A 27-year-old woman diagnosed with Graves' disease, in treatment with propylthiouracil (200 mg daily), was diag- nosed three months later with type 1 diabetes ...
Acta Diabetol (2002) 39:235–237 C A S E R E P O RT
E. Solá • C. Morillas • S. Garzón • M. Gómez-Balaguer • A. Hernández-Mijares
Association between diabetic ketoacidosis and thyrotoxicosis
Received: 30 September 2001 / Accepted in revised form: 13 May 2002
Abstract Three cases of diabetic ketoacidosis precipitated by thyrotoxicosis are presented. Two of them are young women with type 1 diabetes mellitus; the third case is a middle-aged woman with type 2 diabetes mellitus. All of them were diagnosed with Graves’ disease. They typically showed tachycardia at rest in spite of correction of the metabolic disorder. Hyperthyroidism worsens glycemic control in diabetic patients and may precipitate diabetic
ketoacidosis. On the other hand, women with diabetes have a higher prevalence of Graves’ disease. Thus, in diabetic ketoacidosis without an obvious triggering factor, the presence of hyperthyroidism should be investigated, particularly in women. Key words Diabetic ketoacidosis Graves’ disease
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Hyperthyroidism
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Introduction Diabetic ketoacidosis is an acute complication of diabetes mellitus, that occurs more commonly in type 1 diabetics and whose incidence has not decreased in the last few years in spite of medical breakthroughs [1, 2]. The most common triggering factors of diabetic ketoacidosis are infection, insulin therapy omission, and the onset of the disease, but if these are excluded, other less frequent etiologies must be ruled out before classifying it as idiopathic [3]. In addition, thyroid hormones have a hyperglycemic counter-regulatory effect and it is well known that hyperthyroidism worsens metabolic control in diabetic patients. The association of diabetic ketoacidosis with thyrotoxicosis has been well described in the past [4], but recently there have been few cases described in the literature [5, 6]. We present three cases of this association in female diabetics. E. Solá • C. Morillas • S. Garzón • M. Gómez-Balaguer A. Hernández-Mijares () Endocrinology Department Dr. Peset Universitary Hospital Avenida Gaspar Aguilar 90, E-46017 Valencia, Spain
Case reports
C. Morillas • A. Hernández-Mijares Department of Medicine University of Valencia Valencia, Spain
A 27-year-old woman diagnosed with Graves’ disease, in treatment with propylthiouracil (200 mg daily), was diagnosed three months later with type 1 diabetes mellitus after
Case 1
236
severe diabetic ketoacidosis. The patient showed signs of autoimmune diabetes, with anti-insulin antibodies (25.9%, binding percentage of 125I-Tyr-A14-insulin, normal values
