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Hyperthyroidism And Glucose Levels

Insulin Action In Hyperthyroidism: A Focus On Muscle And Adipose Tissue

Insulin Action In Hyperthyroidism: A Focus On Muscle And Adipose Tissue

Insulin Action in Hyperthyroidism: A Focus on Muscle and Adipose Tissue Hellenic National Center for Research, Prevention, and Treatment of Diabetes Mellitus and Its Complications (P.M., S.A.R.), 10675 Athens, Greece; Search for other works by this author on: Hellenic National Center for Research, Prevention, and Treatment of Diabetes Mellitus and Its Complications (P.M., S.A.R.), 10675 Athens, Greece; Second Department of Internal Medicine (S.A.R., G.D.), Research Institute and Diabetes Center, Athens University Medical School, Attikon University Hospital, GR-12462 Athens, Greece Search for other works by this author on: Second Department of Internal Medicine (S.A.R., G.D.), Research Institute and Diabetes Center, Athens University Medical School, Attikon University Hospital, GR-12462 Athens, Greece Address all correspondence and requests for reprints to: Professor George Dimitriadis, M.D., D.Phil., Second Department of Internal Medicine, Research Institute and Diabetes Center, Athens University Medical School, Attikon University Hospital, 1 Rimini Street, GR-12462 Athens, Greece. Search for other works by this author on: Endocrine Reviews, Volume 31, Issue 5, 1 October 2010, Pages 663679, Panayota Mitrou, Sotirios A. Raptis, George Dimitriadis; Insulin Action in Hyperthyroidism: A Focus on Muscle and Adipose Tissue, Endocrine Reviews, Volume 31, Issue 5, 1 October 2010, Pages 663679, Hyperthyroidism leads to an enhanced demand for glucose, which is primarily provided by increased rates of hepatic glucose production due to increased gluconeogenesis (in the fasting state) and increased Cori cycle activity (in the late postprandial and fasting state). Adipose tissue lipolysis is increased in the fasting state, resulting in increased production of glycerol and nonesterif Continue reading >>

Thyroid Disease And Diabetes

Thyroid Disease And Diabetes

Diabetes and thyroid disease are both endocrine, or hormone, problems. When thyroid disease occurs in someone with diabetes, it can make blood glucose control more difficult. The thyroid is a butterfly-shaped gland in your lower neck just beneath your skin. It regulates your body’s metabolism, the processes of using and storing energy, by releasing a substance called thyroid hormone. If it produces too much thyroid hormone, your metabolism quickens (hyperthyroidism), too little and your body functions slow down (hypothyroidism). Hyperthyroidism Symptoms Pounding heart Quick pulse Increased sweating Weight loss despite normal or increased appetite Shortness of breath when exercising Muscle weakness or tremors Trouble concentrating Change in menstrual periods Thick skin on the knees, elbows, and shins Hypothyroidism Symptoms Sluggishness Depression Feeling of being cold even when others feel warm Constipation Weight gain unrelated to increase in eating Low blood pressure Slow pulse Effects on Diabetes Hyperthyroidism. When your metabolism quickens, your medicines go through your body quicker. Your blood glucose level may rise because your usual dosage does not stay in your body long enough to control it. Hyperthyroidism and low blood glucose can be hard to tell apart. If you are sweating and having tremors from hyperthyroidism, you may think you have low blood glucose and eat extra food, causing your blood glucose to rise. Using your glucose meter to verify low blood glucose levels can help you avoid this problem. Hypothyroidism. When your metabolism slows, your blood glucose level may drop because your diabetes medicine doesn’t pass through your body as quickly as usual and so stays active longer. In hypothyroidism, it is often necessary to reduce your dose of diabet Continue reading >>

