The Hidden Cause Of Hypothyroidism
Dr. Michael Ruscio: Hi. This is Dr. Ruscio, and welcome to the next video in our Thyroid Solution Series, the hidden cause of hyperthyroidism Number 2: Insulin, blood sugar and your thyroid.
Insulin and blood sugar can affect your thyroid through four main mechanisms: they are through manipulation of your stress hormones, through modulating inflammation, through causing digestive problems, and through worsening autoimmunity.
Thyroid Disorders And Diabetes Mellitus
Sami T. Azar
1Division of Endocrinology, Department of Internal Medicine, American University of Beirut-Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
Studies have found that diabetes and thyroid disorders tend to coexist in patients. Both conditions involve a dysfunction of the endocrine system. Thyroid disorders can have a major impact on glucose control, and untreated thyroid disorders affect the management of diabetes in patients. Consequently, a systematic approach to thyroid testing in patients with diabetes is recommended.
Thyroid diseases and diabetes mellitus are the two most common endocrine disorders encountered in clinical practice. Diabetes and thyroid disorders have been shown to mutually influence each other and associations between both conditions have long been reported . On one hand, thyroid hormones contribute to the regulation of carbohydrate metabolism and pancreatic function, and on the other hand, diabetes affects thyroid function tests to variable extents. This paper demonstrates the importance of recognition of this interdependent relationship between thyroid disease and diabetes which in turn will help guide clinicians on the optimal screening and management of these conditions.
2. Frequency of Thyroid Disorders in the General Population and in Patients with Diabetes
3. Effects of Thyroid Hormones on Glucose Homeostasis
4. Leptin, Adiponectin, Ghrelin, and Thyroid Hormones
How Does Blood Pressure Work & What Is Hypertension
Blood pressure is the measurement of what kind of pressure is being put on your blood vessels . The top number in a blood pressure reading reveals the pressure on the walls of the vessels when the heart is pumping, systolic blood pressure.
The bottom number represents the pressure on the walls of the vessels when the heart is at rest or between beats, diastolic. Blood pressure acts diurnally, as well: higher during awake hours and lower while sleeping. Blood pressure readings consistently above 140/90 are considered hypertensive.
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What Does The Thyroid Do Again
The thyroid is a little butterfly-shaped gland that lives in the middle of your neck, and its part of the bodys endocrine system, where diabetes also dwells. This system controls your bodys metabolism. One of the thyroids 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 bodys normal equilibrium slows down.
Turns out, thyroid issues are incredibly common. According to , up to 59 million Americans have a thyroid problem and a majority dont know it . This ailment is so widespread, in fact, that Oprah was all about it a few years ago.
Those of us in the Diabetes Community are more prone to thyroid issues . Women are more prone than men, but that doesnt exclude guys like me.
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 Hashimotos Disease
- goiter, which is an enlargement of the thyroid
- thyroid cancer
As you can imagine, none of these are good news for your body.
Insulin Blood Sugar And Thyroid Hidden Cause Of Thyroid Problems #:
Written by Dr. Michael Ruscio, DNM, DC on May 1, 2014
How do insulin and blood sugar levels affect your thyroid? Well lets quickly review insulin and blood sugar regulation. The readers digest version goes like this eat carbs, then your blood sugar rises which then causes a release of insulin. A reasonable amount of carbs and stimulation of this process is OK and actually good, however most people are consuming far too much carbohydrate which then causes a myriad of problems. You could fill an entire book on this topic alone, but for now lets focus on the thyroid connection.
Insulin and blood sugar primarily influence your thyroid through
- Stress hormones
Lets work through each one of these.
