Open Access

Austin Journal of Nephrology and

Hypertension

Special Article - Diabetic Nephropathy

Is there Correlation between Subclinical Hypothyroidism

and Diabetic Nephropathy?
Shokoufeh B* and Bahareh Z
Abstract
Department of Endocrinology, Endocrine Research
Center, Mashhad University of Medical Sciences, Iran Background: Diabetic patients have higher prevalence of subclinical
*Corresponding author: Shokoufeh B, Department hypothyroidism which may be associated with diabetic complications. The aim
of Endocrinology, Endocrine Research Center, Mashhad of this study was to investigate the association of subclinical hypothyroidism
University of Medical Sciences, Mashhad, Iran with diabetic nephropathy (DN) in type 2 diabetic patients.

Received: August 03, 2017; Accepted: September 05, Patients and Methods: A total of 150 type 2 diabetic patients were selected.
2017; Published: October 12, 2017 Fasting blood sugar, HbA1C, lipid profile, creatinine, free T4, TSH and urinary
albumin to creatinine ratio (UACR) were assessed for all patients. Patients with
UACR of ≥30 mg/gr or glomerular filtration rate (GFR) <60 ml/min were defined
as diabetic nephropathy (DN). Subclinical hypothyroidism (SCH) was defined
as an elevated TSH >4 m IU/L and free thyroxine (FT4) level in normal range.
Results: In our study 7.3% of all patients had subclinical hypothyroidism.
No significant difference was found between patients with and without DN in
TSH level. There was no significant difference in GFR and rate of albuminuria
between subclinical hypothyroid and euthyroid patients. TSH was not correlated
with albuminuria and GFR.
Conclusion: Subclinical hypothyroidism is not associated with DN in type
2 diabetes.
Keywords: Hypothyroidism; Diabetes; Diabetic nephropathy; Albuminuria

Introduction also excluded. Patients were informed completely about the study’s
aims and if they fulfilled the written informed consent, they were
Diabetes mellitus (DM) is the most common chronic metabolic
entered in the study. We recorded the demographic characteristics
disease which its incidence is increasing rapidly. The prevalence of
including: age, height, weight, blood pressure and body mass index
DM in urban Iranian population aged ≥20 years was 8.1% in 2008 [1].
(BMI). BMI was calculated according to this formula: Weight (kg)/
Diabetic nephropathy (DN) is one of the main chronic complications
height (m2). Blood pressure of the right arm was taken in a sitting
in type 1 and 2 diabetes and is currently the most common cause
position after resting for ten minutes. After 8 hours overnight
for end stage renal disease (ESRD). It is reported that diabetes
fasting, blood samples were obtained from the brachial vein. Fasting
contributes to approximately 40 percent of newly developed ESRD
plasma glucose was measured by the glucose oxidase method
patients each year [2]. Diabetic nephropathy is likely multi-factorial.
Although genetic and environmental factors can involved in diabetic (Human, Germany). Total cholesterol, triglyceride (TG), and high
nephropathy, resulted hemodynamic and metabolic changes can not density lipoprotein (HDL) were measured by enzymatic method
clearly justify the diabetic nephropathy progression. (Parsazmon Karaj, Iran). Low density lipoprotein (LDL) was
calculated according to Friedwall formula {LDL= total cholesterol-
The prevalence of thyroid disorders is higher in diabetic patients (HDL+TG/5)}. Glycated hemoglobin A1C (HbA1C) was assessed by
and subclinical hypothyroidism (SCH) being the most disorder [3]. Column chromatography (Biosource kit, Barcelona, Spain).Urinary
SCH has been associated with endothelial dysfunction and probably albumin was measured as the albumin to creatinine ratio (ACR)
atherosclerotic risk factors [4]. Hypothyroidism causes remarkable in a morning sample. Urine albumin in spot urine was measured
changes in glomerular filtration rate (GFR), tubular function, by Immunoturbidometry assay (Parsazmon, Karaj, Iran). Urine
water and electrolyte balances but association of SCH and diabetic
creatinine was measured by enzymatic colorimetric assay. Urinary
nephropathy (DN) has not been evaluated so far. The aim of this
microalbumin ≥30 and < 300 mg per gram of creatinine in urine
study was to correlate SCH with DN in Iranian patients with type 2
was considered as microalbuminuria and level ≥300 was considered
diabetes.
as macroalbumiuria. Estimated GFR (e GFR) (ml/min/1.73 m2)
Methods and Materials was calculated according to equation of the Modification of Diet in
Renal Disease. DN was defined as an increased ACR of ≥ 30 mg/gr
In a cross- sectional study, we recruited 150 patients with type
in the absence of other renal abnormalities or e GFR less than 60 ml/
2 diabetes. Patients with: past history of thyroid disease, taking
drugs with effects on thyroid tests and albuminuria and any sever min/1.73 m2according to KDOQI recommendation. Serum thyroid
intercurrent illness were excluded. Furthermore, patients with type stimulating hormone (TSH) was measured by immunoradiometric
1 diabetes, pregnancy, lactation, malignancy and liver failure were assay, and free T4 was determined using radioimmunoassay.

