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.
Therefore, prior to any changes in the thyroid hormone levels, there is a detectable change in the TSH level, which indicates abnormal thyroid function. A normal TSH level ranges from 0.4 mU/ml to 4.0 mU/ml . A below-normal TSH level indicates hyperthyroidism, and an above-normal TSH level indicates hypothyroidism.
If You Have Prediabetes Should You Be Screened For Thyroid Disease
Larry A. Distiller, FCP, FRCP, FACE, an endocrinologist at the Centre for Diabetes and Endocrinology in South Africa,³ who has studied rates of hypothyroidism in people with type 2 diabetes agrees that theres not enough evidence to suggest thyroid screening for people with prediabetes.
Routine screening for hypothyroidism in those with diabetes or is contentious, Dr. Distiller tells EndocrineWeb. Some guidelines recommend routine screening but most do not. Both hypothyroidism and diabetes are common conditions and common things occur commonly, so it is difficult to assume one leads to the other.
It’s important to heed the fact that theres no evidence that treating hypothyroidism would prevent prediabetes from progressing to type 2 diabetes, he says. So the best plan is to work closely with your health provider to assure that your medical status is well cared for.
1. L Chaker et al, Thyroid function and risk of type 2 diabetes: a population-based prospective cohort study. BMC Medicine201614:150. http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0693-4. Accessed October 11, 2016.
2. Interview with Layal Chaker, MD.
3. Interview with Larry A. Distiller.
Thyroid And Low Blood Sugar
When the term blood sugar comes to mind, we usually think of high blood glucose levels, insulin resistance, and other problems.
While these issues are common and pose a major threat to our wellbeing, it is also important to bear in mind low blood sugar isnt good for your health either.
Hypoglycemia, or low blood sugar, is a potentially dangerous condition indicated by insufficient glucose amounts for production of energy in the bodys cells.
Main causes of low blood sugar are certain medications, tumors, endocrine disorders, and some medical conditions.
Studies reveal that hypothyroidism is associated with different hormonal, biochemical, and nervous system abnormalities which have the potential to contribute to hypoglycemia.
For example, hypothyroidism is related to low growth hormone and cortisol responses to insulin-induced hypoglycemia, thus blocking the proper counter regulatory protection.
When blood sugar levels decrease, the adrenal glands address this issue by secreting hormone cortisol. Then, the hormone sends a signal which tells the liver to produce higher amounts of blood sugar, thus bringing the levels of glucose to normal.
The problem occurs when the repeated release of cortisol in patients with hypoglycemia suppresses pituitary function. The thyroid gland cant operate properly without adequate pituitary functioning.
Evidence suggests that dysfunction of pituitary could be a direct consequence of hypothyroidism, rather than a cause of thyroid dysfunction.
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Thyroid Medications For Treatment
Importantly, this is a lifelong condition. But medication can reduce or even wipe away symptoms.
Autoimmune thyroid diseases, like Hashimotos disease, are usually much easier to manage than diabetes. The hormone replacement treatment comes in pill form, so taking the medication is easy. But some patients have difficulty finding the right type of thyroid replacement pill.
The most commonly prescribed medication to treat hypothyroidism is levothyroxine . This medication is a synthetic version of the T4 hormone that copies the action of the thyroid hormone your body would normally produce.
The most common treatment for hyperthyroidism involves medications such as methimazole that stop the thyroid from making hormones.
Given that my thryoid was underactive, I was prescribed levothyroxine. This is usually a daily pill, but it can also be dosed differently depending on what your doctor advises according to your specific needs.
Its important to know that the meds can take 6 to 8 weeks to build up in the system and start working. In my case, that meant getting a baseline thyroid lab test before I started taking any medications and then following it up a couple months later to determine whether that dosage was accurate. Thankfully it was, and my fatigue, dry skin, and other symptoms began to melt away.
