Beyond Graves’ Disease and Type 1 Diabetes Mellitus: Thyrotoxic Heart Failure and Emerging Polyglandular Syndrome Type 2
https://doi.org/10.15605/jafes.041.S1
- Author:
Sharon Mui Kim Lim
1
;
Li Yuen Nyin
2
;
Zulaikha Che Imbi
3
;
Farizan AB Ghani
1
Author Information
1. Paediatric Department, Hospital Melaka
2. Radiology Department, Hospital Melaka
3. Pathology Department, Hospital Putrajaya
- Publication Type:Journal Article
- MeSH:
Diabetes Mellitus, Type 1;
Graves Disease;
Heart Failure;
Diabetes Mellitus, Type 2
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):147-148
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:The coexistence of autoimmune thyroid disease and type
1 diabetes mellitus is well established; however, their
sequential or concurrent presentation in very young
children remains uncommon. We demonstrate two
paediatric cases with concurrent Graves' disease and type
1 diabetes mellitus, each illustrating distinct complications
and clinical courses.
Cases:A 3-year-old female presented with anterior neck swelling,
weight loss, and persistent tachycardia. Biochemical
evaluation confirmed severe thyrotoxicosis (T4 152.3
pmol/L, TSH <0.008 mIU/L) with markedly elevated antithyroglobulin and anti–thyroid peroxidase antibodies.
Thyroid ultrasonography demonstrated a diffusely
enlarged, hypervascular gland with nodular changes,
consistent with Graves’ disease. During longitudinal
follow-up, she developed polyuria, polydipsia, and
hyperglycemia, with positive pancreatic autoantibodies
confirming type 1 diabetes mellitus. Notably, serial early
morning cortisol measurements were persistently low,
raising concern for evolving adrenal insufficiency and
suspicion of autoimmune polyglandular syndrome type 2.
Comprehensive endocrine evaluation is ongoing.
A 4-year-old male presented with a 1-year history of
recurrent self-limiting fever followed by significant
fatigability for 1 month. Salient examination on admission
revealed tachycardia, anterior neck swelling, and an
incidental pansystolic murmur. Thyroid function tests
confirmed thyrotoxicosis (T4 38.6 pmol/L, TSH <0.008
mIU/L). Serial serum glucose was markedly elevated on
admission, prompting further testing that confirmed type
1 diabetes mellitus with positive pancreatic autoantibodies.
Echocardiography demonstrated moderate-to-severe mitral
regurgitation with heart failure secondary to prolonged
uncontrolled hyperthyroidism state. Cardiac function
improved with restoration of a euthyroid state, highlighting
the reversible nature of thyrotoxic heart failure.
Conclusion:These cases highlight the progressive nature of childhood
autoimmunity, where Graves’ disease may precede the
development of type 1 diabetes mellitus and evolving
features of autoimmune polyglandular syndrome type
2. They further emphasize that thyrotoxic heart failure is
potentially reversible with restoration of a euthyroid state,
underscoring the importance of early recognition and
vigilant long-term surveillance.
- Full text:202608101739093588EP_P026.pdf
