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Simultaneous Occurrence of Diabetic Ketoacidosis, Hyperthyroidism, and Moderate Neutropenia on Exposure of Carbimazole - A Case Report
摘要
Introduction: It is rare to see such a complex scenario in which a woman of hyperthyroidism, with coexistent diabetic ketoacidosis(DKA) without history of diabetes mellitus(DM), developed moderate neutropenia two weeks on carbimazole therapy. Case report: A 27 year-old woman presented with palpitation, insomnia and body weight loss for several weeks was diagnosed as Graves' disease with hyperthyroidism. Carbimazole and beta-blocker were given but her symptoms persisted. Further evaluation revealed that she also had a concomitant DKA without history of DM. She was admitted for insulin and fluid therapy. Blood sugar was gradually stabilized. On the 2^(nd) day of admission, moderate neutropenia with low absolute neutrophil count(ANC) was noted. Carbimazole was discontinued immediately. Radioactive iodine therapy was arranged. ANC returned to near normal range on the 11^(th) day of admission. Glucagon test showed poor beta-cell reserve. Glutamic acid decarboxylase antibody(GADab) was positive. Type 1 diabetes was diagnosed. Two months after radioiodine therapy, hypothyroidism was noted and replacement with Eltroxin was given. Her TSH and FT4 levels were kept within normal ranges. Her glycemic control was quite well as shown by HbA1c(6.0%, two months after discharged, and 6.8% one year later). Conclusion: A complex scenario in which a woman with hyperthyroidism, coexisted with DKA without history of DM, developed moderate neutropenia on exposure of carbimazole is described. High index of suspicion, careful history taking and close observation are important in the initial assessment and during followup. Early recognition and appropriate management of both conditions resulted in a favorable outcome.
延伸閱讀
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