The Intricate Relationship Between Thyroid Disorders and Type 2 Diabetes—A Narrative Review
Abstract
:1. Introduction
2. Materials and Methods
- Peer-reviewed articles published between January 2004 and February 2024;
- Adult populations aged 18 years or above;
- Studies investigating the association between thyroid function (hypothyroidism, hyperthyroidism, and subclinical dysfunction) and T2DM;
- Observational studies (cohort, case–control, and cross-sectional) and interventional studies;
- Clinical guidelines from internationally recognized endocrinology and diabetes organizations.
- Non-English language publications;
- Pediatric or adolescent populations (<18 years);
- Studies focused exclusively on type 1 diabetes or gestational diabetes;
- Animal experiments or in vitro research;
- Case reports, editorials, letters to the editor, or opinion pieces without original research data;
- Articles lacking a clear diagnostic definition of thyroid dysfunction.
3. Results
3.1. Unravelling the Prevalence of Thyroid Dysfunction in T2DM
3.2. Thyroid Hormones and Glucose Metabolism: Insights into T2DM Pathogenesis
3.3. Thyroid Dysfunction and Insulin Resistance: Partners in T2DM Pathogenesis?
3.4. Hypothyroidism and T2DM: Is There a Link Between T2DM and Hypothyroidism?
3.5. Effects of Hyperthyroidism on Glucose Metabolism
3.6. Genetic Influences on Thyroid Function and Glucose Metabolism
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
NHANES III | Third United States National Health and Nutrition Examination Survey |
NHIRD | National Health Insurance Research Database |
UCP-3 | uncoupling protein |
GLUT | glucose transporter in the plasma membrane |
NEFA | non-esterified fatty acid |
T2DM | type 2 diabetes mellitus |
TSH | thyroid-stimulating hormone |
TH | thyroid hormone |
SHR | subclinical hyperthyroidism |
FT4 | free thyroxine |
CVD | cardiovascular disease |
TD | thyroid disorder |
DM | diabetes mellitus |
T3 | triiodothyronine |
IR | insulin resistance |
HR | hyperthyroidism |
References
- American Diabetes Association Professional Practice Committee; ElSayed, N.A.; Aleppo, G.; Bannuru, R.R.; Beverly, E.A.; Bruemmer, D. Summary of Revisions: Standards of Care in Diabetes—2024. Diabetes Care 2024, 47, S5–S10. [Google Scholar] [CrossRef]
- Magliano, D.J.; Boyko, E.J.; IDF Diabetes Atlas 10th Edition Scientific Committee. IDF DIABETES ATLAS, 10th ed.; International Diabetes Federation: Brussels, Belgium, 2021. Available online: https://www.ncbi.nlm.nih.gov/books/NBK581934/ (accessed on 26 April 2025).
- Taylor, P.N.; Albrecht, D.; Scholz, A.; Gutierrez-Buey, G.; Lazarus, J.H.; Dayan, C.M.; Okosieme, O.E. Global epidemiology of hyperthyroidism and hypothyroidism. Nat. Rev. Endocrinol. 2018, 14, 301–316. [Google Scholar] [CrossRef]
- Chiovato, L.; Magri, F.; Carlé, A. Hypothyroidism in Context: Where We’ve Been and Where We’re Going. Adv. Ther. 2019, 36, 47–58. [Google Scholar] [CrossRef] [PubMed]
- Han, C.; He, X.; Xia, X.; Li, Y.; Shi, X.; Shan, Z.; Teng, W. Subclinical hypothyroidism and type 2 diabetes: A systematic review and meta-analysis. PLoS ONE 2015, 10, e0135233. [Google Scholar] [CrossRef] [PubMed]
- Roa Dueñas, O.H.; Van der Burgh, A.C.; Ittermann, T.; Ligthart, S.; Ikram, M.A.; Peeters, R.; Chaker, L. Thyroid Function and the Risk of Prediabetes and Type 2 Diabetes. J. Clin. Endocrinol. Metab. 2022, 107, 1789–1798. [Google Scholar] [CrossRef]
