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What Is Thyroid Diabetes?

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 >>

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 >>

Underactive Thyroid May Raise Type 2 Diabetes Risk

Underactive Thyroid May Raise Type 2 Diabetes Risk

underactive thyroid, or hypothyroidism, may be at greater risk for type 2 diabetes -- even if their thyroid hormone levels are kept within normal range, a new study finds. As the Dutch researchers explained, thyroid hormones are essential for the regulation of metabolism -- the conversion of food into either energy or fat. However, an underactive thyroid gland slows metabolism, and that can lead to weight gain, the scientists said. Prior studies suggested that hypothyroidism is tied to reduced insulin sensitivity -- a precursor for type 2 diabetes. In the new eight-year-long study, a team led by Dr. Layal Chaker of Erasmus Medical Center in Rotterdam tracked almost 8,500 people averaging 65 years of age. All of the participants had a blood test to measure their blood sugar levels as well as their thyroid function. They were re-evaluated every few years to check for the onset of type 2 diabetes. The participants' medical records were also reviewed. After nearly eight years, 1,100 of the participants developed prediabetes -- slightly elevated blood sugar levels -- and 798 developed full-blown diabetes. Chaker's team found that low thyroid function boosted the risk for type 2 diabetes by 13 percent. People who had an underactive thyroid and prediabetes were at even greater risk of progressing to type 2 diabetes -- the risk for type 2 diabetes was 40 percent higher for this group. The study could only point to an association between hypothyroidism and diabetes, it couldn't prove cause and effect. However, "these findings suggest we should consider screening people with prediabetes for low thyroid function," Chaker said in a news release from the Endocrine Society. The findings were slated for presentation Sunday at the society's annual meeting, in Boston. "We found it surpr 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 >>

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 >>

Type 1 Diabetes Poses Risk Of Thyroid Disease

Type 1 Diabetes Poses Risk Of Thyroid Disease

HealthDay Reporter FRIDAY, March 15 (HealthDay News) -- People who have type 1 diabetes are more likely than others to develop an autoimmune thyroid condition. Though estimates vary, the rate of thyroid disease -- either under- or overactive thyroid -- may be as high as 30 percent in people with type 1 diabetes, according to Dr. Betul Hatipoglu, an endocrinologist with the Cleveland Clinic in Ohio. And the odds are especially high for women, whether they have diabetes or not, she said, noting that women are eight times more likely than men to develop thyroid disease. "I tell my patients thyroid disease and type 1 diabetes are sister diseases, like branches of a tree," she said. "Each is different, but the root is the same. And, that root is autoimmunity, where the immune system is attacking your own healthy endocrine parts." Hatipoglu also noted that autoimmune diseases often run in families. A grandparent may have had thyroid problems, while an offspring may develop type 1 diabetes. "People who have one autoimmune disease are at risk for another," explained Dr. Lowell Schmeltz, an endocrinologist and assistant professor at the Oakland University-William Beaumont School of Medicine in Royal Oak, Mich. "There's some genetic risk that links these autoimmune conditions, but we don't know what environmental triggers make them activate," he explained, adding that the antibodies from the immune system that destroy the healthy tissue are different in type 1 diabetes than in autoimmune thyroid disease. Hatipoglu said that people with type 1 diabetes are also more prone to celiac disease, another autoimmune condition. Type 1 diabetes occurs when the immune system mistakenly attacks the insulin-producing cells in the pancreas, destroying them. Insulin is a hormone that's necessar 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 >>

