Thyroid disease and Diabetes

Endocrine disorders of the thyroid and pancreas can cause significant GI symptoms.

Certain endocrine disorders like thyroid disease are more common in females and also with age. As we approach menopause and middle age, we may be more likely to develop some of these conditions as women. Having a family history of thyroid disease or diabetes may put you at increased risk. As well, having one autoimmune condition, like Hashimoto’s thyroiditis, often increases your risk of developing another autoimmune condition. Always be sure to inform our staff of all of your medical conditions (GI or not), and family history so that we can best meet your healthcare needs.

How does Thyroid Disease cause GI symptoms?

Thyroid diseases include Hyperthyroidism (overactive thyroid) and Hypothyroidism (underactive thyroid) can cause significant GI symptoms.

Hyperthyroidism means your thyroid glad is overactive and producing too much thyroid hormone. Hyperthyroidism speeds up your metabolism and most metabolic processes. It can cause unintentional weight loss, palpitations, rapid or irregular heartbeat, and GI upset, including nausea, vomiting and diarrhea.

Hyperthyroidism affects the GI tract in many ways:

• If a large goiter or mass is present in the thyroid gland causing the condition this mass can press on your esophagus (which structurally lies behind the thyroid gland) and cause painful or difficult swallowing. Food can get stuck in your esophagus (or impacted), requiring surgical removal. Hyperthyroidism can also affect how the muscles of the esophagus function adding to difficulty swallowing.
• Hyperthyroidism can affect how fast the stomach empties and how much stomach acid (or HCL) the stomach produces. This can disturb digestion and cause symptoms of nausea and vomiting.
• Hyperthyroidism speeds up most metabolic processes including digestion. It can cause you to have more bowel movements, loose bowel movements, and even diarrhea. Food may move so quickly through your GI tract that fats and nutrients end up in your stool undigested and unabsorbed. Malabsorption of critical nutrients may occur including Iodine, Magnesium, B12, Zinc, Vitamin D, Vitamin A, B2, and Selenium.

Hypothyroidism or an underactive thyroid gland occurs when your thyroid gland doesn't produce enough thyroid hormone. Hashimoto’s thyroiditis is the most common cause of hypothyroidism in the United States and is far more common in women than men.

Hypothyroidism slows down metabolism and other metabolic processes including digestion:

• Slowed digestion can result in gas, bloating, heartburn, and constipation, which in severe cases can lead to bowel obstruction requiring surgical intervention. Generally speaking, constipation tends to worsen with age. It is also more common in women. Women with hypothyroidism may notice significant constipation, and gas and bloating exacerbated by untreated, chronic constipation.
• Low levels of thyroid hormone can also disrupt the absorption of critical nutrients from the GI tract including Iodine, Magnesium, B12, Zinc, Vitamin D, Vitamin A, B2, and Selenium.
• Initially, affected individuals may not notice any symptoms at all, but over time if hypothyroidism is left untreated is can cause significant health problems including stubborn weight gain, obesity, joint pain, infertility, and heart disease.
  • Signs and symptoms of hypothyroidism may include:
    • Fatigue, lethargy, and lack of energy
    • Increased sensitivity to cold, you just can’t seem to get warm
    • Constipation
    • Weight gain without an explanation like overeating
    • Generalized weakness and muscle weakness
    • Swelling in your joints resulting in pain and stiffness
    • Heavy and/or irregular periods
    • Thin hair, dry and cracked skin, and brittle nails
    • Depression
    • Memory loss, forgetfulness
    • Enlarged thyroid gland (or goiter)
    • Hoarse voice
    • Difficulty swallowing, the sensation of getting stuck, or food actually getting stuck

DIABETES

What GI symptoms are associated with Diabetes?

About 15 million adult women in the United States have diabetes. This means roughly 1 in every 9 women.

It’s estimated that up to 75% of people with diabetes experience GI symptoms. These may include:

• Heartburn,
• Reflux,
• Early satiety (or feeling full sooner than usual),
• Difficulty swallowing,
• Nausea and/or vomiting,
• Diarrhea,
• Constipation,
• Fecal incontinence, and
• Abdominal pain.

GI complications associated with Diabetes have become much more common as the rate of diabetes has increased substantially in our society.

Some of the more common complications associated with Diabetes include gastroparesis and nonalcoholic fatty liver disease.

Gastroparesis

Gastroparesis is a condition that results when the stomach takes too long to empty its contents into the small intestines. Some people refer to it as “delayed gastric emptying”.

Diabetes is the most common known cause of Gastroparesis. Gastroparesis associated with diabetes results from damage to the nerves that move food through the digestive tract. This results in food sitting in the stomach for prolonged periods of time, undigested.

Consistently elevated blood sugar levels seen in poorly controlled diabetes is often the cause of this type of nerve damage. Gastroparesis is more common in women.

Signs and symptoms may include:

• Early satiety (feeling full sooner than usual),
• Nausea and/or vomiting,
• Bloating,
• Feeling excessively full after eating even just small amounts, and/or
• Upper abdominal pain.
• Gastroparesis can also make it more difficult for diabetics to control their blood sugar levels.

Diabetes and Nonalcoholic Fatty Liver Disease:

Nonalcoholic fatty liver disease (or NAFLD) is a build up of extra fat in the liver NOT caused by alcohol. The liver normally has some fat; however, if more than 5-10% of the liver's weight is fat then it is described as fatty liver (or steatosis).

NAFLD is a growing global health problem, affecting anywhere from one quarter to one third of individuals in the U.S. A woman’s risk for fatty liver increases after menopause.

Other risk factors for NAFLD include:

• Obesity or being overweight
• Diabetes,
• Insulin resistance,
• High blood pressure
• High cholesterol and/or high triglycerides
• NAFLD is strongly associated with obesity.

Fatty liver is associated with an increased risk of cardiovascular disease, whether or not you have other risk factors for cardiovascular disease like obesity and diabetes.

In some cases, nonalcoholic fatty liver disease may progress on to another more serious condition known as Nonalcoholic Steatohepatitis (or NASH).

• NASH is an aggressive form of fatty liver disease marked by liver inflammation and damage that can progress on to advanced scarring (or cirrhosis of the liver), liver failure, liver cancer (also known as hepatocellular carcinoma), and death.

How are NAFLD and NASH diagnosed?

Fatty liver is generally diagnosed because of persistently elevated liver function tests. If your primary care provider notices persistently elevated liver function tests they may refer you to our office for further workup of elevated liver function tests. Fatty liver may be diagnosed based on ultrasound findings.

How are NAFLD and NASH treated?

• Gradual weight loss and good control of blood glucose levels are generally recommended for patients with simple fatty liver.
  • Weight loss seems to be the best treatment so far. Studies show that losing even a small amount of weight can improve liver enzyme function, and reduce liver inflammation caused by the extra fat.
  • Weight loss should be gradual as rapid weight loss may actually worsen the disease.
• NASH requires more aggressive treatment.
  • Patients with NASH should NOT consume any alcohol. Alcohol in patients with NASH is detrimental and has been shown to lead to liver cancer when consumed at ANY quantity. Avoiding alcohol is especially crucial in women diagnosed with NASH!