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Diabetes

Multiple symptoms

05/01/2009

Question:

I HAD BEEN TREATED FOR 8 YEARS FOR PCOS 11 MONTHS AGO IT WAS DISCOVERED THAT I HAD HYPO THYROIDISM [POSSIBLY HASHIMOTOS MY FATHER HAS MYASTHENIA GRAVIS] LAST WEEK MY LABS SHOWED MY GLUCOSE WAS 378. I WOULD LIKE TO KNOW IF THERE IS ONE CONDITION THAT CAN CAUSE ALL OF THESE SYMPTOMS. THANK FOR ANY FOR ANY INFORMATION.

Answer:

It is very difficult to comment on the relationship of your different hormonal conditions based on the provided information. I will try to explain the complexity of the question by drawing different scenarios. Let's say that you are in your 20s and 30s and you were diagnosed with PCOS based on the elevated male hormone levels as well as problems with your menstrual cyclicity and excluding all other hormonal abnormalities, such as hypothyroidism or hyperprolactinemia. With this history, you are affected with a very common condition (involving 5-10% of women in reproductive age), which put you at risk for developing diabetes (insulin resistance and insulin insufficiency) by 10-fold higher rates than what it is seen in general population, so nothing is unusual about having PCOS and diabetes unless your diabetes is caused by circulatory antibodies against your pancreas (autoimmune cause).

As for having hypothyroidism (most likely autoimmune disorder given your family history of Grave's disease) in addition to PCOS, the high prevalence of these conditions could explain having both together. Also there is evidence suggesting that PCOS can be caused by autoimmune process, therefore having the second autoimmune process in presence of the first one is not unusual.

If you are in your teens and you had a long lasting undiagnosed hypothyroidism (not tested at the time of diagnosis for PCOS), then having low thyroid hormone could potentially increase the risk of having ovarian cysts, which is often used for making diagnosis of PCOS by general practitioner without any other key features. In this case you may not have PCOS, and having one autoimmune disorder (hypothyroidism) increase the likelihood of having the second autoimmune disorder (diabetes). Obviously more information from your history, physical exam, and blood work is needed to give you a straightforward answer on your question, therefore, I would suggest seeing an endocrinologist expert in diabetes and PCOS to discuss these issues in details and to make sure that you are receiving appropriate treatment for any of these conditions.

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Response by:

Marzieh  Salehi, MD Marzieh Salehi, MD
Assistant Professor of Endocrinology
College of Medicine
University of Cincinnati