THYROID GLAND RESPONSES TO THERAPEUTIC INTERVENTIONS IN ELDERLY DIABETES TYPE 1 AND TYPE 2 SUBJECTS OF NORTHERN PAKISTAN
Main Article Content
Keywords
Non interventional study, insulin, oral antidiabetic drug, therapeutic treatments, TSH, T4, fT4, T3, fT3
Abstract
A total of 330 study participants with type 1 and type 2 diabetes were involved in the study in a noninterventional setting, they were placed on different therapies for diabetes and thyroid disorders based on clinical protocols. The objective of these treatments was to evaluate their impact on thyroid gland function. Thyroid stimulating hormone (TSH), total thyroxine (T4), free thyroxine (fT4), total triiodothyronine (T3), and free triiodothyronine (fT3) levels were measured to evaluate the thyroid gland's functional status across different therapeutic interventions. It was observed that TSH levels were significantly elevated in subjects treated with insulin alone for type 1 diabetes, as well as in those receiving a combination of insulin and oral antidiabetic drugs for type 2 diabetes. Furthermore, T4 and fT4 levels were significantly reduced in groups with elevated TSH levels, indicating a decrease in thyroxine biosynthesis and subsequent negative feedback response on TSH secretion. Similar patterns were observed in the levels of free T3 (fT3), suggesting a reduction in triiodothyronine biosynthesis. Notably, T3 levels were also lowered in subjects receiving oral antidiabetic drugs alone or in combination with other treatments. The findings highlight the importance of periodic monitoring of thyroid function in type 2 diabetic subjects undergoing oral antidiabetic treatment, as these medications may adversely affect thyroid function and necessitate adjustments in treatment strategies. Overall, the study underscores the need for careful consideration and management of thyroid function in diabetic patients undergoing various therapeutic interventions, to optimize treatment outcomes and minimize potential adverse effects.
References
2. Modell H, Cliff W, Michael J, McFarland J, Wenderoth MP, Wright A. A physiologist's view of homeostasis. Adv Physiol Educ. 2015 Dec;39(4):259-66.
3. Davies KJ. Adaptive homeostasis. Mol Aspects Med. 2016 Jun;49:1-7. doi: 10.1016/j.mam.2016.04.007. Epub 2016 Apr 22. PMID: 27112802; PMCID: PMC4868097.
4. Armstrong M, Asuka E, Fingeret A. Physiology, Thyroid Function. [Updated 2023 Mar 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537039/
5. Biban BG, Lichiardopol C. Iodine Deficiency, Still a Global Problem? Curr Health Sci J. 2017 Apr-Jun;43(2):103-111. doi: 10.12865/CHSJ.43.02.01. Epub 2017 Jun 29. PMID: 30595864; PMCID: PMC6284174.
6. Vander pump MPJ (2019). Epidemiology of Thyroid Disorders. In: Luster, M., Duntas, L., Wartofsky, L. (eds) The Thyroid and Its Diseases. Springer, Cham.https://doi.org/10.1007/978-3-319-72102-6/_6
7. Tsatsoulis A, Mantzaris MD, Bellou S, Andrikoula M. Insulin resistance: an adaptive mechanism becomes maladaptive in the current environment - an evolutionary perspective. Metabolism. 2013 May;62(5):622-33. doi: 10.1016/j.metabol.2012.11.004. Epub 2012 Dec 20. PMID: 23260798.
8. Pisarev MA. Interrelationships between the pancreas and the thyroid. CurrOpinEndocrinol Diabetes Obes.2010Oct;17(5):437-9.doi:10.1097/MED.0b013e32833e0750.PMID:20717019.
9. Biondi B, Kahaly GJ, Robertson RP. Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders. Endocr Rev. 2019 Jun 1;40(3):789-824. doi: 10.1210/er.2018-00163. PMID: 30649221; PMCID: PMC6507635
10. Eom YS, Wilson JR, Bernet VJ. Links between Thyroid Disorders and Glucose Homeostasis. Diabetes Metab J. 2022 Mar;46(2):239-256. doi: 10.4093/dmj.2022.0013. Epub 2022 Mar 24. PMID: 35385635; PMCID: PMC8987680.
11. Walczak and Sieminska, Obesity and Thyroid Axis Int J Environ Res Public Health 2021 Sep 7;18(18):9434. doi: 10.3390/ijerph18189434 PMID: 34574358 PMCID: PMC8467528.
12. Wondmkun YT. Obesity, Insulin Resistance, and Type 2 Diabetes: Associations and Therapeutic Implications. Diabetes Metab Syndr Obes. 2020 Oct 9;13:3611-3616. doi: 10.2147/DMS O.S275898. PMID: 33116712; PMCID: PMC7553667.
13. Umpierrez G.E, Latif KA, Murphy MB, Lambeth HC, Stentz F, Bush A, and Kitabchi A. Thyroid dysfunction in patients with type 1 diabetes: a longitudinal study. Diabetes Care, 2003; 26(4), 1181-1185.
