Islets of Hope  disorders associated with diabetes

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Fast Links to Disorders Often Associated with

Addison's Disease
Asthma and Allergies
Celiac Disease (Sprue)
Cyclic Vomiting Syndrome
Cystic Fibrosis 
Eating Disorders
Fibromyalgia Syndrome
Frozen Shoulder
Hashimoto's Thyroiditis
  (Iron Overload)
Irritable Bowel Syndrome
Polycystic Ovarian 
Weight Gain
Weight Loss

Fast Click to Problems Associated with

Acanthosis Nigricans (AN)
Alopecia Areata (AA)
Gum Disease
Skin Tags
Yeast Infections

Hashimoto's Thyroiditis
Resource Site Links

American Thyroid Association
Endocrine Web
Mary Shoman's About Thyroid

Sinai Div of Endo & Metabolism

Books on Thyroid Disorders

the thyroid diet Mary J. Shoman
The Thyroid Diet:  
For more than 25 million Americans it may be, due to the metabolic slowdown of a malfunctioning thyroid gland. The Thyroid Diet will help many previously unsuccessful dieters get diagnosed and treated -- and proper thyroid treatment might be all that’s needed to successfully lose weight. Even after optimal treatment, however, weight problems plague many thyroid patients. For those patients, The Thyroid Diet will identify the many frustrating impediments to weight loss, and offer solutions-both conventional and alternative -- to help. Discussing optimal dietary changes, thyroid-damaging foods to avoid, and metabolism-supporting herbs and supplements, it contains several different eating plans, food lists, and a set of delicious and healthy gourmet recipes. With handy worksheets to use in weight-loss tracking and a special resource section featuring Web sites, books, and support groups, here is vital help for millions..

living well with hypothyroidism Mary J. Shoman
Living Well With Hypothyroidism:  
As many as one in eight women have a thyroid condition. Shomon covers conventional, alternative, and late-breaking approaches to treatment--such as challenging the gold standard of Synthroid as the thyroid replacement therapy of choice. (Synthroid replaces T4, the less active of the two thyroid hormones, and Shomon features new research on adding T3--the more potent thyroid hormone--to treatment.)

Elizabeth Lee Vliet, M.D., Founder and Medical Director of HER Place Centers:  "If I could recommend only one book on thyroid problems for my patients, this would be it."

Frequently Asked Questions about Thyroid Drugs & Food, Drug and Supplement Interactions Answered by Mary Shoman:

What is the Impact of a High Fiber Diet?

What About Iodine and Kelp Supplements?

How About "Goitrogenic" Foods Like Kale or Brussels Sprouts?

Is There a Problem with Antacids?

What About Calcium and Calcium-Fortified Orange Juice?

What About Over the Counter Drugs Like Cough Medicines, Cold Medicines, Decongestants?

How Should You Take Vitamins with Iron?

What About Thyroid Hormone and Estrogen? (i.e., Hormone Replacement Therapy, Birth Control Pills)

Can You Breastfeed While Taking Thyroid Hormone Drugs, or Antithyroid Drugs?

How Should You Take Your Thyroid Medication

Should You Take Your Thyroid Hormone With Food vs. An Empty Stomach?

thyroid power  Richard L. Shames, MD
Thyroid Power:  Fatigue; weight gain; depression; arthritis; high cholesterol; low sex drive; skin, digestive, and female problems; abnormal blood pressure -- all may be symptoms of low  thyroid, one of the most misdiagnosed disorders in America.

Thyroid Power can help you determine whether you're one of the millions who suffer from low  thyroid. It discusses food, vitamins, and natural remedies that support thyroid health;explains how  to avoid environmental and emotional triggers; and offers tips from thyroid support groups. By following this clear 10-step program and working with your health practitioner, you can channel the incredible power of your thyroid into greater health and well-being.


In opposition to T4/T3 combination therapy...

Combined Thyroxine/ Liothyronine Treatment Does Not Improve Well-Being: Quality of Life, or Cognitive Function Compared to Thyroxine Alone: A Randomized Controlled Trial in Patients with Primary Hypothyroidism.  The Journal of Clinical Endocrinology & Metabolism Vol. 88, No. 10 4543-4550

In favor of combination therapy (also, excellent general medication information) ..  HTML Format

Patient Organizations

American Thyroid Association
Montefiore Medical Center
111 East 210th Street, Room 311
Bronx, NY 10467
Phone: 1–800 THYROID (849–7643)
Diane Miller, Administrator

Purpose: A professional organization of physicians and scientists dedicated to scientific research on the thyroid. The association refers the public to member physicians in their geographic area on request.

Publications:  Newsletter (quarterly); information pamphlets.

Endocrine Society
4350 East West Highway, Suite 500

Bethesda, MD 20814–4410
Phone: 301–941–0200
P. Michael Conn, President
Scott Hunt, Executive Director

Purpose: A professional organization of scientists, educators, clinicians, practicing M.D.'s, nurses, and students representing all basic, applied, and clinical interests in endocrinology and devoted to research, study, and clinical practice of endocrinology. Works to improve understanding of endocrinology among the general public and medical practitioners and to promote the interests of endocrinologists at the national scientific research and health policy levels of government.


