Lishchuk O. The pathogenesis of insulin resistance in diffuse toxic goitre and insulin resistance regulating agents

The research is devoted to the solution of the actual problem of pathological physiology – determining the relationship between pathogenetic changes of insulin resistance markers in diffuse toxic goitre before and after treatment with thyreostatic drugs and insulin resistance regulating agents. The conducted research reveals the advantages of the appointment of agents that regulate insulin resistance (metformin or pioglitazone) in patients with diffuse toxic goiter. Comparing the results of three treatment options, the higher thyroid stimulating hormone (TSH) concentration has been observed under the influence of combined treatment with metformin and thiamazole. 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, the index HOMA-? decreases, and the Caro index rises, indicating the direct effect of the drug on the key link pathogenesis of diffuse toxic goiter - the restoration of sensitivity of insulin-dependent tissues (muscle and adipose tissue to insulin). There was a decrease in the HOMA-IR index, as against the background of treatment with metformin due to decreased glucose uptake due to inhibition of gluconeogenesis in the liver and against the background of pioglitazone intake. Administration of insulin sensitizers has also improved the indexes of lipid metabolism.The proposed approach will prevent the condition of insulin resistance in diffuse toxic goitre and will serve to avoid the development of carbohydrate metabolism disorders and conditions associated with insulin resistance (type 2 diabetes, polycystic ovary syndrome, arterial hypertension, obesity).