Diabetes and thyroid diseases are the commonest endocrine disorders. Thyroid disorders and diabetes may coexist. For example people with type 1 diabetes have a higher risk of autoimmune thyroid disease. Early detection and treatment of hypothyroidism in young persons with type 1 diabetes is obviously important given that these persons are young and that adequate levels of thyroid hormones are important for growth, stature, puberty and maturation. This and other evidence raises the question as to whether hypothyroidism and diabetes can co-exist by chance or whether there is a biological association.

The scientific evidence on the relationship between thyroid disorders and diabetes is growing, but not yet conclusive. It is well-known that hyperthyroidism can increase blood glucose levels, but a mystery has been the publication of case reports about a hypoglycaemic effect of hypothyroidism. With respect to hyperthyroidism and thyroid nodules in diabetes, one paper has shown that TSH-receptor antibodies, associated with Graves Disease causing hyperthyroidism, could be positive in a proportion of subjects with type 1 diabetes. Other studies have shown that hypothyroidism is prevalent among type 2 diabetes, although the relationship between obesity and type 2 diabetes with thyroid disease is not well-defined. The hypothetical role of metformin in suppressing thyroid carcinogenesis could be exciting for clinical practice.

Overall, the occurrence of thyroid disorders in diabetes has multiple facets and further research would help clarify many unanswered questions. In this discussion we would like to know your views on the relationship between thyroid disorders and diabetes, and how this impacts your practice.

How do you act upon the coexistence of thyroid disorders and diabetes in your practice?

Information about the discussion leader

The discussion will be moderated by Dr Unnikrishnan Ambika Gopalakrishnan (Chellaram Diabetes Institute, Pune, India).

Disclosure statement: Dr Unnikrishnan Ambika Gopalakrishnan has acted as a Principal investigator for clinical trials by Novo Nordisk, Eli Lilly and Sanofi, and as a member of scientific advisory panels of Novo Nordisk, Abbott Healthcare Private Limited, Eli Lilly, Sanofi and Boehringer.

References

1. Kadiyala R, Peter R, Okosieme OE. Thyroid dysfunction in patients with diabetes: clinical implications and screening strategies: Thyroid dysfunction and diabetes. International Journal of Clinical Practice. 2010 Jun 16;64(8):1130–9.

2. Joffe BI. Diabetes mellitus and hypothyroidism: Strange bedfellows or mutual companions? World Journal of Diabetes. 2014;5(6):901.

3. Shun CB, Donaghue KC, Phelan H, Twigg SM, Craig ME. Thyroid autoimmunity in Type 1 diabetes: systematic review and meta-analysis. Diabetic Medicine. 2014 Feb;31(2):126–35.