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Subclinical hypothyroidism is a risk factor for nephropathy and cardiovascular diseases in type 2 diabetic patients.
Abstract
AIMS: The purpose of this study was to determine the relationship between subclinical hypothyroidism and prevalence of retinopathy and nephropathy, incident cardiovascular disease, and mortality in Type 2 diabetic patients without taking thyroid medication. METHODS: Serum thyrotropin and free thyroxine concentrations were measured in 588 Type 2 diabetic subjects in Taipei Veterans General Hospital, Taiwan. In a cross-sectional study, we examined the prevalence of retinopathy and nephropathy. In a longitudinal study, we examined the risk of cardiovascular disease events, cardiovascular mortality and total mortality in the 4-year follow-up. RESULTS: In the cross-sectional analysis, subclinical hypothyroidism was associated with a greater prevalence of diabetic nephropathy (odds ratio, 3.15 [95% CI, 1.48-6.69]) and did not show a high prevalence of diabetic retinopathy (odds ratio, 1.15 [95% CI, 0.59-2.26]) compare to euthyroid diabetics. During the 44.0 +/- 7.4 months of follow-up, 51 participants had cardiovascular events. The risk of cardiovascular events was significantly increased in Type 2 diabetics with subclinical hypothyroidism after adjustment for age, sex, A1C, other standard cardiovascular risk factors and medication (hazard ratio, 2.93; 95% CI, 1.15-7.48; P = 0.024), but it became nonsignificant after additional adjustment for urinary albumin-to-creatinine ratio (hazard ratio, 2.06; 95% CI, 0.67-6.36; P = 0.211). The rates of cardiovascular-related and total mortality did not significantly differ by thyroid status. CONCLUSIONS: Type 2 diabetic patients with subclinical hypothyroidism are associated with an increased risk of nephropathy and cardiovascular events, but not with retinopathy. Our data suggest that the higher cardiovascular events in subclinical hypothyroidism with Type 2 diabetes may be mediated with nephropathy.
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“Patients with hypothyroidism and preexisting comorbidities (such as cardiovascular disease) have reducedhealth-related quality of life. 44”
From Hypothyroidism: A Review (2025) · cites this paper as [44]
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“In a prospective, populationbasedcohortstudyof147 201adultsintheNetherlands,ofthe4537 people receiving thyroid hormone therapy, 70% had a score below the age- and sex-specific cutoff values for the RAND 36-Item Short FormHealthSurvey(aquality-of-life measure) in the mental health domain of the general health dimension compared with 50% of people not receiving thyroid hormone therapy ( P < .001)”
From Hypothyroidism: A Review (2025) · cites this paper as [44]
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“In addition to the traditional risk factors for DN, other studies [24, 25] have indicated that thyroid function is closely related to the occurrence of DN.”
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RetractedThyroid hormones and diabetic nephropathy: An essential relationship to recognize
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“Therefore, diabetic patients need to be screened for thyroid dysfunction.(11) In this study, primary hypothyroidism was found in 28 (45.”
Chubb, S. A. P., Peters, K. E., Bruce, D. G., Davis, W. A., & Davis, T. M. E. (2022) · Acta Diabetologica · doi:10.1007/s00592-022-01969-x · Cited by 15
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“Others found that subclinical hypothyroidism is a risk factor for CVD in T2D patients [11].”
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Zhang, S., Feng, G., Kang, F., Guo, Y., Ti, H., Hao, L., Gao, P., & Gao, J. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00889 · Cited by 12
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“[7] demonstrated that SCH in Type 2 diabetics suffered from roughly 3.”
BackgroundCorrelation between subclinical hypothyroidism and renal function in patients with diabetes mellitus
Zhang, L., Yang, G.-R., Su, Z., & Yang, J. (2016) · Nephrology · doi:10.1111/nep.12852 · Cited by 10
“However, reports assessing SCH-associatedmicrovascular complications of diabetes are scarce, with inconsistent findings.(7,8) In this study, clinical data of patients hospitalized with T2D were collected, to evaluate SCH incidence, risk factors, and impact on renal injury and retinopathy.”