The Relationship Between Diabetes And Thyroid Disorder

The Relationship Between Diabetes And Thyroid Disorder

At the clinic today, a patient came in for an initial assessment for Diabetes Self-Management Education. She was taking thyroid medication along with her diabetes and other medications. She was not the first patient that I have seen lately who is taking thyroid medication. I was aware of the link between diabetes and thyroid disease, and had some basic information. I thought it would be interesting to look into the dynamics a little further. After all, the pancreas and the thyroid both fall within the endocrine system. Now let’s take a look at why people with diabetes often seem to have thyroid disorder, and the reasons behind it. What is thyroid disease? In order to understand the relationship between diabetes and thyroid disease, it is helpful to understand what thyroid disease is. At the front of your neck, just under your Adam’s apple is where you will find the thyroid gland. Thyroid disease is a problem that happens when the thyroid gland either under produces or over produces the thyroid hormones. Thyroid hormones are responsible for regulating the body’s metabolism. From research, the percent of the population that will develop thyroid disease is 7 percent. The percentage of people with diabetes who have thyroid disease is greater than the general population. We will dig in a little deeper to find the reasons why, and examine the link between the two. Note from Kirk and Health Institute: A high percentage of low thyroid is “Hashimoto’s”, which like Graves disease is an auto-immune in origin and most often creates low thyroid symptoms. To address Hashimoto’s and Graves affectively you must focus on the immune system, medication can be supportive but does not address the cause. Autoimmune conditions are best managed by change in diet and reducing infl Continue reading >>

Thyroid, Blood Sugar, And Metabolic Syndrome

Thyroid, Blood Sugar, And Metabolic Syndrome

This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here. According to the American Association of Clinical Endocrinologists, 27 million Americans suffer from thyroid dysfunction – half of whom go undiagnosed. Subclinical hypothyroidism, a condition in which TSH is elevated but free T4 is normal, may affect an additional 24 million Americans. Taken together, more than 50 million Americans are affected by some form of thyroid disorder. Metabolic syndrome (MetS), also affects 50 million Americans, and insulin resistance, one of the components of metabolic syndrome, affects up to 105 million Americans. That’s 35% of the population. Metabolic syndrome has become so common that it’s predicted to eventually bankrupt our healthcare system. Both metabolic syndrome and insulin resistance are risk factors for heart disease and diabetes, two of the leading causes of death in the developed world. With such a high prevalence of both thyroid dysfunction and metabolic syndrome, you might suspect there’s a connection between the two. And you’d be right. Studies show an increased frequency of thyroid disorders in diabetics, and a higher prevalence of obesity and metabolic syndrome in people with thyroid disorders. That’s because healthy thyroid function depends on keeping your blood sugar in a normal range, and keeping your blood sugar in a normal range depends on healthy thyroid function. How high blood sugar affects the thyroid Metabolic syndrome is defined as a group of metabolic risk factors appearing together, including: abdominal obesity; high cholesterol and triglycerides; high blood pressure; insulin resistance; tendency to form blood clots; and, inflammation. Metabolic syndrome is caused by chronic hyperglyc Continue reading >>

Background

Background

Hyperthyroidism is a condition of thyroid hyperfunction and overproduction of thyroid hormones. Autoimmune Graves' disease is the most common cause in young people, especially women, and toxic goitre or toxic adenoma are more common in older individuals. BACKGROUND In 1786 Caleb Perry made the first description of the association between goitre and exophthalmos. In 1835 Graves and in 1840 von Basedow independently described the condition associated with their names. Toxic multinodular goitre (Plummer's disease) was first described in 1913. Graves' disease accounts for nearly 60% of cases of hyperthyroidism, and occurs at a median age which is 20 years younger than patients with adenoma (about 10% of cases), and 10 years younger than multinodular goitre (30% of cases). Adenoma and multinodular goitre have a higher prevalence in iodine-deficient areas than in iodine-sufficient ones[1]. These different groups of patients have different relationship to diabetes. Diabetes is more likely to occur in hyperthyroid patients [2], and glucose intolerance is often present in untreated hyperthyroidism. Autoimmune thyroid disease also frequently occurs within type 1 diabetes (anti-TPO antibodies are present in up to 50% of insulin dependent diabetes mellitus patients) or vice versa, in the Autoimmune Polyendocrine Syndromes[3], due to overlapping HLA associations. Thyroid dysfunction does not cause type 1 diabetes, but patients with Graves' disease are more likely to develop type 1 diabetes, and vice versa. EPIDEMIOLOGY A Japanese study showed that patients on treatment for hyperthyroid Graves’ disease are almost twice as likely to develop type 2 diabetes than members of the general population, are less likely to have been overweight, and are less likely to have a family history of Continue reading >>