Diabetes Medical Library                         main "Disorders" page
Disorders Associated with Diabetes                                                        print this article

Hashimoto's Thyroiditis
(Also Called Autoimmune or Chronic Lymphocytic Thyroiditis)
Symptoms and Treatment Options

IOH Founder Lahle Henninger Wolfe has PCOS, diabetes and Hashimoto's Thyroiditis.
See photos of her successful weight loss.

Mini Site Index
What is Hashimoto's Thyroiditis?
Diabetes and Thyroid Disease
Symptoms of Hypothyroid
Testing for Hashimoto's
Do You Need T3 in Addition to T4?
Taking Your Medications
--  Women, Estrogen & Thyroid Medications
--  Drug & Supplement Interactions
Do You Need Preventive Thyroid Treatment?


What is Hashimoto's Thyroiditis?

Thyroiditis is an inflammation (not an infection) of the thyroid gland. Several types of thyroiditis exist but the one most commonly seen in all persons, including those with diabetes, insulin resistance, and polycystic ovarian syndrome (PCOS), is an autoimmune disease called Hashimoto's Thyroiditis.  

Since thyroid antibodies are present in 95% of patients with Hashimoto's Thyroiditis this test can serve as a useful way in identifying the disease without thyroid biopsy or surgery.  It is important to note that persons with Hashimoto's can have subclinical symptoms (standard tests may come back normal but symptoms still exist).  For this reason, it is important to have your doctor test specifically for Hashimoto's antibodies along with testing the thyroid stimulating hormone (TSH).  For those who suffer weight gain and concentration problems, it is also important to have both T4 and T3 levels checked.

Hashimoto's is named after the Japanese physician that first noted this disease in 1912.  Hakaru Hashimoto noted that the thyroid gland is always enlarged, but often with only one side enlarged enough to feel during a physical examination. In Hashimoto's the cells of the thyroid become inefficient in converting iodine into thyroid hormone and the thyroid gland tries to compensate for this by becoming enlarged.

Diabetes and Thyroid Disease

People that are diagnosed with prediabetes, diabetes type 1 or diabetes type 2 have an increased risk of also having antibodies for Hashimoto's thyroiditis.  In fact, the associated risk of thyroid problems and diabetes is high enough that most doctors routinely check thyroid levels and for antibodies to Hashimoto's (and celiac disease) when a patient is newly diagnosed with diabetes.

Persons with type 1 diabetes, or other autoimmune disorders like [polycystic ovarian syndrome and] Addison's disease are 30-50 times more likely to have other autoimmune disorders simultaneously.  ("Birds of a Feather Flock Together": Type 1A Diabetes and Other Autoimmune Disease States, Russell D. White, MD and  George D. Harris, MD, MS, Clinical Diabetes 24:40-43, 2006)

Symptoms of Hypothyroid (Low Thyroid)

Symptoms include weight gain, fatigue, hair loss, heavy or abnormal menstrual bleeding, dry skin, inability to concentrate, clumsiness, depression, change in sleep habits, and intolerance to temperature, especially the cold.  Even in the presence of normal TSH levels, these symptoms (called subclinical) may exist and your physician may decide to begin therapy with a low dose of a thyroid replacement drug.

Hypothyroid problems can develop quickly (within weeks) or slowly, over many years and are often misdiagnosed or overlooked as a possible reason for patient complaints about weight gain, lethargy, and slowed thinking.  

Testing For Hashimoto's

Your doctor should run a specific test for Hashimoto's antibodies and not just a TSH  (thyroid stimulating hormone) test since a person can have Hashimoto's (evidenced in an antibody test) years before thyroid levels fall.  Your doctor may also take a sonogram of your thyroid.  It is important for all persons diagnosed with diabetes, insulin resistance, or polycystic ovarian syndrome (PCOS) to have the specific antibody tests performed.  There is a genetic component to Hashimoto's and it tends to run in families.

For persons who experience weight and/or concentration problems, it is also advisable to have your doctor test your T3 levels in addition to T4 levels.  You will need to ask for this test as it is not routinely performed.   


Treatment involves daily medication to replace certain hormones.  There are several types of medications available and your doctor can help you decide which one is best for your needs.  Medications available include both T4 (thyroxine) and T3 (liothyronine) replacement.  Treatment often helps reduce the size of the enlarged thyroid gland (which can become large enough to make swallowing more difficult) but there is no cure for Hashimoto's Thyroiditis.  Once a person starts taking thyroid medication they will usually be required to stay on it for life.

