Tuesday, 31 January 2012

Thyroid Dysfunction in Diabetes

Thyroid Dysfunction in Diabetes

Thyroid dysfunction is common in the general population and the prevalence increases with age. The assessment of thyroid function is both reliable and inexpensive. Screening for thyroid dysfunction is indicated in certain high risk groups. 

Hypo thyroidism is the most common thyroid disorder in adult population. Diabetic patients have a higher risk of thyroid disorders compared with the normal population. The presence of thyroid dysfunction may affect diabetes. Hyper thyroidism is typically associated with worsening glycemic control and increased insulin requirements. In practice, there are several implications for patients with both diabetes and hyperthyroidism.

Symptoms of hypothyroidism in people with type 2 diabetes are:
    • Fatigue
    • Weight gain
    • Feeling cold and dry skin
    • Heavy menstrual cycles
    • Constipation and a slow down in the thought process.

Sub clinical hypothyroidism is defined as characterised by a normal serum-free thyroxin level and elevated serum thyrotropin. Hypothyroidism is accompanied by a variety of abnormalities in plasma lipid metabolism, like elevated triglycerides and low density lipoprotein, metabolic dysfunction and obesity, hypertension and insulin resistance. This in turn further increases the risk of coronary artery disease.

Sub clinical hyperthyroidism is associated with an increased risk of atrial fibrillation and increased cardio vascular mortality. Tri iodo thyronine increases cardiac output by affecting tissue oxygen consumption, vascular resistance, cardiac contractility and heart rate. Thyroid hormone increases blood volume, as a result of the decrease in systemic vascular resistance and a fall in effective arterial filling volume. Tachycardia is common at rest. The hemodynamic changes typical of  hypothyroidism are opposite to those of hyperthyroidism. The most common signs are bradycardia, hypertension narrowed pulse pressure.

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