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  • Review Article
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The public health burden of diabetes mellitus and thyroid disease: twin epidemics

Nature Reviews Endocrinology (2026)Cite this article

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Abstract

Thyroid dysfunction and diabetes mellitus frequently occur together, with evidence showing higher rates of each condition in individuals affected by the other. Beyond their statistical association, emerging research indicates shared mechanisms involving autoimmunity, obesity, ageing and insulin resistance, which might explain their bidirectional relationship. This Review synthesizes current evidence on these links, with a particular focus on how thyroid dysfunction influences glycaemic control and how antidiabetic therapies affect thyroid function. Unlike earlier reviews, we frame thyroid disorders within the broader category of non-communicable diseases (NCDs), emphasizing their public health relevance and the need for greater attention in global funding and policy agendas. By combining clinical insights with a population health perspective, this Review aims to promote earlier detection, integrated management strategies and recognition of thyroid disease as a neglected NCD priority.

Key points

  • Thyroid disorders and diabetes mellitus often coexist owing to overlapping pathophysiological mechanisms and shared autoimmune and metabolic risk factors.

  • Autoimmune hypothyroidism, particularly Hashimoto thyroiditis, is significantly more prevalent in patients with type 1 diabetes mellitus owing to common genetic predispositions.

  • Hyperthyroidism can worsen glycaemic control in type 2 diabetes mellitus by increasing hepatic glucose output and insulin resistance.

  • Both hypothyroidism and hyperthyroidism can alter glucose metabolism, insulin sensitivity and the pharmacodynamics of diabetes mellitus medications.

  • Regular screening for thyroid dysfunction in patients with diabetes mellitus, especially those with type 1 diabetes mellitus, is important for timely diagnosis and management.

  • Coordinated care between endocrinologists and primary care providers is vital to address the complex interplay between thyroid function and glucose metabolism for optimal patient outcomes.

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Fig. 1: Prevalence of thyroid disorders by diabetes mellitus type and sex.
Fig. 2: Relationship between thyroid dysfunction and diabetes mellitus.
Fig. 3: The mechanistic pathways mediating the relationship between insulin resistance and thyroid function and diseases.
Fig. 4: The bidirectional relationship between thyroid dysfunction and diabetes mellitus.
Fig. 5: Suggested management algorithm for patients with diabetes mellitus for suspected thyroid dysfunction.

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Acknowledgements

Review criteria

Relevant studies were identified through PubMed and Google Scholar searches up to June 2025 using combinations of the terms ‘diabetes mellitus’, ‘thyroid dysfunction’, ‘hypothyroidism’, ‘hyperthyroidism’, ‘obesity’, ‘autoimmunity’ and ‘non-communicable diseases’. Priority was given to publications from the past decade, including epidemiological studies, clinical trials and mechanistic research, with seminal older works cited where foundational. Narrative reviews and meta-analyses were used for context, and references were selected for their quality, relevance and contribution to understanding the epidemiology, mechanisms or management of coexisting diabetes mellitus and thyroid dysfunction.

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    Salman Razvi

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Razvi, S. The public health burden of diabetes mellitus and thyroid disease: twin epidemics. Nat Rev Endocrinol (2026). https://doi.org/10.1038/s41574-025-01226-5

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