Endocrine Abstracts

In patients with Graves disease and Graves’ orbitopathy (GO), the diagnosis was based on clinical activity score (CAS), TSH-receptor antibodies, orbital MRI assesment. Thyreometabolic status was assessed by TSH, FT4, FT3. Before the administration of high-dose intravenous glucocorticoids oral glucose tolerance test (OGTT) was performed obligatory. The patient with confirmed diabetes were excluded form the study. Acute hyperglycaemia was diagnosed at the glucose concentration ≥180 mg/dL, and required insulin therapy.

Results: The study group included 62 euthyroid patients with GO (85.5% women). 32 persons (51.6%) were treated with thiamazole, 16 (25.8%) after 131I, 10 (16.1%) after thyreoidectomy. Carbohydrate metabolism disorders in OGTT were found in 20 (32.2%) of the stoudy group: impaired fastig glucose (IFG) was found in 17 (27.4%); impaired glucose tolerance (IGT) in 2 (3.2%); IFG+IGT in 1 (1.6%) cases. Normal OGTT was found in 42 (67.8%) patients. A cumulative average dose of metylprednisolone was 4.5–6 g. Acute hyperglycaemia requiring insulin therapy was found in 56 (90.32%) patients, mainly at lunch and dinner time.

Conclusions: 1. In euthyroid patient with Graves disease and GO disturbances in carbohydrate metabolism are more common comparing to general population.

2. OGTT should be perfomed routinely in patients with GO before systemic corticosteroid therapy.

3. Acute hyperglycaemia is observed in patient treated with systemic corticosteroid mainly at lunch and dinner time.

4. The administration of short acting insulin analogs at the meal time helps to reduce acute hyperglycaemia.