J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 9, September 2018, pages 707-714

Low Vitamin D Deficiency Associated With Thyroid Disease Among Type 2 Diabetic Mellitus Patients

**Table 1.** Socio-Demographic and Clinical Characteristics of Studied T2DM Patients and Control Subjects (N = 1,092)
	T2DM (N = 546)	Control (N = 546)	P value
Age groups (in years)
< 30 years old	54 (9.9)	58 (10.8)
30 - 39 years old	97 (17.8)	106 (19.4)	0.778
40 - 49 years old	134 (24.5)	128 (23.4)
50 - 59 years old	117 (21.4)	125 (22.9)
60 and above	144 (26.4)	129 (23.6)
Gender
Male	181 (33.2)	177 (32.4)	0.423
Female	365 (66.8)	369 (67.6)
BMI (kg/m²)
Normal (< 25 kg/m²)	136 (24.9)	177 (32.4)
Overweight (29 - 30 kg/m²⁾	237 (43.4)	224 (41.0)	0.017
Obese (> 30 kg/m²)	173 (31.7)	145 (26.6)
Physical activity
Yes	128 (23.4)	158 (28.9)	0.039
No	418 (76.6)	388 (71.1)
Smoking status
Never	428 (78.4)	455 (83.3)
Current smoker	89 (16.3)	58 (10.6)	0.022
Past smoker	29 (5.3)	33 (6.0)
Sheesha smoking status
Yes	99 (18.1)	69 (12.8)	0.015
No	447 (81.9)	477 (87.4)
Family history of DM
Yes	76 (13.9)	39 (7.1)	0.001
No	473 (86.1)	507 (92.9)
Family history of hypertension
Yes	99 (18.1)	64 (11.7)	0.004
No	447 (81.9)	482 (88.3)
Family history of thyroid nodule
Yes	38 (7.0)	20 (3.7)	0.021
No	508 (93.0)	526 (96.3)

Table 1. Socio-Demographic and Clinical Characteristics of Studied T2DM Patients and Control Subjects (N = 1,092)

T2DM (N = 546)

Control (N = 546)

P value

Age groups (in years)

< 30 years old

54 (9.9)

58 (10.8)

30 - 39 years old

97 (17.8)

106 (19.4)

0.778

40 - 49 years old

134 (24.5)

128 (23.4)

50 - 59 years old

117 (21.4)

125 (22.9)

60 and above

144 (26.4)

129 (23.6)

Gender

Male

181 (33.2)

177 (32.4)

0.423

Female

365 (66.8)

369 (67.6)

BMI (kg/m²)

Normal (< 25 kg/m²)

136 (24.9)

177 (32.4)

Overweight (29 - 30 kg/m²⁾

237 (43.4)

224 (41.0)

0.017

Obese (> 30 kg/m²)

173 (31.7)

145 (26.6)

Physical activity

Yes

128 (23.4)

158 (28.9)

0.039

418 (76.6)

388 (71.1)

Smoking status

Never

428 (78.4)

455 (83.3)

Current smoker

89 (16.3)

58 (10.6)

0.022

Past smoker

29 (5.3)

33 (6.0)

Sheesha smoking status

Yes

99 (18.1)

69 (12.8)

0.015

447 (81.9)

477 (87.4)

Family history of DM

Yes

76 (13.9)

39 (7.1)

0.001

473 (86.1)

507 (92.9)

Family history of hypertension

Yes

99 (18.1)

64 (11.7)

0.004

447 (81.9)

482 (88.3)

Family history of thyroid nodule

Yes

38 (7.0)

20 (3.7)

0.021

508 (93.0)

526 (96.3)

