 Hey guys, welcome to SugarMD channel. Today we are talking about the effect of thyroid hormones on your diabetes or glucose metabolism. This is Dr. Rahmet Ergin. I'm an under-canolidist and a diabetes specialist. Let's dive into thyroid and diabetes related issues now. So guys, before we jump to the topic, I want to encourage you to take the quiz in the description below to win a chapter from my diabetes book. Let's move on. Okay guys, so here's why you need to get your thyroid tested. Now both hyper, which is too much thyroid, and hypo, which is too little thyroid, can actually affect, if not cause, diabetes. So how does that happen? Now hyperthyroidism, overactive thyroid, it could be within you. It could be from grave disease or a toxic nodular goiter or something like that, that increases your thyroid within you, right? That's hyperthyroidism. That can happen to anyone, you know, with some genetic inheritance and so forth. Sometimes you don't even need the genetic inheritance. There's something called acute thyroiditis and suddenly, boom, it's like a thyroid flu and your thyroid goes out of whack and then it goes back to normal. Now that is induced within your body. But also studies indicate that up to 30 to 40 percent of people in primary care setting are treated, the patients are treated excessively by their primary care providers. It could be either primary care provider is not checking the thyroid function enough or the patients are forcing doctors to give more thyroid hormone or whatever the reason it may be. It is very common for over treatment to happen. Now we call that iatrogenic, so induced by the medical system, right? So what happens when there's too much thyroid in the system, regardless of the cause? Your body will become more insulin resistant. Your body will break down more protein. So you're gonna lose protein and muscle. You are going to also break down the lipids, but also you are going to, at the same time, increase lipid production. So it's weird the way thyroid works. It kind of makes two things together, breaks it and makes it. But then depending on the overall underactive thyroid situation, the end result is different. In hyperthyroidism, for example, everything becomes faster. So the building becomes faster and degradation becomes faster as well. So in muscle, when it comes to muscle and protein, degradation dominates and you end up losing muscle. Same thing actually happens. You know, other people tend to overuse thyroid to lose weight, which is not the greatest idea because you're losing muscle as well. But it helps with the lipid loss as well. On the other hand, it actually suppresses the insulin production and goes against your insulin. So it makes the insulin resistant. So suddenly your medications may not work enough. Or if you're not on medication and you're doing everything with diet, you may be like, uh, what's going on? Why is my blood sugar suddenly going up? Now, of course, hyperthyroidism can cause a lot of other symptoms. So the high glucose level is not the only one. But when you are hyperthyroid, what's interesting, your body absorbs the glucose a lot faster and then your blood sugar will spark a lot faster too. But when you are hyperthyroid, some people develop symptoms. Not everybody, but some people will develop symptoms like excessive sweating, heart racing, weight loss, irritability, anxiety, anger, hot flashes and so forth. So D or even shaking in the hands and so forth. So if it is coming quick, you may kind of realize that. But if the hyperthyroidism is kind of building in slowly, you may not realize those symptoms, but you may still be affected. So when my patients, diabetes control goes out of whack, I always check their thyroid. If not, you know, in the we try to check it, you know, if they have any symptoms, typically primary care doctors do screenings. But if I don't see any thyroid ever checked, I sometimes check that too to make sure that's not contributing factor. But definitely if diabetes control is worsening, hyperthyroidism is definitely one factor that your doctor and you should be looking into. Now, what does the hypothyroidism does? Hypothyroidism is underactive thyroid. That can happen from Hashimoto's thyroiditis like your body is attacking your own thyroid, for example, that's Hashimoto's thyroiditis. It may be iodine deficiency, it may be other factors, you know, even surgery, for example, you know, somebody has a bunch of nodules, the doctor says, you know what, it's too much, let's take it out. And then boom, your hypothyroid. Now, of course, you know, when you're hypothyroid, you need to be replaced, you know, doctors replace it. But sometimes, you know, either a patient doesn't take the medication right, or they skip medications, or doctor doesn't prescribe the medication, whatever the reason may be. If you are hypothyroid, your TSH will be higher, especially that's the most sensitive hormone. I don't want to get into the details of all the thyroid hormones here. But the TSH is the most important one that will go higher. Now, if your TSH is very high, like about 10, that can definitely affect your diabetes. Now, how does it affect it? Especially if you're on medications, your medications half-life will be longer. If you're an insulin, for example, you may develop low blood sugar way faster, because when you are hypothyroid, everything becomes slower, you will realize that you will be slow. You are going to be like lethargic, sleepy, your reflexes will be slow. You're going to your metabolism will slow down, and you're going to end up basically gaining weight as well. Now, what's interesting is you're gaining weight, but at the same time, your diabetes, it looks like it is getting better initially. These hormones can be interesting because the way they work, the hormones work differently at different levels and the duration. The same hormone does not show the same effect at different levels, and also in the amount of time that it takes to show effect can be very different. So don't try to make sense of why somebody may gain weight, but their diabetes, their blood sugars may go down. Again, there are multiple factors that are involved, but if you are hypothyroid, your levels change kind of acutely or fast, your blood sugars may go down. One of the factors is that your body is not going to be able to absorb sugar. This is true most of the time when people are on medications, and to be honest with you, a lot of people with diabetes are on medications. So the metabolism, the breakdown of those medications will not be as fast, so that can cause low blood sugars. But yeah, in the long term, for example, if you are hypothyroid and you don't even have diabetes, you know, because of the hypothyroidism, your metabolism is slow, your gaining weight, eventually you're going to develop insulin resistance from that, and that can lead to diabetes, or if you're pre-diabetic, that can progress you to the real diabetes as well. Again, the hormones are a very delicate balance. Too much or too little of it, too prolonged amount of time can definitely have harmful effects. So again, if you're diabetic, make sure your thyroid levels are good. If you're feeling symptoms of hyper or hypothyroidism, definitely get checked. And getting your thyroid levels checked once a year by your primary care doctor is a piece of cake. You know, if you're doing physical, they generally do thyroid testing, and if they don't do requested, that's not going to hurt anybody, and potentially will help you. 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