Thyroid Storm Precipitated by Diabetic Ketoacidosis and Influenza A: A Case Report and Literature Review

Ikeoka, Toshiyuki; Otsuka, Hiroaki; Fujita, Naruhiro; Masuda, Yukari; Maeda, Shuichi; Horie, Ichiro; Ando, Takao; Abiru, Norio; Kawakami, Atsushi

doi:10.2169/internalmedicine.56.7593

Cited by 11 publications

(10 citation statements)

References 23 publications

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“…The full-texts of the remaining 28 reports were studied, and 7 were excluded due to mismatch with the selection criteria (absence of thyroid storm − 4, absence of DKA - 3). Finally, 21 reports were subsequently selected which had 26 cases [10, 11, 33–51] (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…We aim to systematically review cases reported on concurrent presentation of TS and DKA concerning its presentation, investigations and management. In 2009 (9 cases) and 2017 (18 cases), two separate summaries on concurrent presentation of TS and DKA were reported along with similar case reports [10, 11]. However, this systemic review includes additional cases and an in-depth analysis.…”

Section: Introductionmentioning

confidence: 99%

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Concurrent presentation of thyroid storm and diabetic ketoacidosis: a systematic review of previously reported cases

Rathish

Karalliyadda

2019

BMC Endocr Disord

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Background Simultaneous development of thyroid storm and diabetic ketoacidosis (DKA) is a rare condition. The review aims to summarise its clinical presentation, investigation findings and treatment options. Methods Databases and reference lists of the selected articles were searched for case reports in English which describe concurrent presentation of thyroid storm and diabetic ketoacidosis. CARE guidelines were used for the quality assessment of the selected articles. Results Twenty-six cases from twenty-one articles were selected out of 198 search results. Western Pacific, and American regions contributed to 77% of the cases. Females were most affected (88%). Features of Graves’ disease like hyperthermia and tachycardia, gastrointestinal and neuro-psychiatric disturbances were the common clinical presentations. In most of the cases, previous diagnosis of diabetes mellitus preceded that of Graves’ disease (46%). Among patients having their drug compliance reported, all had poor compliance to their routine anti-thyroid (9/9) and anti-diabetic (2/2) agents. Moreover, in all cases where HbA 1C (7/7) and T4 (16/16) were measured, the results were elevated and where TSH (17/17) was measured, the results were low. The recommended treatment for DKA and thyroid storm was used in most cases and methimazole was the thionamide of choice in the latest four cases reported. All cases survived except four (15%). Conclusions Concurrent presentation of thyroid storm and diabetic ketoacidosis is rare but life-threatening. Therefore, efforts should be made to maximise patient compliance to anti-thyroid and anti-diabetic agents in treating such patients. Electronic supplementary material The online version of this article (10.1186/s12902-019-0374-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Concurrent presentation of thyroid storm and diabetic ketoacidosis: a systematic review of previously reported cases

Rathish

Karalliyadda

2019

BMC Endocr Disord

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“…DKA usually occurs as a consequence of absolute or relative insulin deficiency that is accompanied by an increase in counterregulatory hormones (glucagon, cortisol, growth hormone, and epinephrine). This hormonal imbalance enhances hepatic gluconeogenesis, glycogenolysis, and lipolysis [1,2,3,4].…”

Section: Discussionmentioning

confidence: 99%

“…Simultaneous presentation of thyrotoxicosis and diabetic ketoacidosis (DKA) have been reported several times, but it is a clinically unusual situation and remains a diagnostic challenge in clinical practice, because both entities share similar manifestations [1,2,3,4,5,6]. Concurrent presentation of DKA, thyroxin (T 4 ) toxicosis and thyrotoxic cardiomyopathy is even rarer.…”

Section: Introductionmentioning

confidence: 99%

Diabetic Ketoacidosis Associated with Thyroxine (T4) Toxicosis and Thyrotoxic Cardiomyopathy

2018

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Thyrotoxicosis and diabetic ketoacidosis (DKA) both may present as endocrine emergencies and may have devastating consequences if not diagnosed and managed promptly and effectively. The combination of diabetes mellitus (DM) with thyrotoxicosis is well known, and one condition usually precedes the other. Furthermore, thyrotoxicosis is complicated by some degree of cardiomyopathy in at least 5% de patients; but the coexistence of DKA, thyroxin (T4) toxicosis, and acute cardiomyopathy is extremely rare. We describe a case of a man, previously diagnosed with DM but with no past history of thyroid disease, who presented with shock and severe DKA that did not improve despite optimal therapy. The patient evolved with acute pulmonary edema, elevated troponin levels, severe left ventricular systolic dysfunction, and clinical and laboratory evidence of thyroxin (T4) toxicosis and thyrotoxic cardiomyopathy. Subsequently, the patient evolved favorably with general support and appropriate therapy for DKA and thyrotoxicosis (hydrocortisone, methimazole, Lugol’s solution) and was discharged a few days later.

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“…11 The literature related to TS was searched from 2016 to 2019, and the clinical characteristics of gastrointestinal symptoms in patients with TS were found to mainly be nausea, and the main cause of TS to be Graves' disease with unknown or poor compliance with anti-thyroid drugs (Table 3). [33][34][35][36][37][38][39][40][41][42][43][44][45][46] Considering that hiccups are not common in either DKA or TS, we speculate that the incidence of intractable hiccups is rare when DKA overlaps with TS. By carefully searching the literature, we found the following related cases.…”

Section: Case Presentationmentioning

confidence: 99%

Intractable hiccups as a rare gastrointestinal manifestation in severe endocrine and metabolic crisis: case report and review of the literature

Jiang

Zhong

et al. 2020

Therapeutic Advances in Endocrinology

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Diabetic ketoacidosis (DKA) and thyroid storm (TS) are severe metabolic and endocrine disorders. Both usually manifest with multiple systemic clinical signs and symptoms, and digestive symptoms, such as nausea and vomiting, are most common in these patients. Moreover, the presence of a concurrent severe or rare complication may worsen the condition or even cause death due to misdiagnosis, delayed diagnosis, or inappropriate treatment. The identification of these symptoms is usually closely related to the severity and prognosis of the disease. Although clinical prognosis might be improved by prompt diagnosis and aggressive treatment, some rare and insidious metabolic complications are difficult to identify early. Moreover, life-threatening gastrointestinal symptoms are very rare in patients with DKA and TS. Here, we report an inpatient diagnosed with DKA and Graves’ disease who developed life-threatening intractable hiccups resulting in TS and respiratory failure during the treatment of DKA. In addition, we review the literature to discuss the possible underlying mechanism of intractable hiccups in the development of TS.

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Thyroid Storm Precipitated by Diabetic Ketoacidosis and Influenza A: A Case Report and Literature Review

Cited by 11 publications

References 23 publications

Concurrent presentation of thyroid storm and diabetic ketoacidosis: a systematic review of previously reported cases

Concurrent presentation of thyroid storm and diabetic ketoacidosis: a systematic review of previously reported cases

Diabetic Ketoacidosis Associated with Thyroxine (T4) Toxicosis and Thyrotoxic Cardiomyopathy

Intractable hiccups as a rare gastrointestinal manifestation in severe endocrine and metabolic crisis: case report and review of the literature

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