methimazole and Diabetic-Ketoacidosis

A 21-year-old young man with no history of diabetes or thyroid disease presented to the emergency department with simultaneous thyroid storm and diabetic ketoacidosis. Notable findings on admission were a ventricular rate of 235 beats/min, tachypnoea, tremors, polydipsia and a lack of fever. Due to the unusual constellation of symptoms, diagnosis was only possible after initial laboratory results came back. While the lack of fever is unusual in thyroid storm, diabetic ketoacidosis has previously been reported to suppress fever, and this case supports the occurrence of this phenomenon. This case was highly unusual because the patient had not previously been diagnosed with either type 1 diabetes or Graves' disease.

Topics: Adult; Anti-Arrhythmia Agents; Anti-Inflammatory Agents; Antithyroid Agents; Diabetic Ketoacidosis; Diagnosis, Differential; Humans; Hydrocortisone; Insulin; Male; Methimazole; Propranolol; Propylthiouracil; Tachycardia; Thyroid Crisis; Young Adult

This chapter represents a selection of 8 clinical scenarios that may commonly be encountered. They help summarize some of the literature and teaching points of the previous chapters. They are not meant to represent every possible presentation of thyroid disease, but rather to present common symptoms and findings that may aid a clinician in making a diagnosis or in selecting initial treatment.

Topics: Adult; Antithyroid Agents; Diabetic Ketoacidosis; Female; Humans; Methimazole; Preconception Care; Pregnancy; Pregnancy Complications; Propylthiouracil; Thyroid Diseases; Thyroid Function Tests

Thyrotoxicosis and diabetic ketoacidosis (DKA) both may present as endocrine emergencies and may have devastating consequences if not diagnosed and managed promptly and effectively. The combination of diabetes mellitus (DM) with thyrotoxicosis is well known, and one condition usually precedes the other. Furthermore, thyrotoxicosis is complicated by some degree of cardiomyopathy in at least 5% de patients; but the coexistence of DKA, thyroxin (T₄) toxicosis, and acute cardiomyopathy is extremely rare. We describe a case of a man, previously diagnosed with DM but with no past history of thyroid disease, who presented with shock and severe DKA that did not improve despite optimal therapy. The patient evolved with acute pulmonary edema, elevated troponin levels, severe left ventricular systolic dysfunction, and clinical and laboratory evidence of thyroxin (T₄) toxicosis and thyrotoxic cardiomyopathy. Subsequently, the patient evolved favorably with general support and appropriate therapy for DKA and thyrotoxicosis (hydrocortisone, methimazole, Lugol's solution) and was discharged a few days later.

Topics: Adult; Cardiomyopathies; Diabetic Ketoacidosis; Diagnosis, Differential; Echocardiography; Heart Failure, Systolic; Humans; Hydrocortisone; Iodides; Male; Methimazole; Pulmonary Edema; Radiography; Thyrotoxicosis; Treatment Outcome; Troponin

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.

Topics: Administration, Oral; Antithyroid Agents; Diabetic Ketoacidosis; Diagnosis, Differential; Female; Fluid Therapy; Graves Disease; Humans; Influenza, Human; Infusions, Intravenous; Insulin; Methimazole; Middle Aged; Thyroid Crisis; Thyroidectomy

Abdominal pain is a common chief complaint that encompasses a broad differential diagnosis at emergency department (ED), ranging from general discomfort to life-threatening disease. Abdominal pain induced by a metabolic disorder should also be considered. Diabetic ketoacidosis (DKA) is a common complication of new-onset type 1 diabetes mellitus in young patients. Although DKA that presented to the ED with complaint of abdominal pain is not uncommon, it is precipitated by hyperthyroidism, which is rare and more complicated. Herein, we present a case of a 20-year-old women who came to our ED with the chief complaint of abdominal pain, which was actually the result of DKA caused by hyperthyroidism without underlying disease.

Topics: Antithyroid Agents; Biomarkers; Diabetic Ketoacidosis; Diagnosis, Differential; Diagnostic Imaging; Electrocardiography; Emergency Service, Hospital; Female; Humans; Hyperthyroidism; Insulin Resistance; Methimazole; Young Adult

A 31-year-old female was well until few years ago when she was diagnosed as having Graves' disease. Methimazole (MMI) and Lugol's solution were prescribed. But 7 months later, she stopped taking them arbitrarily. Three months later, thirst and general fatigue appeared. Therefore insulin (60u/day) and MMI (30 mg/day) were administered and continued for 40 days. However no remarkable effect was brought about. She was then transferred to the radioisotope ward of Kumamoto Univ. Hospital and was treated with regular insulin only. Ten days later, she fell into thyroid storm associated with diabetic ketoacidosis and was transferred to our ward. We began to administer large volumes of transfusion, regular insulin, MMI, Lugol's solution, propranolol, hydrocortisone and digitalis. In 24 hours, ketoacidosis disappeared and she became alert. For hyperthyroidism, the dosage of MMI was increased to 60 approximately 45 mg/day and was continued for a month; however, her thyroid function did not normalize and agranulocytosis developed. MMI was discontinued, and she was treated with 131I. About a year later, she became euthyroid. Her diabetes mellitus was difficult to control during the hyperthyroid state but it was under good control with monocomponent lente insulin (36u/day) when the euthyroid state was resumed.

Topics: Adult; Diabetic Ketoacidosis; Female; Glucose Tolerance Test; Humans; Insulin; Methimazole; Thyroid Crisis; Thyroid Function Tests; Thyroid Gland

Topics: Blood Glucose; Diabetes Complications; Diabetic Coma; Diabetic Ketoacidosis; Electrocardiography; Female; Glucose Tolerance Test; Humans; Hyperthyroidism; Insulin; Iodine; Iodine Radioisotopes; Methimazole; Middle Aged; Prednisolone; Thyroid Crisis

Topics: Adolescent; Diabetic Ketoacidosis; Female; Graves Disease; Humans; Hypokalemia; Insulin; Iodine; Methimazole; Potassium Chloride; Thyroid Crisis; Triiodothyronine; Tromethamine