**Table 2.** Clinical Biochemistry Baseline Value Among T2DM and Control Subjects (N = 1,092)
Variables	T2DM (N = 546, mean ± SD)	Control (N = 546, mean ± SD)	P value
TSH (reference range: 0.35 - 4.0 mIU/L), free triiodothyronine (FT3) (reference range: 1.71 - 4.71 pg/mL), and free thyroxine (FT4) (reference range: 0.8 - 1.9 ng/dL).
Vitamin D (ng/mL)	17.24 ± 3.71	23.67 ± 5.46	0.001
Hemoglobin (g/dL)	12.53 ± 2.45	13.10 ± 2.52	0.276
Magnesium (mmol/L)	0.76 ± 0.09	0.90 ± 0.10	< 0.001
Potassium (mmol/L)	3.39 ± 0.46	3.77 ± 0.53	< 0.001
Calcium (mmol/L)	1.63 ± 0.56	1.75 ± 0.68	0.001
Phosphorous (mmol/L)	1.46 ± 0.62	1.59 ± 0.52	0.038
Creatinine (mmol/L)	68.67 ± 16.17	67.33 ± 16.84	0.101
Fasting blood glucose (mmol/L)	7.49 ± 1.89	6.50 ± 1.98	< 0.001
HbA1C (mmol/L)	7.32 ± 0.97	5.29 ± 0.62	< 0.001
Cholesterol (mmol/L)	4.69 ± 0.71	4.03 ± 0.50	< 0.001
HDL (mmol/L)	0.96 ± 0.21	1.14 ± 0.34	0.911
LDL (mmol/L)	1.63 ± 0.64	1.54 ± 0.61	0.002
Albumin (mmol/L)	41.48 ± 5.57	39.81 ± 5.54	< 0.001
Bilirubin (mmol/L)	6.98 ± 2.43	6.99 ± 2.54	0.015
Triglyceride (mmol/L)	1.71 ± 0.69	1.59 ± 0.68	< 0.001
Uric acid (mmol/L)	278.1 ± 64.57	266.9 ± 61.7	< 0.001
Systolic blood pressure (mm Hg)	130.7 ± 12.9	126.8 ± 12.2	0.009
Diastolic blood pressure (mm Hg)	77.6 ± 6.8	75.9 ± 4.86	0.002
Thyroid stimulating hormone (TSH)	2.58 ± 1.06	2.31 ± 1.19	< 0.001
T3	1.89 ± 1.06	1.57 ± 0.93	< 0.001
T4	1.19 ± 0.70	0.97 ± 0.35	< 0.001

Table 2. Clinical Biochemistry Baseline Value Among T2DM and Control Subjects (N = 1,092)

Variables

T2DM (N = 546, mean ± SD)

Control (N = 546, mean ± SD)

P value

TSH (reference range: 0.35 - 4.0 mIU/L), free triiodothyronine (FT3) (reference range: 1.71 - 4.71 pg/mL), and free thyroxine (FT4) (reference range: 0.8 - 1.9 ng/dL).

Vitamin D (ng/mL)

17.24 ± 3.71

23.67 ± 5.46

0.001

Hemoglobin (g/dL)

12.53 ± 2.45

13.10 ± 2.52

0.276

Magnesium (mmol/L)

0.76 ± 0.09

0.90 ± 0.10

< 0.001

Potassium (mmol/L)

3.39 ± 0.46

3.77 ± 0.53

< 0.001

Calcium (mmol/L)

1.63 ± 0.56

1.75 ± 0.68

0.001

Phosphorous (mmol/L)

1.46 ± 0.62

1.59 ± 0.52

0.038

Creatinine (mmol/L)

68.67 ± 16.17

67.33 ± 16.84

0.101

Fasting blood glucose (mmol/L)

7.49 ± 1.89

6.50 ± 1.98

< 0.001

HbA1C (mmol/L)

7.32 ± 0.97

5.29 ± 0.62

< 0.001

Cholesterol (mmol/L)

4.69 ± 0.71

4.03 ± 0.50

< 0.001

HDL (mmol/L)

0.96 ± 0.21

1.14 ± 0.34

0.911

LDL (mmol/L)

1.63 ± 0.64

1.54 ± 0.61

0.002

Albumin (mmol/L)

