Non-diabetic ketoacidosis secondary to primary hyperthyroidism

Abstract

Introduction: There are variable complications of hyperthyroidism, including atrial fibrillation, heart failure, osteoporosis, and thyroid storm. One infrequent complication of hyperthyroidism is non-diabetic ketoacidosis (NDKA). To the best of our knowledge, our case is the third report of NDKA related to thyrotoxicosis. Patient concern: We describe a case of a 41-year-old African lady with no past medical history presented to our hospital with severe abdominal pain and vomiting for three weeks. This was associated with decreased appetite and weight loss. Diagnosis: Laboratory findings were significant for high anion gap metabolic acidosis, positive ketones in the urine, and high serum B-hydroxybutyrate. The blood glucose readings and HbA1c were within normal limits. Also, serum lactic acid and salicylate levels were within the normal range. The diagnosis of NDKA was made. Later, the thyroid functions test (TFT) confirmed the diagnosis of primary hyperthyroidism. Intervention and outcomes: The patient was managed initially with intravenous fluid and antiemetics. Then, she was started on propranolol and carbimazole. After which, her symptoms improved dramatically, and the metabolic acidosis (with serum ketones) were corrected within a few days of starting anti-thyroid medications. Conclusion: Despite its rarity, NDKA can be associated with severe thyrotoxicosis. Vigorous intravenous hydration and anti-thyroid medication are the mainstay treatment. TFT should be requested in a patient with unexplained NDKA

Safety of Antithyroid Drugs in Avoiding Hyperglycemia or Hypoglycemia in Patients With Graves’ Disease and Type 2 Diabetes Mellitus: A Literature Review

“…In 1982, an early study reported the occurrence of hypoglycemia as a side effect of carbimazole in patients with T2DM with hyperthyroidism [ 31 ]. However, in a case report of non-diabetic ketoacidosis due to hyperthyroidism, carbimazole was found to effectively improve the disease, without affecting blood glucose levels [ 32 ]. Another case study reported severe hypoglycemia in a patient with hyperthyroidism [ 33 ].…”

Thyrotoxic periodic paralysis as the first presentation of Graves' disease: A case report

“…Patients with Graves' disease usually present with classic clinical manifestations, including but not limited to heat intolerance, palpitations, tremor, anxiety, and weight loss. However, rarely, some patients might initially present with unusual clinical manifestations 2,3 . Thyrotoxic periodic paralysis (TPP) is a potentially life‐threatening complication of thyrotoxicosis, and the attack is characterized by acute and reversible severe painless muscle weakness.…”

“…However, rarely, some patients might initially present with unusual clinical manifestations. 2 , 3 Thyrotoxic periodic paralysis (TPP) is a potentially life‐threatening complication of thyrotoxicosis, and the attack is characterized by acute and reversible severe painless muscle weakness. Most patients presenting with TPP have been previously diagnosed with Graves' disease.…”