Abstract:

Objective　To observe the effect of low-dose levothyroxine in the treatment of patients with diabetes mellitus and hyperthyroidism. Methods　A total of 136 patients with diabetes mellitus and hyperthyroidism treated at Yangling Demonstration District Hospital from January 2023 to January 2024 were selected for the randomized controlled trial, and were divided into a conventional group and a small-dose group by the random number table method. There were 32 males and 36 females in the conventional group; they were (54.85±9.63) years old; their diabetic course was (7.12±2.05) years; their hyperthyroidism course was (2.56±0.89) years. There were 37 males and 31 females in the small-dose group; they were (55.12±10.14) years old; their diabetic course was (7.08±2.12) years; their hyperthyroidism course was (2.51±0.92) years. The conventional group were treated with methimazole and dagliflozin; in addition, the small-dose group were treated with small-dose levothyroxine. Both groups were treated for 6 months. The blood glucose indicators, insulin function indicators, intestinal flora, and thyroid hormone levels were compared between the two groups by t test. The clinical efficacies and safety of the two groups were compared by χ² test. Results　After the treatment, the fasting blood glucose, insulin resistance index, postprandial 2 h blood glucose, and glycated hemoglobin were lower than those before the treatment in both groups, and those in the small-dose group were lower than those in the conventional group [(6.34±0.78) mmol/L vs. (7.28±1.04) mmol/L, (2.63±0.34) vs. (3.41±0.37), (8.27±1.76) mmol/L vs. (9.54±2.04) mmol/L, and (6.74±1.12)% vs. (8.31±1.65)%; t=5.963, 12.800, 3.887, and 6.492; all P<0.05]; the islet β-cell indices of the two groups were higher than those before the treatment, and the islet β-cell index in the small-dose group was higher than that in the conventional group [(65.75±10.15) vs. (54.86±8.09); t=6.919; P<0.05]. After the treatment, there were no statistical differences in the numbers of Enterobacteriaceae, Enterococci, Bifidobacteria, and Lactobacillus between the two groups (all P>0.05). After the treatment, the levels of free triiodothyronine and free thyroxine were lower than those before the treatment in both groups, and the levels in the small-dose group were lower than those in the conventional group [(4.41±1.33) ng/L vs. (6.89±2.12) ng/L and (10.25±3.77) ng/L vs. (14.56±5.14) ng/L; t=8.172 and 5.576; both P<0.05]; the levels of thyrotropin in both groups were higher than those before the treatment, and the level in the small-dose group was higher than that in the conventional group [(3.32±0.72) ng/L vs. (2.74±0.58) ng/L; t=5.173; P<0.05]. The total effective rate in the small-dose group was higher than that in the conventional group [92.65% (63/68) vs. 79.41% (54/68); P<0.05]. The total incidence of adverse reactions, such as liver injury, secondary hypothyroidism, hypoglycaemia, and gastrointestinal discomfort, in the small-dose group was 11.76% (8/68), and that in the conventional group 8.82% (6/68), with no statistical difference (P>0.05). Conclusion　Small-dose levothyroxine can modulate thyroid hormone expression in patients with diabetes mellitus and hyperthyroidism, facilitate glycaemic control, and improve their insulin function.

Key words:

Diabetes mellitus, Hyperthyroidism, Small-dose, Levothyroxine, Thyroid hormones, Insulin function

摘要：

目的　观察小剂量左甲状腺素治疗糖尿病合并甲状腺功能亢进患者的效果。方法　选取杨凌示范区医院2023年1月至2024年1月收治的136例糖尿病合并甲状腺功能亢进患者进行随机对照试验。采用随机数字表法将其分为常规组和小剂量组，各68例。常规组男32例，女36例，年龄（54.85±9.63）岁；糖尿病病程（7.12±2.05）年，甲状腺功能亢进病程（2.56±0.89）年。小剂量组男37例，女31例，年龄（55.12±10.14）岁，糖尿病病程（7.08±2.12）年，甲状腺功能亢进病程（2.51±0.92）年。常规组采用甲巯咪唑联合达格列净治疗；小剂量组在常规组基础上联合小剂量左甲状腺素治疗；两组均治疗6个月。两组血糖指标、胰岛素功能指标、肠道菌群、甲状腺激素水平比较采用t检验，两组临床疗效和安全性比较采用χ²检验。结果　治疗后，两组空腹血糖、胰岛素抵抗指数、餐后2 h血糖、糖化血红蛋白均低于治疗前，且小剂量组空腹血糖、胰岛素抵抗指数、餐后2 h血糖、糖化血红蛋白均低于常规组［（6.34±0.78）mmol/L比（7.28±1.04）mmol/L、（2.63±0.34）比（3.41±0.37）、（8.27±1.76）mmol/L比（9.54±2.04）mmol/L、（6.74±1.12）%比（8.31±1.65）%；t=5.963、12.800、3.887、6.492，均P<0.05］；两组胰岛β细胞指数均高于治疗前，且小剂量组胰岛β细胞指数高于常规组［（65.75±10.15）比（54.86±8.09）；t=6.919，P<0.05］。治疗后，两组肠杆菌、肠球菌、双歧杆菌、乳酸杆菌数量差异均无统计学意义（均P>0.05）。治疗后，两组游离三碘甲状腺原氨酸、游离甲状腺素水平均低于治疗前，且小剂量组水平均低于常规组［（4.41±1.33）ng/L比（6.89±2.12）ng/L、（10.25±3.77）ng/L比（14.56±5.14）ng/L；t=8.172、5.576，均P<0.05］；两组促甲状腺激素水平均高于治疗前，且小剂量组高于常规组［（3.32±0.72）ng/L比（2.74±0.58）ng/L；t=5.173，P<0.05］。小剂量组总有效率高于常规组［92.65%（63/68）比79.41%（54/68）；P<0.05］。小剂量组肝损伤、继发性甲状腺功能减退、低血糖、胃肠道不适等总不良反应发生率为11.76%（8/68），常规组为8.82%（6/68），差异无统计学意义（P>0.05）。结论　小剂量左甲状腺素可调节糖尿病合并甲状腺功能亢进患者甲状腺激素表达，有利于控制血糖和改善胰岛素功能。

关键词:

糖尿病, 甲状腺功能亢进, 小剂量, 左甲状腺素, 甲状腺激素, 胰岛素功能