We’ve all heard of it, but do you even know what your thyroid does?
The thyroid gland is one of the most important organs in the human endocrine system. Hormones produced in the thyroid (T3 and T4) are released into the bloodstream and help regulate how the body uses and stores energy. When everything works as it should, thyroid hormone levels are tightly controlled by the pituitary gland in the brain. Loss of this control leads to thyroid hormone levels that are either too low (hypothyroidism) or too high (hyperthyroidism), and abnormal levels can have negative effects on the heart, bones, cholesterol levels, glycemic control, and a lot of other metabolic processes. Thyroid disease is actually fairly common in the general population (especially in women) and risk increases with age. Unfortunately, people living with diabetes have an increased risk of developing thyroid dysfunction.
Hypothyroidism
Hypothyroidism is by far the most common thyroid disorder in adults, and Hashimoto’s disease is easily the most common cause of hypothyroidism. Hashimoto’s is an autoimmune disease in which the immune system attacks the thyroid gland and slowly kills it off over years or decades, leading to a decline in thyroid hormone levels. Symptoms of hypothyroidism may include fatigue, weight gain, intolerance to cold, constipation, dry skin and hair, muscle cramps, aches, decreased concentration, and depressed mood.
Hyperthyroidism
Hyperthyroidism from an overactive thyroid gland is much less common. Graves’ disease (another autoimmune disease) is the most frequent cause of hyperthyroidism. Symptoms may include fatigue, weight loss, heart palpitations, frequent stools, tremors, anxiety, irritability, sweating, intolerance to heat, and dry/irritated eyes. Many of the symptoms of thyroid dysfunction are what we call “nonspecific”, meaning that they could be caused by any number of diseases (like sleep apnea, depression, obesity, and poorly controlled diabetes) or even lifestyle issues (such as poor diet, lack of exercise, stress, etc). The thyroid gets a lot of blame, but sometimes it’s not the thyroid’s fault!
Diabetes and Thyroid Disease
Diabetes and thyroid disease are related in a number of ways. First, it has been shown that having one autoimmune disease increases the chance of developing another autoimmune disease. Therefore, people (especially women) living with type 1 diabetes have a higher rate of both Hashimoto’s and Graves’ disease compared to the general population. Second, there may be an association with type 2 diabetes and thyroid dysfunction, especially hypothyroidism. One study showed that people with low thyroid function were at a greater risk of progressing from prediabetes to type 2 diabetes. Finally, untreated hyperthyroidism generally leads to increased insulin requirements and worsened glycemic control in both type 1 and type 2 diabetes.
Screening and Treatment
Regular screening for thyroid dysfunction should be done in everyone with diabetes; roughly every 1-3 years in type 1 diabetes, and every 3-5 years in type 2 diabetes. The best way to test for abnormal thyroid function is to get a TSH level during a blood draw. If the TSH is normal, the thyroid is working well and no further testing is necessary in most cases. However, if the TSH is out of the normal range or the physician has a high suspicion for thyroid problems, other tests may be ordered including free T4, total T3, TPO antibody (associated with Hashimoto’s), TSI/TRAb (associated with Graves’), or thyroid imaging. If hypo- or hyperthyroidism is diagnosed, your physician should discuss treatment options with you or refer you to an endocrinologist for consultation. Hypothyroidism is treated by replacing the thyroid hormone, usually with a once-daily oral medication called levothyroxine. Treatment for hyperthyroidism depends on the exact cause, with options ranging from medications, to radioactive iodine therapy, to surgery. In both hypo- and hyperthyroidism, the TSH levels should be monitored during and after treatment to assure normal thyroid hormone levels are achieved and maintained. Regular testing of thyroid dysfunction is important for everyone with diabetes, but the good news is that treatment options are available, management of the condition is possible and getting your thyroid numbers in a normal range is very achievable.