Diabetes Control In Thyroid Disease

Diabetes Control In Thyroid Disease

In Brief Thyroid disease is commonly found in most types of diabetes. This article defines the prevalence of thyroid disease in diabetes and elucidates through case studies the assessment, diagnosis, and clinical management of thyroid disease in diabetes. Thyroid disease is a pathological state that can adversely affect diabetes control and has the potential to negatively affect patient outcomes. Thyroid disease is found commonly in most forms of diabetes and is associated with advanced age, particularly in type 2 diabetes and underlying autoimmune disease in type 1 diabetes. This article defines the prevalence of thyroid disease in diabetes, discusses normal physiology and screening recommendations for thyroid disease, and elucidates through case studies the assessment, diagnosis, and clinical management of thyroid disease and its impact on diabetes. Thyroid Disease Prevalence The prevalence of thyroid disease in the general population is estimated to be 6.6%, with hypothyroidism the most common malady.1 Participants attending a health fair in Colorado (n = 25,862) were screened for thyroid disease, using thyroid-stimulating hormone (TSH) and thyroxine (T4) measurements. Of the participants, 9.5% were found to have an elevated TSH level. Also, 6% of study participants were diagnosed with thyroid disease before the screening. However, 40% of those already diagnosed had elevated TSH levels, indicating inadequate treatment. In the undiagnosed population with TSH elevations, 9.9% were found to have an unrecognized thyroid abnormality. Several studies, including the Colorado study, have documented a higher prevalence of thyroid disease in women, with prevalence rates ranging from 4 to 21%, whereas the rate in men ranges from 2.8 to 16%.1 Thyroid disease increases with age. Continue reading >>

The 411 On Diabetes + Thyroid Disease

The 411 On Diabetes + Thyroid Disease

My dad has hypothyroidism, as does my grandmother. For my whole life, my dad has taken a tiny little pill every morning to make sure his metabolism functions properly. I always thought that compared to diabetes, thyroid disease wasn't very "serious" — all my dad needed to do was pop a pill! — and that it was nothing I needed to worry about anyway. But then, because of my diabetes and my "genetic predisposition," my endocrinologist insisted on starting to examine my thyroid regularly... But despite my risk factors, I never knew much about thyroid disease. Now's as good a time as any to learn. January is actually National Thyroid Awareness Month, so for this edition of our 411 series on diabetes complications and co-morbidities, we're taking a look at another body part in distress: the thyroid. What Does It Do Again? The thyroid is a little butterfly-shaped gland that lives in the middle of your neck, and it's part of the body's endocrine system, where diabetes also dwells. This system controls your body's metabolism. One of the thyroid's primary responsibilities is to manage your metabolism by producing two thyroid hormones: T3 and T4. An overactive thyroid can cause weight loss, a quick heartbeat, and other signs that your body is "on the go" a little too much. The opposite, an underactive thyroid, leaves people feeling sluggish, and causes weight gain and slow heartbeat. Essentially, your body's normal equilibrium slows down. Turns out, thyroid issues are incredibly common. They're so widespread, in fact, that Oprah was all on about it a few years ago. Thyroid disease affects 30 million people in the US — and some experts think thyroid disease may affect nearly 56 million Americans. Note that "thyroid disease" is actually an umbrella term for several different co Continue reading >>