- Hollowell, J.G.; Staehling, N.W.; Flanders, W.D.; Hannon, W.H.; Gunter, E.W.; Spencer, C.A.; Braverman, L.E. Serum TSH, T4, and Thyroid Antibodies in the United States Population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J. Clin. Endocrinol. Metab. 2002, 87, 489–499. [Google Scholar] [CrossRef]
- Khassawneh, A.H.; Al-Mistarehi, A.H.; Zein Alaabdin, A.M.; Khasawneh, L.; AlQuran, T.M.; Kheirallah, K.A.; Saadeh, N.A.; Beni yonis, O.; Shawkat, M.; Obeidat, N. Prevalence and predictors of thyroid dysfunction among type 2 diabetic patients: A case–control study. Int. J. Gen. Med. 2020, 13, 803–816. [Google Scholar] [CrossRef]
- Bukhari, S.I.; Ali, G.; Memom, M.Y.; Sandeelo, N.; Alvi, H.; Talib, A.; Ahmed, I.; Lal, H.; Asghar, M.S.; Naseer, U. Prevalence and predictors of thyroid dysfunction amongst patients with Type 2 diabetes mellitus in Pakistan. J. Family Med. Prim. Care 2022, 11, 2739. [Google Scholar] [CrossRef]
- Ogbonna, S.U.; Ezeani, I.U.; Okafor, C.I.; Chinenye, S. Association between glycemic status and thyroid dysfunction in patients with type 2 diabetes mellitus. Diabetes Metab. Syndr. Obes. 2019, 12, 1113–1122. [Google Scholar] [CrossRef]
- Shrestha, B.; Rai, C.K. Hypothyroidism among Type 2 Diabetic Patients Visiting Outpatient Department of Internal Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study. J. Nepal. Med. Assoc. 2023, 61, 325–328. [Google Scholar] [CrossRef]
- Ishay, A.; Chertok-Shaham, I.; Lavi, I.; Luboshitzky, R. Prevalence of subclinical hypothyroidism in women with type 2 diabetes. Med. Sci. Monit. Int. Med. J. Exp. Clin. Res. 2009, 15, CR151-5. [Google Scholar]
- Raghuwanshi, P.K.; Rajput, D.P.S.; Ratre, B.K.; Jain, R.; Patel, N.; Jain, S. Evaluation of thyroid dysfunction among type 2 diabetic patients. Asian J. Med. Sci. 2014, 6, 33–37. [Google Scholar] [CrossRef]
- Mehalingam, V.; Sahoo, J.; Bobby, Z.; Vinod, K. Thyroid dysfunction in patients with type 2 diabetes mellitus and its association with diabetic complications. J. Family Med. Prim. Care 2020, 9, 4277. [Google Scholar] [CrossRef] [PubMed]
- Elgazar, E.H.; Esheba, N.E.; Shalaby, S.A.; Mohamed, W.F. Thyroid dysfunction prevalence and relation to glycemic control in patients with type 2 diabetes mellitus. Diabetes Metab. Syndr. Clin. Res. Rev. 2019, 13, 2513–2517. [Google Scholar] [CrossRef]
- Chubb, S.A.P.; Peters, K.E.; Bruce, D.G.; Davis, W.A.; Davis, T.M.E. The relationship between thyroid dysfunction, cardiovascular morbidity and mortality in type 2 diabetes: The Fremantle Diabetes Study Phase II. Acta Diabetol. 2022, 59, 1615–1624. [Google Scholar] [CrossRef]
- Subekti, I.; Pramono, L.A.; Dewiasty, E.; Harbuwono, D.S. Thyroid Dysfunction in Type 2 Diabetes Mellitus Patients. Acta Medica Indones. 2017, 49, 314. [Google Scholar]
- Pramanik, S.; Ghosh, S.; Mukhopadhyay, P.; Bhattacharjee, R.; Mukherjee, B.; Mondal, S.A.; Ghosh, I.; Bari, R.; Chowdhury, S. Thyroid status in patients with Type 2 diabetes attending a Tertiary Care Hospital in Eastern India. Indian. J. Endocrinol. Metab. 2018, 22, 112–115. [Google Scholar] [CrossRef]
- Eom, Y.S.; Wilson, J.R.; Bernet, V.J. Links between Thyroid Disorders and Glucose Homeostasis. Diabetes Metab. J. 2022, 46, 239–256. [Google Scholar] [CrossRef]