Austin J Nephrol Hypertens - Volume 4 Issue 3 - 2017 Citation: Shokoufeh B and Bahareh Z. Is there Correlation between Subclinical Hypothyroidism and Diabetic
ISSN : 2381-8964 | www.austinpublishinggroup.com Nephropathy?. Austin J Nephrol Hypertens. 2017; 4(3): 1073.
Shokoufeh et al. © All rights are reserved
Shokoufeh B
Austin Publishing Group

Table 1: Baseline characteristic of patients (n= 150). Ethical statement

Characteristics Mean ± SD The study protocol was approved by the local Ethics Committee
Male (%) 28.0% (The research ethics committee of Mashhad University of Medical
Age (years) 55.6 ± 9.3 Sciences), and was conducted according to the principles of Helsinki
Declaration.
Body mass index ( kg/m2) 27.6 ± 4.6

Duration of diabetes (years) 7.52 ± 6.1 Results

Waist circumference(cm) 98.4 ± 12.7 Baseline clinical and Para clinical characteristic of 150 participants
Systolic blood pressure( mm Hg) 124.8 ± 20.0 is shown in Table 1.
Diastolic blood pressure(mm Hg) 77.0 ± 11.9 There was a significant difference in duration of diabetes,
FBS ( mg/dl) 173.4± 68.3 cholesterol and LDL levels and urine albumin to creatinine ratio
HbA1C (%) 8.5 ± 1.79
between patients with and without CKD. TSH level and other variables
were not significant different between two groups. Comparison of
Total cholesterol( mg/dl) 177.1 ± 39.4
laboratory and clinical parameters between patients without CKD
Triglyceride( mg/dl) 168.1 ± 115.4 and CKD is shown in Table 2.
HDL cholesterol(mg/dl) 41.9 ± 7.8
According to Urine albumin to creatinine ratio, we stratified
LDL cholesterol(mg/dl) 103.8 ± 30.5 patients to normal and patients with albuminuria and all parameters
Creatinine(mg/dl) 0.98 ± 0.2 compared with other in these two groups (Table 3). TSH level was not
Urine albumin to creatinine ratio (mg/gr) 47.1±62.3 significant different between patients with and without albuminuria.
TSH(m IU / L) 2.5±1.4 7.3% of all patients had subclinical hypothyroidism. We
divided patients to euthyroid patients and patients with subclinical
Table 2: Comparison of clinical and paraclinical characteristics between non
CKD and CKD patients.
hypothyroidism. There was no significant difference in parameters
between two groups. Only triglyceride level was significantly higher
variable Non-CKD CKD P
in hypothyroid patients (Table 4).
Age (year) 53.6± 8.8 64.3± 8.5 0.70
Duration of diabetes more than 5 years Discussion
42.3 67.7 0.01
(%)
Body mass index (kg/m2) 28.2± 4.4 24.8± 3.3 0.60
This study was undertaken to evaluate relation between thyroid
dysfunction and diabetic nephropathy. The study showed that 7.3%
Systolic blood pressure( mm Hg) 122.9± 20.7 133.0± 19.7 0.86
of all patients had subclinical hypothyroidism. Other studies showed
Diastolic blood pressure( mm Hg) 75.9±12.1 78.8±12.6 0.71 that diabetic patients have a prevalence of 4.1-8.6% of subclinical
Cholesterol (mg/dl) 172.3± 35.5 196.1±48.8 0.01 hypothyroidism [5]. A population study, NHANES III, demonstrated
Triglyceride (mg/dl) 177.7± 130.6 154.4± 89.4 0.27 that the prevalence of subclinical hypothyroidism was 3.4% in
males and 5.8% in females [6]. Our result is similar with them but
LDL (mg/dl) 98.8± 27.1 122.8± 36.4 0.01
we excluded all patients with known thyroid disease from this study
HDL (mg/dl) 42.1± 8.0 42.6± 8.5 0.63 so it seems that subclinical hypothyroidism is more common in our
FBS (mg/dl) 177.1 ± 67.5 160.5± 73.2 0.96 diabetic patients. This difference may be related to preponderance of
HbA1C (%) 8.6±1.7 8.3±1.6 0.71 Table 3: Comparison of clinical and paraclinical characteristics according to
albuminuria.
Creatinine (mg/dl) 0.9± 0.2 1.2 ± 0.3 <0.001
Variable No albuminuria Albuminuria P
Urine albumin to creatinine ratio (mg/gr) 40. 5± 44.7 70.7± 112.6 <0.001
Age (year) 9.4±54.4 57.0±8.9 0.99
TSH(m IU/L) 2.5±1.6 2.4±1.1 0.12
Body mass index (kg/m2) 27.1±4.4 28.3±4.8 0.92

