Related conditions | Diabetes UK
It is common for an individual to be affected by both thyroid disease and The association between Type 2 diabetes and thyroid disorder. There is no link between coeliac disease and Type 2 diabetes. There are two types of thyroid disorder: hypothyroidism (where the body doesn't produce. Type 2 diabetes mellitus (T2DM) has an intersecting underlying pathology . Figure 2: The relation between hypothyroidism and hypoglycemia.
These molecules are in final stages of preclinical and clinical evaluation and may pave the way to unveil a distinct class of drugs to treat metabolic disorders. Introduction The role of hyperthyroidism in diabetes was investigated inby Coller and Huggins proving the association of hyperthyroidism and worsening of diabetes. It was shown that surgical removal of parts of thyroid gland had an ameliorative effect on the restoration of glucose tolerance in hyperthyroid patients suffering from coexisting diabetes [ 1 ].
There is a deep underlying relation between diabetes mellitus and thyroid dysfunction [ 2 ]. A plethora of studies have evidenced an array of complex intertwining biochemical, genetic, and hormonal malfunctions mirroring this pathophysiological association [ 23 ].
Hypothyroidism Hashimoto's thyroiditis or thyroid over activity Graves' disease has been investigated to be associated with diabetes mellitus. Autoimmunity has been implicated to be the major cause of thyroid-dysfunction associated diabetes mellitus [ 5 — 7 ]. The relation between T2DM and thyroid dysfunction has been a less explored arena which may behold answers to various facts of metabolic syndrome including atherosclerosis, hypertension, and related cardiovascular disorders.
T2DM owes its pathological origin to inappropriate secretion of insulin, due to defective islet cell function or beta cell mass. Continuous consumption of calories-rich meals, junk food and sedentary lifestyle have culminated into an epidemic of diabetes projected to afflict around million people across the globe by [ 9 ]. Defective insulin secretion leads to various metabolic aberrations in T2DM, spanning from hyperglycemia due to defective insulin-stimulated glucose uptake and upregulated hepatic glucose production, along with dyslipidaemia, which includes impaired homeostasis of fatty acids, triglycerides, and lipoproteins [ 10 ].
Epidemiology Thyroid dysfunction is a common endocrine disorder with variable prevalence. Wickham survey reveals that a prevalence of thyroid dysfunction in male adults in England was 6. According to Colorado prevalence study, 9. The prevalence of thyroid dysfunction is advancing with age all over the world, and frequency of prevalence was higher in women than men. The prevalence of subclinical hypothyroidism is reported to be about 4 to 8.
The prevalence of thyroid disorder in diabetic population was reported to be The prevalence of thyroid dysfunction in T2DM patients was reported to be Sometimes, however, an unexplained change in growth rate is the only evidence of thyroid failure in children.Diabetes linked to hypothyroidism Mark Starr MD
In women of reproductive age, hypothyroidism can impair fertility and increase the risk of miscarriage during the second trimester. Other symptoms may include a goiter an enlarged thyroid glandfatigue, weight gain, mood swings, depressiondry skin, brittle hair, fluid retention, muscle weakness, and constipation. In the elderly, the symptoms can be very vague and are often mistaken for depression or dementia, since thyroid failure can cause sleep disturbance and poor memory.
Worldwide, the most common cause of hypothyroidism is dietary iodine deficiency. However, since iodine has been added to salt and other foods in the United States, hypothyrodism caused by iodine deficiency is very rare among Americans. The most common cause of hypothyroidism in the United States is an inherited autoimmune condition called Hashimoto thyroiditis, which affects up to 14 million people. These natural defenses use proteins called antibodies.
Hashimoto thyroiditis produces antibodies that damage the thyroid tissue, resulting in thyroid failure.
Other common causes of hypothyroidism include the surgical removal of the thyroid, exposure to radiation such as radioactive iodine therapy, or external radiation used to treat some forms of cancer. Certain drugs such as lithium carbonate for treatment of bipolar disorder and amiodarone brand names Cordarone, Nexterone, Pacerone, a drug prescribed for certain heart conditions can cause hypothyroidism. Rarely, abnormalities of the hypothalamus or pituitary gland may result in hypothyroidism.
Overactive thyroid, or hyperthyroidism, is less common than hypothyroidism. It tends to affect all age groups equally, but it is nine times more common in women.
Like hypothyroidism, the symptoms of hyperthyroidism are varied and can be vague, particularly if the disease progresses slowly over a prolonged period. In children, it can result in accelerated growth, hyperactivity, loss of concentration, poor handwriting, and short-term memory loss. In young women, it may result in absent or irregular periods, recurrent miscarriages, and infertility. In older women, hyperthyroidism can cause hot flashes, mood swings, sweating, and weight changes, symptoms that may be confused with signs of menopause.
Other typical symptoms of hyperthyroidism include irritability, fast heart rate, weight loss despite increased appetite, frequent bowel movements, insomnia, decreased energy level, and shaky hands. In addition, a goiter may be present.
Association between type 2 diabetes mellitus and hypothyroidism: a cas | IJGM
In this case, the antibodies stimulate the thyroid to enlarge and overproduce thyroid hormone. Some people with Graves disease develop eye problems that can cause the eyes to protrude and that may threaten vision. Other causes of hyperthyroidism include thyroid nodules, which are overactive usually noncancerous growths in an otherwise normal thyroid gland, and thyroiditis, or inflammation of the thyroid gland.
