Thyrotoxic Crisis and Diabetic Ketoacidosis

Hanscom, Donald H.; Ryan, Robert J.

doi:10.1056/nejm195710102571503

Cited by 12 publications

(4 citation statements)

References 25 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%

“…The highest number of cases were reported from the United States of America ( n = 11), followed by Taiwan ( n = 4), Japan ( n = 3), United Kingdom ( n = 3), Saudi Arabia ( n = 2), Republic of Korea ( n = 1), New Zealand ( n = 1) and Spain ( n = 1). The first case study was found to be reported by Hanscom and Ryan in 1957 from the United States of America [33]. The latest case was reported by Cheng ET at el.…”

Section: Resultsmentioning

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: Resultsmentioning

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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“…Applying the diagnostic criteria of Burch & Wartofsky, a score of 45 or greater was considered to indicate thyroid storm. Eighteen English-language cases, including the present case, were considered to be cases of thyroid storm with DKA (Table 2) (6-20). The mean age of these cases was 37.4 years (male 2; female 16).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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A 46-year-old woman with a history of Graves' disease presented with the chief complaints of appetite loss, weight loss, fatigue, nausea, and sweating. She was diagnosed with diabetic ketoacidosis (DKA), thyroid storm, and influenza A. She was treated with an intravenous insulin drip, intravenous fluid therapy, intravenous hydrocortisone, oral potassium iodine, and oral methimazole. As methimazole-induced neutropenia was suspected, the patient underwent thyroidectomy. It is important to maintain awareness that thyroid storm and DKA can coexist. Furthermore, even patients who have relatively preserved insulin secretion can develop DKA if thyroid storm and infection develop simultaneously.

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“…The combination of diabetes mellitus with thyrotoxicosis is well known and one condition usually precedes the other (Wilder, 1926) but the co-existence of diabetic ketoacidosis and thyrotoxic crisis is rare (Hanscom and Ryan, 1957). Two cases are described where these serious complications occurred simultaneously as the presenting features and provided difficulties in diagnosis and management.…”

Section: Introductionmentioning

confidence: 99%