---
title: "Central thyroid hormone resistance and CKD risk in type 2 diabetes: cross-sectional analysis"
id: "pubmed-42755292"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42755292"
content_type: "clinical_feed_article"
specialty: "Endocrinology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42755292/"
doi: "10.1080/0886022X.2026.2731649"
published_at: "2026-09-18T10:49:11.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Central thyroid hormone resistance and CKD risk in type 2 diabetes: cross-sectional analysis
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42755292
- **Specialty:** [Endocrinology](https://medichelpline.com/clinical-feed/endocrinology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42755292/)
- **DOI:** [10.1080/0886022X.2026.2731649](https://doi.org/10.1080%2F0886022X.2026.2731649)
- **Published At:** 2026-09-18T10:49:11.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This cross-sectional study evaluated 2,759 patients with **type 2 diabetes mellitus (T2DM)** who had normal peripheral thyroid hormones (normal serum **FT3** and **FT4**). - The investigation focused on markers of central thyroid hormone sensitivity: **TSH**, Thyroid Feedback Quantile-based Index (**TFQI**), thyrotrophic thyroxine resistance index (**TT4RI**), TSH Index (**TSHI**), and the FT3/FT4 ratio. - Chronic kidney disease (**CKD**) was defined using estimated glomerular filtration rate (**eGFR**), and associations were tested using multivariable logistic regression and restricted cubic spline (RCS) analysis. - Higher **TSH** levels and greater central thyroid hormone resistance (higher **TFQI**, **TT4RI**, and **TSHI**) were independently associated with increased odds of CKD in adjusted models. - RCS results indicated a significant non-linear relationship between TSH/central resistance indices and CKD risk (p < 0.001). - Patients in the highest **TSH** quartile had a 1.50-fold higher risk of CKD (OR 1.50, 95% CI 1.08–2.07) in multivariable regression. - Findings were robust after propensity score matching (n = 684 pairs), with the highest-TSH group showing OR 1.66 (95% CI 1.21–2.27). - The authors propose that easily computed central thyroid sensitivity indices may serve as clinical biomarkers for early renal risk stratification in T2DM patients with normal peripheral thyroid hormones. - The study design is cross-sectional; causal inference and some methodological details (covariates in models, exact CKD staging, and measurement methods beyond those reported) were not fully detailed in the abstract.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 18. # Association between central thyroid hormone dysregulation and chronic kidney disease in type 2 diabetes: a cross-sectional study [Heming Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+H&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#full-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Yanjia Shi](https://pubmed.ncbi.nlm.nih.gov/?term=Shi+Y&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#full-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Ping Fang](https://pubmed.ncbi.nlm.nih.gov/?term=Fang+P&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#full-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Sijing Tang](https://pubmed.ncbi.nlm.nih.gov/?term=Tang+S&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#full-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Wei Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+W&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#full-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Chenxia Zhou](https://pubmed.ncbi.nlm.nih.gov/?term=Zhou+C&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#full-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Yun Zhou](https://pubmed.ncbi.nlm.nih.gov/?term=Zhou+Y&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#full-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Keqin Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+K&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#full-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Ying Xue](https://pubmed.ncbi.nlm.nih.gov/?term=Xue+Y&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#full-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.") Affiliations Expand ### Affiliation * 1 Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China. * PMID: **42755292** * DOI: [ 10.1080/0886022X.2026.2731649 ](https://doi.org/10.1080/0886022x.2026.2731649) Item in Clipboard # Association between central thyroid hormone dysregulation and chronic kidney disease in type 2 diabetes: a cross-sectional study Heming Huang et al. Ren Fail. 2026 Dec. Show details Display options Display options Format Abstract PubMed PMID Ren Fail Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Ren+Fail%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ren+Fail%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42755292/) . 2026 Dec;48(1):2731649. doi: 10.1080/0886022X.2026.2731649. Epub 2026 Sep 18. ### Authors [Heming Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+H&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#short-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Yanjia Shi](https://pubmed.ncbi.nlm.nih.gov/?term=Shi+Y&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#short-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Ping Fang](https://pubmed.ncbi.nlm.nih.gov/?term=Fang+P&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#short-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Sijing Tang](https://pubmed.ncbi.nlm.nih.gov/?term=Tang+S&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#short-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Wei Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+W&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#short-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Chenxia Zhou](https://pubmed.ncbi.nlm.nih.gov/?term=Zhou+C&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#short-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Yun Zhou](https://pubmed.ncbi.nlm.nih.gov/?term=Zhou+Y&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#short-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Keqin Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+K&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#short-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China."), [Ying Xue](https://pubmed.ncbi.nlm.nih.gov/?term=Xue+Y&cauthor_id=42755292)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755292/#short-view-affiliation-1 "Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.") ### Affiliation * 1 Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China. * PMID: **42755292** * DOI: [ 10.1080/0886022X.2026.2731649 ](https://doi.org/10.1080/0886022x.2026.2731649) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract This cross-sectional study investigated the association between central thyroid hormone resistance and chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) who have normal peripheral thyroid hormones. The study included 2,759 T2DM patients with normal serum free triiodothyronine (FT3) and free thyroxine (FT4) levels. Central thyroid sensitivity was quantified using the Thyroid Feedback Quantile-based Index (TFQI), thyrotrophic thyroxine resistance index (TT4RI), TSH Index (TSHI), and FT3/FT4 ratio. Utilizing multivariable logistic regression and restricted cubic splines (RCS), we found that elevated TSH levels and increased central thyroid hormone resistance (indicated by higher TFQI, TT4RI, and TSHI) were independently associated with an increased risk of CKD. Notably, RCS analysis revealed a significant non-linear relationship (_p_ < 0.001). Participants in the highest TSH quartile exhibited a 1.5-fold increased risk of CKD in multivariable regression (OR 1.50, 95% CI 1.08-2.07). Crucially, this association remained robust after propensity score-matched analyses (_n_ = 684 pairs, OR 1.66, 95% CI 1.21-2.27). In conclusion, for T2DM patients with normal peripheral thyroid hormones, elevated TSH and reduced central thyroid hormone sensitivity are independently associated with a heightened risk of eGFR-defined CKD. These easily calculated indices may serve as valuable clinical biomarkers for early renal risk stratification. **Keywords:** Central thyroid hormone resistance; Type 2 diabetes mellitus; chronic kidney disease; thyroid stimulating hormone. 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