Sabah TÜZÜN, Hüseyin ÇETİN, Engin Ersin ŞİMŞEK, Emrah TEKİN

Tip 2 Diabetes Mellitusta Cinsiyetlere Göre Hipotiroidi ile Vücut Yağ Kitlesi ve Metabolik Parametreler İlişkisi

Amaç: Tiroid hormonu vücut metabolizmasının düzenlenmesinde önemli rol oynamakta ve tiroid bezi disfonksiyonu diabetes mellitus (DM) olan bireylerde sık gözlenmektedir. Bu çalışmada DM hastalarında hipotiroidi ile vücut yağ kitlesi ve metabolik parametreler arasındaki ilişkisinin değerlendirilmesi amaçlanmaktadır. Materyal ve Metot: Çalışmaya hastanemiz Diyabet Ünitesi’ne Aralık 2017-Mayıs 2018 tarihleri arasında başvuran, 18 yaş ve üzeri DM hastaları kabul edilmiştir. Tüm katılımcıların dosyaları retrospektif olarak değerlendirilmiştir. Tüm katılımcılar hipotiroidi varlığına göre iki gruba ayrılmıştır. Tüm katılımcıların biyoempedans analiz yöntemi ile vücut yağ kitlesi ölçümleri olarak vücut kitle indeksi (VKİ), toplam ekstremite yağ kitlesi (TEYK), toplam yağ kitlesi (TYK), gövde yağ kitlesi (GYK) ve vücut yağ yüzdesi (VYY) ölçülmüştür. Ayrıca katılımcıların metabolik parametrelerinden HbA1c, trigliserid, LDL-kolesterol, HDL-kolesterol ve Cpeptit düzeyleri de değerlendirilmiştir. Hipotiroidi tedavisindeki hedef TSH düzeyleri genç ve orta yaşlı bireylerde 0,4-2,5 mU/mL, 65-80 yaş arası bireylerde 3-6 mU/mL ve 80 yaş üzeri bireylerde ≤10 mU/mL olarak belirlenmiştir. Bulgular: Çalışmaya toplam 620 DM hastası dahil edilmiş ve katılımcıların 141 (%22,74)’de hipotiroidi bulunmuştur. Hipotiroidi olan katılımcıların 55 (%39,01)’de de tiroid regülasyonu saptanmıştır. Hipotirodi olan kadınlarda VKİ 35,18±6,03 kg/m2 iken, olmayanlarda 33,79±6,19 kg/m2 olarak saptanmıştır (p=0.035). Erkeklerde ise hipotiroidi olanlarda VKİ 30,58±3,85 kg/m2 ve olmayanlarda 30,75±4,80 kg/m2 olarak gözlenmiştir (p=0,865). Hipotiroidi olan kadınlarda HbA1c %7,51±1,91; olmayanlarda %8,12±2,02 olarak saptanmıştır (p=0,004). Bununla beraber tiroid regülasyonu olan kadınlarda HbA1c %6,73±1.21 ve olmayanlarda %7,95±2,10 olarak tespit edilmiştir (p=0,001). Sonuç:Hipotiroidi olan kadınlarda VKİ ve toplam ekstremite yağ kitlesi anlamlı yüksek iken, erkeklerde benzer farklılık saptanmamıştır. Ayrıca hipotiroidi olmayan kadınlarda HbA1c yüksek saptanmakla beraber, tiroid regülasyonu olanlarda HbA1c düşük bulunmuştur. Bununla beraber erkeklerde ise, hipotiroidi varlığı ve tiroid regülasyonu açısından HbA1c düzeyinde fark tespit edilmemiştir.

The Relationship Between Hypothyroidism and Body Fat Mass and Metabolic Parameters by Gender in Patients with Type 2 Diabetes Mellitus

Objectives: The thyroid hormone plays a significant role in the regulation of body metabolism and thyroidgland dysfunction is commonly seen in individuals with diabetes mellitus (DM). This study aims to evaluate therelationship between hypothyroidism, body fat mass (BFM) and metabolic parameters in patients with DM.Materials and Methods: The study included patients with DM aged 18 years and above, who admitted to theDiabetes Unit of our hospital between December 2017 and May 2018. The files of all participants werereviewed retrospectively. All participants included in the study were divided into two groups according to thepresence of hypothyroidism. Body mass index (BMI), total extremity fat mass (TEFM), total body fat mass(TBFM), trunk fat mass (TFM) and body fat percentage (BFP) of all participants were measured by bioelectricalimpedance analysis. Hemoglobin A1c (HbA1c), triglyceride, low-density lipoprotein (LDL) cholesterol, highdensity lipoprotein (HDL) cholesterol and C-peptide levels of the patients were evaluated. Targeted TSH levelsin the treatment of hypothyroidism were defined 0.4-2.5 mU/mL in young and middle-aged individuals, 3-6mU/mL in the 65-80 years of age, and ≤10 mU/mL in individuals older than 80 years of age.Results: A total of 620 patients with DM were included in the study and 141 (22.74%) of them hadhypothyroidism. Thyroid regulation was achieved in 55 (39.01%) of the participants with hypothyroidism. Offemale patients with hypothyroidism, BMI was 35.18±6.03 kg/m2, while it was 33.79±6.19 kg/m2 in patientswithout hypothyroidism (p=0.035). In male patients with hypothyroidism, BMI was 30.58±3.85 kg/m2, whileit was 30.75±4.80 kg/m2 in patients without hypothyroidism (p=0.865). In female patients with and withouthypothyroidism, HbA1c was 7.51±1.91% and 8.12±2.02%, respectively (p=0.004). However, in female patientswith and without thyroid regulation, HbA1c was 6.73±1.21% and 7.95±2.10%, respectively (p=0.001).Conclusion: In females with hypothyroidism, BMI and TEFM were significantly higher, while there was no suchdifference in males. Furthermore, HbA1c levels were higher in females without hypothyroidism and HbA1cwas lower in those with thyroid regulation. No significant difference was observed in terms of HbA1c levels inmales with hypothyroidism.

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