14. Kalra S, Aggarwal S. and Khandelwal D. (2019). Thyroid Dysfunction and Type 2 Diabetes Mellitus: Screening Strategies and Implications for Management. Diabetes Therapy 2019; 10(6), 2035–2044.
15. Li Y,YiM,Deng X,LiW,ChenY,andZhangX. EvaluationoftheThyroid Characteristics and Correlated Factors in Hospitalized Patients with Newly Diagnosed Type 2 Diabetes. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2022; 15, 873-884.
16. Nederstigt C, Corssmit EP, de Koning EJ, Dekkers OM. Incidence and prevalence of thyroid dysfunction in type 1 diabetes. J Diabetes Complications. 2016 Apr;30(3):420-5.doi: 10.1016/j.jdiacomp.2015.12.027. Epub 2016 Jan 6. PMID: 26868720.
17. Tseng CH. Sitagliptin use and thyroid cancer risk in patients with type 2 diabetes. Oncotarget. 2016 Apr 26;7(17):24871-9. doi: 10.18632/oncotarget.8399. PMID: 27029076; PMCID: PMC5029749.
18. Ahmad, D, Makhous, R. Evaluation of the effect of metformin therapy on TSH serum levels in diabetic patients. Res J Pharm & Technol 2020 13(8): 3801-3806. DOI :10.5958/0974- 360X.2020.00673.3
19. Krysiak R, Gilowska M, Szkróbka W, and Okopień B. The effect of metformin on the hypothalamic-pituitary-thyroid axis in patients with type 2 diabetes and amiodaroneinduced hypothyroidism. Pharmacological Reports 2016; 68(2), 490-494.
20. European Medicines Agency. Guideline on good pharmacovigilance practices (GVP) Module VIII– Post-authorisation safety studies (Rev 3). 2017.
https://www.ema.europa.eu/documents/scientific-guideline/guideline-goodpharmacovigilance-practices-gvp-module-viii-post-authorisation-safety-studies-rev3_en.pdf
21. Siddiqui A, Zafar A, Irfan T. Comprehensive Analysis of Clinical Trials In Pakistan From September 1992 To February 2019. J Ayub Med Coll Abbottabad. 2022 JulSep;34(3):468-473. doi: 0.55519/JAMC-03-8793. PMID: 36377158.
22. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR; American Diabetes Association (ADA); European for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (DA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 35: 1364–1379, 2012. doi:10.2337/dc12-0413.
23. Bösenberg LH and van Zyl DG. The mechanism of action of oral antidiabetic drugs: A review of recent literature, Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2008; 13(3), 80-88.
24. Lv W, Wang X, Xu Q, Lu W. Mechanisms and Characteristics of Sulfonylureas and Glinides CurrTop Med Chem 2020;20(1):37-56.PMID:31884929DOI:10.2174/15680266206661 91224141617
25. Shahid MA, Ashraf MA, Sharma S. Physiology, Thyroid Hormone. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500006.
26. Junik R, Kozinski M, Debska-Kozinska K. Thyroid ultrasound in diabetic patients without overt thyroid disease. Acta Radiologica. 2006;47:687–691. doi: 10.1080/02841850600806308. [PubMed] [CrossRef] [Google Scholar]
27. Ridha MF, Al Zubaidi MA. Thyroid auto immune antibodies in children with Type-I Diabetes mellitus in relation to diabetes control. Pak J Med Sci. 2019; 35(4), 969-973.
28. John R, Wild D et al., in The Immunoassay Handbook (Fourth Edition), 2013, Elsevier Ltd.
29. Schweizer U, Köhrle J. Function of thyroid hormone transporters in the central nervous system. Biochim Biophys Acta. 2013 Jul;1830(7):3965-73
30. Sabatino L, Vassalle C, Del Seppia C, Iervasi G. Deiodinases and the Three Types of Thyroid Hormone Deiodination Reactions. Endocrinol Metab (Seoul). 2021Oct;36(5):952- 964. doi: 10.3803/EnM.2021.1198. Epub 2021 Oct 21. PMID: 34674502; PMCID: PMC8566136.
31. Spira, D., Buchmann, N., Dörr, M., Markus, M. R. P., Nauck, M., Schipf, S., Spranger, J., Demuth, I., Steinhagen-Thiessen, E., Völzke, H., & Ittermann, T. (2022). Association of thyroid function with insulin resistance: data from two population-based studies. European Thyroid Journal, 11(2), e210063. Retrieved Apr 16, 2024, from https://doi.org/10.1530/ETJ-21-0063
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Amtul Sobhi
Institute of Biochemistry and Biotechnology, University of Lahore, Lahore, Pakistan
Abdul Majeed Cheema
Institute of Biochemistry and Biotechnology, University of Lahore, Lahore, Pakistan
Tahir Maqbool
Institute of Biochemistry and Biotechnology, University of Lahore, Lahore, Pakistan