Association Between Thyroid Parameters and Subclinical Atherosclerosis in Hospitalised Euthyroid Patients with Type 2 Diabetes Mellitus

Figures & data

Figure 1 Flow chart depicting patient selection process.

Table 1 Comparison of Clinical Characteristics Between Patients with and without Subclinical AS

	Without Subclinical AS (n=336)	With Subclinical AS (n=909)	P
Age (years)	43.77±12.62	58.83±11.22	<0.001*
Female	84 (25.0%)	311 (34.2%)	0.002*
Duration of T2DM (years)	1.00 (3.00, 8.00)	10.00 (5.00, 16.00)	<0.001*
Smoking	204 (60.7)	589 (64.8)	0.184
BMI (kg/m^2)	26.50 (23.60, 29.10)	25.70 (23.40, 27.80)	0.001*
SBP (mmHg)	129.00 (120.00, 140.00)	132.00 (120.00, 145.00)	0.550
DBP (mmHg)	80.00 (74.00, 88.00)	80.00 (72.00, 86.00)	0.075
HbA1c (%)	8.65 (6.80, 10.30)	8.60 (7.30, 10.00)	0.292
TC (mmol/L)	4.11 (3.13, 4.89)	4.39 (3.66, 5.30)	<0.001*
TG (mmol/L)	1.91 (1.21, 2.95)	1.59 (1.11, 2.56)	0.081
HDL-C(mmol/L)	0.97 (0.81, 1.15)	0.93 (0.81, 1.07)	0.210
LDL-C(mmol/L)	2.28 (1.58, 2.98)	2.63 (1.98, 3.28)	<0.001*
sCr (µmol/L)	65.00 (55.00, 75.00)	67.00 (56.25, 80.00)	0.003*
eGFR (mL/min/1.73m2)	110.18 (101.00, 118.56)	97.19 (84.93, 106.41)	<0.001*
mUACR(mg/g)	8.64 (5.02, 23.67)	11.19 (5.31, 35.16)	0.025*
FT3 (pmol/l)	4.80 (4.40, 5.20)	4.30 (3.90, 4.70)	<0.001*
FT4 (pmol/l)	17.00 (15.63, 18.78)	16.50 (15.00, 17.90)	<0.001*
TSH (mU/L)	1.88 (1.30, 2.44)	1.81 (1.26, 2.55)	0.874
TFQI	0.10 (−0.23, 0.36)	−0.01 (−0.29, 0.24)	0.570
TT4RI	31.60 (22.05, 42.42)	29.86 (20.74, 41.66)	0.956
TSHI	2.88 (2.52, 3.25)	2.82 (2.41, 3.16)	0.571
FT3/FT4	0.28 (0.25, 0.31)	0.26 (0.23, 0.29)	<0.001*

Note: *P < 0.05.

Abbreviations: AS, atherosclerosis; T2DM, Type 2 diabetes mellitus; BMI, Body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; HbA1c, glycosylated hemoglobin; TC, total cholesterol; TG, triglycerides; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; sCr, serum creatinine; eGFR, Estimated glomerular filtration rate; mUACR, mean urinary albumin/creatinine ratio; FT3, free triiodothyronine; FT4, free thyroxine; TSH, thyroid stimulating hormone; TFQI, Thyroid feedback quantile-based index; TT4RI, Thyrotropin thyroxine resistance index; TSHI, thyroid stimulating hormone index.

Figure 2 Prevalence of subclinical AS in patients with different levels of thyroid parameters (%).

Note: *P _trend < 0.05.

Abbreviations: AS, atherosclerosis; FT3, free triiodothyronine; FT4, free thyroxine; TSH, thyroid stimulating hormone; TFQI, Thyroid feedback quantile-based index; TT4RI, Thyrotropin thyroxine resistance index; TSHI, thyroid stimulating hormone index.

Table 2 Association Between Subclinical AS and Thyroid Parameters

	Model 1		Model 2		Model 3
	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P
FT3	0.290 (0.232–0.363)	<0.001*	0.379 (0.291–0.494)	<0.001*	0.374 (0.277–0.504)	<0.001*
FT4	0.861 (0.809–0.915)	<0.001*	0.909 (0.846–0.976)	0.009*	0.914 (0.845–0.989)	0.025*
TSH	0.988 (0.855–1.142)	0.874	0.919 (0.772–1.093)	0.337	0.936 (0.772–1.136)	0.504
TFQI	1.002 (0.991–1.014)	0.686	1.001 (0.986–1.017)	0.889	0.664 (0.441–1.002)	0.051
TT4RI	1.000 (0.997–1.003)	0.956	0.998 (0.995–1.002)	0.402	0.993 (0.982–1.004)	0.236
TSHI	1.002 (0.992–1.012)	0.675	1.001 (0.986–1.016)	0.891	0.794 (0.590–1.070)	0.129
FT3/FT4	0.018 (0.006–0.031)	<0.001*	0.023 (0.011–0.038)	0.001*	0.036 (0.013–0.061)	0.017*

Notes: Model 1: none (univariable); Model 2: adjusted for sex and age; Model 3: adjusted for sex, age, duration of diabetes, smoking, BMI, SBP, LDL-C, eGFR and mUACR. *P < 0.05.

Abbreviations: AS, atherosclerosis; FT3, free triiodothyronine; FT4, free thyroxine; TSH, thyroid stimulating hormone; TFQI, Thyroid feedback quantile-based index; TT4RI, Thyrotropin thyroxine resistance index; TSHI, thyroid stimulating hormone index.

Table 3 Comparisons the AUCs for FT3, FT4 and FT3/FT4 in Predicting Subclinical AS

	AUC (95% CI)	Cut-off	Specificity (%)	Sensitivity (%)
FT3	0.621 (0.594, 0.648)*	4.45	72.92	59.08
FT4	0.582 (0.554, 0.610)*,^#	17.55	42.26	70.19
FT3/FT4	0.715 (0.689, 0.740)	0.25	83.93	35.09

Notes: Compared with FT3/FT4, *P < 0.001; Compared with FT3, ^#P > 0.05.

Abbreviations: AS, atherosclerosis; FT4, free thyroxine; FT3, free triiodothyronine.

Figure 3 The ROC curves for FT3, FT4 and FT3/FT4 in predicting subclinical AS.

Abbreviations: AS, atherosclerosis; FT3, free triiodothyronine; FT4, free thyroxine.