41.48 ± 5.57

39.81 ± 5.54

< 0.001

Bilirubin (mmol/L)

6.98 ± 2.43

6.99 ± 2.54

0.015

Triglyceride (mmol/L)

1.71 ± 0.69

1.59 ± 0.68

< 0.001

Uric acid (mmol/L)

278.1 ± 64.57

266.9 ± 61.7

< 0.001

Systolic blood pressure (mm Hg)

130.7 ± 12.9

126.8 ± 12.2

0.009

Diastolic blood pressure (mm Hg)

77.6 ± 6.8

75.9 ± 4.86

0.002

Thyroid stimulating hormone (TSH)

2.58 ± 1.06

2.31 ± 1.19

< 0.001

1.89 ± 1.06

1.57 ± 0.93

< 0.001

1.19 ± 0.70

0.97 ± 0.35

< 0.001

**Table 3.** Clinical Biochemistry Baseline Based on Vitamin D Deficiency and Sufficiency With and Without Thyroid Nodules Among T2DM and Control Subject (N = 1,092)
Biochemistry indicators	T2DM patients(N = 546)	Control subjects(N = 546)
Vitamin D deficiency: 25(OH)D level < 20 ng/mL; *Vitamin D sufficiency: 25(OH) D level > 20 ng/mL.
Vitamin D (ng/mL)	17.05 ± 3.71	21.76 ± 4.96	0.001	22.22 ± 8.60	25.43 ± 9.07	< 0.001
Hemoglobin (g/dL)	12.76 ± 2.35	13.09 ± 2.48	0.248	12.90 ± 2.48	13.10 ± 2.56	0.275
Magnesium (mmol/L)	0.78 ± 0.10	0.92 ± 0.11	< 0.001	0.77 ± 0.10	0.89 ± 0.13	< 0.001
Potassium (mmol/L)	3.23 ± 0.38	3.47 ± 0.49	0.001	3.34 ± 0.44	3.58 ± 0.60	< 0.001
Serum calcium level (mmol/L)	1.51 ± 0.46	1.70 ± 0.60	< 0.001	1.66 ± 0.45	1.84 ± 0.84	0.002
Phosphorous (mmol/L)	1.25 ± 0.29	1.58 ± 0.71	0.001	1.58 ± 0.49	1.60 ± 0.99	0.983
Creatinine(mmol/L)	68.2 ± 16.4	68.1 ± 16.7	0.642	68.3 ± 16.2	67.2 ± 17.5	0.492
Fasting blood glucose(mmol/L)	7.60 ± 1.72	7.43 ± 1.96	0.351	6.11 ± 1.35	6.88 ± 2.37	< 0.001
HbA1C (mmol/L)	7.55 ± 0.91	7.19 ± 0.97	0.001	5.22 ± 0.30	5.14 ± 0.32	0.002
Cholesterol (mmol/L)	4.75 ± 0.84	4.65 ± 0.64	0.117	4.04 ± 0.49	4.00 ± 0.51	0.847
HDL (mmol/L)	1.27 ± 0.35	1.45 ± 0.25	0.001	1.19 ± 0.37	1.08 ± 0.30	< 0.001
LDL (mmol/L)	1.92 ± 0.63	1.54 ± 0.65	0.045	1.67 ± 0.66	1.41 ± 0.60	< 0.001
Albumin (mmol/L)	41.50 ± 2.45	40.75 ± 3.92	0.386	39.81 ± 6.08	40.75 ± 3.92	0.470
Bilirubin (mmol/L)	6.39 ± 2.43	7.28 ± 2.38	0.253	6.66 ± 2.47	7.31 ± 2.58	0.003
Triglyceride (mmol/L)	1.82 ± 0.60	1.50 ± 0.72	0.036	1.65 ± 0.63	1.154 ± 0.71	0.083
Uric acid (mmol/L)	299.5 ± 61.46	280.1 ± 64.85	< 0.001	269.0 ± 60.50	264.9 ± 62.90	0.444
Systolic blood pressure (mm Hg)	134.6 ± 13.0	131.31 ± 13.6	0.006	127.6 ± 13.4	126.2 ± 130.76	0.139
Diastolic blood pressure (mm Hg)	78.9 ± 6.60	77.2 ± 6. 7	< 0.001	76.5 ± 4.41	75.5 ± 5.21	0.027
Thyroid stimulating hormone (TSH)	2.75 ± 0.95	2.40 ± 1.05	0.005	1.97 ± 1.26	2.65 ± 1.02	< 0.001
T3	2.07 ± 0.94	1.81 ± 1.10	< 0.001	1.81 ± 0.99	1.33 ± 0.81	< 0.001
T4	1.44 ± 0.91	1.07 ± 0.52	< 0.001	1.01 ± 0.37	0.92 ± 0.32	0.002

