Wechselwirkungen zwischen Schilddrüsenerkrankungen und Diabetes mellitus: Autoimmunerkrankungen, Stoffwechselentgleisungen und Schilddrüsenkarzinom

Zusammenfassung

Zwischen Schilddrüsenerkrankung und einem Diabetes mellitus gibt es vielfältige Beziehungen und Wechselwirkungen:

1. Typ-I- aber auch Typ-II-Diabetiker entwickeln häufiger einer Autoimmunthyreoiditis, besonders wenn bei Manifestation des Diabetes bereits TPO-Antikörper nachweisbar sind.

2. Eine Hyperthyreose kann zu einer Hypergly­kämie führen, während bei einer Hypothyreose ein erhöhtes Hypoglykämierisiko besteht. Entsprechend muss die antidiabetische Therapie während der Behandlung der Schilddrüsenfunktionsstörung kontinuierlich angepasst werden.

3. Aufgrund der wachstumsstimulierenden Wirkung von Insulin haben Typ-II-Diabetiker mit Insulinresistenz und Hyperinsulinämie häufiger eine Struma, eine Knotenstruma und ein Schilddrüsenkarzinom. Das Antidiabetikum Metformin hat nach neusten wissenschaftlichen Erkenntnissen eine präventive Wirkung auf die Strumainzidenz, reduziert das Knotenvolumen und hat eine wachstumshemmende Wirkung auf das Schilddrüsenkarzinom. Metfomin hemmt allerdings auch den Iodid-Uptake, ein experimenteller Befund, der klinisch noch verifiziert werden muss und dessen Bedeutung im Hinblick auf eine Metformintherapie noch diskutiert wird.

Abstract

Between thyroid diseases and diabetes mellitus there are complex relations and interactions:

1. Autoimmune thyroid diseases are more prevalent in type-I- but also in type-II-diabetics, in particular in patients with anti-TPO antibodies at the time of onset of diabetes.

2. Hyperthyroidism may result in hyperglycemia whereas patients with hypothyroidism are at risk of hypoglycemia. Accordingly, anti-diabetic therapy has to be adjusted during treatment of thyroid dysfunction.

3. Due to the growth-stimulatory effect of insulin type-II-diabetics are at a higher risk to develop goiter, thyroid nodules and also thyroid cancer. Recent publications suggest that the anti-diabetic drug metformin may decrease the incidence of goiters, may reduce volume of thyroid nodules and may inhibit growth of thyroid cancer. However, there is recent experimental evidence that metformin may also inhibit iodide uptake which has still to be confirmed by clinical studies.

Schlüsselwörter

Diabetes mellitus - Autoimmunthyreoiditis - Hyperthyreose - Hypothyreose - Schilddrüsenkarzinom - Metformin

Key words

diabetes mellitus - autoimmune thyroiditis - hyperthyroidism - hypothyroidism - thyroid cancer - metformin

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