Moskva C. Pathogenetic peculiarities of insulin resistance in hypothyroidism under the conditions of corrective influences

Object - insulin resistance in hypothyroidism; the purpose - to reveal laws of changes of pathogenetic markers of insulin resistance in hypothyroidism in conditions of correction of a homeostasis replaceable therapy; methods - biochemical, mathematical; results - The thesis presents a comparative assessment of the impact of levothyroxine, metformin and pioglitazone on insulin resistance markers of target tissue in clinical conditions (patients with hypothyroidism and presence of insulin resistance(IR)). Comparing the results of three treatment options, the lower thyroid stimulating hormone (TSH) concentration has been observed under the influence of combined treatment with metformin and levothyroxine, while free thyroxine (fТ4) and free triiodothyronine (fТ3) were higher on the background of pioglitazone and levothyroxine combination. Besides, glucose and glycated hemoglobin were lower on the background of metformin, and C-peptide and insulin in the background of pioglitazone. Under the influence of pioglitazone index HOMA-? was lower and index Caro was higher, which can be explained by their high sensitivity to changes in the insulin concentration in the blood. The impact on various types of insulin resistance has led to the decrease in HOMA-IR index both on the background of metformin (due to reduction in the content of fasting glucose through inhibition of gluconeogenesis in the liver), and pioglitazone (decrease in insulin resistance of muscles and adipose tissue). Administration of insulin sensitizers has also improved the indexes of lipid metabolism. The analysis of correlation connections revealed that the activity of ALT inversely correlated with fT4 in patients with hypothyroidism. Furthermore, the degree of correlation of fT4 with lipid fractions was higher than the association with them in fT3, which may indicate a close relation of fT4 with hepatic IR. A direct correlation between fasting glucose content and TSH level in patients with hypothyroidism with IR and normal BMI has been recorded, representing a direct dependence of carbohydrate metabolism from functional capacity of the thyroid gland just at the level of the initial changes in the pituitary gland.