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Diabetologie und Stoffwechsel 2024; 19(03): 188-199
DOI: 10.1055/a-2288-1783
CME-Fortbildung

Wechselseitige Beziehung zwischen Schilddrüsenerkrankungen und Diabetes

Karsten Müssig 
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Zusammenfassung

Aktuell sind etwa 8,9 Millionen Menschen in Deutschland von Diabetes betroffen, und jedes Jahr kommt mehr als eine halbe Millionen Menschen hinzu. In der Mehrzahl der Fälle handelt es sich um einen Typ-2-Diabetes, ein Typ-1-Diabetes ist hingegen sehr viel seltener. Auch Schilddrüsenerkrankungen weisen eine hohe Prävalenz auf und nehmen mit dem Alter zu. Im mittleren Lebensalter weist bereits jeder Zweite morphologische Schilddrüsenveränderungen auf. Die Rate an Schilddrüsenfunktionsstörungen liegt bei nahezu 10% der Allgemeinbevölkerung. Zahlreiche epidemiologische Untersuchungen weisen darauf hin, dass Diabetes und Schilddrüsenerkrankungen häufig miteinander vergesellschaftet sind. Die vorliegende Arbeite möchte einen Überblick geben über den Zusammenhang zwischen den verschiedenen Diabetestypen und funktionellen und morphologischen Schilddrüsenauffälligkeiten. Auch sollen mögliche zugrundeliegenden Mechanismen diskutiert werden.

Diabetes mellitus und Schilddrüsenerkrankungen weisen – unabhängig voneinander – eine hohe Prävalenz auf und nehmen mit dem Alter zu. Beide sind häufig miteinander vergesellschaftet. Im Fokus der Forschung steht dabei der Zusammenhang zwischen den verschiedenen Diabetestypen sowie funktionellen und morphologischen Schilddrüsenauffälligkeiten. Auch werden mögliche zugrundeliegenden Mechanismen untersucht.

Abstract

Currently, around 8.9 million people in Germany are affected by diabetes and more than half a million people are diagnosed every year. The majority of cases are type 2 diabetes, whereas type 1 diabetes is much rarer. Thyroid disorders also have a high prevalence and increase with age. In middle age, every second person already has morphological thyroid changes. The rate of thyroid dysfunction is almost 10% of the general population. Numerous epidemiological studies indicate that diabetes and thyroid disorders are often associated with each other. This paper aims to provide an overview of the relationship between the different types of diabetes and functional and morphological thyroid abnormalities. Possible underlying mechanisms will also be discussed.

Kernaussagen

  • Bei hypothyreoten Patienten mit Typ-1-Diabetes sind die renale Insulin-Clearance und die Glukoneogenese vermindert.

  • Aufgrund des verminderten Insulinbedarfs und der erhöhten Gefahr einer Hypoglykämie muss die Insulindosis entsprechend angepasst werden.

  • Nach der Initiierung einer Substitutionstherapie mit L-Thyroxin steigt der Insulinbedarf an.

  • Morbus Basedow ist eine häufige Ursache für eine Hyperthyreose bei Patienten mit Typ-1-Diabetes, hingegen liegen bei Patienten mit Typ-2-Diabetes eher Schilddrüsenautonomien vor.

  • Die bei der Hyperthyreose vermehrte hepatische Glukoseproduktion gemeinsam mit der gesteigerten Glykogenolyse begünstigen die Entstehung einer Hyperinsulinämie, einer gestörten Glukosetoleranz und einer Insulinresistenz.

  • Infolge dieser Veränderungen kann ein Prädiabetes zu einem manifesten Typ-2-Diabetes fortschreiten, sich die Stoffwechseleinstellung eines bereits bestehenden Diabetes verschlechtern und sich eine diabetische Ketoazidose entwickeln.

  • Schwerwiegende Erkrankungen, wie eine unzureichende Blutglukosekontrolle, können erheblichen Einfluss auf die Schilddrüsenfunktion haben und so eine die Beurteilung der Schilddrüsenhormone erschweren.

  • Während internationale Fachgesellschaften bei Typ-1-Diabetes regelmäßige Kontrolluntersuchungen der Schilddrüsenfunktion empfehlen, ist dies für Typ-2-Diabetes nicht der Fall.

Schlüsselwörter

Schilddrüsenfunktionsstörung - Schilddrüsenkrebs - Schilddrüsenautoimmunität - Typ-1-Diabetes - Typ-2-Diabetes

Keywords

Thyroid dysfunction - thyroid cancer - thyroid autoimmunity - type 1 diabetes - type 2 diabetes


Publication History

Article published online:
10 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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