Endocrine Abstracts

Introduction: The prevalence of autoimmune thyroid diseases in patients with type 1 diabetes mellitus (T1DM) is high. Thyroid hormones have a pronounced effect on the regulation of glucose homeostasis. We report patient with well controlled T1DM and good compliance, presented with severe diabetic ketoacidosis (DKA) due to thyrotoxicosis.

Case report: A 15-year-old girl with well-controlled T1DM for 5 years (HbA1c<8%) had no tissue complications of diabetes and episodes of DKA. The daily dose of insulin was 0.7 units/kg. She presented to the emergency room feeling unwell with severe weakness, nausea, abdominal pain, vomiting and polyuria. She was dehydrated and shocked with blood pressure 120/50 mmHg and heart rate 160 beats/min, temperature was 37.3°C. She had heavy glycosuria and ketonuria, capillary blood glucose 18.6 mmol/l, HbA1 14.5%, arterial blood pH 6.8, bicarbonate 3.9 mmol/l. Full blood count, liver and renal function, chest X-ray, and electrocardiogram were all normal. Admission diagnosis of DKA was confirmed and patient was started on intravenous fluids and insulin infusion. Patient show improvement, blood sugar levels decrease, bicarbonate also improved. However, tachycardia and expressed weakness remained, fine tremor and goiter (volume of thyroid gland 28 ml) were noted. The thyroid function test showed TSH of 0.057 mU/l (norm 0.25–5 mU\l), fT₄ of 44 pmol/l (norm 12–23) and the TSH receptor antibodies were high (17.8 U\l) confirming the diagnosis of Graves’ disease. Tiamazole 30 mg orally with betablockers was started. The daily dose of insulin increased to 1.1 units/kg. The girl responded well to treatment with normalization of the overall health and positive dynamics at laboratory inspection and went home after 14 days.

Conclusion: All patients with T1DM must periodically assess thyroid function. In patients with unexplained DKA is necessary to investigate the levels of thyroid hormones.