Concurrent Diabetic Ketoacidosis and Thyroid Storm in Late Pregnancy: A Rare Dual Endocrine Emergency
https://doi.org/10.15605/jafes.041.S1
- Author:
Sarojini Devi Simanchalam
1
;
Wong Poh Shean
1
;
Noor Lita Adam
1
;
Lee Pei Shin
2
;
Fauzi Azizan
2
Author Information
1. Unit Endocrinology, Department of Medicine, Hospital Tuanku Ja’afar Seremban
2. Department of Medicine, Hospital Tuanku Ampuan Najihah
- Publication Type:Journal Article
- MeSH:
Female;
Pregnancy;
Diabetic Ketoacidosis;
Thyroid Crisis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):66-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Diabetic ketoacidosis (DKA) and thyroid storm are
individually rare but potentially fatal endocrine crises
in pregnancy. Each carries significant maternal and fetal
morbidity, with mortality risk compounded when they
occur concomitantly. Physiological and pharmacokinetic
changes of pregnancy, combined with overlapping
symptoms, necessitate urgent treatment strategies.
Case:A 29-year-old G2P2 female at 29 weeks’ gestation, with
poorly controlled type 2 diabetes mellitus (hemoglobin
A1c 8.1%) on a basal–bolus insulin regimen and Graves’
disease managed with carbimazole, non-adherent to medications, presented with fever, vomiting, and dyspnea. On
examination, she was tachycardic (HR 138 bpm), hypotensive (BP 94/60 mmHg), and hypoxic. Laboratory investigations revealed hyperglycemia (glucose 27.1 mmol/L), severe metabolic acidosis (pH 7.02, bicarbonate 4.9
mmol/L), and elevated serum ketones (4.6 mmol/L), consistent with DKA. Thyroid function tests showed suppressed
thyroid-stimulating hormone (<0.005 mIU/L) and elevated
free T4 (28.2 pmol/L), with a Burch–Wartofsky score of 70.
Unfortunately, intrauterine fetal demise was confirmed
upon the patient’s presentation to the emergency department. She was intubated and admitted to the intensive care
unit, receiving fluid resuscitation judiciously according to
the DKA regimen, with frequent assessment of volume
status. Intravenous insulin and potassium supplements
were commenced concurrently. Metabolic stabilization was
achieved within 24 hours. Carbimazole, propranolol, Lugol’s iodine, and intravenous hydrocortisone were started
for treatment of thyroid storm. A breech-assisted vaginal
delivery was performed, and her postpartum course was
uneventful.
Conclusion:The case reveals the catastrophic potential of concurrent
DKA and thyroid storm in pregnancy, where rapid
maternal deterioration and poor fetal outcomes can occur
despite timely intervention. High clinical suspicion,
early biochemical confirmation, and coordinated
multidisciplinary management are vital. Precipitating
factors, particularly medication non-adherence, must
be addressed through intensive patient education and
structured follow-up to prevent recurrence.
- Full text:2026080316442844865EP_A085.pdf
