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Tip 2 diyabetes mellitus ve metabolik sendromlu hastalarda iyot eksikliği, tiroid volüm artışı ve tiroid nodülü varlığının sağlıklı kontrol grubu ile karşılaştırılması

Year 2022, Volume: 47 Issue: 2, 672 - 681, 30.06.2022

Abstract

Amaç: Bu çalışmada, Çukurova Bölgesi’nde yaşayan insanlarda iyot tayini, iyotlu tuz kullanım oranını ve bu parametrelerle tiroid volümü ve tiroid nodülü arasında ilişki olup olmadığını, ayrıca Tip 2 Diyabetes Mellitus (T2DM) ve Metabolik Sendrom (MetS) tanılı hastalarda bu parametrelerin nasıl değiştiğini göstermeyi amaçladık.
Gereç ve Yöntem: Çalışmaya 2017-2018 yılları arasında kliniğimizde takipli olan ve yeni tanı konulan, 18-65 yaş aralığında olup T2DM (n=131) ve MetS (n=113) tanısı olan toplam 244 hasta kaydedildi. Seksensekiz birey kontrol grubu olarak çalışmaya dâhil edildi. Kontrol grubu içindeki 54 birey tiroid nodülü, tiroid volüm artışı veya TSH yüksekliği saptananlar sağlıksız kontrol grubu olarak değerlendirildi.
Bulgular: Üriner iyot konsantrasyonu (ÜİK) T2DM, MetS, sağlıksız kontrol ve sağlıklı kontrol grubu için sırası ile 11.5 ± 7.9, 9.5 ± 5.5, 10.5±5.2 ve 8.9±4.5 mcg/L saptandı. Çalışmaya alınanlarda % 89.5 (n=289) ciddi iyot eksikliği (IE), %10.2 (n=33) orta derecede IE ve %0.3 (n=1) hafif derecede IE saptandı. Tiroid volümleri T2DM’li hastalarda sağlıksız ve sağlıklı kontrollere göre (sırası ile 19.2 ± 9.4ml vs, 15.2±8.0 ml/8.7±3.1 ml; MetS’lu hastalarda sağlıklı kontrol grubuna göre (sırası ile 18.0 ± 10.3 ml vs8.7±3.1 ml) istatiksel olarak anlamlı yüksekti. Serum TSH düzeyi MetS grubunda, hem T2DM grubuna göre (1.8 ± 1.0 vs 1.5 ± 0.8 mlU/l) hem de sağlıksız kontrol grubuna göre (1.8 ± 1.0 vs1.5±0.7 mlU/l) anlamlı olarak daha yüksekti.
Sonuç: Bu sonuçlara göre bölgemiz hâlâ ciddi derecede IE olan bir bölgedir. Çalışmamız sonucuna göre ÜİK tayini organizmanın iyot durumunun belirlemesinde kullanıldığı gibi insülin rezistansı ile ilişkili bir biomarker olarak kullanıp kullanılamayacağı hâlen tartışmalıdır.

