A Case of Hyperglycemic Hyperosmolar State Associated with Graves' Hyperthyroidism: A Case Report.
10.3346/jkms.2006.21.4.765
- Author:
Sung Won MOON
1
;
Jong Ryeal HAHM
;
Gyeong Won LEE
;
Mi Yeon KANG
;
Jung Hwa JUNG
;
Tae Sik JUNG
;
Kang Wan LEE
;
Kyoung Ah JUNG
;
Yong Jun AHN
;
Sunjoo KIM
;
Me Ae KIM
;
Deok Ryong KIM
;
Soon Il CHUNG
;
Myoung Hee PARK
Author Information
1. Department of Internal Medicine, College of Medicine, Gyeongsang National University, Korea. jrhahm@gshp.gsnu.ac.kr
- Publication Type:Case Report ; Research Support, Non-U.S. Gov't
- Keywords:
Hyperosmolar Hyperglycemic Nonketotic Coma;
Graves Disease;
Diabetes Mellitus, Type 2;
Methymazole
- MeSH:
Thyroid Function Tests;
Methimazole/therapeutic use;
Insulin/therapeutic use;
Hyperthyroidism/*complications/therapy;
Hyperglycemic Hyperosmolar Nonketotic Coma/*etiology;
Humans;
Graves Disease/*complications;
Fluid Therapy;
Female;
Diabetes Mellitus, Type 2/*complications;
Adult
- From:Journal of Korean Medical Science
2006;21(4):765-767
- CountryRepublic of Korea
- Language:English
-
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 triglyc-erides. 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.
