Wednesday, July 18, 2007

Diabetes and hypothyroidism

I need some information the interaction between these two ailments, and what better forums to turn to than the DOC and TuDiabetes? ;-) I know you guys and gals have a lot of experience to share, so I will give you some background to support my specific questions.

When I moved to Odense more than 6 years ago, I needed another D-team. I had arranged with my former team that they would send my chart to the university hospital in Odense, but here they wanted to start their own chart, only keeping the chart from my former D-team as background reference. Therefore, I received a chart for blood sampling, and I have never before or after seen that many marks for analyses to be performed! It required 9 tubes of blood, almost leaving my arm drained ;-)

When I saw my new doctor at the hospital for the first time, I was informed about the results. Most of them were normal, but among those requiring attention was my TSH-level. It was marginally increased, 6.3 or something like that I believe – the normal range being 0.5-5.0 mU/L. The doc felt my thyroid gland being somewhat enlarged and referred me to an ultrasonic examination and a pin needle biopsy. The ultrasonic examination showed that my thyroid was indeed a bit enlarged, but the biopsy didn’t show any malignancy.

My D-doc (endo) has kept requesting thyroid analyses with most of my blood draws ever since, but otherwise there hasn’t been any follow-up on this. I have rarely seen the results of the analyses, but a couple of times within the past 2 years or so my doc has asked about my dose of Eltroxin (I believe it is called Syntroid in the States) – as if he shouldn’t be one of the first to know if I received any such treatment!

A months and a half ago I had my last appointment with my endo. When he showed me the paper with the most recent lab-result – for me to view my A1c – I noticed that the TSH-level was still off, having been as high as 9.37 in November last year. I was a bit shocked about this, but was told that treatment wasn’t initiated until the level was above 10 (so has my TSH been at this level the times he asked me about my dose of Eltroxin in the past?). He continued asking about my asthma, something that he has never done before, and I could tell him that I have had more problems during this spring when playing soccer. Still, he seemed to conclude that no immediate action needed to be taken, and just set me up for another appointment in 3 months (usually I go 6 months between appointments).

Ever since the realisation that my TSH-level apparently still isn’t normal, thoughts about the consequences of this have filled the back of my mind. I have searched the Internet about it, actually finding a site stating that with hypothyroidism diabetes could be hard to manage, but no case studies of the effect(s) of hypothyroidism on BG-management. I have found my old pathophysiology book, re-reading the section on hypothyroidism, and found some interesting information that put some things into perspective for me.

I’ve been diabetic for 17+ years, and the first 5-7 years were not much of a struggle. In contrast, the past 8 years or so have been very challenging BG-wise. I don’t know if my former D-team ever screened for other autoimmune disorders, but at least they didn’t tell me about it. With the initial result of my TSH-level 6 years ago, I cannot help but wonder if some of the problems I’ve had with maintaining a stabile BG, and not least avoid serious hypoglycaemic episodes, could somehow be related to the fact that an autoimmune attack has been taking place in my thyroid during the years as well. With swinging TSH-levels the levels of the important thyroid hormones have likely lingered around on the low side for the same amount of time as well, and since thyroid hormones among other actions increase the rate of carbohydrate absorption from the gut that may explain why it has sometimes taken “forever” to correct a low BG. As a side note, I can tell you that I have had a synacthen test performed to evaluate the functionality of my adrenals because for some time years ago, I had a lot of severe hypos, requiring a lot of ER visits as well as paramedics attending me in my apartment, at Jimmi’s place, at work – you name, it probably happened. The synacthen test came back perfectly normal, though.

What annoys me, though, is the fact that without saying – and not least doing – anything, I have apparently been “diagnosed” with “myxoedema without specification” and “autoimmune thyroiditis” years ago! Leafing through all my medical documents, ER- and paramedics notes, I found a piece of paper that I cannot really remember the context of, but the information in it seems clear (the diagnoses listed above). Looking at the date of this paper, I infer that it is from around the time where I switched from Insulatard (NPH) to Lantus, although I cannot really see, what the information about thyroiditis and the like has to do with this switch.

