My dad has hypothyroidism, as does my grandmother. For my whole life, my dad has taken a tiny little pill every morning to make sure his metabolism functions properly. I always thought that compared to diabetes, thyroid disease wasn't very "serious" — all my dad needed to do was pop a pill! — and that it was nothing I needed to worry about anyway. But then, because of my diabetes and my "genetic predisposition," my endocrinologist insisted on starting to examine my thyroid regularly...
But despite my risk factors, I never knew much about thyroid disease. Now's as good a time as any to learn.
January is actually National Thyroid Awareness Month, so for this edition of our 411 series on diabetes complications and co-morbidities, we're taking a look at another body part in distress: the thyroid.
What Does It Do Again?
The thyroid is a little butterfly-shaped gland that lives in the middle of your neck, and it's part of the body's endocrine system, where diabetes also dwells. This system controls your body's metabolism. One of the thyroid's primary responsibilities is to manage your metabolism by producing two thyroid hormones: T3 and T4. An overactive thyroid can cause weight loss, a quick heartbeat, and other signs that your body is "on the go" a little too much. The opposite, an underactive thyroid, leaves people feeling sluggish, and causes weight gain and slow heartbeat. Essentially, your body's normal equilibrium slows down.
Turns out, thyroid issues are incredibly common. They're so widespread, in fact, that Oprah was all on about it a few years ago. Thyroid disease affects 30 million people in the US — and some experts think thyroid disease may affect nearly 56 million Americans.
Note that "thyroid disease" is actually an umbrella term for several different conditions that can affect this gland, including:
- autoimmune thyroid disease, which includes Graves' Disease and Hashimoto's Disease
- goiter, which is an enlargement of the thyroid
- thyroid cancer
As you can imagine, none of these are good news for your body.
There are a whole host of different risk factors for thyroid disease, and you guessed it, diabetes is one of them! Experts estimate that about 30% of people with diabetes will be affected with a thyroid disease, so it's a big one for us.
Diabetes itself does not cause thyroid issues, but those with an autoimmune condition are automatically at an increased risk for other conditions. In the case of thyroid disease, PWDs are at risk for the two autoimmune-type of thyroid diseases, Graves' Disease (hyperactive thyroid) or Hashimoto's Disease (underactive thyroid). Approximately 10% of type 1 PWDs will have a thyroid condition. Although type 2 diabetes is not an autoimmune disorder, there's also an increased incidence in thyroid diseases, but for reasons that researchers can't explain. One theory is that thyroid disease and type 2 diabetes both affect the elderly, although we've learned that's not 100% true in all cases. On top of that, women are at a much greater risk for thyroid issues. Once again: lucky us!
How Can You Tell?
The symptoms of hyperthyroid and hypothyroid are starkly different, and it can be difficult to tell there is an issue right away because symptoms can develop very slowly. They also often match symptoms for a whole list of other conditions, so it can be tricky to figure out the culprit. This is why regular thyroid screenings are important.
Hyperthyroidism symptoms include quick pulse and pounding heart, weight loss despite an increased appetite, shortness of breath when exercising, muscle weakness or tremors, and trouble concentrating.
As you can probably guess, hypothyroidism symptoms are the polar opposite: fatigue and sleepiness, persistent feeling of being cold, dry skin, brittle hair, weight gain despite no change in diet, low blood pressure or a slow pulse. Hypothyroidism can also affect fertility in women. Yikes!
Symptoms of thyroid conditions can sometimes be confused with symptoms of diabetes, or attributed to other circumstances. Take veteran diabetes journalist David Mendosa, who wrote about his diagnosis with hypothyroidism last Spring. He writes, "My feet were cold most of the time. Even when I wore thick woolen socks to be, my feet were often so uncomfortable that they interfered with my sleep. Since I have diabetes, I assumed that my problem was that I had one of the most common complications of our condition, peripheral neuropathy. So I focused all the more on controlling my blood glucose levels in hopes of reversing my problem some day. Good strategy in general. But worse than useless when the assumption is faulty. My problem is hypothyroidism."
Does the Thyroid Affect Diabetes Care?
One thing to note is that although hyperthyroidism and hypothyroidism do not directly affect blood sugar levels, not treating thyroid disease can cause lots of issues in managing your blood sugars because the effects the symptoms have on your body and how your body metabolizes glucose and insulin. For instance, with hyperthyroidism, insulin "clears" through your body faster, leaving you with higher blood sugars.
Hyperthyroidism can cause rapid heart rate and increases the risk of abnormal heart rhythm, so it increases the risk of heart problems, compounding the heart risks posed by diabetes.
Hypothyroidism can cause insulin to move through your body much slower, which could leave you with lower blood sugars. because the insulin "sticks around" longer. Hypothyroidism can also cause an increase in cholesterol and LDL levels, and an increase triglyceride levels, which adds to the danger of high cholesterol with diabetes.
So clearly it's all bad news if you don't catch the thyroid problem quickly!
What Up with Diagnosis & Treatment?
You'll want to see your endocrinologist (endocrine system, remember?) or primary care physician asap. You may be referred to a doctor who specializes in thyroid issues (as opposed to diabetes), but your endocrinologist will know exactly how to diagnosis you. The primary way to diagnose thyroid disease is something called a TSH (Thyrotropin Stimulating Hormone) test, which checks the amount of thyroid-stimulating hormone in your system. It's a very easy and inexpensive blood test, so don't delay if you think you have symptoms!
However, sometimes the test will come back false-normal, so testing for antibodies or having a full Thyroid Panel can also turn up things that the TSH test might leave out.
Autoimmune thyroid diseases, like Hashimoto's Disease, are usually much easier to manage than diabetes. The hormone replacement treatment comes in pill form, so taking the medication is easy-peasey. But some patients have difficulty finding the right type of thyroid replacement pill. While there are two types of natural thyroid hormones, called T3 and T4, only T4 is found in the common thyroid replacements. For many people, this doesn't work well. In theory, T4 medication would also convert to T3, but research suggests this doesn't always happen. You'll want to do your homework and make sure you get on the right treatment for you!
Patient Lindsay O'Rourke writes on the TuDiabetes group for Hypothyroidism: "I went on my generic prescription, levothroid, and even at a very low dose it was an extreme difference. I felt back to normal. My energy was back, and a slew of other symptoms went away."
Hyperthyroidism can be treated with anti-thyroid medicines such as methimazole (Tapazole) and propylthiouracil (PTU), but the most common way of treating hyperthyroidsim is radioactive iodine therapy. Weirdly, it kills off the thyroid, causing permanent hypothyroidism. So you're really just trading one problem for another.
So far, I personally have been lucky in the thyroid department, and have not had any issues, although Amy has not been quite so lucky. I know that being a woman with type 1 diabetes puts me at a greater risk for thyroid disease and it's something I fully intend to keep an eye on. If you've dealt with hyperthyroidism or hypothyroidism, we'd love to hear your story in the comments!