Autoimmune Disorders: Thyroid and Diabetes
With guidance from Dr Kalpana Jog, MD and consultant pediatrician at KEM Hospital and Dr Smita Dhadge, consultant at KEM
Definition of Thyroid
Thyroid is a butterfly-shaped endocrine gland usually located in the lower front of the neck below the larynx (the voice box). Its job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. This hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.
The main hormone made by thyroid is thyroxine (T4) because it contains four iodine molecules. Small amounts of another and more potent thyroid hormone containing three iodine molecules, triiodothyronine (T3) are also made by the thyroid gland. However, most of the T3 in the blood is made from T4 in other body tissues.
Thyroid hormones control the way every tissue in our body uses energy. They are essential to help each cell in our tissues and organs work right. For example, thyroid hormone controls the body’s temperature, heart rate, blood pressure, and the rate at which food is turned into energy (metabolism).
Types of Thyroid Disorders
The thyroid gland is the only organ in our body that affects such a large number of body functions. It produces hormones that regulate the body's metabolic rate, heart functions, digestion, muscle control, brain development, mood and maintenance of bones. It is truly said that thyroid affects every inch of your body and its functions.
Let’s take a look at what are the causes of thyroid:
After understanding what causes thyroid, let’s take a look at the symptoms. You can only take corrective steps to deal with any problem in life when you are able to identify the problem. Using that analogy here, the following images list the symptoms of hypothyroidism and hyperthyroidism.
In case the symptoms ring a bell, it’s time to book an appointment with your doctors right away!
Diagnostic Tests for Thyroid Management
Is it preventable and what is the treatment?
So far we have understood what the causes and symptoms of thyroid are. A pertinent question that Chhavi has got a lot is, could it have been prevented? (she was diagnosed with puberty goiter also an autoimmune disease, when she was about 11 or 12)
The answer to this is NO. It's autoimmune, and there isn’t much that can be done to stop the onset of an autoimmune disease. In case the cause is iodine deficiency (hypothyroid) or too much iodine (hyperthyroid), then making diet modifications is highly recommended as abnormal functioning of the thyroid gland will affect overall functioning of the body.
To sum it up, it’s not preventable; especially after the symptoms show, and the diagnostic tests determine it. The most sensible thing to do hereon is to manage your thyroid well (it's possible!) in a manner that it doesn’t become life threatening. However, there are few generic things to keep in mind while managing thyroid.
- Do not smoke
- Celiac: In case you have it, get your thyroid tested. Just like T1s, people with celiac are at higher risk of developing thyroid.
- Food: Depending upon the type of thyroid, there is enough reading material about the foods to include or exclude from your diet. For e.g.: Broccoli is a food that is great for hyperthyroidism since it slows the production of thyroid hormone while it isn’t a good food for hypothyroidism.
Thyroid is manageable with oral medication. However, medicine, adequate dosage and subsequent monitoring of dosage with time can only be determined by your doctor, normally an endocrinologist.
Monitoring doses is very important, otherwise it may lead to development of complications in thyroid hormone development.
For hyperthyroidism besides oral medication, the following are two are also treatments. But what treatment works for you depends on your symptoms, the cause of your hyperthyroidism, and what treatment option makes you most comfortable. Please refer to your endocrinologist before making any treatment decision.
This oral medication is absorbed by your thyroid gland. Radioactive iodine works by gradually destroying the thyroid. This, in turn, reduces your hyperthyroid symptoms. This treatment is effective at permanently curing hyperthyroidism, and there are very little side effects on the rest of your body. Some may require a repeat treatment. Since you will no longer have a thyroid, you will need to take thyroid hormone replacement therapy to replenish the lack of thyroid hormones.
The total or partial surgical removal of the thyroid is called a thyroidectomy. When performed by an experienced surgeon, it's a safe and effective treatment. As with any surgical procedure, it poses some small risks, including potential damage to your vocal cords and parathyroid glands. You are requested to get proper details on all medications from your doctors. Each of us has different cases, thus different treatment plans will work for each of us.
What happens if thyroid is not treated on time or medication is stopped?