Thyroid And Blood Sugar Relationship

Thyroid And Blood Sugar Relationship

Both controlled by the endocrine system, the thyroid gland and your blood sugar levels (controlled by the pancreas) go hand in hand. As such, a problem with one can lead to a problem with the other. If you are suffering from a thyroid problem – or diabetes – then read on to learn more about the relationship between your thyroid and your blood sugar – and how it can affect your health in the long run. The Endocrine System The endocrine system is a group of cells and glands that produce hormones, molecules that regulate the activities of various organs and tissues in the body. Included in this system is the thyroid gland, pituitary gland, adrenal gland, pancreas, testicles, and ovaries. However, only those that will be discussed in detail are the glands relevant to this topic. The Thyroid Gland Located at the front of your neck, the thyroid gland is proof that great things come in small packages. Shaped like a butterfly, this gland controls many vital functions in the body, such as your respiration, heart rate, body temperature, and digestion. If your thyroid is inactive, it is not able to make the hormones that the body needs. This condition is called hypothyroidism. Symptoms include weight gain, cold intolerance, lower heart rate, fatigue, and muscle pain, to name a few. On the other hand, if your thyroid is too active, it will produce more hormones than the body requires. This condition, called hyperthyroidism, is characterized by heat intolerance, sleeping problems, mood swings, weight loss, and faster heart rate, among many others. Pancreas Located behind the stomach’s lower part is the pancreas, a gland responsible for making digestive enzymes as well as insulin, a hormone which regulates the body’s blood sugar levels. Insulin is produced in the islets of Continue reading >>

Hyperthyroidism Induces Glucose Intolerance By Lowering Both Insulin Secretionand Peripheral Insulin Sensitivity.

Hyperthyroidism Induces Glucose Intolerance By Lowering Both Insulin Secretionand Peripheral Insulin Sensitivity.

1. J Med Assoc Thai. 2006 Nov;89 Suppl 5:S133-40. Hyperthyroidism induces glucose intolerance by lowering both insulin secretionand peripheral insulin sensitivity. Roubsanthisuk W(1), Watanakejorn P, Tunlakit M, Sriussadaporn S. (1)Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. OBJECTIVE: The objectives of this study were to examine the effects ofhyperthyroidism on glucose tolerance, insulin secretion, and insulin sensitivity.MATERIAL AND METHOD: Thirty-eight patients with hyperthyroidism and twenty-sixhealthy volunteers with matching age and body mass index were included. Patients with conditions known to affect glucose metabolism were excluded. An oral glucosetolerance test was performed after the diagnosis of hyperthyroidism and againwhen they achieved euthyroid state. Areas under the glucose and insulin curveswere used to assess plasma glucose and insulin responses, respectively. Beta-cellfunction was determined by the corrected insulin response (CIR) and homostaticmodel assessment model 2 (HOMA2-%B). Peripheral insulin sensitivity wasdetermined by the insulin activity (IA) and HOMA2-%S.RESULT: The prevalence of glucose intolerance in hyperthyroid state was 39.4%[impaired glucose tolerance (IGT) 31.5% and diabetes mellitus (DM) 7.9%]. Thiswas significantly higher than that of 30.7% [IGT 19.2% and DM 11.5%] in healthyvolunteers (p < 0.05). Glucose intolerance was associated with higher systolicblood pressure, higher mean arterial pressure, lower CIR, and higher T4 levelsbut not with the levels of T3. IA and HOMA2-%S significantly improved whenachieving a euthyroid state despite the increase in body mass index.CONCLUSION: In conclusion, glucose intolerance is common in hyperthyroidism. Bothimpaired insulin secreti Continue reading >>

Why Can Insulin Resistance Be A Natural Consequence Of Thyroid Dysfunction?

Why Can Insulin Resistance Be A Natural Consequence Of Thyroid Dysfunction?

Journal of Thyroid Research Volume 2011 (2011), Article ID 152850, 9 pages Department of Endocrinology, Dr. César Milstein Hospital, La Rioja 951, C1221ACI, Buenos Aires, Argentina Academic Editor: Masanobu Yamada Copyright © 2011 Gabriela Brenta. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Evidence for a relationship between T4 and T3 and glucose metabolism appeared over 100 years ago when the influence of thyroid hormone excess in the deterioration of glucose metabolism was first noticed. Since then, it has been known that hyperthyroidism is associated with insulin resistance. More recently, hypothyroidism has also been linked to decreased insulin sensitivity. The explanation to this apparent paradox may lie in the differential effects of thyroid hormones at the liver and peripheral tissues level. The purpose of this paper is to explore the effects of thyroid hormones in glucose metabolism and analyze the mechanisms whereby alterations of thyroid hormones lead to insulin resistance. 1. Introduction The effects of T4 and T3 have a large impact on glucose homeostasis. This concept was acknowledged by Nobel Prize winner Dr. Bernardo Alberto Houssay in his lecture in 1947 “The blood sugar and the production and consumption of glucose are kept within normal bounds, therefore there is an equilibrium between the glands of internal secretions which reduce the blood sugar (pancreas) and those which raise it (anterohypophysis, adrenals, thyroid, etc.)”. Thyroid hormones exert both insulin agonistic and antagonistic actions in different organs. However, this occurs in a fine balance necessary Continue reading >>