Thyroid disorder and diabetes People with diabetes have an increased risk of developing thyroid disorder. Since people with one form of autoimmune disorder have an increased chance of developing other autoimmune disorders, people with Type 1 diabetes have a higher risk of autoimmune thyroid disorder.
Postpartum thyroiditis, a form of autoimmune thyroid disease that causes thyroid dysfunction within a few months after delivery of a child, is three times more common in women with diabetes. Although Type 2 diabetes is not an autoimmune disorder, there have been many reports showing a higher occurrence of thyroid diseases, particularly hypothyroidism, among people with Type 2 diabetes. The association between Type 2 diabetes and thyroid disorder, however, remains unexplained.
Effect on diabetes control Since normal thyroid function is essential to regulate energy metabolism, abnormal thyroid function may have profound effects on blood glucose control in diabetes. Both hyperthyroidism and hypothyroidism can affect the course of diabetes, but their effects are somewhat different. Hyperthyroidism is typically associated with worsening blood glucose control and increased insulin requirements.
The Relationship between Type 2 Diabetes Mellitus and Related Thyroid Diseases
The excessive thyroid hormone causes increased glucose production in the liver, rapid absorption of glucose through the intestines, and increased insulin resistance a condition in which the body does not use insulin efficiently.
It may be important to consider underlying thyroid disorder if a person has unexplained weight loss, deterioration in blood glucose control, or increased insulin requirements. Sometimes hyperthyroidism may even unmask latent diabetes. Since hyperthyroidism causes rapid heart rate and increases the risk of abnormal heart rhythm, it may also bring on angina chest painworsen heart failure or interfere with the treatment of heart failure, as well as further increase the risk of other heart problems.
Prolonged, untreated hyperthyroidism can cause excessive bone loss, leading to osteoporosisor bone thinning. Osteoporosis raises the risk of bone fractures, making falling much more dangerous.
People with diabetes who have peripheral neuropathy are at an increased risk for falls due to poor foot sensation and sometimes loss of proprioception, or loss of the stimuli that tell the brain where a body part is in space, in relation to other objects. Therefore, the combination of hyperthyroidism and diabetes, particularly when neuropathy is present, increases the risk of fractures that may result in disability, especially in the elderly. Hypothyroidism rarely causes significant changes in blood glucose control, although it can reduce the clearance of insulin from the bloodstream, so the dose of insulin may be reduced.
More important, hypothyroidism is accompanied by a variety of abnormalities in blood lipid levels. These changes further raise the already high risk of cardiovascular diseases such as heart disease and stroke among people with diabetes. Pregnancy, diabetes, and thyroid disorder Pregnancy-related thyroid dysfunction is three times more common in women with diabetes and should be anticipated in every pregnant woman with Type 1 diabetes. Postpartum thyroiditis may cause fluctuating thyroid hormone levels in the months following delivery.
Continued monitoring of thyroid function is necessary in all women who experience postpartum thyroiditis, since roughly one-third will develop permanent hypothyroidism within three to four years and will require thyroxine replacement. Women who have diagnosed hypothyroidism and already take thyroxine before pregnancy often need to increase the dose of thyroxine during pregnancy.
Women with active Graves disease may enter a period of remission during pregnancy, when the disease becomes less active, but they can expect a recurrence following delivery. If hyperthyroidism is poorly controlled during pregnancy, the risk of maternal complications such as preeclampsia a serious condition characterized by high blood pressure and fetal problems such as prematurity increases.
The maintenance of normal thyroid function and tight blood glucose control is therefore of utmost importance during pregnancy to ensure a successful outcome. Diagnosis of thyroid disorder As mentioned earlier, the diagnosis of abnormal thyroid function based solely on symptoms can be difficult. In people with diabetes, it may be even more difficult because of the complex interrelationships of thyroid function and diabetes.
Both chronically high blood glucose and hyperthyroidism can cause weight loss despite good appetite, weakness, and fatigue. Likewise, severe diabetic kidney disease can produce symptoms such as swelling, weight gain, and hypertension, which may be confused with hypothyroidism. The most reliable method used to diagnose thyroid disease is the simple, relatively inexpensive, yet highly sensitive TSH blood test.
This test measures directly the amount of TSH produced by the pituitary gland. Since the pituitary is the first organ to recognize abnormal thyroid function, testing its function is the most sensitive way to monitor thyroid function. In addition to diagnosis, the TSH test is also used to monitor and adjust the dosage of thyroxine therapy.
Before the introduction of the TSH test in the late s, blood tests for thyroid function measured only the levels of the thyroid hormones, T3 and T4. However, these hormone levels can appear relatively normal even when the thyroid is not functioning normally, because the pituitary gland will compensate for thyroid dysfunction. When the thyroid starts to fail a sign of early hypothyroidismthe pituitary responds by producing higher levels of TSH to stimulate the thyroid to produce more thyroid hormones, thereby maintaining normal circulating T3 and T4 levels.
Conversely, when the thyroid gland produces too much thyroid hormone a sign of early hyperthyroidismthe pituitary responds by producing less TSH, thereby reducing T3 and T4 production from the thyroid.