Read Chhavi's story of autoimmune hypothyroidism diagnosis before her diagnosis with Type 1 Diabetes:
I was diagnosed with thyroid as a child. I don’t remember the exact age, perhaps 11 or 12. What I had was puberty goiter. I had an enlargement in the front portion of my throat and my mum (always is the mother) insisted and took me to a GP who then directed us to a lab test. It’s almost funny that the day of my lab test always stays with me (mostly because that’s where my fear of needles and doctors and hospitals developed and has stayed through even today). I had gotten tested twice. The first test that was done confirmed that I had puberty goiter. Now puberty goiters are enlargements in the thyroid gland that are normally benign in nature. But of course, just to be double sure, we got a biopsy done. They stuck a needle to my throat (no wonder I fear needles so much. Oh and the irony that I live with T1D which means needles are now my best friends!) and went about the drill of doing this exercise. How do I remember it so clearly? Because my mum doesn’t advocate junk food and that day, right as we left the lab, my mum let me eat all kinds of junk food from my fav place near the house.
The biopsy confirmed that I indeed had puberty goiter.
These conversations are more than a decade and a half old, but I do remember parts of doctor visits. He said puberty goiter goes away with, well, puberty! I am way past the end of my puberty now, but the thyroid is still here. I live with hypothyroidism. But here is the difference between our journeys. While Madhura was diagnosed shortly after her T1D diagnosis (and that’s what I observe with fellow T1Ds), I lived with thyroid (an uncontrolled one) for close to a decade before I had T1D. Since both are autoimmune, I sometimes wonder if my T1D was caused due to uncontrolled thyroid. I am slightly embarrassed to admit that I never asked my endo if it was so. This thought crosses my mind a gazillion times, but I haven’t searched for answers yet. Mostly because I wonder how that would change my approach towards my thyroid or diabetes management.
Writing this article is the first time I have dedicatedly studied thyroid. Neither my parents, nor my doc or anybody ever told me the what, hows and whys of effective thyroid management. Every single day I hear how T1D impacts us and our bodies and I can tell you, uncontrolled thyroid does a much worse job. Steve Jobs said,
"You can’t connect the dots looking forward; you can only connect them looking backwards”.
I can vouch for the accuracy of this statement, at least with respect to my journey with autoimmune diseases. I am reminded of the classic symptoms from my teens and college years where I would face extreme fatigue (always heard people around me say, that’s because I was overworked - I attended regular college plus CA internship), had horrible hair fall phases, the most irregular periods (I would be so worried about it all the time but didn’t know what to do). This brings me to the point, caregiver's awareness. My parents though wanting the best for me, never pushed to understand the long-term implications and I don’t blame them. There wasn’t any awareness. Google searches weren’t as accessible then as today. I am sure had they understood how this was going to affect me in the long run, they would have moved heaven and earth to make sure I took my medication on time. Unlike the efforts that caregivers of T1Ds have to take, all my parents had to do was ensure I popped the oral medication every single day. Not until I was diagnosed T1D in 2014 did I get regular with my thyroid management. Now my thyroid is under control but some symptoms still persist, and I know what the long-term impact has been. I feel tired more easily than my peers even now, I feel very cold ALL THE TIME.
If you have one autoimmune condition, you stand at a greater risk of developing others.
I would never know what really caused my T1D, but I always assume that my uncontrolled thyroid had a role to play. We may never know the truth, but prevention is better than cure and if reading this makes you get up and take charge of your health, my task here is done!
Now read what Madhura has to say about her diagnosis of autoimmune hypothyroidism after her diagnosis with T1:
I vividly remember the day I went to KEM hospital, Pune for the first time – six months post T1D diagnosis. Meeting Dr Smita Dhadge (the doctor with a beautiful smile on her face no matter how crowded the OPD is) is my biggest blessing ever! As I told my diagnosis story to Dr Smita, she casually got off her chair and checked my neck. I was a bit surprised as no doctor had ever checked my neck and it looked just fine to me. She handed me a prescription for more tests and explained why.
My reports came in a week, and I learned that I tested positive for TPO antibodies along with GAD 65 antibodies. I panicked as I couldn’t fathom the meaning. Dr Smita calmed me down and explained what it meant – I have antibodies that could destroy my thyroid gland just like the antibodies for GAD 65 which already destroyed the beta cells in my pancreas causing T1. She asked me not to worry about it as it does not necessarily mean that I would definitely have autoimmune thyroid disorder. It’s just a reminder that I should test my TSH levels every six months so that the onset would be diagnosed and treated.