Thyroid Disorders And Diabetes

Thyroid Disorders And Diabetes

Thyroid disorders are very common in the general U.S. population, affecting up to 27 million Americans, although half that number remains undiagnosed. It is second only to diabetes as the most common condition to affect the endocrine system — a group of glands that secrete hormones that help regulate growth, reproduction, and nutrient use by cells. As a result, it is common for an individual to be affected by both thyroid disease and diabetes. Since the thyroid gland plays a central role in the regulation of metabolism, abnormal thyroid function can have a major impact on the control of diabetes. In addition, untreated thyroid disorder can increase the risk of certain diabetic complications and can aggravate many diabetes symptoms. Luckily, abnormal thyroid function can easily be diagnosed by simple blood tests, and effective treatment is available. For all of these reasons, periodic screening for thyroid disorder should be considered in all people with diabetes. What is the thyroid? The thyroid is a butterfly-shaped gland located in the neck, just below the Adam’s apple and above the collarbone. It produces two hormones, thyroxine (T4) and triiodothyronine (T3), which enter the bloodstream and affect the metabolism of the heart, liver, muscles, and other organs. The thyroid gland operates as part of a feedback mechanism involving the hypothalamus, an area of the brain, and the pituitary gland, which is located within the brain. First, the hypothalamus sends a signal to the pituitary through a hormone called TRH (thyrotropin-releasing hormone). When the pituitary gland receives this signal, it releases TSH (thyroid-stimulating hormone) to the thyroid gland. Upon receiving TSH, the thyroid responds by producing and releasing the two thyroid hormones (T3 and T4). The Continue reading >>

Thyroid Disorders And Diabetes Mellitus

Thyroid Disorders And Diabetes Mellitus

Copyright © 2011 Mirella Hage et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Studies have found that diabetes and thyroid disorders tend to coexist in patients. Both conditions involve a dysfunction of the endocrine system. Thyroid disorders can have a major impact on glucose control, and untreated thyroid disorders affect the management of diabetes in patients. Consequently, a systematic approach to thyroid testing in patients with diabetes is recommended. 1. Introduction Thyroid diseases and diabetes mellitus are the two most common endocrine disorders encountered in clinical practice. Diabetes and thyroid disorders have been shown to mutually influence each other and associations between both conditions have long been reported [1, 2]. On one hand, thyroid hormones contribute to the regulation of carbohydrate metabolism and pancreatic function, and on the other hand, diabetes affects thyroid function tests to variable extents. This paper demonstrates the importance of recognition of this interdependent relationship between thyroid disease and diabetes which in turn will help guide clinicians on the optimal screening and management of these conditions. 2. Frequency of Thyroid Disorders in the General Population and in Patients with Diabetes Thyroid disorders are widely common with variable prevalence among the different populations. Data from the Whickham survey conducted in the late 1970s in the north of England revealed a prevalence of 6.6% of thyroid dysfunction in the adult general population [3]. In the Colorado Thyroid Disease Prevalence study involving 25,862 participants attendin Continue reading >>

