20 June, 2010

Thyroid & Diabetes..

Diabetic patients have a higher prevalence of thyroid disorders compared with the normal population. 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.


Thyroid disease in the general
population: 6.6%
Thyroid disease in diabetes:
Overall prevalence: 10.8¬13.4%
Hypothyroidism: 3¬6%
Subclinical hypothyroidism: 5¬13%
Hyperthyroidism: 1¬2%
Postpartum thyroiditis: 11%


The presence of thyroid dysfunction may affect diabetes control. Hyperthyroidism is typically associated with worsening glycemic control and increased insulin requirements. There is underlying increased hepatic gluconeogenesis, rapid gastrointestinal glucose absorption, and probably increased insulin resistance. Indeed, thyrotoxicosis may unmask latent diabetes.

First, in hyperthyroid patients, the diagnosis of glucose intolerance needs to be considered cautiously, since the hyperglycemia may improve with treatment of thyrotoxicosis.

Second, underlying hyperthyroidism should be considered in diabetic patients with unexplained worsening hyperglycemia.

Third, in diabetic patients with hyperthyroidism, physicians need to anticipate possible deterioration in glycemic control and adjust treatment accordingly. Restoration of euthyroidism will lower blood glucose level.

Even subclinical hypothyroidism can exacerbate the coexisting dyslipidemia commonly found in type 2 diabetes and further increase the risk of cardiovascular diseases. Adequate thyroxine replacement will reverse the lipid abnormalities.
In young women with type 1 diabetes, there is a high incidence of autoimmune thyroid disorders. Transient thyroid dysfunction is common in the postpartum period and warrants routine screening with serum thyroid-stimulating hormone (TSH) 6¬8 weeks after delivery. Glucose control may fluctuate during the transient hyperthyroidism followed by hypothyroidism typical of the postpartum thyroiditis. It is important to monitor thyroid function tests in these women since approximately 30% will not recover from the hypothyroid phase and will require thyroxine replacement. Recurrent thyroiditis with subsequent pregnancies is common.

5 comments :

  1. A long break.....Good topics been discussed.

    Thyriod diseases are so common in diabetes pts, that a routine test may required for all pts.Most of them have sub clinical hypothyroidism.And few have a marginally high TSH level requiring Anti-TPO Antibodies levels to decide on the treatment.One point to be kept in mind before starting thyroxine for a diabetic patient is to confirm whether pt has angina. Initiating thyroxine may actually worsen existing angina due to its effect on the cardiac muscle contractility. Diabetic pts being at risk of developing CVD, its worth asking this particular history.
    Incidentally hyperthyroidism is a another disease like diabetes where one loses weight inspite of having excess hunger and polyphagia.They unmask each other.

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