THYROID DISORDER AND DIABETES: WHAT I NEED TO KNOW

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WHAT IS THYROID?

The thyroid is a gland in front of the neck that makes thyroid hormones, hormones that control the way the body uses energy.
These hormones affect nearly every organ in your body and control many of your body's most important functions. For example, they affect your breathing, heart rate, weight, digestion, and mood. The thyroid gland is like a butterfly shape, relatively smaller in size. It moves up and down during swallowing. 

Thyroid disorder is a hormonal problem just like diabetes. The issue of hormones is whether they are making too much or not enough. In diabetes, the gland making the hormone (insulin) is the pancreas and does not make it at all which leads to type 1 diabetes while in type 2 diabetes, the insulin produced is not enough for the body's needs.

The thyroid gland in the neck makes thyroid hormone and the problem is, it can either be too much or not enough.
The different thyroid diseases include:
  1. Goiter: inflammation of the thyroid gland.
  2. Hyperthyroidism: This is when the thyroid gland produces more thyroid hormone than the body needs. 
  3. Hypothyroidism: This is when the thyroid hormone produced is not enough.
  4. Thyroid nodules, lumps in the thyroid gland
  5. Thyroid cancer 
  6. Thyroiditis, swelling of the thyroid.

People living with diabetes have a higher risk of developing thyroid disorders. Type 1 has a much higher risk than type 2 diabetes which is why it is recommended that type 1 diabetes patients get a TSH (thyroid stimulating hormone) blood test every year. Thyroid disorder is more common in women than men. 

HYPERTHYROIDISM 

Hyperthyroidism is also known as overactive thyroid. It is a condition whereby too much thyroid hormone is produced in the body than required.

Symptoms 

  1. Weight loss 
  2. Feeling warm 
  3. Shakiness 
  4. Trauma 
  5. GIT moves faster causing diarrhea 
  6. Muscular weakness 
  7. Heart palpitations 
  8. Mood swings 
  9. Trouble sleeping 
  10. Trouble swallowing 

What causes hyperthyroidism?

There are several causes of hyperthyroidism. This includes:
  1. Graves' disease, is an autoimmune disorder in which the immune system attacks the thyroid gland to produce more thyroid hormone.
  2. Thyroid nodules, which are growth on your thyroid. They are usually not cancer but they can become overactive and make too much thyroid hormone. Thyroid nodules are more common in older adults.
  3. Thyroiditis is inflammation of the thyroid. It causes stored thyroid to leak out of your thyroid gland.
  4. Too much iodine. Iodine is found in some medicines, cough syrups seaweed, and seaweed-based supplements. Taking too much of them can cause your thyroid to make too much thyroid hormone.

HYPOTHYROIDISM 

Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. It is often referred to as an underactive thyroid.

Symptoms 

  1. Dry skin 
  2. Weight gain 
  3. Reflexes is slower 
  4. Cold intolerance
  5. Fatigue 
  6. Muscle cramps 
  7. Change in menses 
  8. Voice change 
  9. Depression 
  10. Thin, brittle hair or fingernails 
It is important to know that there are a lot of people gaining weight and feeling fatigued. It is tempting that it could be a thyroid disorder, sometimes it is and most times it is not.

What causes hypothyroidism?

  1. Hashimoto'sdiseases is an autoimmune disease where the immune system attacks the thyroid gland.
  2. Viral infections (often common cold) or other respiratory infections.
  3. Pregnancy (often called postpartum thyroiditis)
  4. Surgical removal of part or all thyroid gland
  5. Radiation treatment of thyroid 
  6. In rare cases, pituitary diseases or too much or too little iodine in diet.
  7. Certain medicines, such as lithium, amiodarone 
  8. Sheehan syndrome is a condition that may occur in a woman who bleeds severely during pregnancy or childbirth and causes the destruction of the pituitary gland (which regulates the thyroid gland)

How is thyroid disorder diagnosed?