I have an appointment with my D-nurse again tomorrow, and I intend to bring the above-mentioned piece of paper, and ask her about it. She arranged for me to have another blood draw, so that she could discus the newest thyroid results with a doctor prior to our appointment. Although, I don’t like the idea of having to add yet another chronic illness to my chart, I don’t like the though of anything going untreated with the potential of causing additional problems either. I am not sure if any or which of the BG issues that I’ve experienced within the past 8 years have anything to do with a possibly wacky metabolism, because I haven’t found any specific cause-effect descriptions of the effect of untreated, low-grade, hypothyroidism on diabetes, but I would be surprised if there isn’t a DOC-blogger or two out there who has experienced this on their own body. So if any of you have been diagnosed with hypothyroidism – after being diagnosed with D – and can remember any D-related symptoms that subsided once the hypothyroidism was treated, I would like hear from you.

I am tired of having to act as my own doctor, but apparently it is necessary, so the more facts I can collect the better my argumentation for and questioning about lab-results and/or treatment will be. After all, I cannot write the prescription myself, I need a licensed doc to do that :-)


Chrissie in Belgium said...

I also have too low thyroid levels. i must take 112µg levothyroxinum per day. Sometimes the levels change and I have had to adjust the pill amounts. I have been told that too little thyroid, not enough pills, will cause increased bg values. Nevertheless, I have NEVER been able to draw a connection between changing thyroid levels and bg management. NEVER! I have never had any troubles with the hypothyroidism. I just take the pills. So if my thyroid is messing up my bg values - well I have missed it totally! To get the correct thyroid levels it has been necessary to add 1/2 of a 25µg pill( the smallest there is ) to my original 100*g pill. Heidi, I think I will be in Sweden when you take off for Glascow........ so I am sending you tons of good luck wishes. If you change your email pls tell me!

T1 in Japan said...
This comment has been removed by the author.
T1 in Japan said...

Hi Heidi! I follow both your blog and Chrissie's and find them each to be immensely interesting, possibly because I feel I connect with both of you. Anyway, just to add my 2 yen's worth of knowledge (I'm being generous), I was diagnosed with hypothyroidism probably about 10-20 years ago (dx'd D 36 yrs ago). My sister (a doctor) sees a link between my D, my aunt's Lupus, my brother's hypothyroidism (dx age 12), etc., with an autoimmune deficiency. My doc added early menopause to the list. I cannot recall any D-related symptoms being affected when I was treated. However, I am told that synthroid (and probably your version as well) has a very long half life, so it is difficult to pin down the effects of its treatment. My latest TSH was a bit low, and my doc just said try leaving out one pill (like Chrissie, I combine pills to reach the dose I need) once a week and see what that does. Like insulin, this is one drug that I feel is warranted.
Keep us posted on your move. And especially on your adventures. I look forward to getting back to Japan with my new toy (pump!) and fitting it into cycling, skiing, hiking and teaching.
(Sorry--I was trying to edit my post...:-p)

Anonymous said...


I hope things are going well with your D-team. Because you are living with type 1 diabetes, I thought you might be interested in helping out the International Diabetes Federation (IDF).

We are in the midst of our preparations for the first UN-observed World Diabetes Day ( on 14 November this year, and I wanted to ask you if you would like to help us to spread awareness of this worldwide event and the theme we have chosen for it this year - Diabetes in Children and Adolescents.

It is estimated that over 200 children develop type 1 diabetes every day and there's no question that the disease often hits disadvantaged communities the hardest, and that children in the developing world can die because their parents are unable to afford medication. In many countries diabetes is still considered an adult disease and as a result can be diagnosed late with severe consequences, including death. Even after diagnosis many children experience poor control and develop complications early.

This is why one of our key objectives for World Diabetes Day this year is to double the number of children covered by the Life for a Child Program - We also want to encourage initiatives that can help to reduce diabetic ketoacidosis (diabetic coma) and to promote the sort of healthy lifestyles which can prevent the onset of type 2 diabetes in children.

A version of the diabetes circle, the icon we used for our Unite for Diabetes campaign has now been adopted for World Diabetes Day and we have produced a number of web banners that you can view and download here

The way in which you can help us spread awareness of World Diabetes Day is to add one of the banners to your own blog, which we would really appreciate.

The UN's World Diabetes Day Resolution (61/225) was really just the first goal of an ambitious campaign that we have been leading. This is the first time a non-communicable disease has been recognised as a serious threat to global public health and we are hoping now to further raise awareness globally of the disease that is predicted to contribute to 6% of the world’s mortality in 2007.

If you would like to know more about the UN Resolution and our plans for World Diabetes Day this year, just drop me a line and I will get back to you with more information.

Many thanks,
Stephanie Tanner
IDF - Communications Assistant