Ask the Expert: Explain Hypothyroidism and Hyperthyroidism and how this disease can affect those of us with diabetes

May 26, 2009

By Jessica Gibbons, Certified Diabetes Educator and Registered Dietitian

First of all, although there are some exceptions to the rule, thyroid disease is usually an autoimmune disease and goes hand in hand with diabetes. It is hereditary and will often be seen in many family members. It is also more common in women than in men and is more common in older persons.

Hypothyroidism happens when antibodies attack the thyroid gland, and the thyroid gland does not produce enough thyroid hormone anymore. About three percent of the general population has low thyroid levels. \nSome symptoms of hypothyroid include the following: fatigue, poor muscle tone, an increased sensitivity to cold, depression, muscle cramps, goiter, thin brittle fingernails, thin brittle hair, paleness, decreased sweating, dry and itchy skin, weight gain, water retention, low heart rate (less than 60 beats/min), and constipation. If ignored, symptoms can become worse and include slow speech, a hoarse voice, dry puffy skin on one’s face, abnormal menstrual cycles and low body temp. Osteoporosis and hgh cholesterol are other dangerous side effects. There are some other less common symptoms, including impaired memory, hair loss, irritability, and shortness of breath.

To diagnose hypothyroidism, doctors generally measure TSH (thyroid stimulating hormone), which is produced by the pituitary gland. TSH should be between 0.5-4.7 u/L. If TSH is high, the thyroid is not producing enough thyroid hormone (T4 and T3). Hypothyroidism is generally treated with thyroxine (synthroid, levoxyl, levothyroxine re some common names of thyroxine). The medication must be taken daily and not with a multivitamin as iron binds thyroxine and will make it not work effectively.

Hyperthyroidism is when the thyroid gland is overactive, leading to an overproduction of thyroid hormone. When too much hormone is released, body systems “speed up” leading to symptoms including fast heartbeat, nervous system tremors and anxiety, diarrhea and weight loss. Symptoms also include intolerance to heat, hair loss, weakness, rritability, osteoporosis, and tremors. Doctors measure TSH to determine whether you have hyperthyroidism. Generally a physician will use a drug or surgery or radiation treatment to “slow down” the thyroid gland and then eventually the person will end up needing thyroid replacement, long-term. They kind of develop a “secondary” hypothyroidism once the gland has been slowed down.

The most important thing to understand when a person has a problem with their thyroid, is that as long as it is teated and one’s TSH level is normal, there will be no dangerous side effects. One cannot take prescribed pills randomly, pills should be taken as recommended by their physician every single day, preferably at the same time. The side effects of hypothyroidism will resolve once thyroid levels are normal again. One study indicated that if a person has hypothyroidism, the metabolism of insulin may slow down, thus leading to a decreased need for insulin for a short amount of time. Warfarin, dopamine and teroids can effect how thyroid medication works, so just be sure that your physician knows what medications you are taking and that you are taking them the way the doctor recommends. Once again, it is kind of a pain to take yet another med, but at least it is one of the cheapest pills available and is very easy to take. No syringes involved! (Whew!)

Jack DeRuiter (2002) (PDF). Thyroid Pathology. pp. 30. http://www.auburn.edu/~deruija/endp_thyroidpathol.pdf.

From	Comment
majeral	May 31, 2009 3:23 AM I did not know I had thyroid problem till 2 years ago when I was 64. I landed in the hospital for 48 hours while they ran every test they could find. Turns out I have a low thyroid , I then remembered 40 years ago a Doctor had radiated the gland and dissolved it . But he did not put me on any medication to replace it. I have been fighting weight for 40 years. I even told my last diabetic doctor about it and she said it was normal but I was felling so very tired and ichey all over. A friend sent me a site stopthethyroidmaddness.com Boy did I have my eyes open. I found another Doctor who ran T3 and T4 and TSH I was low in T3 I feel better YOU have got to go after the answers. The Problem is Doctors don't like YOU telling Them what you have read test you want taken. We have to be pro health for ourselves.
doris	May 30, 2009 4:10 PM I learned a lot about my hypothyroidism. A lot of the symptoms were identified for me. Iam to have an ultra-soud. Please explain what that measures
lipsie	May 30, 2009 3:36 PM Love it! I really never had a very good understanding of my hypothyroid problem. Thank you VERY much! Sheila