Sugar & Stress Hormones
Stress hormones, specifically cortisol, are intimately linked to your blood sugar levels and imbalances in stress hormones levels will cause problems with your thyroid. Said another way, blood sugar levels have a profound impact on stress hormones and stress hormones effect your thyroid . When cortisol levels become too high you will experience a decrease in TSH. When cortisol levels become too low you will have impaired conversion of T4 to T3. 1-8
- Not sleeping well waking up more in the middle of the night and cant get back to sleep
- Stubborn belly fat
- Energy dips through the day
- Less desire for exercise
- In ability to cope with stress like you used to
- There are just a few, but does this remind you of anyone?
Sugar & Inflammation
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Underlying Mechanisms Of The Association Between Mets In Td
MetS is characterized by a cluster of cardiovascular risk factors . Isulin resistance is the main clinical and pathogenic feature of this syndrome. The definition of MetS is based on central obesity plus any two of the following factors: atherogenic dyslipidemia, with high triglycerides and low high-density lipoprotein cholesterol or specific treatment of this lipid abnormality high blood pressure or antihypertensive treatment insulin resistance and elevated fasting plasma glucose concentration or previously diagnosed of T2D . A prothrombotic state and a proinflammatory state are usually associated with MetS, which is as an independent risk factor for CVDs and T2D .
TH affects food intake, resting energy expenditure, and thermogenesis, and consequently metabolic alterations can develop in patients with TD. T3 influences both metabolism and thermogenesis by regulating transcription factors involved in adipogenesis of WAT and BAT, appetite, and glucose and lipid metabolism and oxidation . Alternatively, the combination of central nutritional state and hormonal signals, including leptin, dopamine, somatostatin, insulin, and adrenergic signaling, integrate information regarding overall nutritional status, circadian rhythms, and stress to modulate TH production .
How Can You Tell If Your Thyroid Is Off
The symptoms of hyperthyroid and hypothyroid are starkly different, but it can be difficult to tell theres 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 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!
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Thyroid Disease And Diabetes
Diabetes and thyroid disease are both endocrine, or hormone, problems. When thyroid disease occurs in someone with diabetes, it can make blood glucose control more difficult.
The thyroid is a butterfly-shaped gland in your lower neck just beneath your skin. It regulates your bodys metabolism, the processes of using and storing energy, by releasing a substance called thyroid hormone. If it produces too much thyroid hormone, your metabolism quickens , too little and your body functions slow down .
Treatment Of Thyroid Disease
Nearly all thyroid diseases are treatable. Hypothyroidism and hyperthyroidism often require long-term or lifelong treatment, depending on the specifics of the diagnosis.
Hypothyroidism. The treatment for hypothyroidism is to replace the missing thyroid hormone. The most common form of thyroid hormone is a synthetic derivative, levothyroxine, which is usually taken as one pill daily. This is a simple yet very effective treatment of hypothyroidism. Once the treatment is started, TSH testing every two or three months is necessary to adjust to the correct dose. When a stable dose is achieved, annual TSH testing is generally adequate for monitoring purposes.
The symptoms of hypothyroidism may take several months of therapy to resolve. Often, lifelong treatment is necessary. Natural thyroid extract derived from animal sources is a less commonly used form of thyroid replacement and has the disadvantage of inconsistent dosage that varies from one batch of pills to another.
Certain supplements, including iron supplements, calcium supplements, and multivitamins that contain iron or calcium, can interfere with the absorption of thyroxine. For this reason, these pills should be taken at least two hours apart from thyroxine. In addition, its a good idea to let your physician know of any supplements or other medicines you take in addition to levothyroxine.
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Screening Of Td In Patients With T2d
T2D accounts for 14% of the health expenditure in the United States to treat complications such as myocardial infarction, stroke, retinopathy, end-stage renal disease, and care for ulcerative lesions . Regarding the screening of T2D, the ADA suggests the screening of this disorder at the age of 45 years as well as screening younger adults who are overweight with one or more of the following risk factors: a positive family history of diabetes coming from high-risk minority ethnic/racial groups the presence of hyperlipidemia being physically inactive experiencing signs/symptoms of insulin resistance and/or the presence of hypertension or treatment of hypertension . The ADA recommends rescreening patients with these risk factors only every 3 years based on the rationale that someone who tests negative would be highly unlikely to develop the disease complications within the 3-year time period .