Are Type 2 Diabetes And Thyroid Disease Connected
As far as we know, there is no direct link between 2 diabetes and thyroid disease. The reason why many live with both thyroid disease and type 2 diabetes is that they are the most common endocrine diseases in the United States, according to R. Mack Harrell, MD, medical imaging director at the Memorial Center for Integrative Endocrine Surgery and past president of the American Association of Clinical Endocrinologists.
However, because factors like weight gain can contribute to the development of type 2 diabetes, there may be indirect links between thyroid disease and type 2 diabetes. If you gain weight due to hypothyroidism, that may put you at risk for type 2 diabetes.
Some studies have shown that people with pre-diabetes are 40 percent more likely to develop type 2 diabetes if they have untreated hypothyroidism.
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How Your Blood Sugar Is Affecting Your Thyroid
Its not uncommon for someone to have both diabetes and a thyroid disease. In fact, having diabetes or metabolic syndrome, increases your risk of developing a thyroid diseaseand vice versa .
Up to 20 million Americans have a thyroid condition, and the go-to remedy is prescription medication or synthetic hormone replacement that must be maintained for life. Scientists, doctors, and researchers have recently connected the dots between thyroid conditions and low blood sugar. In this article, we share the relationship between thyroid and blood sugar levels, how your blood sugar affects your thyroid and natural ways to support healthy blood sugar levels and thyroid function.
How Are Hyperthyroidism And Diabetes Connected
Several studies have found an increased prevalence of thyroid disorders in patients with diabetes and vice versa. In addition, research shows that hyperthyroidism is closely linked with hyperglycemia² .
Metabolism
Thyroid disease is characterized by a change in thyroid hormone levels that affects your metabolism. The changes in your metabolism can cause glucose that the body would usually use to become excessive.
You are also at a greater risk of developing a condition known as metabolic syndrome if you:
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Have a family history of metabolic syndrome
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Are physically inactive
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Have insulin resistance
Metabolic syndrome is a cluster of abnormalities marked by hypertension, abnormal glucose levels or insulin resistance, and dyslipidemia, a condition characterized by abnormally elevated cholesterol or fats in the blood. Metabolic syndrome increases your risk of heart disease, nonalcoholic fatty liver disease, and type 2 diabetes.
Production of insulin
Thyroid disease also interferes with the production of insulin, which enables the cells in your body to use glucose for energy, and helps to control blood sugar levels. Several studies have shown that increased thyroid hormone levels speed up the elimination of insulin³, thus putting patients at further risk of higher than normal blood sugar levels and even type 2 diabetes or prediabetes.
HPT axis
HPA axis
High cortisol levels caused by issues with the HPA axis are associated with hyperglycemia and decreased thyroid hormone levels.
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Lets Take A Look At The Important Role Of Balanced Blood Sugar Levels And Your Low Thyroid Symptoms
Proper Blood Sugar levels are critical for anyone with low thyroid function. Normal blood glucose levels medically have a broad range of anywhere from 70 to 105. Functional or optimal blood glucose levels are 85 to 99. According to the American Diabetic Association, a blood sugar level reading of 106 to 126 is called, Insulin resistance, and anything above 127 is diabetes.
I know you may be thinking, I dont have diabetes. Here is the thing, you dont have to be diabetic to have blood sugar problems. Your body does not like to have the range for blood sugar too high or too low. Anytime the range gets out of the normal functional range , you start to get inflammatory chemicals released in the body. These inflammatory chemicals are called cytokines and they are not a good thing. The events that are triggered by inflammatory cytokines are like a domino effect that is difficult to stop and can lead to autoimmune conditions!
Here is a scary example of how the traditional model can go wrong. One of my patients, Carol, came in for me to take a look at her health challenges. During the exam I noticed several indicators pointing towards blood sugar problems, such as difficulty with memory , belly fat issues and being overweight. This gal already knew she was headed towards diabetes based on tests she had from her medical practitioner.
What Are The Risk Factors For Hyperthyroidism And Diabetes
There are many risk factors associated with hyperthyroidism in the general population. The risk factors for thyroid disease among people with diabetes¹¹ are similar to many of these.
