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Thyroid Disease And Diabetes Symptoms Tests And Treatment Options
Thyroid disease and diabetes often go hand in hand, and its something you should keep an eye on since thyroid disease can significantly impact your diabetes and your overall wellbeing.
According to the American Thyroid Association , more than 12 percent of the U.S. population will develop a thyroid condition during their lifetime. Although its a common disease and easy to test for, the symptoms and test results can be easily overlooked or mistaken for other conditions. This can make an accurate diagnosis challenging.
Since many people living with diabetes have thyroid issues, this article will explore the connection between thyroid and diabetes: what is thyroid disease, what are the symptoms, how to have your thyroid tested, how will it impact your diabetes, and how thyroid disease is treated.
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Effects Of Hypothyroidism On Blood Sugar Levels
Thyroid problems are present in 6.6% of the general population, with hypothyroidism accounting for most of the cases.
Unfortunately, this condition often coexists with type 1 and 2 DM. In fact, low thyroid function, as is the case in hypothyroidism, was pegged by Chaker et al as a risk factor in the development of DM, especially in people suffering from pre-diabetes.
In a 2014 study, Kalra stated that hypothyroidism leads to the development of hypoglycemia due to the numerous abnormalities that come with the former. These include: · Low cortisol and growth hormone responses which prolong recovery from hypoglycemia· Impairment in the processes of gluconeogenesis, or the creation of glucose, and glycogenolysis, or the breakdown of glycogen to glucose. · Adrenal insufficiency which worsens hypoglycemia · Reduced glucagon secretion and impaired glucagon effect on hepatocytes, resulting in slower insulin clearance · Slow gastric emptying which delays glucose absorption in the intestines
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Effects Of Hyperthyroidism On Blood Sugar Levels
Hyperthyroidism is the polar opposite of hypothyroidism as such, its effects on blood sugar is reversed as well.
In this thyroid disorder, hyperglycemia or high blood sugar develops, as stated in the study of Hage et al. This condition occurs because of the following mechanisms:· Reduction of insulin half-life, due to degradation and release of insulin precursors· Increase in the levels of proinsulin, or the building block of insulin · Defective proinsulin processing as evidenced by a reduction in the C-peptide to proinsulin ratio · Increase in glucose absorption due to increased levels of thyroid hormones · Increase in GLUT2 levels which result to faulty glucose metabolism · Increase in FFA that leads to fat breakdown and the creation of glucose from non-carbohydrate substrates · Overproduction of lactate that also enhances gluconeogenesis Because of these, diabetics with hyperthyroidism often fail to control their sugar levels. In effect, long-term or chronic hyperglycemia can lead to many complications, including sexual dysfunction, foot ulcers, cardiovascular, and cerebrovascular diseases.
Similarly, thyrotoxicosis or excessive thyroid hormone in the body oftentimes leads to the development of diabetic ketoacidosis, or an increase in ketone levels due to bodys failure to produce the insulin that it needs.
Unanswered Questions And Future Needs
More studies are needed to better understand the possible role of TD in the development and progression of DM and vice versa. In the future, the use of more sensitive peripheral markers of thyroid function may help clinicians to identify and personalize the treatment of TD in patients with diabetes, particularly in those in which these disorders are difficult to manage.
Large prospective studies are necessary to clarify the adverse effects of TD and DM when associated. Randomized controlled trials could verify whether the treatment of thyroid disorders can counteract the expected risks. Futures studies assessing TD in the early stage and performing an adequate treatment of TD in patients with DM could help understand the prognosis of these associated disorders when appropriately treated.
The discovery of TH analogs to improve metabolic control may help clinicians improve the cardiovascular risk factors associated with DM, MetS, and TH deficiency.
Future studies could clarify the potential role of metformin to improve TSH suppression therapy with L-T4 in patients with differentiated thyroid cancer and the prognosis of medullary thyroid cancer.
Finally, specific guidelines are necessary to recommend a systematic approach for the correct diagnosis and treatment of TD in patients with T1D and T2D.
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Hypothyroidism And Hashimotos Disease
A lot of the symptoms for hypothyroidism can be seen as the opposite of those of hyperthyroidism. This is because hypothyroidism is an underactive thyroid, often caused by Hashimotos disease.
