Endocrinol Metab.  2012 Mar;27(1):63-67. 10.3803/EnM.2012.27.1.63.

A Case of Simultaneous Presentation of Thyroid Crisis and Diabetic Ketoacidosis

• Lee KA
• Park KT
• Yu HM
• Jin HY
• Park JH
• Baek HS
• Park TS

• KMID: 2134820
• DOI: http://doi.org/10.3803/EnM.2012.27.1.63

Abstract

Two important endocrine emergencies, thyroid crisis and diabetic ketoacidosis (DKA), are uncommon when presented together, but pose serious complications. Without appropriate management, they may result in high mortality. Although several cases of simultaneous presentation of thyroid crisis and DKA have been reported, it is a clinically unusual situation and remains a diagnostic and management challenge in clinical practice. We report rare case with simultaneous presentation of thyroid crisis and DKA without previous warning symptoms. A 23-year-old-woman was brought to the emergency department presenting with acute abdominal pain for one day. She was healthy and there was no personal history of diabetes or thyroid disease. Through careful physical examination and laboratory tests, the patient was diagnosed with thyroid crisis combined with DKA. Concomitance of these two endocrine emergencies led to sudden cardiac arrest, but she was successfully resuscitated. This emphasizes the importance of early recognition and prompt management when the two diseases are presented concomitantly.

Keyword

Cardiac arrest; Diabetic ketoacidosis; Thyroid crisis

MeSH Terms

Abdominal Pain
Death, Sudden, Cardiac
Diabetic Ketoacidosis
Emergencies
Heart Arrest
Humans
Physical Examination
Thyroid Crisis
Thyroid Diseases
Thyroid Gland

Reference

1. Solá E, Morillas C, Garzón S, Gómez-Balaguer M, Hernández-Mijares A. Association between diabetic ketoacidosis and thyrotoxicosis. Acta Diabetol. 2002. 39:235–237.

2. Lee JM, Ko BS, Kim DP, Lee JH, Shin JH, Kim HJ, Park KS. A case of diabetic ketoacidosis precipitated by thyrotoxicosis. Korean Clin Diabetes. 2009. 10:115–118.

3. Yoon JH, Kim MJ, Park JH, You KH, Park HS, Chung SM, Chin CJ. A case of hyperthyroidism presented as diabetic ketoacidosis. Korean J Med. 2005. 69:212–215.

4. Bhattacharyya A, Wiles PG. Diabetic ketoacidosis precipitated by thyrotoxicosis. Postgrad Med J. 1999. 75:291–292.

5. Kunishige M, Sekimoto E, Komatsu M, Bando Y, Uehara H, Izumi K. Thyrotoxicosis masked by diabetic ketoacidosis: a fatal complication. Diabetes Care. 2001. 24:171.

6. Lin CH, Chen SC, Lee CC, Ko PC, Chen WJ. Thyroid storm concealing diabetic ketoacidosis leading to cardiac arrest. Resuscitation. 2004. 63:345–347.

7. Yeo KF, Yang YS, Chen KS, Peng CH, Huang CN. Simultaneous presentation of thyrotoxicosis and diabetic ketoacidosis resulted in sudden cardiac arrest. Endocr J. 2007. 54:991–993.

8. Neufeld M, Maclaren NK, Blizzard RM. Two types of autoimmune Addison's disease associated with different polyglandular autoimmune (PGA) syndromes. Medicine (Baltimore). 1981. 60:355–362.

9. Lebovitz HE. Diabetic ketoacidosis. Lancet. 1995. 345:767–772.

10. Wood ET, Kinlaw WB. Nondiabetic ketoacidosis caused by severe hyperthyroidism. Thyroid. 2004. 14:628–630.

11. Weekes TE. Influence of experimental hyperthyroidism on insulin action in growing sheep. Metabolism. 1992. 41:246–252.

12. Cooper DS. Antithyroid drugs. N Engl J Med. 2005. 352:905–917.

13. Bahn RS, Burch HS, Cooper DS, Garber JR, Greenlee CM, Klein IL, Laurberg P, McDougall IR, Rivkees SA, Ross D, Sosa JA, Stan MN. The role of propylthiouracil in the management of Graves' disease in adults: report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. Thyroid. 2009. 19:673–674.