Diabetes and thyroid health are closely linked. If you live with any type of diabetes and experience symptoms that include constant fatigue or dry skin, consult your healthcare team to discuss possible thyroid issues.
More than three decades ago, when I was a teenager, it was the sleepiness and crackly, dry skin that first alerted me that something was wrong. Not just type 1 diabetes (T1D), as I was a teenager and had already been living with that for close to a decade at the time.
No, these symptoms were different.
I had a visibly enlarged gland on the side of my neck, so swollen that it hurt when I turned my head. The dry skin was coarse and almost scaly, so severe that lotions or moisturizers were useless.
Another symptom was constant fatigue, the kind of stuck-in-molasses tiredness that comes when your blood sugar is super high — even when it wasn’t. I felt exhausted from the moment I woke up in the morning, and I couldn’t function throughout the day without a nap or concentrate on simple tasks. It certainly didn’t help that in those days, my glucose levels were riding the glucoaster up and down, causing further fatigue.
Frankly, it was all a bit scary because I couldn’t put my finger on how all these seemingly unrelated symptoms might tie together.
As it turned out, all were signs that the little thyroid gland in my neck was not working properly — which causes an array of symptoms that are easily overlooked or worse and mistaken for other ailments.
What came next for me was a correct diagnosis of
The thyroid is a little butterfly-shaped gland that lives in the middle of your neck. It’s part of the body’s endocrine system, where diabetes also dwells.
One of the thyroid’s primary responsibilities is to manage your body’s metabolism by producing two thyroid hormones: T3 and T4. An overactive thyroid can cause weight loss, a quick heartbeat, and other signs that your body is “on the go” a little too much.
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Thyroid issues are common, with a majority of the 59 million people in the United States not knowing they have thyroid disease.
Note that “thyroid disease” is actually an umbrella term for several different conditions that can affect this gland, including:
- hypothyroidism
- hyperthyroidism
- autoimmune thyroid disease
- goiter (enlargement of the thyroid gland)
- thyroiditis
- thyroid cancer
Research shows that people with diabetes are more prone to thyroid issues, and women are more prone than men (but that does not exclude guys like me).
People with T1D, an autoimmune condition, are
- hyperactive thyroid (Graves’ disease)
- underactive thyroid (Hashimoto’s disease)
For me, it came in the form of hypothyroidism. I’m not alone, as stats show that
The symptoms of hyperthyroid and hypothyroid are starkly different, but it can be difficult to tell there’s an issue at all because symptoms can develop very slowly.
| Hypothyroidism | Hyperthroidism |
|---|---|
| fatigue and exhaustion | quick pulse |
| persistently feeling cold | pounding heart |
| dry skin | weight loss despite increased appetite |
| weight gain despite no eating changes | shortness of breath during exercise |
| slower reflexes | muscle weakness or tremors |
| brittle hair | difficulty concentrating |
| increased depression |
They may also overlap with symptoms tied to many other conditions, including diabetes, so it can be challenging to diagnose the exact culprit.
This is why regular thyroid screenings are important.
Although hyperthyroidism and hypothyroidism do not directly affect blood sugar levels, not treating thyroid disease can lead to diabetes management challenges.
This includes managing your blood sugar levels, relatd to how your body metabolizes glucose and insulin. For instance, with hyperthyroidism, insulin “clears” through your body faster, leaving you with higher blood sugars.
Hyperthyroidism can cause rapid heart rate, and it increases the risk of abnormal heart rhythm, so it increases the risk of heart problems, compounding the heart risks posed by diabetes.
Hypothyroidism can cause insulin to move through your body much slower, which could leave you with lower blood sugars, because the insulin “sticks around” longer.
Hypothyroidism can also cause an increase in low-density lipoprotein (LDL) cholesterol, overall cholesterol, and triglyceride levels, which adds to the danger of high cholesterol with diabetes.
Diabetes meds and thyroid effects
When talking with your doctor about thyroid levels and possible prediabetes or diabetes treatments, make to understand that some diabetes medications may affect thyroid levels.