This causes the immune system to attack the thyroid, reducing its ability to create hormones.
This slows down a lot of the metabolic processes in the body due to producing a low amount of thyroxine and triiodothyronine.
Symptoms of hypothyroidism include:
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 Poor Thyroid Function Affects Blood Sugar
Flip the situation around, and low thyroid function can cause dysglycemia and metabolic syndrome. It does this a couple of ways:
- Slows the rate of glucose uptake by cells
- Slows the clearance of insulin from the blood
- Slows response of insulin to elevated blood sugar
These mechanisms are associated with hypoglycemia, and when someone is hypoglycemic, their cells arent sensitive to glucose.
Cortisol Blood Sugar & Thyroid Function
The connection between your thyroid and blood sugar goes even deeper than what we’ve discussed so far.
Going deeper, we also see a connection between thyroid function, stress, and blood sugar.
Before we talk about this, let’s do a quick recap of what we’ve already discussed:
So far we know that both hypothyroid and hyperthyroid states can lead to high blood sugar.
We also know that medications which impact thyroid hormone levels can also impact blood sugar.
Thyroid medications such as levothyroxine or Cytomel must be dosed correctly if you want to have normal blood sugar.
Antithyroid medications like methimazole can also result in insulin resistance and high blood sugar due to their impact on thyroid function.
Any medication which impacts your thyroid will have an impact on your blood sugar. Period.
The degree of that impact will depend on the dose and therapeutic strength of the medication you are taking.
But there’s another factor that can impact blood sugar in hypothyroid patients as well.
And that is cortisol.
We know that there is a strong connection between thyroid function and cortisol levels.
Physiologic studies have shown that as cortisol rises it also tends to bring up TSH levels .
For those who may not understand the TSH lab test, a rising TSH is an indication of low thyroid function or hypothyroidism.
In other words, high cortisol causes low thyroid function.
So now we have a system that looks like this:
And it doesn’t stop there.
The bottom line?
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Management Of Thyroid Diseases And Diabetes
One consideration for the prevention and management of thyroid disease and diabetes is weight management.
It is best to maintain close control over the bodys thyroid and glucose levels to help prevent diabetes among people with thyroid disease.
There are specific tools and methods to monitor the thyroid hormone and glucose levels in the body.
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Prognosis Of Patients With T2d And Associated Td: Long
DM is associated with increased morbidity and mortality. Patients with DM have an increased risk of heart disease, stroke, heart failure, kidney disease, blindness, amputations, and neuropathy . DM caused 1.5 million deaths in 2012, with an excess relative risk of mortality, ranging from 1.15 to 3.15, mainly attributable to cardiovascular causes .
Epidemiological studies have shown an increased cardiovascular risk in patients with subclinical and overt hypothyroidism . Insulin resistance, diastolic hypertension, increased systemic vascular resistance, increased arterial stiffness, endothelial dysfunction, and altered coagulability represent the main risk factors responsible for the increased cardiovascular mortality associated with TH deficiency . Individual participant data meta-analyses reported that SHypo was associated with an increased risk for coronary heart disease events and mortality and heart failure , especially in patients with serum TSH > 10 mU/L.
There are conflicting results on cardiovascular mortality in patients with diabetes and TH deficiency . Patients with diabetes have up to a sixfold higher risk of future CHD events compared with nondiabetic individuals . The coexistence of both T2D and thyroid diseases could further increase the risk of CHD .
Impact Of Obesity Insulin Resistance And Other Risk Factors For Mets In Patients With Clinical And Shypo
Obesity
Obesity can induce insulin resistance and diabetes because the adipose tissue is an active endocrine tissue it releases free fatty acids, leptin, adiponectin, resistin, and other products that play an important major role in glucose and lipid metabolism . An early marker for the risk of diabetes is the increased accumulation of lipid within nonadipose tissue, including the skeletal muscle and liver. Inflammation within the adipose tissue, particularly related to obesity and high fat consumption, may contribute to systemic insulin resistance .
In vivo, the administration of recombinant human TSH at supraphysiological doses can induce the release of small, but significant amounts of leptin, which are proportional to the adipose mass . Leptin can also regulate D2, activating the conversion of T4 to T3 .
