TY - JOUR
T1 - Diabetic Ketoacidosis Associated with Thyroxine (T₄) Toxicosis and Thyrotoxic Cardiomyopathy
AU - Meregildo Rodriguez, Edinson Dante
AU - Gordillo Velásquez, Luis Iván
AU - Alvarado Moreno, José Gustavo
PY - 2018/11/26
Y1 - 2018/11/26
N2 - 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.
AB - 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.
KW - cardiomyopathy
KW - diabetic ketoacidosis
KW - thyroid storm
KW - thyrotoxicosis
UR - http://www.scopus.com/inward/record.url?scp=85057553458&partnerID=8YFLogxK
U2 - 10.3390/medicina54060093
DO - 10.3390/medicina54060093
M3 - Article
C2 - 30486325
AN - SCOPUS:85057553458
SN - 1010-660X
VL - 54
JO - Medicina (Kaunas, Lithuania)
JF - Medicina (Kaunas, Lithuania)
IS - 6
ER -