This can make it more complicated to get a proper diagnosis, as a medication (such as metformin for type 2 diabetes) may lower thyroid TSH levels and could mask hypothryoidism and correct dosages.
Typically, doctors treat thyroid issues first before assessing and treating prediabetes or type 2 diabetes. This is because thyroid issues may raise blood sugar and A1C levels, and the body’s metabolic system may not be balanced.
The American Diabetes Association (ADA) recommends screening for thyroid problems soon after a T1D diagnosis, with a standard thyrotropin stimulating hormone (TSH) blood test.
However, the ADA currently has no specific screening guidelines for people with type 2 diabetes.
Generally, anyone experiencing any potential thyroid-related symptoms may want to consult their diabetes or healthcare team as a first step.
My own diagnosis with hypothyroidism as a teenager came during a regularly scheduled endo appointment, almost by accident. Then later as an adult, my medication usage became lax, and when thyroid issues popped up periodically, I didn’t always talk with my doctor about it readily.
It can be easy to brush aside symptoms, such as dry skin and sleepiness, as mere annoyances caused by colder weather, too much stress, or other lifestyle factors.
But I can personally attest to how pinpointing the cause of my symptoms and talking with my doctors about the cause has been hugely helpful throughout my life — especially as I’ve gotten older with T1D.
To help address missed or delayed diagnoses and raise awareness of possible thyroid issues among those living with diabetes, the American Association of Clinical Endocrinologists created a thyroid awareness website that provides guidance and resources.
Getting a thyroid diagnosis
Typically, there are two main ways to diagnose a thyroid issue, particularly hypothyroidism:
- a physical exam and review of your medical history, where your doctor will check for physical signs for any of the aforementioned symptoms
- blood tests conducted in a lab
The primary way to diagnose thyroid disease is called a TSH test, which checks the amount of thyroid-stimulating hormone in your system. It’s a very easy and inexpensive blood test.
However, sometimes that test will come back false-normal, so testing for antibodies or having a full thyroid panel can also reveal things the TSH test might not.
Learn more about TSH testing.
Importantly, this is a lifelong condition. But medication can reduce or even wipe away symptoms.
Autoimmune thyroid diseases, like Hashimoto’s disease, are usually much easier to manage than diabetes. The hormone replacement treatment comes in pill form, so taking the medication is easy. But some patients have difficulty finding the right type of thyroid replacement pill.
The most commonly prescribed medication to treat hypothyroidism (underactive thyroid) is levothyroxine (Synthroid). This medication is a synthetic version of the T4 hormone that mimics the action of the thyroid hormone your body usually produces.
The most common treatment for hyperthyroidism involves medications such as methimazole (Tapazole) that stop the thyroid from making hormones.
Given that my thryoid was underactive, I was prescribed levothyroxine. This is usually a daily pill, but it can also be dosed differently depending on what your doctor advises according to your specific needs.
Medication timing
It’s important to know that thyroid medication can take 6 to 8 weeks to build up in the system to reflect they’ve started working in your body.
Medical experts also emphasize the importance of taking the same dosage of the same medication at the same time every day, typically at least 30 minutes before you eat.
In my case, that meant getting a “baseline” thyroid lab test before I started taking any medications and then following it up a couple months later to determine whether that dosage was accurate.
After that timeframe, that’s when my fatigue, dry skin, and other thyroid-related symptoms began to ease.
Personally, I’ve been taking the generic thyroid med levothyroxine for years now. When I go a few days without taking my daily pill, I definitely feel myself getting sleepy more often and becoming unfocused, so I’m glad to have it in my arsenal.
Dealing with diabetes can be a challenge all on its own any day of the week, so I’m glad to have simple options to treat this related condition effectively.
My message to all would be: Pay attention to symptoms that may be bringing you down on a daily basis and derailing your diabetes management. It very well may be (an easily treatable) thyroid condition.
Health and wellness touch everyone’s life differently. This is one person’s story. The views and opinions expressed are those of the speaker and do not necessarily reflect the views or positions of Healthline Media.