I recalled events when I lost lustrous locks of my hair, gained a lot of weight for no reason, and felt exhausted. Not a single doctor/trichologist asked me to check for thyroid even though I was clearly showing the classic symptoms for years. I took the TSH test after six months which revealed autoimmune hypothyroidism. Dr Smita assured me that managing thyroid isn’t much stress – all I need to do is take my medication (a small pill containing Thyroxine Sodium) everyday without fail.
It’s been four months since I started thyroid medication. I can clearly see the HUGE difference it has made. I cannot emphasize enough the importance of finding the right doctor at the right time (Dr Smita) and a buddy who can relate to you and help you (Chhavi) just by being there! I really hope that if you're reading this blog, you get your TSH test done at least once a year because
Thyroid plays a vital role in the metabolism, growth and development of the human body, and has the power to change your life for the better.
Myths about thyroid
At Blue Circle Diabetes, we love to bust myths associated with diabetes. Today we extend the courtesy to another autoimmune that so many of us live with, Thyroid.
Here’s our top list:
- If you have thyroid, you'll be able to identify it easily
It is easy to miss the fact that several apparent symptoms are all to do with a thyroid problem as these can include extreme fatigue, anxiety, palpitations, changes in pulse or blood pressure, hair loss, weight loss or gain and dry skin. Such non-specific symptoms are often misattributed to hormone related conditions in women such as perimenopause or menopause. Thyroid sometimes is also asymptomatic to begin with. Get your tests done to be sure.
2. Thyroid problems only affect older women
Thyroid disease affects both men and women and can present at any age, although it is true that it is much more prevalent in women.
3. You must stop thyroid medication when pregnant
There is no problem continuing any prescribed thyroid treatment, in fact your baby is dependent upon you to provide for its thyroxine requirement to develop a healthy brain.
4. Problems conceiving in case a woman has hypothyroidism
This is not true unless you totally neglect to treat it.
5. You can’t lose weight if you have hypothyroidism
Finding it hard to lose weight is probably more down to your naturally slowed metabolism in your forties and fifties. If you are on medication to treat thyroid, you are effectively on the same level playing field as everyone else although you may be at a disadvantage compared to earlier as a consequence of your thyroid condition.
6. Taking extra iodine is good for thyroid health
Iodine is essential for the thyroid to function correctly but in fact too much iodine can cause problems too.
7. If you are sensitive to gluten it can trigger thyroid problems
There is no clear evidence that removing gluten from your diet will protect you from developing thyroid disease. This myth has probably come about because celiac disease is common in those with Hashimoto's or Graves’ Disease and of course people with Celiac Disease will need to remove gluten.
8. A higher level of thyroid hormone medication is better for you
Some people mistakenly believe this will give them extra energy and will help lose weight, but this is totally incorrect. Excessive medication is equally harmful. Your medication is designed to take you into normal parameters and having too much can cause you to shake, have palpitations, insomnia and be more hungry.
9. You can manage your hypothyroidism by watching what you eat
It’s not unusual for people to seek alternative treatments but diet alterations and alternate medications don’t substitute your medications under any circumstances.
10. My TSH levels are normal so I can’t have a thyroid problem
There are many different ways in which your thyroid can malfunction, normal TSH levels may not always be accurate. It is important to consider differences in gender, age, pregnancy or treatment of thyroid disease. A normal test for an elderly person will be very different for a pregnant woman. Your thyroid gland may be producing enough thyroid hormones, but your cells may not be able to use them efficiently. A normal TSH does not exclude pituitary dysfunction.
Top 3 tips from our endocrinologists for thyroid management
- Take routine TSH test, and understand the meaning of your result from your endocrinologist. If you show symptoms of thyroid malfunctioning with a normal TSH result, consider getting ultrasonography done after consulting your doctor. The ultrasonographic image helps your doctor detect abnormalities of your thyroid gland. If found, your doctor can immediately start medication.
- If diagnosed with antibodies for autoimmune thyroid, ask your immediate blood relatives (especially female blood relatives - your mother, sisters and/or daughters) to take the test for antibodies for autoimmune thyroid. Make sure they check TSH test annually.
- Make sure you take your prescribed medication at the suggested time everyday and never change your medication on your own.