- Venditti, P.; Reed, T.T.; Victor, V.M.; Di Meo, S. Insulin resistance and diabetes in hyperthyroidism: A possible role for oxygen and nitrogen reactive species. Free Radic. Res. 2019, 53, 248–268. [Google Scholar] [CrossRef]
- Mullur, R.; Liu, Y.Y.; Brent, G.A. Thyroid Hormone Regulation of Metabolism. Physiol. Rev. 2014, 94, 355. [Google Scholar] [CrossRef]
- Rong, F.; Dai, H.; Wu, Y.; Li, J.; Liu, G.; Chen, H.; Zhang, X. Association between thyroid dysfunction and type 2 diabetes: A meta-analysis of prospective observational studies. BMC Med. 2021, 19, 257. [Google Scholar] [CrossRef] [PubMed]
- Biondi, B.; Kahaly, G.J.; Robertson, R.P. Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders. Endocr. Rev. 2019, 40, 789–824. [Google Scholar] [CrossRef] [PubMed]
- Solá, E.; Morillas, C.; Garzón, S.; Gómez-Balaguer, M.; Hernández-Mijares, A. Association between diabetic ketoacidosis and thyrotoxicosis. Acta Diabetol. 2002, 39, 235–237. [Google Scholar] [CrossRef] [PubMed]
- Hage, M.; Zantout, M.S.; Azar, S.T. Thyroid disorders and diabetes mellitus. J. Thyroid Res. 2011, 2011, 439463. [Google Scholar] [CrossRef]
- Jali, M.V.; Kambar, S.; Jali, S.M.; Pawar, N.; Nalawade, P. Prevalence of thyroid dysfunction among type 2 diabetes mellitus patients. Diabetes Metab. Syndr. Clin. Res. Rev. 2017, 11, S105–S108. [Google Scholar] [CrossRef]
- Demitrost, L.; Ranabir, S. Thyroid dysfunction in type 2 diabetes mellitus: A retrospective study. Indian. J. Endocrinol. Metab. 2012, 16, 334. [Google Scholar] [CrossRef]
- Jun, J.E.; Jee, J.H.; Bae, J.C.; Jin, S.M.; Hur, K.Y.; Lee, M.K.; Kim, T.H.; Kim, S.W.; Kim, J.H. Association Between Changes in Thyroid Hormones and Incident Type 2 Diabetes: A Seven-Year Longitudinal Study. Thyroid 2017, 27, 29–38. [Google Scholar] [CrossRef]
- de Vries, T.I.; Kappelle, L.J.; van der Graaf, Y.; de Valk, H.W.; de Borst, G.J.; Nathoe, H.M.; Visseren, F.L.; Westerink, J.; SMART Study Group. Thyroid-stimulating hormone levels in the normal range and incident type 2 diabetes mellitus. Acta Diabetol. 2019, 56, 431–440. [Google Scholar] [CrossRef]
- Chang, C.H.; Yeh, Y.C.; Shih, S.R.; Lin, J.W.; Chuang, L.M.; Caffrey, J.L.; Tu, Y.K. Association between thyroid dysfunction and dysglycaemia: A prospective cohort study. Diabet. Med. 2017, 34, 1584–1590. [Google Scholar] [CrossRef]
- Al-Geffari, M.; Ahmad, N.A.; Al-Sharqawi, A.H.; Youssef, A.M.; Alnaqeb, D.; Al-Rubeaan, K. Risk factors for thyroid dysfunction among type 2 diabetic patients in a highly diabetes mellitus prevalent society. Int. J. Endocrinol. 2013, 2013, 417920. [Google Scholar] [CrossRef]
- Lee, S.H.; Park, S.Y.; Choi, C.S. Insulin Resistance: From Mechanisms to Therapeutic Strategies. Diabetes Metab. J. 2021, 46, 15. [Google Scholar] [CrossRef]
- Ahmed, A.; Atkinson, R.L. Obesity|Complications. In Encyclopedia of Human Nutrition; Elsevier: Amsterdam, The Netherlands, 2005; pp. 406–413. [Google Scholar] [CrossRef]
- Gupta, A. Etiopathogenesis of insulin resistance. In Understanding Insulin and Insulin Resistance; Elsevier: Amsterdam, The Netherlands, 2022; pp. 231–273. [Google Scholar] [CrossRef]
- Insulin Resistance—An Overview|ScienceDirect Topics n.d. Available online: https://www.sciencedirect.com/topics/medicine-and-dentistry/insulin-resistance (accessed on 26 April 2025).