Table 3. Clinical Biochemistry Baseline Based on Vitamin D Deficiency and Sufficiency With and Without Thyroid Nodules Among T2DM and Control Subject (N = 1,092)

Biochemistry indicators

T2DM patients(N = 546)

Control subjects(N = 546)

*Vitamin D deficiency with thyroid nodule (N = 186, mean ± SD)

**Vitamin D sufficiency without thyroid nodule (N = 360, mean ± SD)

P value

*Vitamin D deficiency with thyroid nodule (N = 178, mean ± SD)

**Vitamin D sufficiency without thyroid nodule (N = 368, mean ± SD)

P value

*Vitamin D deficiency: 25(OH)D level < 20 ng/mL; **Vitamin D sufficiency: 25(OH) D level > 20 ng/mL.

Vitamin D (ng/mL)

17.05 ± 3.71

21.76 ± 4.96

0.001

22.22 ± 8.60

25.43 ± 9.07

< 0.001

Hemoglobin (g/dL)

12.76 ± 2.35

13.09 ± 2.48

0.248

12.90 ± 2.48

13.10 ± 2.56

0.275

Magnesium (mmol/L)

0.78 ± 0.10

0.92 ± 0.11

< 0.001

0.77 ± 0.10

0.89 ± 0.13

< 0.001

Potassium (mmol/L)

3.23 ± 0.38

3.47 ± 0.49

0.001

3.34 ± 0.44

3.58 ± 0.60

< 0.001

Serum calcium level (mmol/L)

1.51 ± 0.46

1.70 ± 0.60

< 0.001

1.66 ± 0.45

1.84 ± 0.84

0.002

Phosphorous (mmol/L)

1.25 ± 0.29

1.58 ± 0.71

0.001

1.58 ± 0.49

1.60 ± 0.99

0.983

Creatinine(mmol/L)

68.2 ± 16.4

68.1 ± 16.7

0.642

68.3 ± 16.2

67.2 ± 17.5

0.492

Fasting blood glucose(mmol/L)

7.60 ± 1.72

7.43 ± 1.96

0.351

6.11 ± 1.35

6.88 ± 2.37

< 0.001

HbA1C (mmol/L)

7.55 ± 0.91

7.19 ± 0.97

0.001

5.22 ± 0.30

5.14 ± 0.32

0.002

Cholesterol (mmol/L)

4.75 ± 0.84

4.65 ± 0.64

0.117

4.04 ± 0.49

4.00 ± 0.51

0.847

HDL (mmol/L)

1.27 ± 0.35

1.45 ± 0.25

0.001

1.19 ± 0.37

1.08 ± 0.30

< 0.001

LDL (mmol/L)

1.92 ± 0.63

1.54 ± 0.65

0.045

1.67 ± 0.66

1.41 ± 0.60

< 0.001

Albumin (mmol/L)

41.50 ± 2.45

40.75 ± 3.92

0.386

39.81 ± 6.08

40.75 ± 3.92

0.470

Bilirubin (mmol/L)

6.39 ± 2.43

7.28 ± 2.38

0.253

6.66 ± 2.47

7.31 ± 2.58

0.003

Triglyceride (mmol/L)

