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Abstract

Introduction. The most common endocrinopathy in adults are diabetes mellitus (DM) and thyroid disease. Hyperthyroidism decreases blood glucose control and increased the need of insulin. However, the mechanism of abnormal glucose metabolism in hyperthyroidism is not fully understood. This study aims to determine the relationship of thyroid status with incidence of glucose intolerance in hyperthyroid patients compared to hyperthyroid patients who have achieved clinical status of eutyroid and normal population. Methods. This study was cross sectional design in outpatients with hyperthyroidism in hyperthyroid and euthyroid/subclinical hyperthyroid status, and healthy volunteers who had matching age and sex. An oral glucose test and Homeostatic Model Assesment Insulin Resistance was performed after the diagnosis of hyperthyroidism by FT4 and TSH measurement. Data analysis was performed using SPSS for Windows version 20.0. Results. There were 114 eligible patients (40 case hyperthyroid, 40 case euthyroidism/subclinical hyperthyroidism and 34 healthy subjects). Proportion of glucose intolerance in hyperthyroidism is 52,5% (10% DM, 32,5% impaired glucose tolerance (IGT), and 10% impaired fasting glucose (IFG)), in euthyroidism/subclinical hyperthyroidism was 20% (5% DM, 15% IGT, and 0% IFG), and in healthy subjects was 11,8% (0% DM, 8,8% IGT, and 2,9% IFG). Glucose intolerance in hyperthyroidism was significantly different than euthyroidism/subclinical hyperthyroidism (p=0.002). We also found that the association between thyroid status and glucose intolerance in the group without insulin resistance was significantly different (p=0.004). Conclusions. Our study conclude that there is association between hyperthyroidism and glucose intolerance. Hyperthyroid patients in euthyroidism/subclinical hyperthyroidism status have the same risk as the healthy subject to became glucose intolerance.

References

1. Gierach M, Gierach J, Junik R. Insulin resistance and thyroid disorders. Endokrynol Pol. 2014;65(1):70-6. 2. Kapadia KB, Bhatt PA, Shah JS. Association between altered thyroid state and insulin resistance. J Pharmacol Pharmacother. 2012;3(2):156-60. 3. AACE Thyroid Task Force. American Association Of Clinical Endocrinologist. Hyperthyroidism And Other Causes Of Thyrotoxicosis: Management Guidelines Of The American Thyroid Association And American Association Of Clinical Endocrinologists. Thyroid. 2011;21(6):593-646. 4. Palma CC, Pavesi M, Nogueira VG, Clemente EL, Vasconcellos MF, et al. Prevalence of thyroid dysfunction in patients with diabetes mellitus. Diabetol Metab Syndr. 2013;5(1):58. 5. Masjhur JS. Disfungsi Tiroid dan Diabetes. Forum Diabetes Nasional 4 dan Forum Endokrin dan Diabetes Regional Sumatera 2, Padang 2-4 Nopember; 2007. 6. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87(2):489-99. 7. Hayashi T, Boyko EJ, Leonetti DL, McNeely MJ, Newell-Morris L, Kahn SE, et al. Visceral adiposity and the risk of impaired glucose tolerance. Diab Care. 2003;26(3):650-5.. 8. Shields M, Tremblay MS, Connor GS, Janssen I. Abdominal obesity and cardiovascular disease risk factors within body mass index categories. Health Rep. 2012 Jun;23(2):7-15. 9. Haffner SM. Abdominal obesity, insulin resistance, and cardiovascular risk in pre-diabetes and type 2 diabetes. Eu Heart Journal supp. 2006;3:20-5. 10. Roubsanthisuk W, Watanakejorn P, Tunlakit M, Sriussadaporn S. Hyperthyroidism induces glucose intolerance by lowering both insulin secretion and peripheral insulin sensitivity. J Med Assoc Thai. 2006;89(5):133-40. 11. Paul DT, Mollah FH, Alam MK, Fariduddin M, Azad K, Arslan MI. Glycemic status in hyperthyroid subjects. Mymensingh Med. 2004;13(1):71-5. 12. Kravets I. Hyperthyroidism: diagnosis and treatment. Am Fam Phys. 2016;93(5)363-70. 13. Biondi B, Bartalena L, Cooper DS, Hegedus L, Laurberg P, Kahaly GJ. The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism. Eur Thyroid J. 2015;4:149-63. 14. Perkumpulan Endokrinologi Indonesia. Konsensus pengelolaan dan pencegahan diabetes mellitus tipe 2 di Indonesia. Jakarta: Perkumpulan Endokrinologi Indonesia; 2015. 15. American Diabetes Association. Standards of medical care in diabetes – 2015. Diabetes Care. 2015;38(suppl 1):S1-90. 16. Ozdemir D, Dagdelen S, Usman A. Serum adiponectin levels and changes in glucose metabolism before and after treatment for thyroid dysfunction. Intern Med. 2015;54:1849–57. 17. Litaka M, Katayama S. Insulin resistance in pituitary, thyroid, and adrenal diseases. Nippon Rinsho. 2000;58(2):451-5. 18. Suyono S, Kamso S, Oemardi M. Metabolic syndrome inelderly should it be treated? In Surabaya Metabolic Syndrome Update 1, Surabaya, 19-20 Februari; 2005. p.9-20. 19. Pranoto A, Kholili U, Tjokroprawiro A, Hendromartono, Sutjahjo A, Murtiwi S. Metabolic syndrome as observed in Surabaya. In Surabaya Metabolic Syndrome Update 1, Surabaya, 19-20 Februari; 2005. p.245-7. 20. Nasution IR. Gambaran resistensi insulin dan sindrom metabolik pada perempuan usia lanjut di panti wreda [Tesis]. Jakarta: Fakultas Kedokteran Universitas Indonesia; 2005. 21. Kodama K, Tojjar D, Yamada S. Ethnic differences in the relationship between insulin sensitivity and insulin response. Diab Care. 2013;36(6):1789-96. 22. Mendoza-Nunez VM, Garcia-Sanchez A, Sanchez-Rodriguez M, Galvan-Duarte RE, Fonseca-Yerena ME. Overweight, waist circumference, age, gender, and insulin resistance as risk factors for hyperleptinemia. Obese R. 2002;10(4):253-60. 23. Karakelides H, Irving BA, Short KR, O’brien P, Nair KS. Age, obesity, and sex effects on insulin sensitivity and skeletal muscle mitochondrial function. Diabetes. 2010;59(1):89-97. 24. Karbalaei N, Noorafshan A, Hoshmandi E. Impaired glucosestimulated insulin secretion and reduced β-cell mass in pancreatic islets of hyperthyroid rats. Exp Physiol. 2016;101:1114–27.

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