- Courtney, C.H.; Olefsky, J.M. Insulin Resistance. In Mechanisms of Insulin Action: Medical Intelligence Unit; Springer: New York, NY, USA, 2023; pp. 185–209. [Google Scholar] [CrossRef]
- Zhao, X.; An, X.; Yang, C.; Sun, W.; Ji, H.; Lian, F. The crucial role and mechanism of insulin resistance in metabolic disease. Front. Endocrinol. 2023, 14, 1149239. [Google Scholar] [CrossRef] [PubMed]
- Kocatürk, E.; Kar, E.; Küskü Kiraz, Z.; Alataş, Ö. Insulin resistance and pancreatic β cell dysfunction are associated with thyroid hormone functions: A cross-sectional hospital-based study in Turkey. Diabetes Metab. Syndr. Clin. Res. Rev. 2020, 14, 2147–2151. [Google Scholar] [CrossRef]
- Gierach, M.; Gierach, J.; Junik, R. Insulin resistance and thyroid disorders. Endokrynol. Pol. 2014, 65, 70–76. [Google Scholar] [CrossRef] [PubMed]
- Maratou, E.; Hadjidakis, D.J.; Kollias, A.; Tsegka, K.; Peppa, M.; Alevizaki, M.; Mitrou, P.; Lambadiari, V.; Boutati, E.; Nikzas, D.; et al. Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. Eur. J. Endocrinol. 2009, 160, 785–790. [Google Scholar] [CrossRef]
- Matsuzu, K.; Segade, F.; Wong, M.; Clark, O.H.; Perrier, N.D.; Bowden, D.W. Glucose transporters in the thyroid. Thyroid 2005, 15, 545–550. [Google Scholar] [CrossRef]
- Weinstein, S.P.; Haber, R.S. Differential regulation of glucose transporter isoforms by thyroid hormone in rat heart. BBA—Mol. Cell Res. 1992, 1136, 302–308. [Google Scholar] [CrossRef]
- Matthaei, S.; Trost, B.; Hamann, A.; Kausch, C.; Benecke, H.; Greten, H.; Höppner, W.; Klein, H.H. Effect of in vivo thyroid hormone status on insulin signalling and GLUT1 and GLUT4 glucose transport systems in rat adipocytes. J. Endocrinol. 1995, 144, 347–357. [Google Scholar] [CrossRef]
- Santalucía, T.; Palacín, M.; Zorzano, A. T3 strongly regulates GLUT1 and GLUT3 mRNA in cerebral cortex of hypothyroid rat neonates. Mol. Cell Endocrinol. 2006, 251, 9–16. [Google Scholar] [CrossRef]
- Torrance, C.J.; Devente, J.E.; Jones, J.P.; Dohm, G.L. Effects of Thyroid Hormone on GLUT4 Glucose Transporter Gene Expression and NIDDM in Rats. Endocrinology 1997, 138, 1204–1214. [Google Scholar] [CrossRef]
- Lyu, J.; Imachi, H.; Yoshimoto, T.; Fukunaga, K.; Sato, S.; Ibata, T.; Kobayashi, T.; Dong, T.; Yonezaki, K.; Yamaji, N.; et al. Thyroid stimulating hormone stimulates the expression of glucose transporter 2 via its receptor in pancreatic β cell line, INS-1 cells. Sci. Rep. 2018, 8, 1–10. [Google Scholar] [CrossRef]
- Dimitriadis, G.; Mitrou, P.; Lambadiari, V.; Boutati, E.; Maratou, E.; Panagiotakos, D.B.; Koukkou, E.; Tzanela, M.; Thalassinos, N.; Raptis, S.A. Insulin Action in Adipose Tissue and Muscle in Hypothyroidism. J. Clin. Endocrinol. Metab. 2006, 91, 4930–4937. [Google Scholar] [CrossRef] [PubMed]
- Sotak, S.; Felsoci, M.; Lazurova, I. Type 2 diabetes mellitus and thyroid disease: A two-sided analysis. Bratisl. Med. J. 2018, 119, 361–365. [Google Scholar] [CrossRef]
- Bermúdez, V.; Salazar, J.; Añez, R.; Rojas, M.; Estrella, V.; Ordoñez, M.; Chacín, M.; Hernández, J.D.; Arias, V.; Cabrera, M.; et al. Metabolic Syndrome and Subclinical Hypothyroidism: A Type 2 Diabetes-Dependent Association. J. Thyroid Res. 2018, 2018, 8251076. [Google Scholar] [CrossRef] [PubMed]
- Alsolami, A.A.; Alshali, K.Z.; Albeshri, M.A.; Alhassan, S.H.; Qazli, A.M.; Almalki, A.S.; Bakarman, M.A.; Mukhtar, A.M. Association between type 2 diabetes mellitus and hypothyroidism: A case–control study. Int. J. Gen. Med. 2018, 11, 457–461. [Google Scholar] [CrossRef] [PubMed]
- Nair, A.; Jayakumari, C.; Jabbar, P.K.; Jayakumar, R.V.; Raizada, N.; Gopi, A.; George, G.S.; Seena, T.P. Prevalence and Associations of Hypothyroidism in Indian Patients with Type 2 Diabetes Mellitus. J. Thyroid Res. 2018, 2018, 5386129. [Google Scholar] [CrossRef]
- Fang, T.; Deng, X.; Wang, J.; Han, F.; Liu, X.; Liu, Y.; Sun, B.; Chen, L. The effect of hypothyroidism on the risk of diabetes and its microvascular complications: A Mendelian randomization study. Front. Endocrinol. 2023, 14, 1288284. [Google Scholar] [CrossRef]