I have been able to find very little information on the correlation between the 2 diseases. I have had T1D for 44 years and recently was diagnosed with Hashimoto’s. I was disappointed as the endocrinologist said it was thyroiditis and we would monitor. She did not say what they were looking for specifically. The TPO antibodies were at 522. The TSH level was rising and both T3 and T4 were at the bottom of the range. I finally went to my primary care physician and my TSH was 14.45. I was disappointed in the process for treatment. I was finally prescribed levothyroxine. I could not find any information regarding what the TPO antibodies should be absent a thyroid condition. My primary care physician said that because I have T1D I will always show antibodies, but didn’t know the level. My TSH went from 4.21 (4.5 was the upper limit) to 14.45 in 4 months and was tested twice in between. I was glad to see the article.
Hi Tricia,
It is not uncommon for thyroid function values such as the TSH to bounce from high to low, and what’s more important is what your numbers are and how they even out over time. The one issue with thyroiditis is that your thyroid levels can change over time, typically getting lower and lower and then needing the medication that you were put on. So just hang in there, get your thyroid tested every 3-6 months, and you should be fine.
the endocrinologist I saw informed me that the TSH level Goal was About 1.
Hi Cindy,
The normal TSH range is different in every laboratory, but 1 sounds like it is in the normal range, though not 100% sure.
I appreciate this work amazing post for us I like it.
Thanks Akhil!
I’m so glad to see someone put up a post about thyroid-related matters. My wife also suffering from thyroid i will share this article with her.
Thanks.
Hypothyroidism is a condition that occurs when your thyroid gland doesn’t produce enough thyroid hormones.
There are many glands in the body, but the thyroid gland is the small, butterfly-shaped organ at the base of your neck that makes hormones that regulate your metabolism — which affects how the body uses energy — and other processes. While your body goes through hormonal changes every day (hello, mood swings!), big dips — like those that occur during hypothyroidism — can signal danger, as a lack of thyroid hormone production causes the body’s functions to slow down.
Hyperthyroidism due to Graves’ disease is caused by antibodies attacking the thyroid and turning it on (see Graves’ disease brochure). Antithyroid medication, radioactive iodine, and surgery are all effective treatments and can restore thyroid function to normal. Radioactive iodine and surgery also can “cure” the hyperthyroidism by removing the thyroid. However, the thyroid stimulating antibodies often are unaffected by these treatments, so the underlying cause of Graves’ disease persists. Occasionally, the thyroid stimulating antibodies do go away in patients treated with antithyroid drugs, resulting in remission of the Graves’ disease and allowing for discontinuation of the medications. However, the thyroid stimulating antibodies may return causing the Graves disease to relapse.
High amounts of T4, T3, or both can cause an excessively high metabolic rate. This is called a hypermetabolic state. When in a hypermetabolic state, you may experience a rapid heart rate, elevated blood pressure, and hand tremors. You may also sweat a lot and develop a low tolerance for heat. Hyperthyroidism can cause more frequent bowel movements, weight loss, and, in women, irregular menstrual cycles.
Visibly, the thyroid gland itself can swell into a goiter, which can be either symmetrical or one-sided. Your eyes may also appear quite prominent, which is a sign of exophthalmos, a condition that’s related to Graves’ disease.
Your thyroid is a small butterfly-shaped gland found at the base of your neck, just below your Adam’s apple. This gland makes thyroid hormone that travels in your blood to all parts of your body. The thyroid hormone controls your body’s metabolism in many ways, including how fast you burn calories and how fast your heart beats.
Your doctor’s choice of treatment will depend on your symptoms and the cause of your hyperthyroidism. Treatments include:
Antithyroid medicines block your thyroid from making new thyroid hormone. These drugs do not cause lasting damage to the thyroid.
Beta-blockers block the effects of thyroid hormone on your body. These medicines can be helpful in slowing your heart rate and treating other symptoms until one of the other forms of treatment can take effect. Beta-blockers do not reduce the amount of thyroid hormones that are made.
Radioiodine. This treatment kills the thyroid cells that make thyroid hormones. Often, this causes permanent hypothyroidism.
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How is my thyroid gland controlled?
