title: Thyroid Storm Precipitated by Diabetic Ketoacidosis and Influenza A: A Case Report and Literature Review.
abstract: A 46-year-old woman with a history of Graves' disease presented with the chief complaints of appetite loss, weight loss, fatigue, nausea, and sweating. She was diagnosed with diabetic ketoacidosis (DKA), thyroid storm, and influenza A. She was treated with an intravenous insulin drip, intravenous fluid therapy, intravenous hydrocortisone, oral potassium iodine, and oral methimazole. As methimazole-induced neutropenia was suspected, the patient underwent thyroidectomy. It is important to maintain awareness that thyroid storm and DKA can coexist. Furthermore, even patients who have relatively preserved insulin secretion can develop DKA if thyroid storm and infection develop simultaneously.
authors.affiliation: Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ikeoka
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Otsuka
authors.forename: Naruhiro
authors.initials: N
authors.lastname: Fujita
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Masuda
authors.forename: Shigeto
authors.initials: S
authors.lastname: Maeda
authors.forename: Ichiro
authors.initials: I
authors.lastname: Horie
authors.forename: Takao
authors.initials: T
authors.lastname: Ando
authors.forename: Norio
authors.initials: N
authors.lastname: Abiru
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawakami
mesh_terms: D000284:Administration, Oral; D013956:Antithyroid Agents / Q000008:administration & dosage; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D005260:Female; D005440:Fluid Therapy; D006111:Graves Disease; D006801:Humans; D007251:Influenza, Human / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage; D008713:Methimazole / Q000008:administration & dosage; D008875:Middle Aged; D013958:Thyroid Crisis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D013965:Thyroidectomy
chemical_list: D013956:Antithyroid Agents; D007328:Insulin; D008713:Methimazole