Does autoimmune hypothyroidism increase the risk of neurovascular complications in type 1 diabetes?
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ORIGINAL ARTICLE
Does autoimmune hypothyroidism increase the risk of neurovascular complications in type 1 diabetes? A. Rogowicz‑Frontczak1 · B. Falkowski1 · A. Grzelka‑Wozniak1 · A. Uruska1 · A. Araszkiewicz1 · D. Zozulinska‑Ziolkiewicz1 Received: 14 May 2019 / Accepted: 21 December 2019 © Italian Society of Endocrinology (SIE) 2020
Abstract Background Type 1 diabetes (T1DM) often coexists with other autoimmune diseases, most commonly with hypothyroidism. To date, the influence of coexisting autoimmune hypothyroidism (AHT) on the course of chronic neurovascular complications of autoimmune diabetes has not been established. The aim of the study was to assess the relationship between AHT and the occurrence of chronic T1DM complications. Methods The study group comprised 332 European Caucasian participants with T1DM [165 (49.7%) men]. AHT was recognized in subclinical and overt hypothyroidism and confirmed by the presence of anti-thyroid autoantibodies: antiperoxidase (ATPO) and/or anti-thyroglobulin (ATg) and ultrasonography (hypoechogenicity, parenchymal heterogeneity, lymph nodes assessment). Results In the analyzed group, 48.5% of patients were diagnosed with at least one neurovascular complication. At the time of enrollment, 16.3% of participants were diagnosed with AHT. Patients with AHT, compared to those without AHT, were characterized by a higher prevalence of neurovascular complications (64.8 vs. 45.3%; P = 0.009) and retinopathy (55.6 vs. 38.9%; P = 0.02). There were significant differences between groups with and without neurovascular complications, with regard to classic risk factors for chronic diabetes complications: age, T1DM duration, SBP, DBP, H bA1c, TG, eGFR and hypertension prevalence. In the multivariate logistic regression analysis, AHT was an independent predictor of neurovascular complications after adjusting for age, DBP, H bA1c and TG (odds ratio, 2.40; 95% confidence interval, 1.17–4.92; P = 0.02). Conclusions AHT coexisting with T1DM was associated with a higher incidence of neurovascular complications. Keywords Type 1 diabetes mellitus · Neurovascular complications · Autoimmune hypothyroidism · Microvascular complications
Introduction Type 1 diabetes mellitus (T1DM) and autoimmune thyroid disease (AITD) are common endocrinopathies in clinical practice. The prevalence of thyroid dysfunction in T1DM is higher than in the general population and most often presents as autoimmune hypothyroidism (AHT) [1–4]. Frequent coexistence of both AITD and T1DM has its etiology in common genetic factors [5]. Undiagnosed thyroid dysfunction may influence the control of diabetes. It is known that * B. Falkowski [email protected] 1
Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60‑834 Poznan, Poland
hypothyroidism causes weight gain, impairs metabolic control and increases the risk of hypoglycemia in patients with diabetes [6]. Overt hypothyroidism leads to progression of atherosclerosis and increases the ris
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