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Coexistent insulin dependent diabetes mellitus and hyperthyroidism in a patient with Down's syndrome
1Department of Pediatrics, Kaohsiung Medical University Hospital, Taiwan.
Insights
Thyroid disease and insulin-dependent diabetes mellitus are uncommon in children with Down syndrome. This case highlights a rare co-occurrence, emphasizing the need for careful thyroid evaluation in these patients.
Area of Science:
- Pediatrics
- Endocrinology
- Genetics
Background:
- Thyroid disease is more prevalent in individuals with Down syndrome.
- Thyroid dysfunction and insulin-dependent diabetes mellitus are less commonly reported in children with Down syndrome compared to adults.
- The co-occurrence of insulin-dependent diabetes mellitus and hyperthyroidism in Down syndrome is exceptionally rare, with only one prior reported case.
Observation:
- An 8-year-old girl with Down syndrome presented with symptoms of diabetic ketoacidosis, including polyuria, polydipsia, abdominal pain, and urinary incontinence.
- Physical examination revealed characteristic facial features of Down syndrome (Mongolism) and tachycardia.
- Laboratory results confirmed diabetic ketoacidosis (plasma glucose 860 mg/dl) and hyperthyroidism (TSH < 0.1 microU/ml, T3 219.7 ng/dl, T4 15 micrograms/dl).
Findings:
- The patient exhibited significantly elevated thyroid autoimmune antibodies.
- A Tc-99 thyroid scan showed markedly increased radiotracer uptake in both thyroid glands, indicative of hyperthyroidism.
- This case represents a rare instance of coexistent insulin-dependent diabetes mellitus and hyperthyroidism in a child with Down syndrome.
Implications:
- Children with Down syndrome diagnosed with insulin-dependent diabetes mellitus require thorough evaluation of thyroid function.
- Screening for thyroid dysfunction and autoimmune thyroid disease is crucial in Down syndrome patients with diabetes.
- Early detection and management of coexisting endocrine disorders can improve patient outcomes in this vulnerable population.
Abstract:
The prevalence of thyroid disease is increased in Down's syndrome. Compared with adults, thyroid dysfunction in children with Down's syndrome is less frequently reported. Insulin dependent diabetes mellitus is also uncommon in Down's syndrome children. Coexistent insulin dependent diabetes mellitus and hyperthyroidism in Down's syndrome was only reported once previously in literature. We report an 8-year-old girl with Down's syndrome that had polyuria, polydipsia, abdominal pain and urinary incontinence one and half a month prior to admission. Physical examination revealed typical face of Mongolism and tachycardia. Thyroid glands were not palpable. Laboratory data revealed diabetic ketoacidosis with plasma glucose: 860 mg/dl. She had thyroid hyperfunction with TSH: < 0.1 microU/ml, T3: 219.7 ng/dl, T4: 15 micrograms/dl. Thyroid autoimmune antibodies were also increased. There was markedly increased radiotracer uptake in the bilateral thyroid glands in Tc-99 thyroid scan. We suggest that Down's syndrome children with insulin dependent diabetes mellitus should be evaluated carefully for thyroid function and autoimmune disease.