[The prevalence of type 2 diabetes mellitus in patients with autoimmune thyroiditis in hypothyroid stadium]. / Výskyt diabetes mellitus 2. typu u pacientov s autoimunitnou tyroiditídou v stádiu hypotyreózy.

INTRODUCTION: Autoimmune thyroiditis (AIT) and type 2 diabetes mellitus (DM2T) are the two most common endocrinological diseases worldwide. The relationship between T1DM and autoimmune thyreopathies is known and described, but the relationship between thyreopathies and diabetes type 2 is not clarified sufficiently through that studies manifest increasingly the connection between them. OBJECTIVE: Investigate the prevalence of DM2T in patients with AIT in hypothyroid stadium and compare with common population and investigate a possible association between thyroid and glucose metabolism parameters. MATERIAL AND METHODS: The group consisted of 100 patients (33 men and 67 women) with AIT without until now documented glucose metabolism disorder, average age 65.63 ± 19.05 years. The control group (CG) consisted of 100 subjects without until now documented thyreopathy and glucose metabolism disorder (37 men and 63 women), average age 63.85 ± 18.98 years. We realised venous blood sampling and determined thyroidal and glycid metabolism parameters. RESULTS: The study did not confirm higher prevalence of diabetes in patients with AIT [3 (3 %) vs 4 (4 %), p = 1]. There were no statistical significant differences between glycid metabolism parameters in patients with AIT and CG. Also no glycid metabolism parameters correlated to thyroidal parameters. CONCLUSION: We did not confirm higher prevalence of DM in patients with AIT.Key words: autoimmune thyroiditis - diabetes mellitus type 2.

Relationship between type 2 diabetes mellitus and hypothalamic-pituitary-adrenal axis.

INTRODUCTION: Hypercortisolism often leads to impaired glucose tolerance or type 2 diabetes mellitus. On the other hand, changes in the regulation of hypothalamic-pituitary-adrenal axis become a matter of debate in patients with type 2 diabetes mellitus/metabolic syndrome. PATIENTS, MATERIALS, AND METHODS: Authors assessed the hypothalamic-pituitary-adrenal axis activity and subclinical Cushing's syndrome occurrence in 50 patients with type 2 diabetes mellitus in comparison to 25 sex-, age-, and BMI-matched control nondiabetic subjects. 1 mg dexamethasone suppression test with NIH recommended cut-off level for adrenal incidentaloma (serum cortisol after suppression > 138 nmol/l) was used to postulate the diagnosis of subclinical hypercortisolism. RESULTS: There were no significant differences in serum ACTH, DHEA-S, baseline serum cortisol as well as serum cortisol after suppression of 1 mg dexamethasone/subclinical Cushing's syndrome prevalence in both diabetic and control groups (18 vs. 24% respectively, p = 0.54) and there was no relation to the type of treatment (OAD vs. insulin) in group of diabetics. When divided according to age, diabetics older than 60 years suppressed their serum cortisol significantly worse than their age-related controls (99.3 vs. 85.5 nmol/l, p = 0.0001). Furthermore, diabetics did not show an age-related decrease in DHEA-S levels, whereas controls did (r = -0.302, p = 0.033; r = -0.596, p = 0.0017 respectively). Within the group of diabetics, a positive correlation between C-peptide levels and baseline serum cortisol/DHEA-S levels was detected as well (r = 0.445, p = 0.001 and r = 0.339, p = 0.017 respectively). CONCLUSION: Our data show relatively high but comparable lack of cortisol suppression in both diabetic and control groups; however, we consider the subclinical Cushing's syndrome diagnose to be criteria dependent. There is no dependence of type of diabetes treatment (OAD vs. insulin) on HPA axis activity. Our results might indicate the possible role of cortisol in pathogenesis of type 2 diabetes mellitus in patients with metabolic syndrome as well as possible protective role of DHEA-S within the frame of secondary contraregulatory mechanisms aimed to improve insulin sensitivity and reduce the hyperinsulinemia.

Maternal autoimmune thyroiditis and congenital malformations of newborns in a cohort of Slovak women.

BACKGROUND: Aim of this study was to compare the thyroidal status of mothers to children with and without congenital malformations (CM). METHODS: We examined 129 mothers of newborns with CM and 228 mothers without CM. The assessment included particular history, physical examination, thyroid ultrasonography, fT4, TSH, and anti-TPO measurement of mothers and comparison to birth proportions of newborns. RESULTS: The total volume of the thyroid gland and anti-TPO levels were significantly higher in mothers of the group with CM (p < 0.001 and p < 0.01, respectively). The birth weight and length were significantly lower in the group with congenital malformation when compared to controls (p < 0.0001 and p < 0.001, respectively). CONCLUSIONS: Based on the results of our study, we suggest that thyroid diseases of a mother might participate in congenital malformations of their newborn, although no direct association between thyroid autoantibodies and congenital malformations has been described as of yet.