thyroid dysfunction in type 2 DM

-

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848627/

Both T2DM and TD are chronic diseases that require lifelong treatment and have a long-lasting effect on cardiovascular health. According to the International Diabetes Federation (IDF), in the year 2017, approximately 425 million adults worldwide were living with diabetes. The total prevalence of diabetes is increasing and is expected to be 629 million by 2045.

As per a large European meta-analysis, TD is present in 3.82% of the general population. Its prevalence among those with T2DM is significantly higher, ranging from 9.9 to 48% 

A little light on thyroid effect on Diabetes and Vice versa

Excess circulating thyroid hormones in hyperthyroidism is associated with poor glycaemic control. When normal individuals develop hyperthyroidism, nearly 2–3% of them develop overt diabetes. Nearly 50% of those with Graves’ disease have some degree of glucose intolerance. Diabetic patients with hyperthyroidism experience worsened glycaemic control.

Thyroid hormone can act on various organs to affect glucose metabolism. It increases gastrointestinal motility and enhances glucose absorption. In the liver, it increases the activity of phosphoenolpyruvate carboxykinase (PEPCK), an enzyme that enhances gluconeogenesis. This hepatic gluconeogenesis may occur through the direct effect of the thyroid hormone or indirectly via glucagon or catecholamine.

The enhanced glycogenolysis and increased hepatic glucose output induces hyperinsulinaemia and glucose intolerance, causing peripheral insulin resistance. This worsens subclinical diabetes and exaggerates the hyperglycaemia in T2DM, increasing the risk of diabetic complications.
In the adipose tissues, thyroid hormone increases lipolysis. The increased serum free fatty acid level causes insulin resistance. 
Hyperthyroidism increases GLUT4 gene expression and glucose uptake in skeletal muscles. 

Hypothyroidism reduces glucose-induced insulin secretion, whereas hyperthyroidism enhances the response of beta cells to glucose. Degradation of insulin is also increased by thyroid hormone, and thyrotoxicosis increases insulin clearance. Thyroid hormone also increases glucagon secretion by pancreatic alpha cells.



Diabetes affects thyroid function by altering the thyroid-stimulating hormone (TSH) level and impairing the conversion of thyroxine (T4) to triiodothyronine (T3) in the peripheral tissues.



Comments

Post a Comment

Popular posts from this blog

DAYS IN NEPHROLOGY

-
Image
My day started on 9th May 2020 with Morning rounds of my patients in Nephrology ward with my intern. At around 11am , A Patient presented to the casualty, A 60 year old man, Farmer from a local village, Occasional Alcoholic since 25 years and Chronic Beedi Smoker since 25 years, who was diagnosed to be hypertensive and diabetic 6 months back.  He apparently had no medical issues until an year back when he started getting breathless on walking for a few miles and he gradually started experiencing breathlessness even on rest, on & off though he had no complains of associated chest pain, palpitations, nausea, vomitings or associated giddiness. One fine morning, before he started for work he observed his feet were swollen upto his ankles for which he decided not to consult a doctor and managed by resting for a few days. Over the next few days the swelling in his feet gradually progressed up to his thighs and it alarmed him when he had developed facial puffiness. He also sta...
Read more

Brain Stem Strokes

-
Image
BRAIN STEM STROKES: Here's a brief discussion regarding the Ventral Midbrain Syndromes which I've gone through on 9th & 10th of May. Will update regarding the other syndromes in my further posts. The posterior surface of midbrain has a Tectum portion & a Tegmental portion. The Tectum portion consists of Corpora Quadrigemina & 4th cranial nerve where as the Tegmental portion comprises of Floor of the 4th ventricle, Median Sulcus, Facial colliculus & Sulcus Limitans.  Three important Ventral Midbrain Syndromes are  : 1) Weber syndrome 2) Claude syndrome 3) Benedikt syndrome These occur due to the involvement of P1 segment of Posterior cerebral artery.  Posterior Cerebral Artery is divided into P1 & P2 segment ( proximal & distal to Posterior communication artery)  1) Weber Syndrome:   The lesion is at the level of crus cerebri, here you can see the location of the cor...
Read more

62 year old woman with breathlessness

-
Image
A 60 year old woman presented with the complaints of  Dyspnea at rest since 15 days Left lower limb swelling upto knee since 10 days Reduced urine output since 10 days A 60 year old woman who used to work as a farmer 3 years back, mother of 5 children (3 daughters and 2 sons - 1 son expired, patients attendant reluctant to discuss the cause) presented to the casualty with the complains of dyspnea on exertion since 1 year. 1 year back she visited Osmania hospital for these complaints after which she has been put on medications which she has been using on and off (not documented). Since the past 4 months she has been experiencing dyspnea at rest on and off, whenever she experiences dyspnea she visits a hospital, takes medication and then stops taking them. Since the past 15 days she has been experiencing dyspnea at rest and 10 days back she has had a trauma to her right 2nd toe after which she developed left lower limb swelling along with reduced urine output. She was taken to a loca...
Read more