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A case of hyperglycemic hyperosmolar state associated with Graves' hyperthyroidism: a case report
Sung Won Moon1, Jong Ryeal Hahm, Gyeong-Won Lee
1Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea.
Journal of Korean Medical Science
|August 8, 2006
Summary
A young woman with Graves' disease and type 2 diabetes mellitus developed Hyperglycemic Hyperosmolar State (HHS). Aggravated hyperthyroidism exacerbated her diabetes, leading to HHS despite treatment.
Area of Science:
- Endocrinology
- Metabolic Disorders
Background:
- Hyperglycemic Hyperosmolar State (HHS) is a severe acute complication primarily affecting elderly patients with type 2 diabetes mellitus (DM).
- Thyrotoxicosis, a condition of excess thyroid hormones, can significantly worsen glucose intolerance in diabetic individuals by increasing glucose production and fat breakdown.
Observation:
- A 23-year-old female with a history of Graves' disease and type 2 DM presented with nausea, polyuria, and weakness.
- Her laboratory results indicated severe hyperglycemia (serum glucose 32.7 mM/L) and hyperosmolarity (321 mosm/kg).
- Thyroid function tests showed a marked increase in hyperthyroid status compared to two weeks prior, despite ongoing treatment.
Findings:
- The patient was diagnosed with HHS and refractory Graves' hyperthyroidism.
- Treatment involved intravenous fluids, insulin, and high-dose methimazole (90 mg daily).
- Successful management of both HHS and the hyperthyroid state was achieved.
Implications:
- This case highlights the critical interaction between hyperthyroidism and diabetes, demonstrating how exacerbated thyrotoxicosis can precipitate HHS in a younger patient.
- It underscores the importance of vigilant monitoring of thyroid function in diabetic patients and aggressive management of both conditions.
- The successful treatment protocol provides a valuable reference for managing similar complex endocrine emergencies.
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