- Talwalkar, P.; Deshmukh, V.; Bhole, M. Prevalence of hypothyroidism in patients with type 2 diabetes mellitus and hypertension in india: A cross-sectional observational study. Diabetes Metab. Syndr. Obes. 2019, 12, 369–376. [Google Scholar] [CrossRef]
- Brenta, G.; Caballero, A.S.; Nunes, M.T. Case finding for hypothyroidism should include type 2 diabetes and metabolic syndrome patients: A Latin American Thyroid Society (LATS) position statement. Endocr. Pract. 2019, 25, 101–105. [Google Scholar] [CrossRef]
- Martinez, B.; Ortiz, R.M. Thyroid hormone regulation and insulin resistance: Insights from animals naturally adapted to fasting. Physiology 2017, 32, 141–151. [Google Scholar] [CrossRef]
- Majeed, S.; Hussein, M.; Abdelmageed, R.M. The Relationship Between Type 2 Diabetes Mellitus and Related Thyroid Diseases. Cureus 2021, 13, e20697. [Google Scholar] [CrossRef]
- Bar-Tana, J. Insulin Resistance, Secretion and Clearance –Taming the Three Effector Encounter of Type 2 Diabetes. Front. Endocrinol. 2021, 12, 741114. [Google Scholar] [CrossRef] [PubMed]
- Althausen, T.L.; Stockholm, M. Influence of the thyroid gland on absorption in the digestive tract. Am. J. Physiol.-Leg. Content 1938, 123, 577–588. [Google Scholar] [CrossRef]
- Dimitriadis, G.; Parry-Billings, M.; Bevan, S.; Leighton, B.; Krause, U.; Piva, T.; Tegos, K.; Challiss, R.A.J.; Wegener, G.; Newsholme, E.A. The effects of insulin on transport and metabolism of glucose in skeletal muscle from hyperthyroid and hypothyroid rats. Eur. J. Clin. Investig. 1997, 27, 475–483. [Google Scholar] [CrossRef]
- Rohdenburg, G.L. Thyroid diabetes. Endocrinology 1920, 4, 63–70. [Google Scholar] [CrossRef]
- Singh, I.; Srivastava, M.C. Hyperglycemia, keto-acidosis and coma in a nondiabetic hyperthyroid patient. Metabolism 1968, 17, 893–895. [Google Scholar] [CrossRef]
- Chambers, T.L. Coexistent coeliac disease, diabetes mellitus, and hyperthyroidism. Arch. Dis. Child. 1975, 50, 162–164. [Google Scholar] [CrossRef]
- Mitrou, P.; Raptis, S.A.; Dimitriadis, G. Insulin action in hyperthyroidism: A focus on muscle and adipose tissue. Endocr. Rev. 2010, 31, 663–679. [Google Scholar] [CrossRef]
- Butterfield, W.J.H.; Whichelow, M.J. Are thyroid hormones diabetogenic? A study of peripheral glucose metabolism during glucose infusions in normal subjects and hyperthyroid patients before and after treatment. Metabolism 1964, 13, 620–628. [Google Scholar] [CrossRef]
- Orsetti, A.; Collard, F.; Jaffiol, C. Abnormalities of carbohydrate metabolism in experimental and clinical hyperthyroidism: Studies on plasma insulin and on the A- and B-chains of insulin. Acta Diabetol. Lat. 1974, 11, 486–492. [Google Scholar] [CrossRef]
- Seino, Y.; Taminato, T.; Kurahachi, H.; Ikeda, M.; Goto, Y.; Imura, H. Comparative insulinogenic effects of glucose, arginine and glucagon in patients with diabetes mellitus, endocrine disorders and liver disease. Acta Diabetol. Lat. 1975, 12, 89–99. [Google Scholar] [CrossRef] [PubMed]
- Dimitriadis, G.D.; Raptis, S.A. Thyroid hormone excess and glucose intolerance. Exp. Clin. Endocrinol. Diabetes 2001, 109 (Suppl. S2), S225–S239. [Google Scholar] [CrossRef] [PubMed]
- Mendez, D.A.; Ortiz, R.M. Thyroid hormones and the potential for regulating glucose metabolism in cardiomyocytes during insulin resistance and T2DM. Physiol. Rep. 2021, 9, e14858. [Google Scholar] [CrossRef] [PubMed]
- Salleh, M.; Ardawi, M.; Khoja, S.M. Effects of hyperthyroidism on glucose, glutamine and ketone-body metabolism in the gut of the rat. Int. J. Biochem. 1993, 25, 619–624. [Google Scholar] [CrossRef]
- Wang, C. The Relationship between Type 2 Diabetes Mellitus and Related Thyroid Diseases. J. Diabetes Res. 2013, 2013, 390534. [Google Scholar] [CrossRef]
- Grigoriadis, G.; Koufakis, T.; Kotsa, K. Epidemiological, Pathophysiological, and Clinical Considerations on the Interplay between Thyroid Disorders and Type 2 Diabetes Mellitus. Medicina 2023, 59, 2013. [Google Scholar] [CrossRef]
- Duntas, L.H.; Orgiazzi, J.; Brabant, G. The interface between thyroid and diabetes mellitus. Clin. Endocrinol. 2011, 75, 1–9. [Google Scholar] [CrossRef]
- Panicker, V. Genetics of Thyroid Function and Disease. Clin. Biochem. Rev. 2011, 32, 165. [Google Scholar]