There has to be some sort of mechanism that regulates very carefully the amount of T4 and T3 secreted by your thyroid gland so that the right – the normal – amounts are manufactured and delivered into the blood stream. The mechanism is very similar to that which regulates the central heating in a house where there is a thermostat in, say, the living room, which is set to a particular temperature and which activates the gas- or oil-fired furnace, or boiler that heats the hot water. In the case of the thyroid the ‘thermostat’ consists of a little gland, called the pituitary gland that lies underneath your brain in your skull. The pituitary senses the level of thyroid hormones in your blood stream, just as the thermostat in your living room senses the temperature. Under normal circumstances, if the level drops just a little below normal, the pituitary reacts by secreting a hormone called the thyroid stimulating hormone, also known as TSH, and this hormone activates the thyroid gland to put out more T4 and T3.
Conversely, when the thyroid hormone levels rise above normal the ‘thermostat’ senses this and the pituitary stops secreting TSH so that the thyroid gland stops working so hard and the secretion of T4 and T3 is reduced.
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See your doctor if you’re feeling tired for no reason or have any of the other signs or symptoms of hypothyroidism, such as dry skin, a pale, puffy face, constipation or a hoarse voice.
You’ll also need to see your doctor for periodic testing of your thyroid function if you’ve had previous thyroid surgery; treatment with radioactive iodine or anti-thyroid medications; or radiation therapy to your head, neck or upper chest. However, it may take years or even decades before any of these therapies or procedures result in hypothyroidism.
If you have high blood cholesterol, talk to your doctor about whether hypothyroidism may be a cause. And if you’re receiving hormone therapy for hypothyroidism, schedule follow-up visits as often as your doctor recommends. Initially, it’s important to make sure you’re receiving the correct dose of medicine. And over time, the dose you need may change.
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Levothyroxine may lower your cholesterol levels and help you return to a normal weight. The medicine causes very few side effects and is relatively inexpensive, The generic form of the drug is covered by most Medicare and insurance plans. (18)
Treatment with levothyroxine is usually continued for the rest of your life, but your doctor may adjust your dose over time.
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Standard treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine (Levo-T, Synthroid, others). This oral medication restores adequate hormone levels, reversing the signs and symptoms of hypothyroidism. You’ll likely start to feel better soon after you start treatment.
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My tsh was 0.01, my t3 was 32 and my t4 was 7.2. No antibodies found. I have an enlarged thyroid. My brain has been feeling weird for almost a year now. What can that be? The doctor assistant told me to see an endocronologist and I am still waiting for that appointment.
This is a complicated topic so you really do need to see an endocrinologist familiar with thyroid problems.
I was engaged to be married to a woman, Jennifer Wise, when her hypothyroidism began to affect her more and more due to a low medicine dose. It took time to get the medication right with her doctor but while it was too low she got really angry at me and frustrated. I tried to make good with her but she wasn’t patient and instead walked out. She left everything! She blocked my phone number, emails, and all social media. All of our mutual friends were just stunned and confused. Many thought she left me for another man but that wasn’t the case at all! We had a nearly 8 year perfect relationship until this happened! Since we never fought in the past, I didn’t know how to deal with it and I lost her. Now she is alone and I presume miserable but she’s telling herself that she needs this alone time. Since the diagnosis a few years back, I had noticed mood changes with other people but she was never grumpy to me- until the day she left. She was rude and snappy with all of my coworkers, some of our friends, and my cousin.
My advice to you as a spouse, pay attention to the warning signs! If you see your partner getting more grumpy, snappy, rude to people for little reason then please get them into the doctor. Maybe they aren’t being grumpy or snappy to you, but one day they will and it might go in the worst possible direction. Find a counselor who can help your partner cope with their emotions. Mine refused to go to counselling with me even when I offered to pay for it all.
If you have hypothyroidism then please be patient with your spouse. They aren’t really the bad one. It’s not the end of the world no matter how serious it may seem. Don’t listen to “friends” who have only known you for a year. Take a deep breath, meet with the doctor, give it time.