title: A high thyroid stimulating hormone level is associated with diabetic peripheral neuropathy in type 2 diabetes patients.
abstract: OBJECTIVE
  The association between thyroid stimulating hormone (TSH) and type 2 diabetes mellitus (T2DM) is well known. However, whether TSH is related to diabetic peripheral neuropathy (DPN) has not been studied. The aim of this study was to explore the relationship between TSH and DPN in Chinese patients with T2DM.
  
  
  METHODS
  In this cross-sectional study, 605 patients with T2DM were enrolled. Subclinical hypothyroidism (SCH) was defined as an elevated TSH level (>4.0mIU/L) and a normal free thyroxine level. DPN was evaluated by neurological symptoms, neurological signs, and electromyogram.
  
  
  RESULTS
  Serum TSH levels were significantly higher in DPN and signs of DPN compared with non-DPN T2DM patients (both P<0.01).The prevalence of DPN and signs of DPN in SCH subjects was higher than that in euthyroid subjects (both P<0.01). Spearman's correlation analysis showed that the serum TSH level was positively associated with DPN (r=0.172, P<0.01). A significant independent association between TSH and DPN was found by multiple logistic regression analysis after adjusting for potential confounding variables [odds ratio (OR)=1.365, P<0.01]. The patients were sequentially assigned to quartiles according to TSH level. Compared with quartile 1, patients in quartile 2 (P<0.01), quartile 3 (P=0.01), and quartile 4 (P<0.01) had a higher risk of DPN. Receiver-operating characteristic curve analysis revealed that the optimal cutoff point of TSH to indicate DPN was 3.045mIU/L in men and 2.94mIU/L in women.
  
  
  CONCLUSIONS
  TSH level is independently associated with DPN in Chinese population with T2DM. A high serum TSH level may be a potential risk factor for DPN.
authors.affiliation: Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
authors.forename: Weijing
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zeng
authors.affiliation: Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
authors.forename: Fengjing
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
authors.forename: Jiemin
authors.initials: J
authors.lastname: Pan
authors.affiliation: Department of Interventional Radiology, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Jungong
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Vascular Surgery, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
authors.forename: Lianxi
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
authors.forename: Yuqian
authors.initials: Y
authors.lastname: Bao
authors.affiliation: Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China. Electronic address: f-liu@sjtu.edu.cn.
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China. Electronic address: wpjia@sjtu.edu.cn.
authors.forename: Weiping
authors.initials: W
authors.lastname: Jia
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D003929:Diabetic Neuropathies / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000097:blood
chemical_list: D015415:Biomarkers; D013972:Thyrotropin; D013974:Thyroxine
keywords: Diabetic peripheral neuropathy; Subclinical hypothyroidism; Thyroid stimulating hormone; Type 2 diabetes mellitus