BackgroundTuliani, T. A., Shenoy, M. H., Belgrave, K., Deshmukh, A. J., Pant, S., Hilliard, A. A., & Afonso, L. (2017) · The American Journal of the Medical Sciences · doi:10.1016/j.amjms.2017.04.022 · Cited by 10
The effects of glibenclamide on thyroid function tests in type 2 diabetic patients
Merkhan, M. M. (2013) · Al-Mağallaẗ al-ʻirāqiyyaẗ li-l-ṣaydalaẗ · doi:10.33899/iphr.2013.086556 · Cited by 10
Subclinical hypothyroidism ups the risk of vascular complications in type 2 diabetes
Mohamed, G. A., & Elsayed, A. M. (2017) · Alexandria Journal of Medicine · doi:10.1016/j.ajme.2016.10.003 · Cited by 10
“study which showed that type 2 diabetic patients with subclinical hypothyroidism are associated with an increased risk of nephropathy and cardiovascular events, but not with retinopathy.(7) While Kim et al.”
BackgroundResultInfluentialHeidari, Z., & Asadzade, R. (2021) · Medical Journal of the Islamic Republic of Iran · doi:10.47176/mjiri.35.186 · Cited by 10
Thyroid function and autoantibody status in Bangladeshi patients with type 2 diabetes mellitus
Kamrul-Hasan, A. B. M., Akter, F., Selim, S., Asaduzzaman, M., Rahman, M., Chanda, P. K., Mustari, M., Alam, M., & Siddiqui, M. I. (2018) · Thyroid Research and Practice · doi:10.4103/trp.trp_26_18 · Cited by 9
Das, G. C., Taylor, P. N., Abusahmin, H., Ali, A., Tennant, B. P., Geen, J., & Okosieme, O. E. (2018) · Annals of Clinical Biochemistry International Journal of Laboratory Medicine · doi:10.1177/0004563218797979 · Cited by 9
Geng, J., Hu, T., Wang, B., Lu, W., & Ma, S. (2014) · International Journal of Cardiology · doi:10.1016/j.ijcard.2014.04.205 · Cited by 8
“Mild thyroid dysfunction is associated with adverse cardiovascular outcomes, including coronary heart disease (CHD) events [1–4], CHD deaths [4–6], heart failure [7,8], and atrial fibrillation (AF) [9–11].”
BackgroundPrevalence of hypothyroidism in type 2 diabetic female Kurdish subjects
Muhammed, S., & Albustani, D. (2018) · Medical Journal of Babylon · doi:10.4103/mjbl.mjbl_99_18 · Cited by 8
“The previous study has explored the effect of hypothyroidism on T2DM complication such as nephropathy and cardiovascular events; therefore, diabetic patients need to be screened for thyroid dysfunction.[10]”
BackgroundThyroid Dysfunction and Cardiovascular Events in Patients With Dysglycemia
Shah, R., Orlov, S., Paré, G., & Gerstein, H. C. (2023) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2023.01.007 · Cited by 8
BEHERA, B. P., & SEN, R. K. (2023) · International Journal of Pharmacy and Pharmaceutical Sciences · doi:10.22159/ijpps.2023v15i6.48019 · Cited by 7
Raj, R., Kumar, V. L., Bhushan, D., Biswas, R., & Ojha, V. S. (2023) · Cureus · doi:10.7759/cureus.43065 · Cited by 7
“The risk of nephropathy and cardiovascular events increases in type 2 diabetes mellitus with subclinical hypothyroidism (SCH) [7].”
BackgroundGao, X., Wang, X., Zhong, Y., Liu, L., Teng, W., & Shan, Z. (2022) · Journal of Diabetes Research · doi:10.1155/2022/2552186 · Cited by 7
Марущак, М. І. (2021) · Acta Clinica Croatica · doi:10.20471/acc.2021.60.03.20 · Cited by 8
Asuti, S., Purad, S., & Hosamani, P. (2023) · Journal of Medical Sciences and Health · doi:10.46347/jmsh.v9i2.23.125 · Cited by 6
Subclinical hypothyroidism in adults: Consensus statement of Indian thyroid society
Rajput, R., Bajaj, S., Kalra, P., Menon, A. S., Pillai, M. G., Ghosh, S. K., Joshi, S., Seshadri, K., Kumar, P. R. G., Jayakumar, R., et al. (2022) · Thyroid Research and Practice · doi:10.4103/trp.trp_4_23 · Cited by 7
Manshahia, P. K., Nahar, S., Kanda, S., Chatha, U., Odoma, V. A., Pitliya, A., AlEdani, E. M., Bhangu, J. K., Javed, K., & Khan, S. (2023) · Cureus · doi:10.7759/cureus.44729 · Cited by 6
“TSH levels, however, were only linked with DN [9].”