Low Thyroid Hormone Raises Risk For Type 2 Diabetes

Low Thyroid Hormone Raises Risk For Type 2 Diabetes

People with prediabetes and low thyroid function were more than twice as likely to progress to full-blown type 2 diabetes compared to those with normal thyroid-hormone levels in a new study1 published September 30 in the journal BMC Medicine. For the study, researchers from the Erasmus Medical Center in the Netherlands followed 8,492 adults, ages 54 to 74, for nearly eight years. At the start, 1,338 had prediabetes and 7,114 had normal blood sugar levels. After 7.9 years, 798 had developed type 2 diabetes. Overall, low thyroid function—even in the low-normal range—increased risk for diabetes by 13%. But among those with prediabetes, the risk for progressing to type 2 diabetes ranged from 15% for those with normal thyroid function to 35% for those with signs of low function. Even “low normal” thyroid functioning increased risk. It’s the first large study to track low and low-normal thyroid function and diabetes risk. “There are no other studies addressing the relation between diabetes and thyroid function in the euthyroid range or in individuals with prediabetes,” the researchers note. Lead study author Layal Chaker, MD2 a Research and Curriculum Fellow at the Harvard T.H. Chan School of Public Health and a research fellow in the Department of Endocrinology and Epidemiology at the Erasmus Medical Center told EndocrineWeb that its too soon to recommend thyroid screening tests for people with prediabetes. And while treating low thyroid can help people with type 2 control their blood sugar, it’s not known whether treatment could prevent or delay it. “Our findings suggest that screening in people with prediabetes could be considered for further research,” Dr. Chaker said. “There are many ways in which low thyroid hormone levels can increase the risk of Continue reading >>

Low Thyroid Function And Type 2 Diabetes

Low Thyroid Function And Type 2 Diabetes

Study finds hypothyroidism tied to type 2 diabetes. Having too little thyroid hormone in the blood–even in the low-normal range–raises the risk of developing type 2 diabetes, especially in people with prediabetes, a new study in nearly 8,500 people finds. Adults in the lowest third of thyroid function levels had a 1.4 time higher risk of progressing from prediabetes to type 2 diabetes than those in the highest third of thyroid function, according to a study presented at the Endocrine Society annual meeting. Dutch researchers used a cohort of adults without diabetes at baseline, ages 45 and older, and found those with higher thyroid-stimulating hormone had a 1.2-fold increased risk of developing diabetes. Patients diagnosed with prediabetes have a 40% greater likelihood of developing diabetes if they are also diagnosed with hypothyroidism. Layal Chaker, MD, of Erasmus Medical Center in Rotterdam, Netherlands, in his presentation, added that, “Low thyroid function is associated with higher risk of developing diabetes, but also the progression from prediabetes to diabetes and this is even within the normal range of thyroid function, “Low thyroid function as represented by higher TSH [thyroid-stimulating hormone] is with a 1.2-fold increased risk of diabetes and a 1.4-fold increased risk for progression from prediabetes.” She added that, over a lifetime, 70% to 75% of people diagnosed with prediabetes will progress to diabetes. Dr. Chaker presented the results at ENDO 2016. Thyroid hormone is important for metabolism, and thus important in controlling weight and cholesterol metabolism. Therefore, Dr Chaker and her team hypothesized that thyroid hormone could also be important in the development of type 2 diabetes. To test their hypothesis, the research team evalua Continue reading >>

Is Your Thyroid Killing You? Diabetes

Is Your Thyroid Killing You? Diabetes

Dana, your blood sugar and cholesterol are very high. Do you have a family history of diabetes and heart disease? Several months later… Dana, your blood sugar and cholesterol are high again. You should start a cholesterol-lowering statin drug and diabetes medication. Let’s wait until your next lab test to decide. 347 million people worldwide have diabetes. The World Health Organization warns that its escalating rates around the world will result in the doubling of diabetes deaths between 2005 and 2030.[1. World Health Organization. World Diabetes Day 2012] Thyroid Disease and Diabetes The frequency of thyroid dysfunction in diabetic patients is higher than that of the general population. The Journal of Thyroid Research published an article in 2011 reviewing the scientific research worldwide on thyroid disorders and diabetes mellitus.[2. Hage, M., Zantout, M.S., Azar, S.T. Review Article: Thyroid Disorders and Diabetes Mellitus. Journal of Thyroid Research Volume 2011 (2011), Article ID 439463, 7 pages] Perros et al. demonstrated an overall prevalence of 13.4% of thyroid diseases in diabetics with the highest prevalence in type 1 female diabetics (31.4%). A prevalence of 12.3% was reported among Greek diabetic patients and 16% of Saudi patients with type 2 diabetes were found to have thyroid dysfunction. In Jordan, a study reported that thyroid dysfunction was present in 12.5% of type 2 diabetic patients. Thyroid disorders remain the most frequent autoimmune disorders associated with type 1 diabetes. Positive TPO antibodies have been reported in as high as 38% of diabetic individuals. Ghawil et al. documented that 23.4% of type 1 diabetic Libyan subjects had positive TPO antibodies and 7% had positive TG antibodies. According to the World Health Organization, 50% of Continue reading >>