Thyroid Disease And Diabetes

Thyroid Disease And Diabetes

CLINICAL DIABETES VOL. 18 NO. 1 Winter 2000 PRACTICAL POINTERS Thyroid Disease and Diabetes By Patricia Wu, MD, FACE, FRCP Thyroid disease is common in the general population, and the prevalence increases with age. The assessment of thyroid function by modern assays is both reliable and inexpensive. Screening for thyroid dysfunction is indicated in certain high-risk groups, such as neonates and the elderly. Hypothyroidism is by far the most common thyroid disorder in the adult population and is more common in older women. It is usually autoimmune in origin, presenting as either primary atrophic hypothyroidism or Hashimoto's thyroiditis. Thyroid failure secondary to radioactive iodine therapy or thyroid surgery is also common. Rarely, pituitary or hypothalamic disorders can result in secondary hypothyroidism. Approximately 4 million people in the United States are hypothyroid and receive thyroxine replacement therapy. By contrast, hyperthyroidism is much less common, with a female-to-male ratio of 9:1. Graves' disease is the most common cause and affects primarily young adults. Toxic multi-nodular goiters tend to affect the older age-groups. Diabetic patients have a higher prevalence of thyroid disorders compared with the normal population (Table 1). Because patients with one organ-specific autoimmune disease are at risk of developing other autoimmune disorders, and thyroid disorders are more common in females, it is not surprising that up to 30% of female type 1 diabetic patients have thyroid disease. The rate of postpartum thyroiditis in diabetic patients is three times that in normal women. A number of reports have also indicated a higher than normal prevalence of thyroid disorders in type 2 diabetic patients, with hypothyroidism being the most common disorder. Table Continue reading >>

How To Interpret Your Lab Results

How To Interpret Your Lab Results

You may log into your patient portal to review all the lab tests we have ordered on you. Your physician will interpret for you these lab results with you at a clinic visit but if you would like more information, then this page provides some general information. Laboratory tests are tools helpful in evaluating the health status of an individual. It is important to realize that laboratory results may be outside of the "normal range" for many reasons. These variations may be due to such things as race, dietetic preference, age, sex, menstrual cycle, degree of physical activity, problems with collection and/or handling of the specimen, non-prescription drugs (aspirin, cold medications, vitamins, etc.), prescription drugs, alcohol intake and a number of non-illness-related factors, Any unusual or abnormal results should be discussed with your physician. It is not possible to diagnose or treat any disease or problem with this blood test alone. It can, however, help you to learn more about your body and detect potential problems in early stages when treatment or changes in personal habits can be most effective. Our lab, like almost all labs, sets the normal result range for a particular test so that 95% of our healthy patients fall within the normal range. That means that 5% of our healthy patients fall outside of the normal range, even when there is nothing wrong with them. Thus an abnormal test does not necessarily mean that there is something wrong with you. Statistically if you have 20 or 30 individual tests run as part of a panel, chances are 1 or 2 will be slightly outside the normal range. Part of what you see your doctor for is to interpret whether or not these changes are meaningful. This review is a brief summary of the most common tests and is not intended to be com Continue reading >>

Hyperthyroidism Symptoms

Hyperthyroidism Symptoms

When you have hyperthyroidism, your body is producing excessive amounts of the thyroid hormones T3 and T4. Since these hormones regulate your metabolism (how your body processes and uses energy), having too high a level will cause symptoms related to a high metabolism. In essence, hyperthyroidism speeds up some of your body's processes. However, not everyone with hyperthyroidism will experience all of the symptoms listed below. These are all the possible symptoms, but symptoms vary based on how long your thyroid gland has been producing too much T3 and T4, how much extra T3 and T4 you have, and your age. Here's what you may experience with hyperthyroidism: Appetite change (decrease or increase) Difficulty sleeping (insomnia) Fatigue Frequent bowel movement—perhaps diarrhea Heart palpitations Heat intolerance Increased sweating Irritability Light menstrual periods—perhaps even missed periods Mental disturbances Muscle weakness Nervousness Problems with fertility Shortness of breath Sudden paralysis Tremor/shakiness Vision changes Weight loss-but perhaps weight gain Dizziness Thinning of hair Itching and hives Possible increase in blood sugar If Graves' disease is the underlying cause of your hyperthyroidism, there are some additional symptoms associated with that. Please read our article on Graves' disease symptoms to learn more about those. Continue reading >>

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