Like in nondiabetics, an enlarged thyroid gland, known as a goiter, is recognized as a risk factor for thyroid disease in diabetic patients. The duration of the diabetic condition has also been found to increase the risk of developing thyroid autoimmune diseases in children and adolescents with type 1 diabetes.
Your risks are also higher if you:
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Eat large amounts of food containing iodine
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Were pregnant within the past six months
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Your Thyroid And What It Does
Your thyroid is a hormone-producing gland that regulates the bodys metabolism. Its located in the lower front of your neck.
Your thyroid plays a critical role in regulating a tremendous number of things in your body, including your weight, energy, blood pressure, heart rate, mood, menstrual cycles, sex-drive, and even your memory.
Should You Get Tested For Diabetes If You Have An Overactive Thyroid
Research shows that thyroid disorders and diabetes mutually influence each other, and the association between the two conditions has long been recognized. Both diabetes and thyroid disorders involve a dysfunction of the endocrine system, and thyroid hormones greatly influence the metabolism, which can significantly impact the control of blood sugar levels.
Studies have shown that diabetes and thyroid disorders tend to coexist in patients. With the close relationship between the two conditions, you should also get tested for diabetes if you have an overactive thyroid.
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Screening Of Td In Pregnant Patients With Dm
The screening of TD and PPTD is recommended in pregnant women with T1D or other autoimmune disorders by the ATA/American Association of Clinical Endocrinologists , the Endocrine Society , the British Thyroid Association , and the American Diabetes Association . The ATA/ACE and the Endocrine Society also recommend the screening of TD in women with morbid obesity , TPO positivity, family or personal history of TD, and age > 30 years, before and after pregnancy . TSH and TPO Abs should be evaluated in women with T1D planning pregnancy or at the beginning of pregnancy. When thyroid function is normal, the screening should be repeated in the first trimester. In case of positive TPO Abs and normal serum TSH during pregnancy, it is essential to recheck thyroid function at 3, 6, and 12 months after delivery. Screening for postpartum thyroiditis is recommended in patients with T1D at 3 and 6 months postpartum .
Regulation Of Glucose Metabolism In The Skeletal Muscle And Adipose Tissue
T3 upregulates the expression of genes involved in glucose transport and glycolisis in peripheral tissues . In the skeletal muscle, T3 modulates mRNA and protein expression of GLUT4, adenosine monophosphateactivated protein kinase, and acetyl coenzyme A carboxylase . Therefore, T3 increases basal and insulin-stimulated glucose transport in this tissue . The transcriptional regulation of the sarcoplasmic endoplasmic reticulum and other important proteins can explain the TH-induced shift to faster contractile function in the muscle and the concomitant increase in both glycolytic and oxidative capacities . T3 can also act by a nongenomic mechanism because it is able to induce within 30 minutes an increase in insulin-dependent GLUT4-mediated glucose uptake, without interfering with other transporters such as GLUT1 and GLUT3 . Adipose tissue can modulate insulin sensitivity of skeletal muscle by the release of adipokines and, alternatively, the skeletal muscle can affect adipose tissue by the production of several myokines . Interestingly, both hypothyroidism and hyperthyroidism can interfere with the normal adipocytemyocyte crosstalk, thus contributing to the insulin resistance . Another T3 target in the skeletal muscle is mitochondrial uncoupling protein 3 this effect explains the increased energy expenditure induced by TH excess .
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Examining The Impact Of Hypothyroidism And Diabetes
There are many ways in which low thyroid hormone levels can increase the risk of diabetes, he says. First of all, thyroid hormones are crucial for our bodys metabolism and energy expenditure. Low thyroid hormone levels are associated with higher Body Mass Index, which in turn is a risk factor for diabetes.
