arthritis. Thyroid. 2004 Jun; 14 (6):443-6.
Eirini Maratou, Dimitrios J Hadjidakis, Anastasios Kollias et al. Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. European Journal of Endocrinology. 2009; 160:785–790.
Amati F, Dubé JJ, Stefanovic-Racic M, Toledo FG, Goodpaster BH. Improvements in insulin sensitivity are blunted by subclinical hypothyroidism. Med Sci Sports Exerc. 2009 February; 41(2):265-9.
Singh BM, Goswami B, Mallika V. Association between insulin resistance and hypothyroidism in females attending a tertiary care hospital. Indian Journal of Clinical Biochemistry. 2010; 25(2):141-145.
Bakker SJL, Ter Maaten JC, Popp-Snijders C, Slaets JPJ, Heine RJ, Gans ROB. The relationship between thyrotropin and low density lipoprotein cholesterol is modified by insulin sensitivity in healthy euthyroid subjects. J Clin Endocrinol Metab 2001; 86:1206-11.
Al Sayed A, Al Ali N, Bo Abbas Y, Alfadhli E. Subclinical hypothyroidism is associated with early insulin resistance in Kuwaiti women. Endocr .J. 2006 Oct; 53(5):653-7. Epub 2006 Aug 11.
Owecki M, Nikisch E, Sowi´nski J. Hypothyroidism has no impact on insulin sensitivity assessed with homa-ir in totally thyroidectomized patients. Acta Clin Belg. 2006 Mar-Apr; 61(2):69-73.
Viguerie N, Millet l, Avizou S et al. regulation of human adipocyte gene expression by thyroid hormone. J Clin Endocrinol Metab 2002; 87:630-4.
Weinstein SP, O’Boyle E, Haber RS. Thyroid hormone increases basal & insulin stimulated glucose transport in skeletal muscle: The role of GLUT-4 glucose transporter expression. Diabetes. 1994 Oct; 43(10):1185-1189.
George Eimitriadis, Panayota Mitrou, Vaia Lambadiari. Insulin action in Adipose tissue and muscle in hypothyroidism. Journal of Clinical Endocrinology & Metabolism. 91(12):4930-4937.
Moeller lC, Dumitrescu AM, Walker rl et al. Thyroid hormone responsive genes in cultured human fibroblasts. J Clin Endocrinol Metab 2005; 90:936-43.
Rochon C, Tauveron I, Dejax C et al. response of glucose disposal to hyperinsulinemia in human hypothyroidism and hyperthyroidism. Clin Sci 2003; 104:7-15.
Dimitriadis G, Mitrou P, lambadiari V et al. Insulin action in adipose tissue and muscle in hypothyroidism. J Clin Endocrinol Metab 2006; 91: 4930-7.
Brenta G, Celi FS, Pisarev M et al. Acute thyroid hormone withdrawal in athyreotic patients results
in a state of insulin resistance. Thyroid 2009; 19: 665-9.
Patricia Wu, Thyroid Disease and Diabetes clinical diabetes. 18(1).
Duntas LH. Thyroid disease and lipids. Thyroid 2002; 12:287-93.
Squizzato A, Gerdes VEA, Brandjes DPM, Büller HR, Stam J. Thyroid Diseases and Cerebrovascular Disease. Stroke. 2005; 36:2302-2310.
Randle PJ, Newsholme EA, Garland PB. Regulation of glucose uptake by muscle. Effects of fatty acids, ketone bodies and pyruvate, and of alloxan, diabetes and starvation, on the uptake and metabolic fate of glucose in rat heart and diaphragm muscles. Biochem J. 1964; 93:652-665.
Gerald I. Shulman. Cellular mechanisms of insulin resistance. Journal of Clinical Investigation. 106(2): 171-176.