1.82 ± 0.60

1.50 ± 0.72

0.036

1.65 ± 0.63

1.154 ± 0.71

0.083

Uric acid (mmol/L)

299.5 ± 61.46

280.1 ± 64.85

< 0.001

269.0 ± 60.50

264.9 ± 62.90

0.444

Systolic blood pressure (mm Hg)

134.6 ± 13.0

131.31 ± 13.6

0.006

127.6 ± 13.4

126.2 ± 130.76

0.139

Diastolic blood pressure (mm Hg)

78.9 ± 6.60

77.2 ± 6. 7

< 0.001

76.5 ± 4.41

75.5 ± 5.21

0.027

Thyroid stimulating hormone (TSH)

2.75 ± 0.95

2.40 ± 1.05

0.005

1.97 ± 1.26

2.65 ± 1.02

< 0.001

2.07 ± 0.94

1.81 ± 1.10

< 0.001

1.81 ± 0.99

1.33 ± 0.81

< 0.001

1.44 ± 0.91

1.07 ± 0.52

< 0.001

1.01 ± 0.37

0.92 ± 0.32

0.002

**Table 4.** Clinical Biochemistry Baseline Based on Vitamin D Deficiency With Thyroid Nodules Among T2DM and Compared to Control Subject (N = 364)
Biochemistry indicators	T2DM patients (N = 186)	Control subjects (N = 178)	P value
*Vitamin D deficiency: 25(OH)D level < 20 ng/mL.
Vitamin D (ng/mL)	17.05 ± 3.71	22.22 ± 8.60	< 0.001
Hemoglobin (g/dL)	12.76 ± 2.35	12.90 ± 2.48	0.635
Magnesium (mmol/L)	0.78 ± 0.10	0.77 ± 0.10	0.340
Potassium (mmol/L)	3.23 ± 0.38	3.34 ± 0.44	0.011
Serum calcium level (mmol/L)	1.51 ± 0.46	1.66 ± 0.45	< 0.001
Phosphorous (mmol/L)	1.25 ± 0.29	1.58 ± 0.49	< 0.001
Creatinine (mmol/L)	68.2 ± 16.4	68.3 ± 16.2	0.953
Fasting blood glucose (mmol/L)	7.60 ± 1.72	6.11 ± 1.35	< 0.001
HbA1C (mmol/L)	7.55 ± 0.91	5.22 ± 0.30	< 0.001
Cholesterol (mmol/L)	4.75 ± 0.84	4.04 ± 0.49	< 0.001
HDL (mmol/L)	1.27 ± 0.35	1.19 ± 0.37	0.034
LDL (mmol/L)	1.92 ± 0.63	1.67 ± 0.66	< 0.001
Albumin (mmol/L)	41.50 ± 2.45	39.81 ± 6.08	< 0.001
Bilirubin (mmol/L)	6.39 ± 2.43	6.66 ± 2.47	0.293
Triglyceride (mmol/L)	1.82 ± 0.60	1.65 ± 0.63	0.008
Uric acid (mmol/L)	299.5 ± 61.46	269.0 ± 60.50	< 0.001
Systolic blood pressure (mm Hg)	134.6 ± 13.0	127.6 ± 13.4	< 0.001
Diastolic blood pressure (mm Hg)	78.9 ± 6.60	76.5 ± 4.41	< 0.001
Thyroid stimulating hormone (TSH)	2.75 ± 0.95	1.97 ± 1.26	< 0.001
T3	2.07 ± 0.94	1.81 ± 0.99	0.010
T4	1.44 ± 0.91	1.01 ± 0.37	< 0.001

Table 4. Clinical Biochemistry Baseline Based on Vitamin D Deficiency With Thyroid Nodules Among T2DM and Compared to Control Subject (N = 364)

Biochemistry indicators

T2DM patients (N = 186)

Control subjects (N = 178)

P value

*Vitamin D deficiency with thyroid nodule (mean ± SD)

*Vitamin D deficiency: 25(OH)D level < 20 ng/mL.

