Journal of Obesity and Metabolic Research

EDITORIAL
Year
: 2014  |  Volume : 1  |  Issue : 2  |  Page : 83--84

Association of thyroid dysfunction and diabetes mellitus: Is the co-existence incidental?


Rama Vaidya 
 Unit of Endocrine and Metabolic Disorders, Medical Research Centre, Kasturba Health Society, Mumbai, Maharashtra, India

Correspondence Address:
Rama Vaidya
Unit of Endocrine and Metabolic Disorders, Medical Research Centre, Kasturba Health Society, Mumbai, Maharashtra
India




How to cite this article:
Vaidya R. Association of thyroid dysfunction and diabetes mellitus: Is the co-existence incidental?.J Obes Metab Res 2014;1:83-84


How to cite this URL:
Vaidya R. Association of thyroid dysfunction and diabetes mellitus: Is the co-existence incidental?. J Obes Metab Res [serial online] 2014 [cited 2019 Sep 23 ];1:83-84
Available from: http://www.jomrjournal.org/text.asp?2014/1/2/83/134395


Full Text

Studies from India and abroad have shown a close association between thyroid dysfunction and type 2 diabetes mellitus. [1],[2],[3],[4],[5],[6],[7] A high prevalence rate (31.2%) of thyroid dysfunction among known cases of type 2 diabetes was reported from Manipur, India. [2] Hypothyroidism, both overt (11.4%) and subclinical hypothyroidism (16.3%), was more common as compared with hyperthyroidism. Though such high prevalence rates (30-32%) of thyroid dysfunctions in patients of type 2 diabetes have been reported by other Indian [3] and some international studies, [4] the majority have shown these rates to be 13-16%, respectively. [5],[6] Thyroid dysfunctions are more common in females having type 2 diabetes, those diabetics with family history of thyroid dysfunction and also in older patients with long duration of diabetes. [7] Since, the occurrence of thyroid dysfunction is more common in patients with diabetes as compared to the prevalence in general population, it is recommended that all the cases of type 2 diabetes should be screened for thyroid dysfunctions and preferably annually. [8],[9]

Both conditions, thyroid dysfunctions and type 2 diabetes, are common endocrine disorders; question asked is whether the coexistence of these two endocrine disorders is incidental. Do they have common underlying pathogenic mechanism that they share (vide infra)? Question also arises if metabolic syndrome (MS) and/or type 2 diabetes are prevalent in those patients who have had thyroid dysfunction/s to begin with. This question is relevant as MS, a cluster of risk factors, is a forerunner of type 2 diabetes and cardiovascular problems.

There are a few studies that have determined the prevalence of MS among those who have hypothyroidism. [10],[11] A study from Nigeria reports that MS occurred in 1 out of 4 individuals who had thyroid disorders. [10] In another study of 100 patients with overt hypothyroids prevalence of MS was 44% (P = 0.016) as compared to 30% in 200 euthyroid controls. [11] In the present issue of JOMR,  Purohit et al. report's a high incidence of MS (66%) among hypothyroid individuals, while none in the control euthyroid group had even a single feature of the MS. [12] In a study from a tertiary center from south India, the investigators have tried to assess the prevalence of thyroid dysfunction among 420 patients with documented MS as compared to the prevalence in the control group of 406 individuals without any feature of MS. [13] Thyroid dysfunction was detected in significantly higher percentage (≈30%) of patients with MS as compared to that (8.8%) in the nonMS control group. These studies indicate a need for investigating all hypothyroid patients for underlying MS and conversely to look for presence of thyroid dysfunction in patients with MS.

Several studies have been undertaken to unravel the common mechanism for the association of hypothyroidism and type 2 diabetes. Insulin resistance (IR) is considered as the most likely shared pathological mechanism as shown by many investigators. [14],[15],[16] However, there are conflicting reports about the relationship of hypothyroidism and insulin sensitivity. [17] In an elegant clinical study, it is shown that glucose uptake in muscle and adipose tissue in response to insulin was compromised in hypothyroid individuals indicating IR. [16] Association of nonalcoholic fatty liver disease, a common liver metabolic disease, with hypothyroidism has been reported in adults and recently in children. [18],[19] β1-selective thyromimetics have selective action that targets thyroid receptor β1isoform in the liver and has a promise of treating hepatosis, dyslipidemia, and atherosclerosis. [20],[21]

Relationship between thyroid dysfunction and type 2 diabetes mellitus is highly complex. [22] This research area of interaction between thyroid dysfunction and type 2 diabetes is still open for exploration by fresh innovative basic and clinical studies and/or demands a further scrutiny by systematic reviews and/or meta-analysis of the existing data.

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