References

  • Kaynaklar 1-Zimmermann MB, Boelaert K.Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015 Apr;3(4):286-95
  • 2- S-Zimmermann MB1, Jooste PL, Pandav CS. Iodine-deficiency disorders.Lancet. 2008 Oct 4;372(9645):1251-62.
  • 3 -Erdoğan G, ErdoganMF, Emral R, et al.Iodinestatusandgoiter prevalence in Turkey before mandatory iodization. J Endocrinol Invest 2002;25:224–8.
  • 4- Erdoğan MF, Demir O, Emral R, Kamel AN, Erdoğan G. More than a decade of iodine prophylaxis is needed to eradicate goiter among school age children in a moderately iodine-deficient region.2009 Mar;19(3):265-8.
  • 5-Erdoğan MF, Ağbaht K, Altunsu T, Ozbaş S, Yücesan F, Tezel B, Sargin C, Ilbeğ I, Artik N, Köse R, Erdoğan G. Currentiodinestatus in Turkey. J Endocrinol Invest. 2009 Jul;32(7):617-22.
  • 6-American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2008;1(Suppl 1):S55–60.
  • 7-Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640-1645
  • 8- WHO, UNICEF, ICCIDD: Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination: A Guide forProgrammeManagers. Geneva, WHO, 2007.
  • 9- Nils K. Peter L, Hans P, IngeB, LarsO. Torben J. Risk Factors for Goiter and Thyroid Nodule Thyroid Vol. Clinical Endocrinology (2001) 55,41-46
  • 10- Cavit Ç. Erişkinde İyot Eksikliği ve Destek Tedavisi Turkiye Klinikleri J Endocrin-Special 8 Topics 2014;7(3)
  • 11- Ma ZF1, Skeaff SA. Thyroglobulin as a biomarker of iodine deficiency: a review.Thyroid. 2014 Aug; 24(8):1195-209. Epub
  • 12-O. S. Al-Attas ,N. M. Al-Daghri, K. M. Alkharfy, M. S. Alokail, N. J. Al-Johani, S. H. Abd-Alrahman1, S. M. Yakout, H. M. Draz, S. Sabico1. Urinary Iodine is Associated with Insulin Resistance in Subjects with Diabetes Mellitus Type 2. Exp Clin Endocrinol Diabetes 2012; 120: 618–622
  • 13- Skrypnyk NV. Correlation between adipocytokines with iodine deficiency criteria in patients with metabolic syndrome and type 2 diabetes mellitus in Carpathians region. Lik Sprava 70–77 Jan-Mar 2010;(1-2):70-7.
  • 14-Lai Y, Wang J, Jiang F et al. The relationship between serum thyrotropin and components of metabolic syndrome. Endocr J 2011;58(1):23-30
  • 15-Pearce EN. Update in lipid alterations in subclinical hypothyroidism. J Clin Endocrinol Metab 2012 Feb;97(2):326-33
  • 16-Anil C, Akkurt A, Ayturk S, Kut A, Gursoy A.Impaired glucose metabolism is a risk factor for increased thyroid volume and nodule prevalence in a mild-to-moderate iodine deficient area. Metabolism. 2013 Jul;62(7):970-5
  • 17- Rezzonico J, Rezzonico M, Pusiol E, Pitoia F, and Niepomniszcze H. Introducing the Thyroid Gland as Another Victim of the Insulin Resistance Syndrome. Thyroid 2008; 18:461-464
  • 18- Junik R, Kozinski M, Debska-Kozinska K. Thyroid ultrasound in diabetic patients without overt thyroid disease. Acta Radiol. 2006;47:687-91.
  • 19-Tode B, SerioM,Rotella CM, GalliG,FranceschelliF,Tanini A, Toccafondi R İnsülin -likegrowthfactor -1 autocrine secretionby human thyroid follicular cells in primary culture. J ClinEndocrinol Metal 1989 69:639-647
  • 20- Semra Ayturk, Alptekin Gursoy, Altug Kut, CuneydAnil, Asli Nar and Neslihan BascilTutuncuMetabolic syndrome and its components are associated with increased thyroid volume and nodule prevalence in a mild-to-moderate iodine-deficient areaEuropean Journal of Endocrinology (2009) 161 599–605

Comparison of iodine deficiency, thyroid volume increase, and the presence of thyroid nodules in patients with type 2 diabetes mellitus and metabolic syndrome and healthy controls

Year 2022, Volume: 47 Issue: 2, 672 - 681, 30.06.2022

Abstract

Purpose: This study aimed to show levels of iodine in people living in the Cukurova region, the rate of use of iodized salt, and whether there was a relationship between these parameters and thyroid volume and thyroid nodules, and how these parameters changed in patients with type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS).
Materials and Methods: A total of 244 patients aged 18-65 years who were newly diagnosed as having T2DM (n = 131) and MetS (n = 113), who were followed up in our clinic between 2017 and 2018, were enrolled in the study. Eighty-eight individuals were included in the study as a control group. Among the control group, 54 individuals with thyroid nodules, increased thyroid volume, or increased thyroid-stimulating hormone (TSH) were considered as unhealthy controls.
Results: The urinary iodine concentration was 11.5 ± 7.9, 9.5 ± 5.5, 10.5 ± 5.2, and 8.9 ± 4.5 mcg/L for the T2DM, MetS, unhealthy control, and healthy control groups, respectively, 89.5% (n = 289) had severe iodine deficiency (ID), 10.2% (n = 33) had moderate ID, and 0.3% (n = 1) had mild IE. Thyroid volumes in patients with T2DM compared with unhealthy and healthy controls were 19.2 ± 9.4 mL vs. 15.2 ± 8.0 mL / 8.7 ± 3.1 mL, respectively. Thyroid volumes were statistically significantly higher in patients with MetS compared with the healthy control group (18.0 ± 10.3 mL vs 8.7 ± 3.1 mL, respectively). Serum TSH levels were significantly higher in the MetS group compared with the T2DM group (1.8 ± 1.0 vs 1.5 ± 0.8 mlU/l) and the unhealthy control group (1.8 ± 1.0 vs. 1.5 ± 0.7 mlU/l).
Conclusion: According to the results, our region is still a region with severe ID. It remains controversial whether it can be used as a biomarker associated with insulin resistance as it is used to determine the iodine status of the organism.

