title: Prolonged honeymoon phase in an adolescent with diabetes and thyrotoxicosis provides support for the accelerator hypothesis.
abstract: 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.
authors.affiliation: Department of Paediatrics, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Abdullah
authors.forename: Omer
authors.initials: O
authors.lastname: Al-Khalidi
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Brown
authors.forename: Judith
authors.initials: J
authors.lastname: Reid
authors.forename: Tim D
authors.initials: TD
authors.lastname: Cheetham
mesh_terms: 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*