The Relationship Between Type 2 Diabetes Mellitus And Related Thyroid Diseases

The Relationship Between Type 2 Diabetes Mellitus And Related Thyroid Diseases

Go to: 1. Introduction The role of hyperthyroidism in diabetes was investigated in 1927, by 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 [2, 3]. 5′ adenosine monophosphate-activated protein kinase (AMPK) is a central target for modulation of insulin sensitivity and feedback of thyroid hormones associated with appetite and energy expenditure [3]. Hypothyroidism (Hashimoto's thyroiditis) or thyroid over activity (Graves' disease) has been investigated to be associated with diabetes mellitus. A meta-analysis reported a frequency of 11% in thyroid dysfunction in the patients of diabetes mellitus [4]. Autoimmunity has been implicated to be the major cause of thyroid-dysfunction associated diabetes mellitus [5–7]. Unmanaged pro diabetes, both type 1 and type 2, may induce a “low T3 state” characterized by low serum total and free T3 levels, increase in reverse T3 (rT3) but near normal serum T4 and TSH concentrations [8]. 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 consump 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 >>

Autoimmune Thyroid Disease And Type 1 Diabetes: What’s The 411?

Autoimmune Thyroid Disease And Type 1 Diabetes: What’s The 411?

Thyroid disease is something we hear more and more about these days, especially among the type 1 diabetes community. You may recall from our recent article on Glu that the thyroid is responsible for stimulating the secretion of hormones by the pituitary gland in the brain. These hormones (called T3 and T4) regulate the bodies’ metabolic rate, and contribute to brain development and cardiac functioning. In one Question of the Day, approximately 40% of you told Glu that you or your loved ones have experienced both thyroid disease and type 1 diabetes. We sat down with G. Todd Alonso, MD, Director of Quality Improvement at the University of Colorado’s Barbara Davis Center in Denver to learn more about this wide-spread health problem. Why is it so common for people with type 1 to also develop thyroid challenges? Autoimmune thyroid disease is a common condition. According to the National Health and Nutrition Examination Survey (NHANES 1999-20021), 3.7% of people suffer from hypothyroidism, most of which is autoimmune, whereas the rate is higher in people with type 1 diabetes (T1D), ranging from 3-8% in children and adolescents2 to 13.4% in adults3. Higher rates are seen in women and as people age. Autoimmune hyperthyroidism is far less common, affecting around one person for every ten with autoimmune hypothyroidism in both the general population and among people with T1D4. It appears that some of the genes which can put people at risk of getting T1D also increase the risk for developing other autoimmune conditions such as thyroid disease, celiac disease, Addison’s disease, lupus, multiple sclerosis, vitiligo, and others. What recommendations do you have for patients diagnosed with both conditions? The American Diabetes Association recommends that all people diagnosed wi 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 >>

Hyperthyroidism And Diabetes

Hyperthyroidism And Diabetes

Hyperthyroidism can make blood glucose control difficult, so proper diagnosis and treatment are important. People with type 1 diabetes are at a high risk for hyperthyroidism, a condition caused by the overproduction of thyroid hormones. This excess of hormones speeds up the metabolism, the rate at which the body uses energy. Hyperthyroidism is usually associated with poor blood glucose control and a need for additional insulin. A increased metabolism “clears” insulin from the system at a faster rate, and an increased production and absorption of glucose can raise blood sugars. All of this can lead to insulin resistance – where cells are unable to respond to insulin in order to use glucose for energy. In extreme cases, this can lead to dangerously high blood sugars and diabetic ketoacidosis. Hyperthyroidism can also aggravate diabetic heart conditions. It can cause a rapid heart rate as well as arrhythmia (an irregular heartbeat). People with type 1 diabetes are particularly vulnerable to developing hyperthyroidism because thyroid disorders often result from problems with the immune system. The most common cause of hyperthyroidism in people under 40 is Graves’ disease, an autoimmune disorder. People with type 2 diabetes can also be affected by hyperthyroidism. However, people with type 2 are more likely to have hypothyroidism, a condition where the body produces too little thyroid hormones and the metabolism is slowed. What is Hyperthyroidism? The source of the problem is the thyroid, a butterfly-shaped gland located in the front of the neck below the larynx or voice box. The thyroid consists of two lobes, one located on either side of the windpipe. The job of the gland is to store hormones and release them into the bloodstream, where they circulate throughout th Continue reading >>

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