Table 6.

Recommendations on the Treatment of TD in Patients With DM

• TSH levels should be monitored after beginning metformin treatment in diabetic patients with overt and SHypo.

• There is insufficient evidence to recommend the assessment of serum TSH and FT4 levels and thyroid ultrasound in patients treated with sulphonylureas.

• Pioglitazone should not be administered to diabetic patients with GO.

• GLP-1 receptor agonists are not recommended in patients with a personal or family history of MTC or type 2 multiple endocrine neoplasia.

• The adjustment of insulin treatment should be considered in patients with diabetes after the occurrence of TD.

• The evaluation of thyroid function should be performed during ketoacidosis in patients with clinical symptoms and signs raising a suspicion of hyperthyroidism.

• Glycemic control should be reassessed in hyperthyroid subjects after the control of hyperthyroidism with ATDs.

• An increased insulin dose may be necessary when starting treatment with L-T4 in hypothyroid patients with DM.

• Excessive L‐T4 therapy inducing TSH suppression should be avoided because it may induce iatrogenic hyperthyroidism determining an impaired glycemic control.

• The use of statins should be considered only after the correction of hypothyroidism to prevent the risk of myopathy.