Thyroid Drugs Brand Names
  • Armour Thyroid (this drug is still made and available)
  • Cytomel
  • Levothroid
  • Levoxyl
  • Naturethroid
  • Synthroid
  • Tapazole
  • Thyrogen
  • Thyrolar
  • Unithroid
  • Westhroid

Generic Thyroid Drug Names

  • Liothyronine
  • Liotrix
  • Methimazole
  • Propylthiouracil / PTU
  • Natural Thyroid
  • Thyrotropin alfa
  • Levothyroxine /L-thyroxine

Do You Need T3 in Addition to T4?

Persons that are insulin resistance seem to have another problem with resistance related to thyroid medications and resistance to converting T4 into T3.  It is common to replace T4 with a drug like Levoxyl but which can normalize TSH test values.  However, having normal TSH results does not always alleviate patient symptoms.  Some patients that are resistant to converting T4 to T3, despite normal TSH and T4 levels, may continue to have symptoms of low thyroid, particularly weight gain, mental confusion, clumsiness, and intolerance to heat and cold despite T4 therapy.  Your physician can test T3 levels in addition to T4 levels to make sure that your medication is working best for you.

If your T3 levels are low, or your symptoms persist, your physician may choose to supplement T4 with T3 (i.e., the drug Cytomel).  While this treatment is controversial as to its effectiveness, if a patient is not happy with T4 replacement therapy alone, it is an option that can be safely tried.  Typically, a lower does of T4 is given (taken once daily) and T3 replacement is added, which is taken twice daily (once in the morning and once at night).  

The most important aspect of living with a thyroid disorder is the alleviation of your symptoms.  Having a normal TSH is important, but will mean little to you if you still have subclinical problems.

An excellent article about the controversy of T4/T3 combination therapy is:  Combined T4/T3 is Therapy: Placebo or Tomato? An Assessment of the October 2003 T4/T3 Studies (October 2003).

Author's personal note:  Lahle Wolfe, IOH Founder, has Hashimoto's. Prior to going on combination therapy, she was unable to concentrate, and only received minimal symptom relief on T4 replacement alone.  Placebo or not, her T3 levels were always low while only taking T4.  After adding Cytomel (T3) replacement, her T3 levels became normal after several months and her symptoms improved significantly.   

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Taking Your Medications

It is important that you always take your thyroid medications about the same time each day.  If you normally take your medication with food, you should always take it with food.  The important thing is consistency when taking your medication.

It is important that you take only the amount of medication that is prescribed for you.  It takes time to see if a dose is working properly (your doctor may retest your thyroid levels every 3-6 months until your dose is correct).  Taking too much thyroid replacement can result in hyperthyroid levels (too high) and serious consequences.  It is not true that taking more medication than prescribed to you will result in substantial, or easy weight loss, but it can result in heart palpitations and episodes of psychotic behavior.  

Women, Estrogen and Thyroid Medication

Women taking estrogen either as a hormone replacement or in birth control pills, as well as those who have estrogen dominant disorders such as polycystic ovarian syndrome, may require an increase in thyroid medication.  Excess estrogen can diminish the effectiveness of thyroid medication, making it inactive.  If you start birth control pills or HRT, be sure to have your thyroid levels checked to see if an adjustment in dosage is needed.  

Drug & Supplement Interactions

Both oral hypoglycemia drugs and insulin may reduce the efficacy of replacement thyroid hormone.  If you are on thyroid medication and become diabetic and require medication/insulin to treat your diabetes, have your doctor follow your thyroid closely.  The reverse is also true:  if you are diabetic and develop thyroid problems that require medication, you should be carefully monitored when thyroid medication is first introduced.

There are many other medications that may interfere with thyroid medications so it is important that you let your doctor and pharmacist know all drugs you are taking, including those that are over-the-counter drugs.

Supplements and vitamins including calcium and iron can affect the action of thyroid medications as can certain foods. A good source of information can be found here:  Frequently Asked Questions about Food, Drug and Supplement Interactions.  

Another interesting source of information regarding thyroid medication and interaction of antidepressants and helping patients with combination T4/T3 therapy can be found on Dr. Bob's Psychopharmacology Tips, a forum where medical professionals discuss their experience regarding patient treatment protocol.

Do You Need Preventive Thyroid Treatment?

Some studies show that even when TSH levels are normal, if a patient shows positive for thyroid antibodies, treatment with T4 may still be of benefit.

    "In a June 2005 presentation at the Endocrine Society's Endo 2005 conference, Dr. Ting Chang and colleagues reported on giving levothyroxine (i.e., Synthroid, Levoxyl, etc.) to euthyroid Hashimoto's thyroiditis patients -- patients who had normal range TSH (known as "euthyroid), but elevated antibodies..."  Read an article on preventive therapy.


Important Medical Disclaimer

All material found on this site is  presented strictly for  information and resource purposes only .  It is not intended for self- diagnosis or self-treatment or changes in doctor-prescribed treatment plans.  We strongly recommend  you speak with your doctor  for diagnosis , treatment options, or before making  changes  to your current diabetes  or other medical care plan.


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Page Updated 04/01/2006