Term Paper: Aspects of Diabetes and Thyroid

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[. . .] Sulfonylureas should not be used during pregnancy or patients who are likely to get pregnant because they are potentially teratogenic. Sulfonylureas can be used safely with other oral drugs like metformin or glitazones.


Summarize the biosynthesis of the thyroid hormones

Biosynthesis of the thyroid hormones begins with the thyroid gland trapping iodine, which is essential for forming thyroid hormones. Iodine is found in soil and is contained in many foods. The gastrointestinal tract absorbs the iodine anion rapidly, and this is taken up by the thyroid gland. There is a specialized co transporter located at the basolateral membrane of the thyroid follicular cell. The cotransporter moves iodine anions in the follicular cell. There are other anions that might compete with the iodine anion for uptake by the thyroid. Iodine will leave the follicular cells and enter the follicle lumen across the apical membrane. Pendrin found on the apical membrane contributes to iodine anion secretion. As iodine anions are secreted into the follicle lumen, thyroglobulin is secreted by the follicular cells in the lumen. The thyroid hormones remain inactive while in the follicular lumen until they are hydrolyzed. Hydrolyzation results in the formation of T4 and T3 hormones.

What are the different roles of T3 and T4?

T3 is the most active and usable form of thyroid hormone. T3 is produced in tiny amounts based on what is needed, T4 is converted to T3 by the body when it needs T3 (Reinehr, 2010). The functions of the two hormones are similar, but they have differing roles. T4 is mainly used to regulate the heart's rhythm. An absence of T4 would lead to heart failure even if the person has a perfect heart. The main function of T3 is regulation of kidney rhythm. A person with a deficiency of T3 will manifest this symptoms bloating, loose bowels, fluid retention, colitis, weight gain, gas, and swelling of legs and ankles. The failure of the kidneys to filter blood properly, and flush out wastes and fluids leads to these symptoms.

How does the presentation of thyroid hyperfunction differ from hypofunction?

Thyroid hyperfunction occurs when there are too many thyroid hormones circulating in the body. The person will not realize this anomaly and the symptoms will develop gradually. Most of the times the symptoms are not noticed, and the person will experience raised pulse rate, lose weight, restlessness, heart trouble, or nervousness. Increased perspiration could also be a manifestation of a thyroid hyperfunction (Stohl, Ouzounian, Rick, Hueppchen, & Bienstock, 2013). Women might mistake the increased perspiration for menopause symptoms. A complete clinical picture of hyperfunction would take years to develop. Thyroid Hypofunction occurs when there is insufficient thyroid hormones circulating in the body. The metabolic processes will continue to take place, but at reduced and slower rates. The person will feel unmotivated, tired, easily gain weight, depressed easily, hair becomes brittle and falls off. The person's skin might dry and become flaky. Hypofunction could also occur in children. A child suffering from hypofunction would be overweight, and they will not concentrate in school, as they are always tired.

How a patient receiving thyroid hormone replacement therapy should be monitored?

Monitoring should be done once every six to eight weeks after any dosage change. If a patient has achieved a stable dosage, monitoring annually for their thyroid-stimulating hormone is not necessary, but for patients whose dosage has not stabilized they should undergo annual monitoring. Elderly patients require annual monitoring of their thyroid-stimulating hormone. This annual monitoring will determine if they can produce enough thyroid to support their bodily functions. Thyroid binding does decrease with age, and this is another reason why elderly people should be monitored annually. For a patient using thyroid hormone replacement for a long-term, they should be monitored once every three months. Once they become stable, the monitoring can be done annually.


Kahn, S.E. (2013). Incretin therapy and islet pathology: a time for caution. Diabetes, 62(7), 2178-2180.

Reinehr, T. (2010). Obesity and thyroid function. Molecular and cellular endocrinology, 316(2), 165-171.

Stohl, H.E., Ouzounian, J., Rick, A.-M., Hueppchen, N.A., & Bienstock, J.L. (2013). Thyroid disease and gestational diabetes mellitus (GDM): is there a connection? The Journal of Maternal-Fetal & Neonatal Medicine, 26(11), 1139-1142.

Trauner, A., Richert, K., & Luddeke, H.-J. (2013). Start of an insulin therapy in type 1… [END OF PREVIEW]

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