Studies of insulin resistance in patients with clinical and subclinical hyperthyroidism

Abstract

Objective Although clinical hyperthyroidism (HR) is associated with insulin resistance, the information on insulin action in subclinical hyperthyroidism (SHR) is limited. Design and methods To investigate this, we assessed the sensitivity of glucose metabolism to insulin in vivo (by an oral glucose tolerance test) and in vitro (by measuring insulin-stimulated rates of glucose transport in isolated monocytes) in 12 euthyroid subjects (EU), 16 patients with HR, and 10 patients with SHR. Results HR and SHR patients displayed higher postprandial glucose levels (area under the curve, AUC 0 – 300 32 190±1067 and 31 497±716 mg/dl min respectively) versus EU (27 119±1156 mg/dl min, P <0.05). HR but not SHR patients displayed higher postprandial insulin levels (AUC 0 – 300 11 020±985 and 9565±904 mU/l min respectively) compared with EU subjects (AUC 0 – 300 7588±743 mU/l min, P <0.05). Homeostasis model assessment index was increased in HR and SHR patients (2.81±0.3 and 2.43±0.38 respectively) compared with EU subjects (1.27±0.16, P <0.05), while Matsuda and Belfiore indices were decreased in HR (4.21±0.41 and 0.77±0.05 respectively, P <0.001) and SHR patients (4.47±0.33 and 0.85±0.05 respectively, P <0.05 versus EU (7.76±0.87 and 1 respectively). At 100 μU/ml insulin, i) GLUT3 levels on the monocyte plasma membrane were increased in HR (468.8±7 mean fluorescence intensity (MFI)) and SHR patients (522.2±25 MFI) compared with EU subjects (407±18 MFI, P <0.01 and P <0.05 respectively), ii) glucose transport rates in monocytes (increases from baseline) were decreased in HR patients (37.8±5%) versus EU subjects (61.26±10%, P <0.05). Conclusions Insulin-stimulated glucose transport in isolated monocytes of patients with HR was decreased compared with EU subjects. Insulin resistance was comparable in patients with both HR and SHR.