A case of hyperglycemic hyperosmolar state associated with Graves' hyperthyroidism: a case report.
Hyperglycemic hyperosmolar state (HHS) is an acute complication mostly occurring in elderly type 2 diabetes mellitus (DM). Thyrotoxicosis causes dramatic increase of glycogen degradation and/or gluconeogenesis and enhances breakdown of triglycerides. Thus, in general, it augments glucose intolerance in diabetic patients. A 23-yr-old female patient with Graves' disease and type 2 DM, complying with methimazole and insulin injection, had symptoms of nausea, polyuria and generalized weakness. Her serum glucose and osmolarity were 32.7 mM/L, and 321 mosm/kg, respectively. Thyroid function tests revealed that she had more aggravated hyperthyroid status; 0.01 mU/L TSH and 2.78 pM/L free T3 (reference range, 0.17-4.05, 0.31-0.62, respectively) than when she was discharged two weeks before (0.12 mU/L TSH and 1.41 pM/L free T3). Being diagnosed as HHS and refractory Graves' hyperthyroidism, she was treated successfully with intravenous fluids, insulin and high doses of methimazole (90 mg daily). Here, we described the case of a woman with Graves' disease and type 2 DM developing to HHS.
Moon
Sung Won
SW
Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea.
Hahm
Jong Ryeal
JR
Lee
Gyeong-Won
GW
Kang
Mi Yeon
MY
Jung
Jung Hwa
JH
Jung
Tae Sik
TS
Lee
Kang Wan
KW
Jung
Kyoung Ah
KA
Ahn
Yong Jun
YJ
Kim
Sunjoo
S
Kim
Me Ae
MA
Kim
Deok Ryong
DR
Chung
Soon Il
SI
Park
Myoung Hee
MH
D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005440:Fluid Therapy; D006111:Graves Disease / Q000150:complications*; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000209:etiology*; D006980:Hyperthyroidism / Q000150:complications* / Q000628:therapy; D007328:Insulin / Q000627:therapeutic use; D008713:Methimazole / Q000627:therapeutic use; D013960:Thyroid Function Tests
D007328:Insulin; D008713:Methimazole