title: A case of hyperglycemic hyperosmolar state associated with Graves' hyperthyroidism: a case report.
abstract: 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.
authors.affiliation: Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea.
authors.forename: Sung Won
authors.initials: SW
authors.lastname: Moon
authors.forename: Jong Ryeal
authors.initials: JR
authors.lastname: Hahm
authors.forename: Gyeong-Won
authors.initials: GW
authors.lastname: Lee
authors.forename: Mi Yeon
authors.initials: MY
authors.lastname: Kang
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Jung
authors.forename: Tae Sik
authors.initials: TS
authors.lastname: Jung
authors.forename: Kang Wan
authors.initials: KW
authors.lastname: Lee
authors.forename: Kyoung Ah
authors.initials: KA
authors.lastname: Jung
authors.forename: Yong Jun
authors.initials: YJ
authors.lastname: Ahn
authors.forename: Sunjoo
authors.initials: S
authors.lastname: Kim
authors.forename: Me Ae
authors.initials: MA
authors.lastname: Kim
authors.forename: Deok Ryong
authors.initials: DR
authors.lastname: Kim
authors.forename: Soon Il
authors.initials: SI
authors.lastname: Chung
authors.forename: Myoung Hee
authors.initials: MH
authors.lastname: Park
mesh_terms: 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
chemical_list: D007328:Insulin; D008713:Methimazole