Diabetes Metab J.  2019 Oct;43(5):718-726. 10.4093/dmj.2018.0222.

Low-Normal Free Thyroxine Levels in Euthyroid Male Are Associated with Prediabetes

Affiliations
  • 1Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
  • 2Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea. kpark@knu.ac.kr, pridejb@naver.com
  • 3Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
  • 4Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.

Abstract

Abnormal thyroid function is associated with impaired glucose homeostasis. This study aimed to determine whether free thyroxine (FT4) influences the prevalence of prediabetes in euthyroid subjects using a cross-sectional survey derived from the Korea National Health and Nutrition Examination Survey, conducted between 2013 and 2015. We studied 2,399 male participants of >20 years of age who were euthyroid and non-diabetic. Prediabetic participants had lower FT4 concentrations than those without prediabetes, but their thyrotropin concentrations were similar. We stratified the population into tertiles according to FT4 concentration. After adjusting for multiple confounding factors, glycosylated hemoglobin (HbA1c) levels significantly decreased with increasing FT4 tertile, whereas fasting plasma glucose (FPG) levels were not associated with FT4 tertiles (HbA1c, P<0.01 in T3 vs. T1; FPG, P=0.489 in T3 vs. T1). The prevalence of prediabetes was significantly higher in T1 (odds ratio, 1.426; 95% confidence interval, 1.126 to 1.806; P<0.01) than in T3. In conclusion, subjects with low-normal serum FT4 had high HbA1c and were more likely to have prediabetes. These results suggest that low FT4 concentration is a risk factor for prediabetes in male, even when thyroid function is within the normal range.

Keyword

Blood glucose; Glycated hemoglobin A; Prediabetic state; Thyroxine

MeSH Terms

Blood Glucose
Cross-Sectional Studies
Fasting
Glucose
Hemoglobin A, Glycosylated
Homeostasis
Humans
Korea
Male*
Nutrition Surveys
Prediabetic State*
Prevalence
Reference Values
Risk Factors
Thyroid Gland
Thyrotropin
Thyroxine*
Blood Glucose
Glucose
Thyrotropin
Thyroxine

Reference

1. Mullur R, Liu YY, Brent GA. Thyroid hormone regulation of metabolism. Physiol Rev. 2014; 94:355–382. PMID: 24692351.
Article
2. Brenta G, Danzi S, Klein I. Potential therapeutic applications of thyroid hormone analogs. Nat Clin Pract Endocrinol Metab. 2007; 3:632–640. PMID: 17710084.
Article
3. O'Meara NM, Blackman JD, Sturis J, Polonsky KS. Alterations in the kinetics of C-peptide and insulin secretion in hyperthyroidism. J Clin Endocrinol Metab. 1993; 76:79–84. PMID: 8421108.
4. Verga Falzacappa C, Mangialardo C, Raffa S, Mancuso A, Piergrossi P, Moriggi G, Piro S, Stigliano A, Torrisi MR, Brunetti E, Toscano V, Misiti S. The thyroid hormone T3 improves function and survival of rat pancreatic islets during in vitro culture. Islets. 2010; 2:96–103. PMID: 21099301.
Article
5. Verga Falzacappa C, Panacchia L, Bucci B, Stigliano A, Cavallo MG, Brunetti E, Toscano V, Misiti S. 3,5,3'-Triiodothyronine (T3) is a survival factor for pancreatic beta-cells undergoing apoptosis. J Cell Physiol. 2006; 206:309–321. PMID: 16021636.
6. Fox CS, Pencina MJ, D'Agostino RB, Murabito JM, Seely EW, Pearce EN, Vasan RS. Relations of thyroid function to body weight: cross-sectional and longitudinal observations in a community-based sample. Arch Intern Med. 2008; 168:587–592. PMID: 18362250.
7. Knudsen N, Laurberg P, Rasmussen LB, Bulow I, Perrild H, Ovesen L, Jorgensen T. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metab. 2005; 90:4019–4024. PMID: 15870128.
Article
8. Garduno-Garcia Jde J, Alvirde-Garcia U, Lopez-Carrasco G, Padilla Mendoza ME, Mehta R, Arellano-Campos O, Choza R, Sauque L, Garay-Sevilla ME, Malacara JM, Gomez-Perez FJ, Aguilar-Salinas CA. TSH and free thyroxine concentrations are associated with differing metabolic markers in euthyroid subjects. Eur J Endocrinol. 2010; 163:273–278. PMID: 20516204.
9. Roos A, Bakker SJ, Links TP, Gans RO, Wolffenbuttel BH. Thyroid function is associated with components of the metabolic syndrome in euthyroid subjects. J Clin Endocrinol Metab. 2007; 92:491–496. PMID: 17090642.
Article
10. Mehran L, Amouzegar A, Tohidi M, Moayedi M, Azizi F. Serum free thyroxine concentration is associated with metabolic syndrome in euthyroid subjects. Thyroid. 2014; 24:1566–1574. PMID: 25069017.
Article
11. Tabak AG, Herder C, Rathmann W, Brunner EJ, Kivimaki M. Prediabetes: a high-risk state for diabetes development. Lancet. 2012; 379:2279–2290. PMID: 22683128.
12. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F. American Heart Association. National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005; 112:2735–2752. PMID: 16157765.
13. Papazafiropoulou A, Sotiropoulos A, Kokolaki A, Kardara M, Stamataki P, Pappas S. Prevalence of thyroid dysfunction among greek type 2 diabetic patients attending an outpatient clinic. J Clin Med Res. 2010; 2:75–78. PMID: 21811523.
Article
14. Fleiner HF, Bjoro T, Midthjell K, Grill V, Asvold BO. Prevalence of thyroid dysfunction in autoimmune and type 2 diabetes: the population-based HUNT study in Norway. J Clin Endocrinol Metab. 2016; 101:669–677. PMID: 26583583.
Article
15. Brandt F, Thvilum M, Almind D, Christensen K, Green A, Hegedus L, Brix TH. Morbidity before and after the diagnosis of hyperthyroidism: a nationwide register-based study. PLoS One. 2013; 8:e66711. PMID: 23818961.
Article
16. Gronich N, Deftereos SN, Lavi I, Persidis AS, Abernethy DR, Rennert G. Hypothyroidism is a risk factor for new-onset diabetes: a cohort study. Diabetes Care. 2015; 38:1657–1664. PMID: 26070591.
Article
17. Chaker L, Ligthart S, Korevaar TI, Hofman A, Franco OH, Peeters RP, Dehghan A. Thyroid function and risk of type 2 diabetes: a population-based prospective cohort study. BMC Med. 2016; 14:150. PMID: 27686165.
Article
18. Park SY, Kim HI, Oh HK, Kim TH, Jang HW, Chung JH, Shin MH, Kim SW. Age- and gender-specific reference intervals of TSH and free T4 in an iodine-replete area: data from Korean National Health and Nutrition Examination Survey IV (2013–2015). PLoS One. 2018; 13:e0190738. PMID: 29390008.
Article
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