Your healthcare provider may use many tools for diagnosis:
  1. Medical history, asking about your symptoms.
  2. Physical exam 
  3. Thyroid test: this is simply to know your thyroid hormone status by a measurement called thyroid stimulating hormone test. These measures indicate whether you have enough thyroid hormone or not.

How is thyroid disorder treated?

Thyroid disorder is treated based on the condition whether it is overactive or underactive.
Hyperthyroidism: 
  • Can be slowed down by tablets 
  • A radioactive iodine can be introduced whereby it goes to the overactive hormone and kills the tissue.
  • Removal of the enlarged thyroid through surgery. Patients who undergo thyroidectomy will have to receive thyroid hormone for the rest of their lives.
Hypothyroidism can be treated by replacing the thyroid hormone which involves taking in a tablet based on the right amount required. This treatment requires a medicine to replace the hormone that your thyroid can no longer make. 

If you take your medicine according to the instructions, you usually should be able to control hypothyroidism. You should never stop taking your medicine without talking with your healthcare provider first and asking for the next visit to ensure proper monitoring of your thyroid status.

While you are taking thyroid replacement treatment, inform your health provider if you notice any symptoms in your dose intake; sweating, restlessness, shakiness, palpitations, or weight loss.

If you have Hashimoto's disease or other types of autoimmune thyroid disorders, you may be sensitive to harmful side effects from iodine. Talk to your healthcare provider about which foods, supplements, and medicines you need to avoid.

Women need more iodine when they are pregnant because the baby gets iodine from the mother's diet. Individual thyroid status must be normal during pregnancy and before pregnancy because having a good thyroid level is essential for the baby. If you are pregnant, talk with your healthcare provider about how much iodine you need.

What is the proper weight management for people with type 2 diabetes who have a thyroid disorder?

In an underactive thyroid, gaining of weight can be controlled through the following process:

  • Make sure to get the right amount of thyroid.
  • Speak to your healthcare provider concerning the next visit for a TSH blood test. This will tell if you are at the normal value or not.
  • Also, weight loss requires monitoring whereby you can achieve this without further complications by speaking to your healthcare team (Nutritionist, Dietitian)

Is Thyroid Disorder preventable?

It is preventable for individuals with no existing autoimmune disorder like diabetes. It can be prevented in a healthy individual with normal thyroid function through dietary diversification.

When you are taking thyroid medicine, be aware of the following:

  1. Do not stop taking the medicine, even when you feel better. Continue taking it exactly as your provider prescribed.
  2. If you change brands of thyroid medicine, let your provider know. Your levels may need to be checked.
  3. What you eat can change the way your body absorbs thyroid medicine. Talk with your provider if you are eating a lot of soy products, cabbage, and cassava or are on a high-fiber diet as those can hinder the absorption of iodine.
  4. Thyroid medicine works best on an empty stomach and when taken 1 hour before any other medicines. Ask your provider if you should take your medicine at bedtime. Taking it at bedtime may allow your body to absorb the medicine better than taking it in the daytime.
  5. Wait at least 4 hours after taking thyroid hormone before you take fiber supplements, calcium, iron, multivitamins, aluminum hydroxide antacids, colestipol, or medicines that bind bile acids.
It is important to speak to your healthcare provider and ask questions for adequate monitoring of your thyroid health. 


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Reference 

MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated Jun 24; cited 2020 Jul 1]. Available from: https://medlineplus.gov/thyroid disease.html 

https://www.ncbi.nlm.nih.gov/books/NBK241/#:~:text=For%20diagnoses%20related%20to%20hypothyroidism,context%20of%20hyper%2D%20or%20hypothyroidism.

American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18(6):988-1028. PMID: 23246686 pubmed.ncbi.nlm.nih.gov/23246686/.

American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid. 2014;24(12):1670-1751. PMID: 25266247 pubmed.ncbi.nlm.nih.gov/25266247/.
Brent GA, Weetman AP. Hypothyroidism and thyroiditis. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 13.
https://pubmed.ncbi.nlm.nih.gov/28806820/

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