- Sterenborg, R.B.; Steinbrenner, I.; Li, Y.; Bujnis, M.N.; Naito, T.; Marouli, E.; Galesloot, T.E.; Babajide, O.; Andreasen, L.; Astrup, A.; et al. Multi-trait analysis characterizes the genetics of thyroid function and identifies causal associations with clinical implications. Nat. Commun. 2024, 15, 888. [Google Scholar] [CrossRef]
- Medici, M.; Visser, T.J.; Peeters, R.P. Genetics of thyroid function. Best. Pract. Res. Clin. Endocrinol. Metab. 2017, 31, 129–142. [Google Scholar] [CrossRef]
- Zuanna, T.D.; Pitter, G.; Canova, C.; Simonato, L.; Gnavi, R. A systematic review of case-identification algorithms based on italian healthcare administrative databases for two relevant diseases of the endocrine system: Diabetes mellitus and thyroid disorders. Epidemiol. Prev. 2019, 43, 17–36. [Google Scholar] [CrossRef] [PubMed]
- Lee, S.A.; Choi, D.W.; Kwon, J.; Lee, D.W.; Park, E.C. Association between continuity of care and type 2 diabetes development among patients with thyroid disorder. Medicine 2019, 98, e18537. [Google Scholar] [CrossRef] [PubMed]
- Chen, R.H.; Chen, H.Y.; Man, K.M.; Chen, S.J.; Chen, W.; Liu, P.L.; Chen, Y.H.; Chen, W.C. Thyroid diseases increased the risk of type 2 diabetes mellitus: A nation-wide cohort study. Medicine 2019, 98, e15631. [Google Scholar] [CrossRef] [PubMed]
First Author, Title | T2DM Participants | Hypothyroidism (Subclinical + Overt) | Hyperthyroidism (Subclinical + Overt) |
---|---|---|---|
Khassawneh AH, “Prevalence and predictors of thyroid dysfunction among type 2 diabetic patients: A case-control study” [8] | 998 | 220 (22.04%) | 46 (4.61%) |
Bukhari S, “Prevalence and predictors of thyroid dysfunction amongst patients with Type 2 diabetes mellitus in Pakistan” [9] | 317 | 82 (25.8%) | 35 (11%) |
Ogbonna SU, “Association between glycemic status and thyroid dysfunction in patients with type 2 diabetes mellitus” [10] | 354 | 44 participants with thyroid dysfunction (12.4%) | |
Shrestha B, “Hypothyroidism among Type 2 Diabetic Patients Visiting Outpatient Department of Internal Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study” [11] | 384 | 127 (33.07%) | No data |
Ishay A, “Prevalence of subclinical hypothyroidism in women with type 2 diabetes” [12] | 410 (women) | 37 (9%): just subclinical hypothyroidism | No data |
Raghuwanshi PK, “Evaluation of thyroid dysfunction among type 2 diabetic patients” [13] | 40 | 10 (25%) | 1 (2.5%) |
Mehalingam V, “Thyroid dysfunction in patients with type 2 diabetes mellitus and its association with diabetic complications” [14] | 331 | 46 (13.9%) | 12 (3.6%) |
Essmat HE, “Thyroid dysfunction prevalence and relation to glycemic control in patients with type 2 diabetes mellitus” [15] | 200 | 40 (20%) | 18 (9%) |
Chubb SAP, “The relationship between thyroid dysfunction, cardiovascular morbidity and mortality in type 2 diabetes: The Fremantle Diabetes Study Phase II” [16] | 1250 | 76 | 3 |
Subekti I, “Thyroid Dysfunction in Type 2 Diabetes Mellitus Patients” [17] | 303 | 23 (7.6%) | 7 (2.3%) |
Pramanik S, “Thyroid Status in Patients with Type 2 Diabetes Attending a Tertiary Care Hospital in Eastern India” [18] | 100 | 26 (26%) | 0 (0%) |
First Author, Title | Publication Year | Type | Key Findings |
---|---|---|---|
Shrestha B, “Hypothyroidism among Type 2 Diabetic Patients Visiting Outpatient Department of Internal Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study” [11] | 2023 | Descriptive cross-sectional study | A total of 384 subjects with T2DM participated in this study using convenience sampling. Hypothyroidism prevalence was 33.07% (95% CI: 28.36–37.78) among patients, with 56 (44.09%) males and 71 (55.90%) females. The mean age was 55.17 ± 7.53 years. The prevalence of hypothyroidism was higher than that reported in comparable studies [11]. |
Bukhari S, “Prevalence and predictors of thyroid dysfunction amongst patients with Type 2 diabetes mellitus in Pakistan” [9] | 2022 | Descriptive cross-sectional study | TD, especially hypothyroidism, is more common in individuals with T2DM, with a higher prevalence observed in women [9]. |