Vitamin D (ng/mL)

17.05 ± 3.71

22.22 ± 8.60

< 0.001

Hemoglobin (g/dL)

12.76 ± 2.35

12.90 ± 2.48

0.635

Magnesium (mmol/L)

0.78 ± 0.10

0.77 ± 0.10

0.340

Potassium (mmol/L)

3.23 ± 0.38

3.34 ± 0.44

0.011

Serum calcium level (mmol/L)

1.51 ± 0.46

1.66 ± 0.45

< 0.001

Phosphorous (mmol/L)

1.25 ± 0.29

1.58 ± 0.49

< 0.001

Creatinine (mmol/L)

68.2 ± 16.4

68.3 ± 16.2

0.953

Fasting blood glucose (mmol/L)

7.60 ± 1.72

6.11 ± 1.35

< 0.001

HbA1C (mmol/L)

7.55 ± 0.91

5.22 ± 0.30

< 0.001

Cholesterol (mmol/L)

4.75 ± 0.84

4.04 ± 0.49

< 0.001

HDL (mmol/L)

1.27 ± 0.35

1.19 ± 0.37

0.034

LDL (mmol/L)

1.92 ± 0.63

1.67 ± 0.66

< 0.001

Albumin (mmol/L)

41.50 ± 2.45

39.81 ± 6.08

< 0.001

Bilirubin (mmol/L)

6.39 ± 2.43

6.66 ± 2.47

0.293

Triglyceride (mmol/L)

1.82 ± 0.60

1.65 ± 0.63

0.008

Uric acid (mmol/L)

299.5 ± 61.46

269.0 ± 60.50

< 0.001

Systolic blood pressure (mm Hg)

134.6 ± 13.0

127.6 ± 13.4

< 0.001

Diastolic blood pressure (mm Hg)

78.9 ± 6.60

76.5 ± 4.41

< 0.001

Thyroid stimulating hormone (TSH)

2.75 ± 0.95

1.97 ± 1.26

< 0.001

2.07 ± 0.94

1.81 ± 0.99

0.010

1.44 ± 0.91

1.01 ± 0.37

< 0.001

**Table 5.** Multivariate Logistic Regression Analysis for Predictors Presence of Thyroid Disorder Among T2DM Patients (N = 1,092)
Independent variables	Adjusted odds ratio	95% Confidence interval	P value
TSH, mIU/L	4.41	3.22 - 5.61	< 0.001
HbA1C (mmol/L)	3.67	2.84 - 4.92	< 0.001
Vitamin D deficiency	3.34	1.60 - 5.50	< 0.001
Systolic blood pressure, mm Hg	2.7	2.39 - 3.10	< 0.001
Family history of T2DM	2.41	2.13 - 3.87	< 0.001
BMI ( kg/m²)	2.23	1.94 - 3.06	0.005
Serum calcium level (mmol/L)	1.98	1.66 - 2.84	0.008
Family history of thyroid	1.75	1.43 - 2.92	0.01

Table 5. Multivariate Logistic Regression Analysis for Predictors Presence of Thyroid Disorder Among T2DM Patients (N = 1,092)

Independent variables

Adjusted odds ratio

95% Confidence interval

P value

TSH, mIU/L

4.41

3.22 - 5.61

< 0.001

HbA1C (mmol/L)

3.67

2.84 - 4.92

< 0.001

Vitamin D deficiency

3.34

1.60 - 5.50

< 0.001

Systolic blood pressure, mm Hg

2.7

2.39 - 3.10

< 0.001

Family history of T2DM

2.41

2.13 - 3.87

< 0.001

BMI ( kg/m²)

2.23

1.94 - 3.06

0.005

Serum calcium level (mmol/L)

1.98

1.66 - 2.84

0.008

Family history of thyroid

1.75

1.43 - 2.92

0.01