Keywords
combined endocrine pathology
vitamin D deficiency
hypothyroidism
chronic stress
How to Cite
Abstract
Abstract. In patients with diabetes mellitus (DM), compared to normoglycemic individuals, pathology of the thyroid gland is more common, patients with combined endocrinopathies have worse glycemic control and are more prone to the development of complications. Thyroid hormones affect glucose metabolism through their effect on peripheral tissues; in turn, with type 2 diabetes mellitus (T2DM), the conversion of thyroxine into triiodothyronine in tissues decreases, and insulin resistance (IR) and hyperinsulinemia contribute to proliferation of thyroid tissue, nodule formation, and thyroid gland growth in size. Vitamin D deficiency is observed in 70% of people with DM. Considering the
stress load of recent years, it is relevant to study the dynamics of the combination of T2DM and hypothyroidism, including on the background of vitamin D deficiency as an aggravating factor.
The aim: to evaluate the dynamics of the proportion of elevated thyroid-stimulating hormone (TSH) levels in T2DM patients, patients with IR, and patients without DM and IR during the period from 2021 to 2024, inclusive, and the average level of vitamin D provision as of 2024.
Material and methods. In the period 2021-2024 a prospective study was conducted, which included patients with T2DM and a glycated hemoglobin level ≥7%, patients with IR without DM, and patients without DM and IR aged 19-75 years. As part of the study, the TSH level was determined in 649 patients with T2DM (group 1) aged 19-75 from different regions of Ukraine. 690 patients with IR without DM (group 2) and 665 patients without DM and IR (group 3) were included in the comparison group. Examination for TSH was carried out annually. The results for 2021-2024 were compiled in 3 groups of patients. The assessment of the level of 25-hydroxyvitamin D (25(OH)D) was
carried out in 2024. Laboratory assessment of the level of vitamin D and TSH was carried out by chemiluminescent immunoassay.
Results. In the studied group of patients with T2DM, a significant increase in the proportion of patients with elevated TSH was found in 2022. In patients with IR, there is a trend of a progressive increase in the proportion of elevated TSH from 2022 to 2024, the changes are not reliable. In the group of patients without DM and IR in the 3rd year of the war (2024), the proportion of elevated TSH significantly increased compared to the pre-war period. The average level of 25(OH)D in patients with T2DM and elevated TSH is significantly lower (48.6 nmol/L) than in patients without DM and IR (72.6 nmol/L).
Conclusions. Taking into account the increase in the number of cases of elevated TSH among patients with T2DM, patients with IR on the background of chronic stress, it is necessary to actively identify this category of people, with the aim of clarifying the thyroid gland pathology and for correction of hypothyroidism in time. The level of vitamin D supply in patients with combined endocrine pathology remains within the imits of vitamin D deficiency, which increases the risks of developing of chronic complications of DM and autoimmune pathology. It is necessary to supply sufficient correction of vitamin D deficienc y in terms of duration and dose
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