A case of severe hypoglycaemia in a patient with hyperthyroidism

Patwari, Pranjali; Narasimhan, Anirudhan; Ramalingam, Srinivasan

doi:10.1530/endoabs.32.p996

Cited by 3 publications

(3 citation statements)

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“…In our part of the world, where thyroid disorders are very common and antithyroid drugs routinely administered, IAS has been virtually unreported. Recently, carbimazole-induced IAS has been reported in a man of Indian decent 5. To the best of our knowledge, ours is the first reported case of IAS in Nepal.…”

Section: Discussionmentioning

confidence: 55%

Spontaneous hypoglycaemia in a patient with Graves' disease

Paudyal

Shakya

Basnyat³

2016

BMJ Case Reports

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A 23-year-old man, on treatment for Graves' disease, presented to the emergency department, with 2 separate episodes of loss of consciousness. During the first episode, the initial serum glucose was 19 mg/mL, and 44 mg/dL during the second episode. The patient was non-diabetic, and had elevated blood insulin, C peptide and insulin antibody levels. His abdominal radiographic findings were normal. He was diagnosed with Hirata disease, and put on propylthiouracil as a replacement for carbimazole. Hypoglycaemia was managed with dextrose infusions and frequent meals. The patient's condition improved and he had no further episodes of hypoglycaemia during the follow-up period.

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Section: Discussionmentioning

confidence: 55%

Spontaneous hypoglycaemia in a patient with Graves' disease

Paudyal

Shakya

Basnyat³

2016

BMJ Case Reports

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“…The pathophysiology mechanism were air leakage through the alveolar walls, damage by inflammation and damage by subsequent cytokine storm. 7,8 The chest X-ray shows air in the soft tissue space and prominent striations of the pectoralis muscle which gives an impression of Ginkgo leaf and hence the name of the sign as Gingko leaf sign. 3 Ideally the diagnosis of subcutaneous emphysema is done clinically by palpating the subcutaneous tissue which gives a crepitant feeling.…”

Section: Discussionmentioning

confidence: 99%

“…First case was reported in 2013. [5][6][7] This can be the most important syndrome in the differential diagnosis of endogenous hyperinsulinemic hypoglycemia (EHH) so that early recognition can be done and unnecessary investigations can be avoided.…”

Section: Introductionmentioning

confidence: 99%

Hypoglycemia due to insulin autoimmune syndrome (Hirata’s disease): a rare cause of hypoglycaemia

Patel¹,

Kumar²,

Moradiya³

et al. 2021

Int J Adv Med

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Although the most common cause of recurrent hypoglycaemia is diabetes mellitus as patient is on antidiabetic medications which can be prevented by modification of antidiabetic doses, nutrition therapy and lifestyle modifications. Some endogenous hyperinsulinemic conditions like insulinoma, functional beta cell disorders and insulin autoimmune syndromes, hormonal deficiencies can cause serious and sometimes life threatening hypoglycaemia. So further laboratory evaluation like plasma/serum glucose levels, c-peptide levels, insulin levels, insulin antibodies and imaging studies are needed to evaluate unexplained hypoglycaemia. Here we report a case of insulin autoimmune syndrome in a 67 year old Indian male who had presented to us with multiple episodes of spontaneous hypoglycaemia. On further workup, the patient was found to have endogenous hyperinsulinemic hypoglycemia. As the patient’s abdominal imaging revealed no apparent cause of EHH, on further evaluation he came positive for insulin antibodies. Patient was diagnosed as IAS and he was given frequent small meals and complex carbohydrate diet and he had improved symptomatically. The incidence of IAS is most common in Japan and very few cases have been reported from India, so it should be kept in differential diagnosis of recurrent hypoglycaemia.

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