4. Leptin, Adiponectin, Ghrelin, and Thyroid Hormones Thyroid hormones may influence carbohydrate mechanisms via its interaction with adipocytokines and gut hormones. Among these adipocytokines, adiponectin is the most abundant adipokine secreted by the adipose tissue and has important insulin-sensitizing properties.
Therefore, it is best to start with a low dose, such as 25 g daily, and increase slowly by monthly increments of 25 g while monitoring the patient's clinical status and serum TSH levels.
Moreover, the nonoxidative glucose disposal in hyperthyroidism is enhanced resulting in an overproduction of lactate that enters the Cori cycle and promotes further hepatic gluconeogenesis. The increase in GH, glucagon and catecholamine levels associated with hyperthyroidism further contributes to the impaired glucose tolerance 37 39.
Explains the thyroid gland, and its connection to diabetes. Also, discusses hypothyroidism, and alternative treatment strategies.
It is well known that diabetic patients with hyperthyroidism experience worsening of their glycemic control and thyrotoxicosis has been shown to precipitate diabetic ketoacidosis in subjects with diabetes 40, 41. As for hypothyroidism, glucose metabolism is affected as well via several mechanisms.
L-thyroxine is the most widely used thyroid hormone replacement. Natural thyroid extracts such as desiccated thyroid should no longer be used. The usual full replacement dose is 1.6 g L-thyroxine per kg of body weight.
Often, patients with mild thyroid failure require less than a full replacement dose initially. The dose can be adjusted by measuring TSH every 23 months. Once the TSH is normalized and the patient is established on a stable dose of L-thyroxine, TSH monitoring can be done annually.
With progression to complete thyroid failure, there is usually a need to increase the thyroxine dose with time. In diabetic patients with underlying coronary artery disease, L-thyroxine therapy may exacerbate angina by increasing myocardial contractility and heart rate.
This raises the issue whether routine screening for thyroid disease in all patients newly diagnosed with metabolic syndrome will be cost effective. Furthermore, an increased risk of nephropathy was shown in type 2 diabetic patients with subclinical hypothyroidism 51 which could be explained by the decrease in cardiac output and increase in peripheral vascular resistance.
Common susceptibility genes have been acknowledged to confer a risk for development of both AITD and type 1 diabetes mellitus. Currently, at least four shared genes have been identified including HLA 17 22, CTLA -4 23, PTPN 22 24, 25, and FOXP 3 genes 26.
It is usually autoimmune in origin, presenting as either primary atrophic hypothyroidism or. Hashimoto's thyroiditis. Thyroid failure secondary to radioactive iodine therapy or thyroid surgery is also common. Rarely, pituitary or hypothalamic disorders can result in secondary hypothyroidism.
Toxic multi-nodular goiters tend to affect the older age-groups. Diabetic patients have a higher prevalence of thyroid disorders compared with the normal population (Table 1). Because patients with one organ-specific autoimmune disease are at risk of developing other autoimmune disorders, and thyroid disorders are more common in females, it is not surprising that up to.
CLINICAL DIABETES VOL. 18 NO. PRACTICAL POINTERS Thyroid Disease and Diabetes By. Patricia Wu, MD, FACE, FRCP T hyroid disease is common in the general population, and the prevalence increases with age.