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. 2016 Sep 30;14(1):150.
doi: 10.1186/s12916-016-0693-4.

Thyroid function and risk of type 2 diabetes: a population-based prospective cohort study

Layal Chaker  1   2   3 , Symen Ligthart  3 , Tim I M Korevaar  1   2   3 , Albert Hofman  3   4 , Oscar H Franco  3 , Robin P Peeters  5   6   7 , Abbas Dehghan  3
Affiliations

Thyroid function and risk of type 2 diabetes: a population-based prospective cohort study

Layal Chaker et al. BMC Med. .

Abstract

Background: The association of thyroid function with risk of type 2 diabetes remains elusive. We aimed to investigate the association of thyroid function with incident diabetes and progression from prediabetes to diabetes in a population-based prospective cohort study.

Methods: We included 8452 participants (mean age 65 years) with thyroid function measurement, defined by thyroid-stimulating hormone (TSH) and free thyroxine (FT4), and longitudinal assessment of diabetes incidence. Cox-models were used to investigate the association of TSH and FT4 with diabetes and progression from prediabetes to diabetes. Multivariable models were adjusted for age, sex, high-density lipoprotein cholesterol, and glucose at baseline, amongst others.

Results: During a mean follow-up of 7.9 years, 798 diabetes cases occurred. Higher TSH levels were associated with a higher diabetes risk (hazard ratio [HR] 1.13; 95 % confidence interval [CI], 1.08-1.18, per logTSH), even within the reference range of thyroid function (HR 1.24; 95 % CI, 1.06-1.45). Higher FT4 levels were associated with a lower diabetes risk amongst all participants (HR 0.96; 95 % CI, 0.93-0.99, per 1 pmol/L) and in participants within the reference range of thyroid function (HR 0.96; 95 % CI, 0.92-0.99). The risk of progression from prediabetes to diabetes was higher with low-normal thyroid function (HR 1.32; 95 % CI, 1.06-1.64 for TSH and HR 0.91; 95 % CI, 0.86-0.97 for FT4). Absolute risk of developing diabetes type 2 in participants with prediabetes decreased from 35 % to almost 15 % with higher FT4 levels within the normal range.

Conclusions: Low and low-normal thyroid function are risk factors for incident diabetes, especially in individuals with prediabetes. Future studies should investigate whether screening for and treatment of (subclinical) hypothyroidism is beneficial in subjects at risk of developing diabetes.

Keywords: Diabetes; Prediabetes; Thyroid function; Thyroid hormone; Type 2 diabetes.

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Figures

Fig. 1
Fig. 1
Participant selection
Fig. 2
Fig. 2
Association of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels in tertiles within the normal range and incident diabetes in individuals with prediabetes. The normal range of TSH was defined as 0.4–4.0 mIU/L and of FT4 as 11–25 pmol/L (Conversion 1 pmol/L = 0.0777 ng/dL), thyroid hormone medication users were excluded. The analyses were adjusted for sex, age, smoking, cohort, fasting glucose, serum insulin measurements, systolic blood pressure, diastolic blood pressure, blood pressure lowering medication, cholesterol, and body mass index. AF atrial fibrillation, HR hazard ratio, CI confidence interval
Fig. 3
Fig. 3
The 7-year absolute risk of progression from prediabetes to type 2 diabetes is plotted against thyroid-stimulating hormone (TSH) and free thyroxine (FT4) values within the normal range. These analyses are adjusted for sex, age, smoking, cohort, fasting serum glucose levels, fasting serum insulin measurements, systolic blood pressure, diastolic blood pressure, blood pressure lowering medication, high-density lipoprotein cholesterol, and body mass index
See this image and copyright information in PMC

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