A carregar...
Publicação
Effects of thyroid dysfunction in patients with diabetes mellitus
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 1.03 MB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
A diabetes mellitus e os distúrbios associados à tiróide são frequentemente observados na prática clínica e muitas vezes ocorrem em simultâneo. Estas doenças estão intimamente relacionadas e é importante compreender a relação entre elas, nomeadamente quais os mecanismos fisiopatológicos associados.
O objetivo desta revisão monográfica foi descrever os efeitos das hormonas da tiróide no metabolismo energético, nomeadamente glicídico, e estudar como é que a disfunção tiroideia afeta o controlo glicémico em doentes diabéticos.
Observou-se que a resistência à insulina, presente no hipertiroidismo, está associada ao aumento da gliconeogénese e glicogenólise hepática. Adicionalmente, no hipertiroidismo há aumento dos níveis de GLUT-2, o que também contribui para a saída de glicose do fígado. O excesso de hormonas tiroideias é ainda responsável pela hiperinsulinémia e intolerância à glicose.
No hipotiroidismo, a gliconeogénese hepática encontra-se reduzida, aumentando o risco de hipoglicémia. Um dos efeitos dos baixos níveis de hormonas tiroideias é a menor absorção intestinal de glicose, diminuindo por isso a sua disponibilidade e utilização pelos tecidos periféricos. As necessidades fisiológicas de insulina estão reduzidas no hipotiroidismo devido à diminuição da depuração renal da insulina com prolongamento da sua semi-vida.
Adicionalmente, observou-se que a diabetes mellitus tipo 1 e os distúrbios autoimunes da tiróide compartilham uma base genética comum.
O tratamento dos distúrbios da tiróide em diabéticos é importante para melhorar o controlo glicémico destes doentes. Foi discutida nesta revisão a necessidade de rastrear as doenças da tiróide em diabéticos e foi abordada a controvérsia das várias diretrizes em relação a esse rastreio. Além disso, foram ainda fornecidas algumas recomendações para a avaliação e tratamento desses distúrbios durante a terapêutica com antidiabéticos, uma vez que podem afetar a função tiroideia.
Em conclusão, os distúrbios da tiróide, quando não tratados, podem impactar negativamente o controlo da diabetes. Mais pesquisas serão necessárias para explorar a relação fisiopatológica entre estas duas doenças.
Diabetes mellitus and thyroid disorders are very common in clinical practice and often occur simultaneously. These diseases are closely related, and it is important to understand the relationship between them and the underlying mechanisms linking thyroid dysfunction to type 1 and type 2 diabetes mellitus. The aim of this review was to describe the effects of thyroid hormones on glucose metabolism and to determine the relationship between thyroid dysfunction and glycemic control in diabetic patients. It was observed that insulin resistance is present in hyperthyroidism, which is associated with increased hepatic gluconeogenesis and glycogenolysis. Elevated levels of GLUT-2 have also been reported, further contributing to the hepatic glucose output and anomalous glucose metabolism. Excess of thyroid hormones is also associated with hyperinsulinemia and glucose intolerance. In hypothyroidism, hepatic gluconeogenesis is reduced, which increases the risk of hypoglycemia. One of the effects of low thyroid hormone levels is reduced intestinal glucose absorption and, therefore, reduced disposal and utilization of glucose by peripheral tissues. Physiological insulin requirements are reduced in hypothyroidism due to decreased renal insulin clearance with prolonged insulin half-life. Furthermore, it is interesting to notice that type 1 diabetes mellitus and autoimmune thyroid disorders have been observed to share a common genetic background because they have a strong genetic association. Treating thyroid disorders in diabetic patients is important to improve their outcomes. The need to screen for the onset of thyroid diseases in diabetic patients is discussed and the controversy surrounding screening in various guidelines is addressed in the present work. Additionally, some recommendations are provided for assessment and treatment of these disorders during therapy with antidiabetic medications, which may affect thyroid function. In conclusion, untreated or inadequately treated thyroid dysfunction can negatively impact diabetes control. Further research is needed to explore the pathophysiological links between diabetes mellitus and thyroid disease.
Diabetes mellitus and thyroid disorders are very common in clinical practice and often occur simultaneously. These diseases are closely related, and it is important to understand the relationship between them and the underlying mechanisms linking thyroid dysfunction to type 1 and type 2 diabetes mellitus. The aim of this review was to describe the effects of thyroid hormones on glucose metabolism and to determine the relationship between thyroid dysfunction and glycemic control in diabetic patients. It was observed that insulin resistance is present in hyperthyroidism, which is associated with increased hepatic gluconeogenesis and glycogenolysis. Elevated levels of GLUT-2 have also been reported, further contributing to the hepatic glucose output and anomalous glucose metabolism. Excess of thyroid hormones is also associated with hyperinsulinemia and glucose intolerance. In hypothyroidism, hepatic gluconeogenesis is reduced, which increases the risk of hypoglycemia. One of the effects of low thyroid hormone levels is reduced intestinal glucose absorption and, therefore, reduced disposal and utilization of glucose by peripheral tissues. Physiological insulin requirements are reduced in hypothyroidism due to decreased renal insulin clearance with prolonged insulin half-life. Furthermore, it is interesting to notice that type 1 diabetes mellitus and autoimmune thyroid disorders have been observed to share a common genetic background because they have a strong genetic association. Treating thyroid disorders in diabetic patients is important to improve their outcomes. The need to screen for the onset of thyroid diseases in diabetic patients is discussed and the controversy surrounding screening in various guidelines is addressed in the present work. Additionally, some recommendations are provided for assessment and treatment of these disorders during therapy with antidiabetic medications, which may affect thyroid function. In conclusion, untreated or inadequately treated thyroid dysfunction can negatively impact diabetes control. Further research is needed to explore the pathophysiological links between diabetes mellitus and thyroid disease.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2024, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
Thyroid disorders Hyperthyroidism Hypothyroidism Diabetes mellitus Glycemic control Mestrado Integrado - 2024