However, most of the available guidelines are too general and not detailed regarding routine screening and monitoring of T2D and TD. Even current guidelines from the ETA and ATA do not specifically address screening of thyroid function or treatment of TD in individuals with T2D.
Therefore, there is insufficient evidence to evaluate whether a specific screening of TD policy is necessary in T2D. These uncertainties do not allow us to adopt specific recommendations from the guidelines published by the major endocrine and diabetes societies .
Sugar Thyroid Disease And Diabetes
If you have thyroid disease, you are at an increased risk of developing type 1 diabetes or type 2 diabetes. And if you have diabetes, you are at increased risk of thyroid disease. When these conditions occur together, they can also exacerbate each other’s symptoms and interfere with treatment.
The complex links between these two disorders are not fully understood. The connection is believed to be related to multiple factors, including an increased tendency to develop an autoimmune disease, glucose level irregularities, and alterations in fat metabolism.
With the inherent risk of developing one condition if you have the other, there are some recommended prevention strategies, the most important of which is making sure that your blood glucose levels stay between 70 and 105 mg/dL. Avoiding excess added sugar and fructose is an important part of keeping your glucose in the recommended range.
It is often advised that you maintain a moderate sugar intake and have your blood sugar levels checked regularly if you have thyroid disease.
Your weight can be affected by thyroid disease and diabetes, and being over- or underweight can trigger either condition. As such, weight control is another important strategy when it comes to the prevention of these conditions.
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Balancing Blood Sugar Levels With Diet
Focusing on the impact of food on our blood sugar is the most effective way to balance our blood sugar levels, and this is best accomplished by paying close attention to the glycemic index of foods.
The glycemic index is a measure of how quickly food becomes assimilated into our bodies. It can also be referred to as the burn rate how quickly we burn the fuel we receive from these foods. Focusing on low glycemic index and low glycemic-loaded foods, which burn slower, can really help with balancing blood sugars.
Foods with a glycemic index of less than 55 are considered to have a low glycemic index. These include most non-starchy vegetables, meats, nuts, seeds, and some whole grains. Fruits with less fructose also have a low glycemic index.
Foods with a glycemic index above 55 are considered high glycemic index foods and include processed grains, sugar, starchy vegetables like potatoes, and sweet fruits like watermelon.
The glycemic index of foods can be referenced at glycemicindex.com.
The graphic below gives you an idea of how high and low GI foods affect blood sugar over a two-hour period. As you can see, high GI foods spike blood sugar levels high, which crash dramatically after 30 minutes have passed. Low GI foods, however, produce a smaller spike that declines relatively slowly.
The following quick reference can be printed out to make balancing your blood sugar much easier:
Thyroid Disease And Insulin
Diabetes can cause alterations in thyroid hormone levels. Insulin imitates the actions of thyroid hormones in some tissues of the body, which decreases the production of thyroid hormones. But insulin also functions in the opposite way thyroid hormones do in other tissues, which increases thyroid hormone levels.
Excess or deficient insulin can induce changes in thyroid hormone production and activity.
Looking at the association from another direction, the metabolic changes of thyroid disease can interfere with the effects of insulin, whether endogenous or taken as a medical treatment for diabetes.
Hyperthyroidism increases metabolism and can cause insulin to be processed and eliminated from the body more quickly than normal. Some people with type 1 diabetes who are also diagnosed with hyperthyroidism may need to take higher doses of insulin until thyroid hormones are stabilized.
When metabolism is slowed in hypothyroidism, insulin may linger longer in the body, causing a greater risk of hypoglycemia . Hypothyroidism has also been associated with an increased sensitivity to insulin, which can contribute to hypoglycemia.
Its important that you discuss all adjustments in your prescribed insulin dose with your healthcare provider, if applicable.
