Correlation Between Subclinical Hypothyroidism And Peripheral Neuropathy In Type 2 Diabetes Mellitus

Objective:Diabetes and thyroid dysfunction are the two most common endocrine diseases.Among them,Diabetic Peripheral Neuropathy(DPN)is one of the most common complications in diabetic patients.Subclinical hypothyroidism(SCH)is a common thyroid disease with an incidence of 4%-10%.Based on the complex relationship between thyroid hormones and glucose metabolism,several studies at home and abroad have found that SCH is an independent risk factor for diabetic retinopathy(DR)and diabetic nephropathy(DN).However,there are few studies on the relationship between SCH and DPN.Therefore,the purpose of this study was to investigate the association between subclinical hypothyroidism and peripheral neuropathy in type 2diabetes.To investigate whether thyroid stimulating hormone(TSH)is a risk factor for DPN in patients with type 2 diabetes with normal thyroid function or with subclinical hypothyroidism.It also provides new ideas and clinical basis for the need for early thyroid function screening and early diagnosis of DPN in patients with type2 diabetes.Method:From September 2015 to March 2017,431 patients with type 2 diabetes(223males and 208 females)admitted to the Department of Endocrinology and Metabolism of China-Japan Union Hospital of Jilin University were selected.Collect general patient data and laboratory indicators,including height,weight,blood pressure,neurological examinations,etc.,to determine fasting venous glucose,intravenous glucose,glycosylated hemoglobin,total cholesterol,triglyceride,free thyroxine,free tristimulus Thyroid thyroidine,thyrotropin,thyroid peroxidase antibodies and other related indicators.According to the results of thyroid function,they were divided into subclinical hypothyroidism group(observation group)and normal group(normal control group).Each index between the two groups was calculated and the data were analyzed statistically.Results:1.Baseline data from two groups of subjects were analyzed for discrepancies.Independent sample t-tests and chi-square tests showed clinical features of observation group and control group,including gender,DR,DPN,FT4,FT3,TSH,TPO,fasting blood glucose,cholesterol,triglycerides,HDL were statistically different.2.Spearman correlation analysis among various indicators showed that there is a positive correlation between TSH and DPN,age,triglyceride and course of disease,and there is a negative correlation between fasting blood glucose and TSH.3.Multivariate logistic regression analysis showed that DN,DR,age,duration of disease and TSH were risk factors for DPN.With DN,DR,or as the age,duration,and TSH increase,the risk of diabetic peripheral neuropathy increases.4.ROC curve analysis of the diagnostic value of TSH for DPN.The results showed that when the male TSH is higher than 2.825mIU/L,the risk of DPN increased.The area under the curve was 0.727(P<0.001),the Youden index was 0.442,the sensitivity was 93.4% and the specificity was 50.8%.When the female TSH was higher than 3.04 m IU/L,the risk of DPN increased.The area under the curve was0.641(P<0.001),the Youden index was 0.696,the sensitivity was 93.0% and the specificity was 43.4%.Conclusions:1.In T2DM patients with SCH,the TSH level is significantly associated with DPN,which is a risk factor for DPN.The higher the TSH level,the higher the risk forpatients with DPN.2.In patients with type 2 diabetes,even with normal thyroid function,high TSH(men> 2.825 mIU/L,women> 3.04 m IU/L)will increase the risk of DPN,and TSH may be used as a predictor of the risk of DPN in T2DM.