Thyroid hormone therapy diabetes with

Endocrine disorders Thyroid hormone therapy in patients with concomitant diabetes mellitus or insipidus or adrenal insufficiency (Addison disease) exacerbates the intensity of their symptoms. 

Autoimmune polyglandular syndrome-Chron c autoimmune thyroiditis may occur in association with other autoimmune disorders. Treat patients with concomitant adrenal insufficiency with replacement glucocorticoids prior to initiation of treatment. Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated. Patients with diabetes mellitus may require upward adjustments of their antidiabetic therapeutic regimens. Nontoxic diffuse goiter or nodular thyroid disease Use caution when administering levothyroxine to patients with nontoxic diffuse goiter or nodular thyroid disease in order to prevent precipitation of thyrotoxicosis. If the serum TSH is already suppressed, do not administer levothyroxine. 

Thyroid hormone replacement therapy in patients with diabetes may increase the intensity of the symptoms or the diabetes. The nurse closely monitors the patient with diabetes during thyroid hormone replacement therapy for signs of hyperglycemia (see Chap. 49) and notifies the primary health care provider if this problem occurs. 

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