糖尿病合并促甲状腺激素、甲状腺激素异常28例临床分析

目的分析糖尿病合并甲状腺功能减退或低三碘甲状腺原氨酸(T3)综合征鉴别诊断与治疗。方法对照28例糖尿病合并甲状腺功能减退或低三碘甲状腺原氨酸(T3)综合征患者临床治疗前后血糖、血脂、甲状腺激素水平变化。结果糖尿病合并高胆固醇血症、甲状腺功能减退患者,仅用L型甲状腺素钠片替补治疗,胆固醇恢复正常者占60%,空腹及餐后2h血糖完全正常者20%,餐后2h血糖水平下降70%;糖尿病合并低T3综合征,同时分别合并高胆固醇血症、高三酰甘油血症、酮症酸中毒(DKA)、糖尿病肾病(DA),经控制血糖、血脂,积极治疗DKA及DA后,T3恢复正常。结论甲状腺功能减退可致高胆固醇血症,血脂代谢紊乱而产生胰岛素抵抗,引发2型糖尿病。甲状腺素激素替补治疗纠正甲减后,糖代谢紊乱也可纠正;糖尿病合并低T3综合征,经纠正血糖、血脂代谢紊乱、治疗各种并发症后,甲状腺激素水平也逐渐恢复正常。

Objective To analyze the diabetic patients with hypothyroidism or low-Triiodothyronine （ T3 ） differential diagnosis and treatment of SARS. Methods Control ：28 cases of diabetic patients with hypothyroidism or low-Triiodothyronlne（ T3 ） SARS patients before and after treatment of blood glucose and lipids, thyroid hormone level changes. Results Diabetic patients with hypercholesterolemia, hypothyroidism patients, only Lthyroxine sodium tablets replacement therapy, cholesterol returned to normal ,60 percent, fasting and postprandial ：2 hour blood glucose completely normal ：20 percent, postprandial two hours blood sugar levels dropped 70 percent ; diabetic patients with low T3 syndrome, respectively merger hypercholesternlemia, high triglyceride hyperlipidemia,ketoacidosls （ DKA ）, diabetic nephropathy （ DA ）, the control of blood glucose and lipids, aggressive treatment DKA and DA,T3 back to normal. Conclusion Hypothyroidism can be induced hypercholesterolemia and dyslipidemia and insulin resistance and trigger type 2 diabetes. Thyroxin hormone replacement therapy to correct hypothyroidism, glucose metabolic disorder also corrected ; diabetic patients with low T3 syndrome, the correct blood glucose and lipid metabolism disorders, treatment complications, thyroid hormone level is gradually returning to normal.