Mr.Y... is a male patient and 60 years old.he is diagnosed as type 2 diabetes and is a1c level is maintainin 7-7.4. no dyslipidemia and normal liver enzymes.but is thyroid level in 2 visits are are;Ft3: 3.5, Ft4: 9.4 and TSH :18.5.(normal range :ft3: 3.1-6.8, ft4 : 12 - 22, TSH : 1.27 - 4.2 )so dr prescribed and started levothyroxin along with diabetes medication.exactly after three months,his Ft3: 2.99, Ft4: 5.35 and TSH: 45.73 and we done anti TPO is >600IU/ml.
so can you please give some conclusion about this study?
I'm not a specialist in medical cases, but here's what I think: Elevated anti TPO is often seen in diabetes, and I think this can cause the thyroid gland to malfunction and underproduce fT4 independent of TSH levels in the blood, even if no dyslipidemia is present and the diabetes is under control. Because the fT4 stays too low, TSH secretion increases but fails to stimulate the thyroid gland. The injected levothyroxine is probably sufficient for the generation of enough T3 as this value is quite normal, but not enough to keep fT4 levels in a normal range? I'm not sure this is correct reasoning...
Or the diabates is responsible for the elevated anti-TPO values, but there is an independent pathology of the thyroid axis, where the negative feedback mechanisms is impaired? Because the injected levothyroxine should provide negative feedback on the thyroid axis, and consequently lead to decreased TSH secretion by the thyroid gland...Not sure
This is a patient with autoimmune thyroiditis and primary hypothyroidism . If TSH increases despite adequate thyroxin (2 yg/kg/daily) medication, you should consider non-compliance of the paptien or malabsorbion due to celiac disease which is often associated with Hashimoto`s disease ( Poliglandular Syndrome II/III)
Dear Andrew: Autoimmune thyroid diseases are clearly related with type 1 diabetes mellitus but not so much with type 2; in any case they must be managed as independent diseases. The reason why current hormones are even worse than the initial ones is not clear, there are several possible causes:
- insufficient thyroxin dosage
- progression of autoinmune aggression on thyroid gland
- patient non-compliance
- malabsortion (celiac disease is the most frequent associated cause)
- interference with other drugs (Fe, Mg, antiacid)
- H. pylori infection
I hope this comment could be useful for you
Of course there is no association between Typ II Diabetes and Hashimoto`s disease. Maybe my message was not clear enough. I did not suggest that this certain patient is suffering from a Poliglandular syndrome II, where Typ I Diabetes may associated with autoimmune thyroid disease (AITD). I just wanted to say, that one has to suggest that this patient may suffer from a Poliglandular syndrome (III) without TypI Diabetes where the association of AITD with celiac disease is rather common and clinically relevant. I personally know several of these cases.
Basal thyroid profile (before the administration of LT4) correspond typically to the clinical "stage 3" of Hashimoto's Thyroiditis (HT) hypothyroidism: that is : high TSH, low free T4 and free T3 still normal- since it is the last to descend in the natural evolution of the TH-. After the administration of LT4 (even when optimum time for dose titration with TSH would be 6 months in forward, and not 3 (in our experience) , because the time to reach the balance pituitary- thyroid (P-T) is longer), is observed a typical profile of not adhesion to the treatment. Any other possibility, would have produced a change at least in FT4 (used for monitoring doses before reaching the optimum balance of the P-T). However, FT4 continued dropping and FT3 became low , i.e., is nothing more than the natural evolution of the disease 3 months later, as if there had not been medication.
- Badges
- Science topic
- Similar topics
- Medicine
- Disease
- Metabolic Diseases
- Glucose Metabolism Disorders
- Diabetes