Prolonged honeymoon phase in an adolescent with diabetes and thyrotoxicosis provides support for the accelerator hypothesis.
A 14-yr-old female presented with diabetes and Graves' disease. Eighteen months later, she was euthyroid on carbimazole, and her haemoglobin A1c (HbA1c) was normal (5.2%) on a small insulin dose (0.3-0.4 units/kg/day). An assessment of her pancreatic beta-cell reserve, determined by comparing HbA1c and insulin dose, suggested that this was greater than other patients with type 1 diabetes in our service 18 months postdiagnosis (n = 185). We suspect that excess thyroid hormone led to an insulin-resistant state and accelerated her presentation with hyperglycaemia. Insulin resistance fell once normal thyroid function was restored and helped to attenuate further beta-cell destruction when beta-cell mass was relatively well preserved.
Abdullah
Nadeem
N
Department of Paediatrics, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Al-Khalidi
Omer
O
Brown
Kathryn J
KJ
Reid
Judith
J
Cheetham
Tim D
TD
D000293:Adolescent; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D013971:Thyrotoxicosis / Q000150:complications / Q000503:physiopathology*