Endocrine Abstracts

Introduction: Hyperthyroidism is defined as thyroid hyperfunction due to overproduction of thyroid hormones. Graves disease is the most common cause of hyperthyroidism. Hyperthyroidism may be associated with glycemic dysregulation. We are presenting a case with diabetic ketoacidosis who had Graves disease and acute appendicitis.

Case presentation: A nineteen years old female patient wtih Graves disease who had hyperthyroidism despite high dose antithyroid medication. She applied with diabetic ketoacidosis and acut appendicitis. Respiratory arrest developed and she was intubated. Hydration, electrolyte replacement, HCO3 replacement and intravenous insulin started due to diabetic ketoacidosis. Surgical treatment was planned for acut appendicitis. Potassium iodide, anti- thyroid theraphy and beta-blocker was started. Appendectomy was performed under spinal anesthesia after diabetic ketoacidosis had partially improved. Post-operative propylthiouracil 20tb / day, beta-blocker and cholestyramine treatment was given. Free thyroid hormones were normal after these treatment and total thyroidectomy was planned.

Conclusion: Hyperthyroid patients have an higher risk to develop hyperglycemia. Possible mechanisms are increased hepatic glucose output, rapid glucose absorption from the intestine, increased gluconeogenesis and insulin resistance. Patients presenting with diabetic ketoacidosis should be carefully evaluated in terms of precipitating factors such as hyperthyroidism.