Thyroid Management With Diabetes
Thyroid disorder and diabetes
People with diabetes have an increased risk of developing thyroid disorder. In the general population, approximately 6% of people have some form of thyroid disorder. However, the prevalence of thyroid disorder increases to over 10% in people with diabetes.
Since people with one form of autoimmune disorder have an increased chance of developing other autoimmune disorders, people with Type 1 diabetes have a higher risk of autoimmune thyroid disorder. Up to 30% of women with Type 1 diabetes have some form of autoimmune thyroid disease. Postpartum thyroiditis, a form of autoimmune thyroid disease that causes thyroid dysfunction within a few months after delivery of a child, is three times more common in women with diabetes.
Although Type 2 diabetes is not an autoimmune disorder, there have been many reports showing a higher occurrence of thyroid diseases, particularly hypothyroidism, among people with Type 2 diabetes. The association between Type 2 diabetes and thyroid disorder, however, remains unexplained.
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.
Effect on diabetes control
Since normal thyroid function is essential to regulate energy metabolism, abnormal thyroid function may have profound effects on blood glucose control in diabetes. Both hyperthyroidism and hypothyroidism can affect the course of diabetes, but their effects are somewhat different.
Hyperthyroidism. Hyperthyroidism is typically associated with worsening blood glucose control and increased requirements. The excessive thyroid hormone causes increased glucose production in the liver, rapid absorption of glucose through the intestines, and increased resistance (a condition in which the body does not use efficiently). It may be important to consider underlying thyroid disorder if a person has unexplained weight loss, deterioration in blood glucose control, or increased requirements. Sometimes hyperthyroidism may even unmask latent diabetes.
Having diabetes increases a person’s risk for heart disease, and many people with diabetes have a heart condition such as coronary heart disease or heart failure. Since hyperthyroidism causes rapid heart rate and increases the risk of abnormal heart rhythm, it may also bring on angina (chest pain), worsen heart failure or interfere with the treatment of heart failure, as well as further increase the risk of other heart problems.
Hypothyroidism. Hypothyroidism rarely causes significant changes in blood glucose control, although it can reduce the clearance of from the bloodstream, so the dose of lin may be reduced. More important, hypothyroidism is accompanied by a variety of abnormalities in blood lipid levels. This includes increased total cholesterol and LDL (low-density lipoprotein or “bad”) cholesterol levels and increased triglyceride levels. The abnormal lipid pattern typical of Type 2 diabetes (low HDL, or “good” cholesterol; high triglycerides; and a high proportion of small, dense LDL particles) is usually worsened by hypothyroidism. These changes further raise the already high risk of cardiovascular diseases such as heart disease and stroke among people with diabetes.
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Thyroid Management With Diabetes