InfluentialMoslem, F., Bithi, T. S., & Biswas, A. (2015) · Science Journal of Clinical Medicine · Cited by 6
TRPV2 Polymorphisms Change the Risk of Type 2 Diabetes - Hashimoto Thyroiditis Comorbidity
Arıkan, F. B. (2020) · Acta Endocrinologica (Bucharest) · doi:10.4183/aeb.2020.15 · Cited by 5
Association between subclinical hypothyroidism and diabetic nephropathy in type 2 diabetes
Nsr-Allah, A. A.-E. M., El-Fatah, A. H. A., Azab, M., & Fawzi, M. M. (2018) · The Egyptian Journal of Internal Medicine · doi:10.4103/ejim.ejim_25_18 · Cited by 5
Thyroid and Eye: Where They Meet in Clinical Practice
El-Eshmawy, M. M., & Shahin, M. M. (2019) · Endocrine Metabolic & Immune Disorders - Drug Targets · doi:10.2174/1871530319666190618120107 · Cited by 6
Sahu, S., Dutta, S. K., Kuiri, S. S., Nandi, M. M., Kabiraj, P., & De, U. (2015) · Asian Journal of Medical Sciences · doi:10.3126/ajms.v6i6.12603 · Cited by 5
Ahmad, A., Lim, L., Morieri, M. L., Tam, C., Cheng, F., Chikowore, T., Dudenhöffer‐Pfeifer, M., Fitipaldi, H., Huang, C., Kanbour, S., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2929263/v1 · Cited by 5
Kumar, J., & A, U. M. (2024) · Cureus · doi:10.7759/cureus.70462 · Cited by 4
“Subclinical hypothyroidism has been identified as an independent risk factor for DN [5], with serum thyroid-stimulating hormone (TSH) levels and tissue insulin sensitivity significantly impacting serum lipid profiles.”
BackgroundThe effect of glycaemic control in type 2 diabetic patients with subclinical hypothyroidism
Fu, X., Xia, H., Mao, H., Zhao, S., & Wang, Z. (2016) · Journal of Endocrinological Investigation · doi:10.1007/s40618-016-0519-4 · Cited by 4
“Furthermore, an increased risk of cardiovascular disease was shown in type 2 diabetic patients with SCH [10].”
BackgroundThe Dilemma of Subclinical Hypothyroidism in Chronic Kidney Disease.
Chandra, A. (2018) · PubMed · Cited by 4
Thyroid hormones profile of patients with type 2 diabetes mellitus in Kano, Nigeria
Abubakar, M. Z., Abdulsalam, K., & Yahaya, I. A. (2020) · Annals of African Medical Research · doi:10.4081/aamr.2020.112 · Cited by 4
Subclinical hypothyroidism and type 2 diabetes mellitus: An update
Sk, S., Singh, R., Bedi, S., Pandey, A. K., Tiwari, A., & Kumar, P. (2024) · Thyroid Research and Practice · doi:10.4103/trp.trp_33_24 · Cited by 4
Spilack, A. D. M., Goulart, A. C., de Almeida-Pititto, B., Janovsky, C. C. P. S., Lotufo, P. A., Santos, I. S., & Benseñor, I. M. (2023) · Clinics · doi:10.1016/j.clinsp.2022.100154 · Cited by 4
Metadata
- Authors
- Chen, H. ‐., Wu, T. ‐. J., Jap, T. ‐., Lu, R. ‐., Wang, M. ‐., Chen, R. ‐., & Lin, H. ‐.
- Affiliations
- Taipei Veterans General Hospital (TW)
- National Yang Ming University (TW)
- ORCID
- Chen, H.‐S.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2007-11-26
- Volume
- 24
- Issue
- 12
- Pages
- 1336-1344
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W2052124893
- Cited by
- 189
- References
- 37
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 10 · 2023: 19 · 2022: 12 · 2021: 14 · 2020: 16 · 2019: 12 · 2018: 13 · 2017: 9 · 2016: 11 · 2015: 8 · 2014: 16 · 2013: 11 · 2012: 6
- FWCI
- 3.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- subclinical hypothyroidism, type 2 diabetes, diabetic nephropathy, diabetic retinopathy, cardiovascular disease, cardiovascular mortality, all-cause mortality, albumin-creatinine ratio, thyroid-stimulating hormone, free thyroxine, thyroid function
- MeSH terms
- Aged, Cardiovascular Diseases, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Diabetic Retinopathy, Female, Humans, Hypothyroidism, Male, Middle Aged, Risk Factors, Taiwan, Thyrotropin, Thyroxine, Cohort Studies, Incidence, Odds Ratio
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