J Korean Med Sci.  2006 Aug;21(4):765-767. 10.3346/jkms.2006.21.4.765.

A Case of Hyperglycemic Hyperosmolar State Associated with Graves' Hyperthyroidism: A Case Report

• Moon SW
• Hahm JR
• Lee GW
• Kang MY
• Jung JH
• Jung TS
• Lee KW
• Jung KA
• Ahn YJ
• Kim S
• Kim MA
• Kim DR
• Chung SI
• Park MH

• KMID: 2157837
• DOI: http://doi.org/10.3346/jkms.2006.21.4.765

Abstract

Hyperglycemic hyperosmolar state (HHS) is an acute complication mostly occurring in elderly type 2 diabetes mellitus (DM). Thyrotoxicosis causes dramatic increase of glycogen degradation and/or gluconeogenesis and enhances breakdown of triglyc-erides. Thus, in general, it augments glucose intolerance in diabetic patients. A 23-yr-old female patient with Graves' disease and type 2 DM, complying with methimazole and insulin injection, had symptoms of nausea, polyuria and generalized weakness. Her serum glucose and osmolarity were 32.7 mM/L, and 321 mosm/kg, respectively. Thyroid function tests revealed that she had more aggravated hyperthyroid status; 0.01 mU/L TSH and 2.78 pM/L free T3 (reference range, 0.17-4.05, 0.31-0.62, respectively) than when she was discharged two weeks before (0.12 mU/L TSH and 1.41 pM/L free T3). Being diagnosed as HHS and refractory Graves' hyperthyroidism, she was treated successfully with intravenous fluids, insulin and high doses of methimazole (90 mg daily). Here, we described the case of a woman with Graves' disease and type 2 DM developing to HHS.

Keyword

Hyperosmolar Hyperglycemic Nonketotic Coma; Graves Disease; Diabetes Mellitus, Type 2; Methymazole

MeSH Terms

Thyroid Function Tests
Methimazole/therapeutic use
Insulin/therapeutic use
Hyperthyroidism/*complications/therapy
Hyperglycemic Hyperosmolar Nonketotic Coma/*etiology
Humans
Graves Disease/*complications
Fluid Therapy
Female
Diabetes Mellitus, Type 2/*complications
Adult

Figure

• 

  Fig. 1 The clinical course and laboratory data of this patient.

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