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Are Type 1 Diabetes And Thyroid Disease Connected
Much like type 1 diabetes, most types of thyroid disease are autoimmune disorders. Unfortunately, if you have one autoimmune disease, research shows that youre more likely to develop another or several.
In type 1 diabetes, the immune system attacks the cells in the pancreas that make insulin. In some types of thyroid disease, the immune system attacks the cells of the thyroid.
Why people develop autoimmune diseases is not well understood, but there are many theories.
In an interview, Dr. Lowell Schmeltz remarks: Theres some genetic risk that links these autoimmune conditions, but we dont know what environmental triggers make them activate.
While research does not indicate that type 1 diabetes is actually causing thyroid disease, the diabetes diagnosis generally occurs first, with the thyroid condition developing at some point in the years afterwards.
However, as we see more and more people being diagnosed with type 1 diabetes later in life, this could switch.
Prevalence Of Td In Patients With T2d
A few studies have prospectively investigated the relationship between TD and the incidence of diabetes . Two Danish register-based studies have reported conflicting results . A nationwide registry study reported an increased risk of DM in individuals with hyperthyroidism , whereas two other studies reported an increased risk of DM in patients with hypothyroidism .
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Lets Take A Look At The Important Role Of Balanced Blood Sugar Levels And Your Low Thyroid Symptoms
Proper Blood Sugar levels are critical for anyone with low thyroid function. Normal blood glucose levels medically have a broad range of anywhere from 70 to 105. Functional or optimal blood glucose levels are 85 to 99. According to the American Diabetic Association, a blood sugar level reading of 106 to 126 is called, Insulin resistance, and anything above 127 is diabetes.
I know you may be thinking, I dont have diabetes. Here is the thing, you dont have to be diabetic to have blood sugar problems. Your body does not like to have the range for blood sugar too high or too low. Anytime the range gets out of the normal functional range , you start to get inflammatory chemicals released in the body. These inflammatory chemicals are called cytokines and they are not a good thing. The events that are triggered by inflammatory cytokines are like a domino effect that is difficult to stop and can lead to autoimmune conditions!
Here is a scary example of how the traditional model can go wrong. One of my patients, Carol, came in for me to take a look at her health challenges. During the exam I noticed several indicators pointing towards blood sugar problems, such as difficulty with memory , belly fat issues and being overweight. This gal already knew she was headed towards diabetes based on tests she had from her medical practitioner.
Insulin Resistance And Severe Insulin Resistance
Insulin resistance occurs when the cells of the body do not respond properly to insulin. This means the insulin produced by the pancreas cannot be used effectively. People with IR may need a much larger amount of insulin or other insulin sensitising medications to reach and stay within their blood glucose targets.
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Pathophysiologic Correlation: Hypothyroidism And Hypoglycemia
Hypothyroidism is linked with various hormonal biochemical and nervous system abnormalities, which may contribute to hypoglycemia.
The condition is linked with low growth hormone and cortisol responses to insulin induced hypoglycemia, and this prevents adequate counter regulatory protection. It must be noted that in some cases, pituitary dysfunction may be a consequence of primary hypothyroidism, rather than a cause of thyroid dysfunction. For example, hypothyroidism reduces basal and stimulated growth hormone levels, by acting on both the hypothalamus and pituitary. As it is linked with suboptimal growth hormone response, the recovery from hypoglycemia may be prolonged in hypothyroidism.
Hypothyroid patients have relative adrenal insufficiency, even if they are not associated with primary adrenal failure. There is a blunted hypothalamo-pituitary-adrenal response to hypoglycemia in hypothyroid persons. The reduced cortisol responses to insulin-induced hypoglycemia that are noted in hypothyroidism also worsen hypoglycemia.
The role of gluconeogenesis is reduced in hypothyroidism, both in skeletal muscle and in adipose tissue. Glycogenolysis is also impaired in hypothyroidism. These biochemical defects lead to a delayed recovery from hypoglycemia.