Three decades ago, when I was a teenager, it was the sleepiness and crackly, dry skin that first alerted me something was wrong. Not just type 1 diabetes (T1D), as I’d already been living with that for close to a decade at the time.
No, these symptoms were different.
I had a visibly enlarged gland on the side of my neck, so swollen that it hurt when I turned my head. The dry skin was coarse and almost scaly, so severe that lotions or moisturizers were useless.
And I suffered from constant fatigue, the kind of stuck-in-molasses tiredness that comes when your blood sugar is super high — even when it wasn’t. I felt exhausted from the moment I woke up in the morning, and I couldn’t function throughout the day without a nap or concentrate on simple tasks. And it didn’t help that in those days, my glucose levels were all over the place, causing further fatigue.
Frankly, it was all a bit scary because I couldn’t put my finger on how all these seemingly unrelated symptoms might tie together.
As it turned out, all were signs that the little thyroid gland in my neck was not working properly — which causes an array of symptoms that are easily overlooked or worse and mistaken for other ailments. Thankfully, what came next for me was a correct diagnosis of
This all happened when I was about 15. Not a great time for additional hormone issues, although I guess there’s never a great time for any type of diagnosis, right?
With January marking National Thyroid Awareness Month in the United States, it’s a good time to talk about recognizing the symptoms, and getting treatment can make all the difference for a better, happier life for people with diabetes (PWDs) who so often experience thyroid disorders along with their glucose management challenges.
The thyroid is a little butterfly-shaped gland that lives in the middle of your neck. It’s part of the body’s endocrine system, where diabetes also dwells.
One of the thyroid’s primary responsibilities is to manage your body’s 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.
An underactive thyroid can leave you feeling sluggish and causes weight gain and a slow heartbeat. Essentially, your body’s normal equilibrium slows down.
Thyroid issues are incredibly common. According to authorities, up to 59 million Americans have a thyroid problem, and a majority don’t know it (kind of like
Note that “thyroid disease” is actually an umbrella term for several different conditions that can affect this gland, including:
- autoimmune thyroid disease
- goiter (enlargement of the thyroid gland)
- thyroid cancer
Those of us who live with diabetes are more prone to thyroid issues, and women are more prone than men (but that does not exclude guys like me).
People with T1D, the autoimmune kind, are especially at risk for the two autoimmune types of thyroid disease: hyperactive thyroid (Graves’ disease) or underactive thyroid (Hashimoto’s disease).
The symptoms of hyperthyroid and hypothyroid are starkly different, but it can be difficult to tell there’s an issue at all 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
- pounding heart
- weight loss despite an increased appetite
- shortness of breath when exercising
- muscle weakness or tremors
- trouble concentrating
As you might guess, hypothyroidism symptoms are the polar opposite:
- fatigue and sleepiness
- persistent feeling of being cold
- dry skin
- slower reflexes
- brittle hair
- weight gain despite no change in diet
- low blood pressure or a slow pulse
- increased depression
Symptoms of these thyroid conditions can sometimes be confused with symptoms of diabetes or attributed to other circumstances.
Take the late veteran diabetes journalist David Mendosa, who wrote about his diagnosis with hypothyroidism: “My feet were cold most of the time. Even when I wore thick woolen socks to bed, 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 someday. Good strategy in general. But worse than useless when the assumption is faulty. My problem was hypothyroidism.”
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 sugar due to the effects the symptoms have on 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 it 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 low-density lipoprotein (LDL) cholesterol, overall cholesterol, and 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.
In fact, the American Diabetes Association (ADA) recommends screening for thyroid problems soon after a diagnosis of type 1 diabetes, with a standard thyrotropin stimulating hormone (TSH) blood test (which is in fact controversial, details below). The ADA currently has no specific screening guidelines for people with type 2 diabetes.
Of course, anyone experiencing any of the symptoms described should see their endocrinologist or primary care doctor ASAP. That’s a first step that should seem obvious enough, but that’s not always the way it goes.
