Background: In the euthyroid state, the risk of developing diabetes according to changes in thyroid-stimulating hormone (TSH) levels remains controversial. Additionally, the correlation of various body indices affecting blood glucose levels according to changes in TSH levels over a certain period is not well known.
Methods: Patients who underwent health check-ups twice at a 2 year interval at a tertiary university hospital between 2009 and 2018 were included. By dividing baseline TSH levels into quartiles (TSH_Q1, Q2, Q3, and Q4), various variables were compared, and their changes after 2 years (∆TSH_Q1, Q2, Q3, and Q4) were confirmed.
Results: Among 15 557 patients, the incidence of diabetes mellitus after 2 years was 2.4% (377/15 557 patients). There was no statistically significant difference in the incidence of diabetes according to TSH_Q (p = 0.243) or ∆TSH_Q (p = 0.131). However, as TSH levels increased, skeletal muscle mass decreased (p < 0.001), and body fat mass and percent body fat significantly increased (p < 0.001). As ∆TSH increased, ∆fasting blood glucose and ∆body mass index also significantly increased (all p < 0.001). The incidence of diabetes decreased significantly as skeletal muscle mass increased (odds ratio 0.734, p < 0.001).
Conclusions: Owing to the short study period, it was not possible to prove a statistical relationship between the incidence of diabetes mellitus and TSH levels in the euthyroid state. Significant decreases in skeletal muscle mass and increases in body mass index and body fat mass according to baseline TSH levels were demonstrated. Therefore, a focus on improving physical functions, such as increasing muscle mass and decreasing fat, is required in this case.
背景: 在甲状腺功能正常的状态下，促甲状腺激素(TSH)水平的变化导致糖尿病的风险仍然存在争议。此外，根据TSH水平在一定时期内的变化来影响血糖水平的各种身体指数之间的相关性还不是很清楚。 方法: 纳入2009-2018年间在某三级大学医院接受两次健康检查的患者，每隔两年进行一次健康检查。通过将基线TSH水平分为四个分位数(TSH_Q1, Q2, Q3和Q4)，比较各个变量，并确认它们在两年后的变化(∆TSH_Q1, Q2, Q3和Q4)。 结果: 15557例患者中，两年后糖尿病的发生率为2.4%(377/15557例)。根据TSH_Q(p=0.243)或∆TSH_Q(p=0.131)，糖尿病的发病率无统计学差异。但是随着TSH水平的升高，骨骼肌质量下降(p<0.001)，体脂质量和体脂百分比显著增加(p<0.001)。随着∆TSH的升高，∆空腹血糖和∆体重指数也显著升高(均P<0.001)。糖尿病的发病率随着骨骼肌量的增加而显著降低(优势比=0.734，p<0.001)。 结论: 由于研究时间较短，尚不能证明糖尿病的发病率与甲状腺功能正常时TSH水平之间的统计关系。与基线TSH水平相比，骨骼肌质量显著减少，身体质量指数和身体脂肪质量增加。因此，在这种情况下，需要把重点放在改善身体功能上，如增加肌肉质量和减少脂肪。.
Keywords: HbA1c; TSH; diabetes mellitus; euthyroid; glucose; hypothyroidism; 促甲状腺激素; 甲状腺功能减退; 甲状腺功能正常; 糖化血红蛋白; 糖尿病; 血糖.
© 2022 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.