But there seems to be a deeper connection. When we account for in our analyses we still see an association of thyroid hormone levels with the risk of diabetes, especially in individuals with glucose levels within the prediabetic range, he says. Thyroid hormone is also directly involved in the control of insulin secretion and glucose homeostasis. Hypothyroidism is associated with decreased insulin sensitivity and glucose tolerance and treatment of hypothyroidism has shown to improve these effects. The exact mechanism or mechanisms that are involved in the association need to be investigated.
Participants in the study are all part of the large, on-going Rotterdam Study tracking the development of age-related diseases in residents of Ommoord, a large neighborhood in the Dutch city of Rotterdam. Volunteers thyroid status had already been checked by measuring levels of thyroid stimulating hormone and thyroxine . Elevated TSH and reduced T4 indicate low thyroid function.
Symptoms Of High Blood Sugar Level
Hyperglycemia, often known as high blood sugar, can be brought on by various factors, such as being ill, being under stress, eating more than you intended, and not taking enough insulin.
A persons pancreas secretes more insulin when blood sugar levels are too high. Their pancreas releases glucagon to increase blood sugar levels when they fall. This equilibrium aids in giving the cells enough energy while avoiding damage that persistently elevated blood sugar levels could bring.
Long-term, major health issues might develop from elevated blood sugar over time. High blood sugar symptoms include:
- Incredibly fatigued
- Having visual problems
- A higher need to urinate
Managing your blood sugar can be challenging if you become sick. Your ability to eat and drink may be limited, impacting your blood sugar levels. Use an over-the-counter ketone test kit to screen your urine for ketones if youre sick and your blood sugar is 240 mg/dL or above.
If your ketones are high, call your doctor. High ketones may be a precursor to diabetic ketoacidosis, a medical emergency that requires prompt treatment.
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What Is The Best Exercise For Hypothyroid
It can include walking, hiking, running, swimming, or working out in a gym. A program of low impact aerobics exercise and strength training is probably the best type of exercise for hypothyroidism, explains Dr. Akhunji. Low impact aerobics can increase heart rate without putting too much exertion on your joints.
Effects Of Hypothalamic Pituitary Thyroid Axis On Appetite Regulation
The brain-derived neurotrophic factor is highly expressed in the VMN. The central infusion of BDNF reduces food intake and induces weight loss in rats . The VMN receives NPY/AgRP, and POMC neuronal projections from the ARC and POMC neurons from the ARC play a role in activating BDNF neurons in the VMN to decrease the food intake . The TRH, secreted from the hypothalamus, has direct anorectic effects and can regulate food intake independent of effects on the HPT axis. In rodents, central and peripheral administration of TRH reduces food intake . TSH has also been shown to reduce food intake when injected centrally into rats and could be involved with the seasonal alterations in food intake and body weight that occur in some species . T3 in the brain is crucial for the feedback regulation of TSH secretion. T3 directly stimulates food intake at the level of the hypothalamus, independently of changes in energy expenditure. In rodent models, peripheral and central hypothalamic administration of T3 increases food intake . In fact, T3 can directly cross the bloodbrain barrier, and the central administration of T3 activates the mTOR signaling pathway and is associated with increased expression of AgRP and NPY, as well as decreased POMC expression in hypothalamic ARC . Direct administration of T3 into the VMN increases food intake in rats . The effects of T3 in the VMN may be mediated by glutamatergic neurons that modulate ARC POMC neurons and/or BDNF neurons .
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How To Treat Thyroid Disease
If your test comes back out of range, youll need to discuss treatment options with your doctor The good news is that thyroid disease is fairly straightforward to treat.
If youre diagnosed with hypothyroidism, youll most likely be given a daily pill such as Thyroxine or Synthroid which contains synthetic human thyroid hormone. Your doctor might have to adjust the dose a few times until your thyroid hormone levels are back in range. For most people, its a chronic condition so you might need dose adjustment several times over the years.
If youre experiencing uncomfortable symptoms, that may be a sign that your thyroid medication dosages need an adjustment with help from your medical team.
Treatment of hyperthyroidism is a little more complex and may include medication, radiation therapy, surgery, or a combination of these. In some cases, hyperthyroidism resolves on its own.
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