Subclinical hypothyroidism (SCH) was defined as an elevated Systolic blood pressure (mm Hg) 122.6±18.4 126.8±21.0 0.19
TSH >4 m IU / L and free thyroxine (FT4) level in normal range Diastolic blood pressure (mm Hg) 74.4±11.7 79.2±11.4 0.3
(0.7-1.8 ng/ dl). Only Type 2 diabetic patients who were euthyroid or Total cholesterol (mg/dl) 170.8±38.3 182.7±39.5 0.85
subclinically hypothyroid were included in the analyses.
Triglyceride (mg/dl) 145.3±97.3 190.5±106.8 0.4
Statistics HDL(mg/dl) 43.0±8.3 40.9±7.3 0.94
We used SPSS (SPSS 21.0 for Windows; SPSS Inc. Chicago, LDL(mg/dl) 100.8±31.1 106.5±29.9 0.46
Illinois) for data analysis. Quantitative data was shown as mean FBS(mg/dl) 161.1±64.1 186.0±71.3 0.19
± SD. Student T-Test or ANOVA was used for variables with
HbA1C (%) 8.2±1.6 8.9±1.7 0.31
normal distribution between DN groups with patients without DN.
Quantitative variables with non-normal distribution were compared GFR (ml/min/1.73 m2) 82.3±29.6 78.3±22.9 0.03

with Mann-Whitney test. Qualitative variables between the groups Creatinine (mg/dl) 0.96±0.21 1.0±0.3 0. 2
were analyzed by Chi-square test. TSH(m IU/L) 2.3±1.4 2.6±1.5 0.92

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Shokoufeh B
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Table 4: comparison of clinical and paraclinical characteristics between eutyroid should be conducted to confirm these results.
and subclinical hypothyroid patients.
Variable Euthyroid
Subclinical Conclusion
hypothyroidism
Age (year) 8.96±56.03 11.44±50.50 Our results suggest that subclinical hypothyroidism is not
Body mass index (kg/m ) 2
27.5±4.6 28.1±3.8
associated with diabetic nephropathy.
Systolic blood pressure (mm Hg) 125.7±19.0 124.0±29.5 Acknowledgement
Diastolic blood pressure (mm Hg) 77.4±11.5 76.0±16.8 The authors would like to thank the Vice Chancellor of Research
Total cholesterol (mg/dl) 176.3±38.9 186.3±46.1 (MUMS) for financial support of this study. We are also grateful to all
Triglyceride (mg/dl) 168.2±115.5 219.7±172.4 co-workers who helped us in the procedure of this study which was a
dissertation of an MD degree in medicine.
HDL (mg/dl) 41.6±7.7 45.8±8.3

LDL (mg/dl) 103.8±30.4 104.0±32.9 References

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Austin J Nephrol Hypertens - Volume 4 Issue 3 - 2017 Citation: Shokoufeh B and Bahareh Z. Is there Correlation between Subclinical Hypothyroidism and Diabetic
ISSN : 2381-8964 | www.austinpublishinggroup.com Nephropathy?. Austin J Nephrol Hypertens. 2017; 4(3): 1073.
Shokoufeh et al. © All rights are reserved

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