References

  • Kaynaklar 1-Zimmermann MB, Boelaert K.Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015 Apr;3(4):286-95
  • 2- S-Zimmermann MB1, Jooste PL, Pandav CS. Iodine-deficiency disorders.Lancet. 2008 Oct 4;372(9645):1251-62.
  • 3 -Erdoğan G, ErdoganMF, Emral R, et al.Iodinestatusandgoiter prevalence in Turkey before mandatory iodization. J Endocrinol Invest 2002;25:224–8.
  • 4- Erdoğan MF, Demir O, Emral R, Kamel AN, Erdoğan G. More than a decade of iodine prophylaxis is needed to eradicate goiter among school age children in a moderately iodine-deficient region.2009 Mar;19(3):265-8.
  • 5-Erdoğan MF, Ağbaht K, Altunsu T, Ozbaş S, Yücesan F, Tezel B, Sargin C, Ilbeğ I, Artik N, Köse R, Erdoğan G. Currentiodinestatus in Turkey. J Endocrinol Invest. 2009 Jul;32(7):617-22.
  • 6-American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2008;1(Suppl 1):S55–60.
  • 7-Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640-1645
  • 8- WHO, UNICEF, ICCIDD: Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination: A Guide forProgrammeManagers. Geneva, WHO, 2007.
  • 9- Nils K. Peter L, Hans P, IngeB, LarsO. Torben J. Risk Factors for Goiter and Thyroid Nodule Thyroid Vol. Clinical Endocrinology (2001) 55,41-46
  • 10- Cavit Ç. Erişkinde İyot Eksikliği ve Destek Tedavisi Turkiye Klinikleri J Endocrin-Special 8 Topics 2014;7(3)
  • 11- Ma ZF1, Skeaff SA. Thyroglobulin as a biomarker of iodine deficiency: a review.Thyroid. 2014 Aug; 24(8):1195-209. Epub
  • 12-O. S. Al-Attas ,N. M. Al-Daghri, K. M. Alkharfy, M. S. Alokail, N. J. Al-Johani, S. H. Abd-Alrahman1, S. M. Yakout, H. M. Draz, S. Sabico1. Urinary Iodine is Associated with Insulin Resistance in Subjects with Diabetes Mellitus Type 2. Exp Clin Endocrinol Diabetes 2012; 120: 618–622
  • 13- Skrypnyk NV. Correlation between adipocytokines with iodine deficiency criteria in patients with metabolic syndrome and type 2 diabetes mellitus in Carpathians region. Lik Sprava 70–77 Jan-Mar 2010;(1-2):70-7.
  • 14-Lai Y, Wang J, Jiang F et al. The relationship between serum thyrotropin and components of metabolic syndrome. Endocr J 2011;58(1):23-30
  • 15-Pearce EN. Update in lipid alterations in subclinical hypothyroidism. J Clin Endocrinol Metab 2012 Feb;97(2):326-33
  • 16-Anil C, Akkurt A, Ayturk S, Kut A, Gursoy A.Impaired glucose metabolism is a risk factor for increased thyroid volume and nodule prevalence in a mild-to-moderate iodine deficient area. Metabolism. 2013 Jul;62(7):970-5
  • 17- Rezzonico J, Rezzonico M, Pusiol E, Pitoia F, and Niepomniszcze H. Introducing the Thyroid Gland as Another Victim of the Insulin Resistance Syndrome. Thyroid 2008; 18:461-464
  • 18- Junik R, Kozinski M, Debska-Kozinska K. Thyroid ultrasound in diabetic patients without overt thyroid disease. Acta Radiol. 2006;47:687-91.
  • 19-Tode B, SerioM,Rotella CM, GalliG,FranceschelliF,Tanini A, Toccafondi R İnsülin -likegrowthfactor -1 autocrine secretionby human thyroid follicular cells in primary culture. J ClinEndocrinol Metal 1989 69:639-647
  • 20- Semra Ayturk, Alptekin Gursoy, Altug Kut, CuneydAnil, Asli Nar and Neslihan BascilTutuncuMetabolic syndrome and its components are associated with increased thyroid volume and nodule prevalence in a mild-to-moderate iodine-deficient areaEuropean Journal of Endocrinology (2009) 161 599–605
There are 20 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research
Authors

Seher Çetinkaya Altuntaş 0000-0002-9733-9443

Mehtap Evran Olgun 0000-0002-1796-3845

Ozl Gorur 0000-0001-9325-5296

Murat Sert 0000-0001-5376-9874

Bekir Tamer Tetiker 0000-0002-9185-7557

Publication Date June 30, 2022
Acceptance Date April 22, 2022
Published in Issue Year 2022 Volume: 47 Issue: 2

Cite

MLA Çetinkaya Altuntaş, Seher et al. “Tip 2 Diyabetes Mellitus Ve Metabolik Sendromlu Hastalarda Iyot eksikliği, Tiroid volüm artışı Ve Tiroid nodülü varlığının sağlıklı Kontrol Grubu Ile karşılaştırılması”. Cukurova Medical Journal, vol. 47, no. 2, 2022, pp. 672-81.