Insulin resistance
Lipids, blood pressure, and nonalcoholic fatty liver disease
Two meta-analyses found that systolic and diastolic blood pressure were higher in the group with SHypo than in euthyroid controls.
One of the mechanisms that links the MetS with hepatic steatosis is the insulin stimulation of lipogenesis, which can lead to fatty liver and worsen insulin resistance . Longitudinal studies support the association of nonalcoholic fatty liver disease with either T2D or MetS. Moreover, SHypo and high serum TSH levels were associated with nonalcoholic fatty liver disease .
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Low Blood Sugar Impacts Thyroid Function
Just as high blood sugar can weaken thyroid function, chronically low blood sugar can also cause problems.
Your body is genetically programmed to recognize low blood sugar as a threat to survival.
When your blood sugar levels drop below normal, your adrenal glands respond by secreting cortisol .
Cortisol then tells the liver to produce more glucose, bringing blood sugar levels back to normal.
The problem is that cortisol is also a sympathetic nervous system hormone involved in the flight or fight response.
Unfortunately for hypoglycemics, repeated cortisol release caused by episodes of low blood sugar suppresses pituitary function.
Without proper pituitary function, your thyroid cant function properly.
So high blood glucose and low blood glucose can both impact thyroid function.
Together, hyperglycemia and hypoglycemia are referred to as dysglycemia.
Dysglycemia weakens and inflames the gut, lungs and brain, imbalances hormone levels, exhausts the adrenal glands, disrupts detoxification pathways, and impairs overall metabolism.
Each of these effects significantly weakens thyroid function and as long as you have dysglycemia , whatever you do to fix your thyroid isnt going to work.
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.
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Blood Sugar Stress Hormones Connections
So what is the connection between blood sugar and stress hormones and your thyroid. Well, blood sugar levels have a profound impact on your stress hormones and stress hormones have a very strong impact on your thyroid.
Now specifically when one ingests too much carbohydrates this may be a bowl of cereal, and a glass of orange juice and maybe a banana for breakfast for example. Which is way too much carbohydrate for someone to ingest in a meal.
This will cause blood sugar levels to go high, as you see in this graph. This high blood sugar will give some people a little big of jolt of energy, known as a sugar rush, will also cause the body to release high amounts of insulin. This insulin is strongly implicated in weight gain, in insulin resistance and in diabetes. Now because the body is not ideally suited to deal with high levels of carbohydrate intake the body can over react and push your blood sugar too low, as you can see here with this lull on this graph. That is known as reactive hypoglycemia, this is where your blood sugar go to low. When that happens, this is what many people will recognize as the afternoon energy dip/sweet craving. So when blood sugar gets low people tend to become fatigued and crave sweets. So this is why many people reach for caffeine, caffeine and sugar, sugar, some sort of stimulate to help bring up their low blood sugar.
This is Dr. Ruscio and I hope you find this information helpful. Thanks.
Links & Resources
Home Thyroid Testing With Lets Get Checked
Ive used the Lets Get Checked home tests to test my thyroid levels and can testify to how convenient it is.
I ordered the test online at LetsGetChecked.com. When it arrived at my home, I created an online account and activated the test before collecting the blood sample myself . I then dropped off the return package at UPS.
Once the lab had done the analysis, I received a call from a nurse from Lets Get Checked who discussed the results with me before the results were released to my online dashboard. Generally, youll receive the results after only 2-5 business days. Had the test showed any sort of thyroid issues, the nurse would have discussed treatment options.
You can see the entire home test process in this video:
The major upside to doing the test at home is that I dont have to drive to see my doctor, hang out in the waiting room, or pay a co-pay to see my doctor and a co-pay to get the test done.
A thyroid test through Lets Get Checked is $99 and a full thyroid antibody test is $149, so whether thats worth it for you will depend on how much you pay to see your doctor, how much you pay to get blood work done, and how far you have to go to see your doctor.
Lets Get Checked use the same labs that our doctors or hospitals would use, so the quality of the tests is similar. All of their tests are FDA approved and they have a team of board-certified physicians who review your medical information and test results.
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