My own diagnosis with hypothyroidism as a teenager came during a regularly scheduled endo appointment, almost by accident. Then later as an adult, my medication usage became lax, and when thyroid issues popped up periodically, I didn’t always talk with my doctor about it readily.
It can be easy to brush aside symptoms like dry skin and sleepiness, as simply annoyances caused by colder weather or too much stress. But I can personally tell you that pinpointing the cause of my symptoms and talking with my doctors about the cause has been hugely helpful.
Typically, there are two main ways to diagnose a thyroid issue (particularly hypothyroidism):
- a physical exam and review of your medical history, where your doctor will check for physical signs for any of the aforementioned symptoms
- blood tests conducted in a lab
- The primary way to diagnose thyroid disease is called a TSH test, which checks the amount of thyroid-stimulating hormone in your system. It’s a very easy and inexpensive blood test.
- However, sometimes that 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.
Importantly, this is a lifelong condition. But medication can reduce or even wipe away symptoms.
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. But some patients have difficulty finding the right type of thyroid replacement pill.
The most commonly prescribed medication to treat hypothyroidism (underactive thyroid) is levothyroxine (Synthroid). This medication is a synthetic version of the T4 hormone that copies the action of the thyroid hormone your body would normally produce.
The most common treatment for hyperthyroidism involves medications such as methimazole (Tapazole) that stop the thyroid from making hormones.
Given that my thryoid was underactive, I was prescribed levothyroxine. This is usually a daily pill, but it can also be dosed differently depending on what your doctor advises according to your specific needs.
It’s important to know that the meds can take 6 to 8 weeks to build up in the system and start working. In my case, that meant getting a “baseline” thyroid lab test before I started taking any medications and then following it up a couple months later to determine whether that dosage was accurate. Thankfully it was, and my fatigue, dry skin, and other symptoms began to melt away.
Longtime diabetes advocate Lindsay O’Rourke shared previously in an online forum: “I went on my generic prescription, [levothyroxine], 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.”
Due to common problems with misdiagnosis and mistreatment, a whole movement has emerged for Thyroid Patient Advocacy, both in the United States and abroad.
“Even a ‘normal’ TSH result may be abnormal for you… If your TSH levels don’t seem to reflect how you are feeling, speak up!” writes Mary Shomon, hormonal health coach and author of the New York Times bestseller “The Thyroid Diet Revolution: Manage Your Metabolism for Lasting Weight Loss.”
Denise Roguz, founder of the group Thyroid Change, is behind a long-running awareness petition drive called “Patients with Thyroid Dysfunction Demand Better Care,” which calls on the International Society of Endocrinology to adopt two core changes going forward:
- Doctors must demonstrate proficiency in diagnosis of and treatments in thyroid disorders BEFORE receiving their board certification in endocrinology.
- Board certified endocrinologists who treat thyroid disorder must keep up to date on current thyroid disorder treatments.
These demands may seem like no-brainers, but apparently thyroid care has traditionally been haphazard and inconsistent.
Perhaps as a counter to this kind of distrust, a few years ago, the American Association of Clinical Endocrinologists set up a thyroid awareness website that provides advice for patients. It emphasizes the importance of taking the same dosage of the same medication at the same time every day.
Some advice they give is: “Even the slightest variance in the manufacturer of the prescription (whether generic or brand name), the time of day meds are taken or the medication dosage can interfere with the delicate balance thyroid medications are designed to achieve, sending the body into a tailspin and resulting in a host of side effects that can range from mildly uncomfortable to severe.”
Personally, I’ve been taking the generic thyroid med levothyroxine for years now. When I go a few days without taking my daily pill, I definitely feel myself getting sleepy more often and becoming unfocused, so I’m glad to have it in my arsenal.
Dealing with diabetes can be a challenge all on its own any day of the week, so I’m glad to have simple options to treat this related condition effectively.
My message to all would be: Pay attention to symptoms that may be bringing you down on a daily basis and derailing your diabetes management. It very well may be (an easily treatable) thyroid condition!