Diabetes mellitus is the most commonly occurring hormonal (endocrine) disorder worldwide and it is followed by thyroid disorders such as hyperthyroidism and hypothyroidism. So is there a link between the two where patients with diabetes have an increased risk of developing hyperthyroidism or hypothyroidism, and vice versa? Does the presence of thyroid diseases affect the outcome of diabetes, and whether it increases the risk of developing long-term complications?
Diabetes is a life-long or chronic condition that occurs when the body can't regulate its blood glucose (sugar) levels. Normal glucose levels are maintained by insulin, which is produced by the ß cells of the pancreas when blood glucose levels are high and drives glucose into cells, and glucagon, which stimulates glucose release from the liver.
Type 1 diabetes occurs when the immune system produces antibodies which attack and destroy the ß cells. Therefore, type 1 diabetes is an auto immune condition which results in decreased insulin production.
Genetic traits, together with certain lifestyle factors, predispose one to develop type 2 diabetes. The way type 2 diabetes develops isn't fully understood, but two essential metabolic abnormalities have been identified. These include insulin resistance, where insulin can't drive glucose into cells, and impaired insulin responsiveness, where insulin levels don't rise in response to high glucose levels.
Thyroid stimulating hormone(TSH) stimulates the thyroid gland to release the thyroid hormones T3 and T4 into the blood stream. These hormones are responsible for regulating the body’s metabolic activities.
Thyroid gland disorders include hyperthyroidism (e.g., Grave’s disease), where T3 and T4 levels are high and TSH levels are reduced, and patients can experience issues such as heart palpitations, hot flushes, tremors, excessive sweating, weight loss and diarrhea. Hypothyroidism(e.g., Hashimoto disease) is characterized with a T3 and T4 deficiency and raised TSH levels. Symptoms here can include feeling cold, lethargy, weight gain, constipation, brittle hair, hoarseness, dry skin and puffiness, difficulty with concentration and mood changes.
Patients with diabetes mellitus are at higher risk of developing thyroiditis
In individuals diagnosed with an auto immune condition, the chances are good that they can develop another auto immune disease. Therefore, patients with type 1 diabetes are more at risk of developing conditions such as Grave's Disease and vice versa. Thyroid disorders are also more common in patients with type 2 diabetes than in the general population.
Hyperthyroidism can worsen diabetes mellitus
Thyroid hormones increase blood glucose levels in the body because they increase the absorption of glucose from the intestines and stimulate the liver to produce glucose. In hyperthyroidism, insulin is metabolized faster which means that insulin medication given to treat diabetes is eliminated from the body sooner than in a person with a normal thyroid. Thyroid hormones also stimulate ß cells, but in the long term this results in cell death which results in worsening of diabetes. Hyperthyroidism also causes increased insulin resistance, but the mechanism of which isn’t fully understood yet.
Hypothyroidism can increase the risk of heart disease in patients with diabetes mellitus
In hypothyroidism, insulin is metabolized at a slower rate and there is reduced secretion of glucose by the liver. This can then lower the insulin needs in a diabetic patient. However, hypothyroidism in diabetes is accompanied by insulin resistance and abnormalities in blood lipid metabolism. This results in triglyceride and LDL cholesterol levels to become elevated which can further increase the risk of developing or worsening cardiovascular diseases in diabetics.
Management of thyroid disorders and diabetes
In patients diagnosed with hyperthyroidism and diabetes, it's very important to correct the excessive presence of thyroid hormones. This is managed by using single or combination therapies of radio-active iodine, carbimazole and surgery.
Hypothyroidism is corrected by using thyroid replacement in the form of levothyroxine. Lipid abnormalities can be followed up and treated accordingly, and the need for adopting a healthy lifestyle by reducing weight, taking regular exercise and avoiding sugars and saturated fats can't be stressed enough.
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