Chubb SAP, The relationship between thyroid dysfunction, cardiovascular morbidity and mortality in type 2 diabetes: The Fremantle Diabetes Study Phase II [16] | 2022 | Original article | In the Fremantle Diabetes Study Phase II, involving 1250 individuals with T2DM and no prior TD, subclinical hypothyroidism emerged as the most frequent thyroid dysfunction (77.2%). Over a 6.2–6.7 year follow-up, subclinical hypothyroidism was not significantly associated with an increased risk of cardiovascular events or mortality (p > 0.05), despite correlations with risk factors such as lower eGFR and higher systolic blood pressure [16]. |
Rong F, “Association between thyroid dysfunction and type 2 diabetes: a meta-analysis of prospective observational studies” [22] | 2021 | Research article | This meta-analysis demonstrated an association between TD and an elevated risk of developing T2DM. However, the evidence did not support an association between thyroid dysfunction and CVD events or overall mortality in individuals with T2DM. Consequently, measurement of TSH levels in individuals with risk factors for diabetes may assist in the further assessment of T2DM risk [22]. |
Khassawneh AH, “Prevalence and predictors of thyroid dysfunction among type 2 diabetic patients: A case-control study” [8] | 2020 | Case–control study | In patients with T2DM, TD was observed in 26.7% of cases, higher than the 13.7% seen in non-diabetic controls (p < 0.001). Subclinical hypothyroidism was the most prevalent form of pathology. The condition was more likely in individuals over 50 years old (p < 0.001), women (p = 0.013), those with goiter (p = 0.029), and patients with poor glycemic control [8]. |
Mehalingam V, “Thyroid dysfunction in patients with type 2 diabetes mellitus and its association with diabetic complications” [14] | 2020 | Original article | The prevalence of TD among 331 patients with T2DM was found to be 17.5%. Hypothyroidism was observed in 13.9% of participants, while hyperthyroidism was noted in 3.6%. Thyroid dysfunction was more prevalent among female patients. The study did not find a significant association between TD and diabetic complications such as nephropathy, neuropathy, retinopathy, or cardiovascular disease (p > 0.05) [14]. |
Ogbonna SU, “Association between glycemic status and thyroid dysfunction in patients with type 2 diabetes mellitus” [10] | 2019 | Original research | In this study, the mean HbA1c was significantly higher in T2DM patients with TD than in those without (8.1 ± 1.9% vs. 5.1 ± 1.2%, p = 0.001). Additionally, a positive linear relationship was observed between HbA1c levels and the presence of TD (regression coefficient = 1.89, p = 0.001). It suggests that poor glycemic control may be associated with an increased risk of TD in individuals with T2DM [10]. |
Zuanna TD, “A Systematic Review of Case-Identification Algorithms Based on Italian Healthcare Administrative Databases for Two Relevant Diseases of the Endocrine System: Diabetes Mellitus and Thyroid Disorders” [76] | 2019 | Systematic Review | This systematic review examined algorithms for identifying cases of DM and TD using Italian healthcare administrative databases. The authors concluded that, while numerous algorithms exist for identifying DM using healthcare administrative databases, the literature on TDs is relatively sparse, and further validation and implementation of these algorithms are needed [76]. |
Elgazar EH, “Thyroid dysfunction prevalence and relation to glycemic control in patients with type 2 diabetes mellitus” [15] | 2019 | Cross-sectional study | A cross-sectional study of 200 T2DM patients and 200 controls found significantly elevated TSH and T3 levels in diabetics (p < 0.001). Thyroid dysfunction was more common in those with poor glycemic control (HbA1c ≥ 8%) and longer diabetes duration. Subclinical hypothyroidism was the most frequent thyroid disorder observed [15]. |
Lee, S.A. “Association between continuity of care and type 2 diabetes development among patients with thyroid disorder” [77] | 2019 | Research article | This study investigated the link between continuity of care and the onset of T2DM in patients with thyroid disorders. Findings showed that patients with lower continuity of care were significantly more likely to develop T2DM, particularly among those with hypothyroidism, younger adults, and women. Maintaining consistent care was essential for stabilizing TH levels, which played a key role in preventing glucose dysregulation. The results highlight the importance of regular follow-up and sustained care in managing thyroid conditions to reduce diabetes risk [77]. |
