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Diabetes & Thyroid: The endocrine connection

By Apollo 24/7, Published on- 22 December 2020

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The thyroid is a butterfly-shaped gland present in the front of the neck, just below the Adam’s apple. It plays an important role in hormone regulation, body metabolism and ensuring proper growth and development. Thyroid dysfunction occurs when the thyroid gland produces either too much thyroid hormone, resulting in hyperthyroidism or too less thyroid hormone, resulting in hypothyroidism.
It has been estimated that globally around 200 million people suffer from some form of thyroid disorder. However, various studies reveal that the risk of developing thyroid disease is higher in people with diabetes as both are endocrine diseases (hormone-related disorders).

Is there a connection between diabetes and thyroid disease?

Several studies conducted in past have found that diabetes and thyroid disease co-exist in many patients. In a recent study published in the journal BMC Medicine, it was concluded that people with prediabetes and thyroid disease are at increased risk of developing full-blown type 2 diabetes. In this study, the scientists examined 8492 adults for 8 years. At the end of the study, 798 participants with prediabetes and low thyroid function developed type 2 diabetes. The risk of developing diabetes was 15% for those with normal thyroid function and 35% for those with low thyroid function.
According to a study published in the Journal of Diabetes Research, scientists found that both hypothyroidism and hyperthyroidism can result in insulin resistance in the body, ultimately leading to diabetes. The study revealed, in the state of thyrotoxicosis (excess thyroid hormone release), there is a hike in the levels of hepatic glucose (sugar levels in the liver) along with increased glycogenolysis (the breakdown of glycogen into glucose) activity. This translates to a higher risk of developing type 2 diabetes.

How does thyroid hormone affect glucose levels in the body?

It has been determined that thyroid hormones affect glucose metabolism in several ways.
  • Research shows that thyroid hormones oppose the action of insulin in the body and promotes glycogenolysis and hepatic gluconeogenesis (the formation of glucose in the liver).
  • Studies have concluded that hyperthyroidism can result in increased blood sugar levels in the body as it reduces the half-life of insulin (the point where only half of the actual insulin stays in the blood) and promotes the release of inactive precursors of insulin.
  • It was further found that untreated Graves' disease (a form of hyperthyroidism) results in the increase of proinsulin, which indicates the state of hypoglycemia (low blood sugar levels).
  • It has been reported that undiagnosed hyperthyroidism can result in a low C-peptide to proinsulin ratio, which suggests a defect in the production of insulin in the body.
  • Hypothyroidism increases insulin resistance in the body, thus increasing the risk of diabetes.

What are the signs of thyroid disease?

There are two different types of thyroid disease, thus they present a different set of symptoms. The symptoms of hyperthyroidism include:
  • Weight loss despite having a normal appetite
  • Increased body metabolism
  • Heat intolerance
  • Increased heart and pulse rate
  • Increased sweating
  • Weakness in the muscles
  • Shortness of breath while doing any strenuous work
  • Disturbed menstrual cycle
  • Diarrhoea
  • Inability to concentrate
The symptoms of hypothyroidism include:
  • Sudden weight gain
  • Reduced body metabolism
  • Cold intolerance
  • Slow pulse rate
  • Low blood pressure
  • Fatigue
  • Constipation

How can a person with diabetes deal with thyroid disease? 

A diabetic person diagnosed with thyroid disease needs to keep certain things in mind, which include:
  • The blood sugar levels must be under control. They must be checked every day using a glucometer at home.
  • Thyroid medications must be consumed as directed by the doctor, as missing doses or taking the medication at different times would prevent it from working.
  • Thyroid medications must be taken on an empty stomach as consumption of food along with the medicine can reduce its absorption in the body. Fibrous foods such as bran cereals, whole grains, fruits and beans must be consumed hours after consuming the thyroid medication.
  • Consumption of calcium, iron or iodine supplements along with thyroid medication should only be done after consulting a doctor as it can reduce or block the absorption of thyroid medicine.
  • Moderate forms of exercise such as jogging, swimming or riding a bicycle must be practices, as it would help in utilising the sugar in the blood and would also help in shedding the extra weight gained due to thyroid disease.
Additionally, it is important that people on insulin take note of the following:
In hyperthyroidism, the metabolism gets accelerated, causing insulin to get absorbed at a much faster rate. Hence, people with diabetes and hyperthyroidism can sometimes experience extremely high blood sugar levels despite taking medications on time. The insulin dose for such people must be increased accordingly, after consulting the physician.
In hypothyroidism, the metabolism slows down, and the insulin stays in the body for a longer period of time, making people with diabetes and hypothyroidism prone to hypoglycemic shocks (dangerously low levels of blood sugar). Hence, insulin dose must be reduced accordingly, or as recommended by the physician.

Takeaway

Thyroid hormones have a major role in the circulation of insulin, and the absorption of glucose in the intestines and muscles. It is also essential in the production of counter-regulatory hormones such as glucagon, adrenaline and cortisol, during hypoglycemia (low blood sugar levels).
Diabetes and thyroid disorders often tend to co-exist in patients. Thyroid disorders can have a significant impact on blood sugar control, and untreated thyroid problems can adversely affect people who have diabetes.
Consult with an expert endocrinologist, who will guide you to keep both problems in check and empower you to live a healthy life.

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