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Disorders Associated with Diabetes Hashimoto's Thyroiditis
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). 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 diabetes types 1 or 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 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. Treatment 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
Generic Thyroid Drug Names
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.
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 on www.thyroid.about.com. Look for the link to 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 (http://www.dr-bob.org/tips/split/Thyroid-replacement.html) , 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., Synthyroid, Levoxyl, etc.) to euthyroid Hashimoto's thyroiditis patients -- patients who had normal range TSH (known as "euthyroid), but elevated antibodies..." Read an About.com 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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