Chen RH, “Thyroid diseases increased the risk of type 2 diabetes mellitus A nation-wide cohort study” [78] | 2019 | Research article | In a nationwide cohort study, patients with TD had a higher cumulative incidence of T2DM than the control group, with a log-rank p-value < 0.0001. The development between TD and T2DM was the strongest within the first year after TD diagnosis. Female patients and those aged 18–64 years exhibited a higher incidence of T2DM than the controls (p < 0.0001) [78]. |
Pramanik S, “Thyroid Status in Patients with Type 2 Diabetes Attending a Tertiary Care Hospital in Eastern India” [18] | 2018 | Original article | In this study of 100 diabetes patients, thyroid function was assessed. Subclinical hypothyroidism was found in 23% of patients, overt hypothyroidism in 3%, and positive thyroid autoantibodies in 13.1%. All patients were iodine-sufficient. About one in four diabetes patients had TD. Routine thyroid screening was recommended. The success of the salt iodination program in this region was noted [18]. |
Alsolami AA, “Association between type 2 diabetes mellitus and hypothyroidism: a case–control study” [50] | 2018 | Case–control study | This study analyzed 121 cases and 121 controls, and it found higher risk rates of hypothyroidism in patients with T2DM. Multivariate analysis revealed a stronger association between T2DM and hypothyroidism, with an odds ratio (OR) of 4.14 (p < 0.001). The results suggest that T2DM patients are at an elevated risk of developing hypothyroidism. Improved management of T2DM may help mitigate this risk [50]. |
Jun JE, “Association between changes in thyroid hormones and incident type 2 diabetes: A seven-year longitudinal study” [28] | 2017 | Research article | In a cohort of 6235 euthyroid individuals without DM, monitored annually between 2006 and 2012, variations in TH levels were evaluated in relation to incident T2DM. Over 25,692 person-years of follow-up, 229 new T2DM cases were identified. After adjusting for confounders, individuals in the highest tertile of TSH change (2.5–4.2 μIU/mL) demonstrated an increased risk of developing T2DM (p for trend = 0.027) compared to those with smaller TSH changes. Notably, baseline TH levels were not predictive of diabetes risk. These findings indicate that even subtle changes in thyroid function, within the normal range, can influence the risk of developing T2DM [28]. |
Raghuwanshi PK, “Evaluation of thyroid dysfunction among type 2 diabetic patients” [13] | 2014 | Original article | In a cohort of 80 subjects, TD was significantly more prevalent in T2DM patients than in controls (p < 0.05). Hypothyroidism and subclinical hypothyroidism were observed in 10% and 15% of diabetic patients, respectively, compared to in 2.5% and 7.5% in non-diabetic individuals [13]. |
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Tilici, D.-M.; Paun, D.L.; Arnautu, A.M.; Mirica, A.; Duta, C.; Costea, M.; Guja, C. The Intricate Relationship Between Thyroid Disorders and Type 2 Diabetes—A Narrative Review. Diabetology 2025, 6, 41. https://doi.org/10.3390/diabetology6050041
Tilici D-M, Paun DL, Arnautu AM, Mirica A, Duta C, Costea M, Guja C. The Intricate Relationship Between Thyroid Disorders and Type 2 Diabetes—A Narrative Review. Diabetology. 2025; 6(5):41. https://doi.org/10.3390/diabetology6050041
Chicago/Turabian StyleTilici, Dana-Mihaela, Diana Loreta Paun, Ana Maria Arnautu, Alexandra Mirica, Carmen Duta, Mirona Costea, and Cristian Guja. 2025. "The Intricate Relationship Between Thyroid Disorders and Type 2 Diabetes—A Narrative Review" Diabetology 6, no. 5: 41. https://doi.org/10.3390/diabetology6050041
APA StyleTilici, D.-M., Paun, D. L., Arnautu, A. M., Mirica, A., Duta, C., Costea, M., & Guja, C. (2025). The Intricate Relationship Between Thyroid Disorders and Type 2 Diabetes—A Narrative Review. Diabetology, 6(5), 41. https://doi.org/10.3390/diabetology6050041