We experienced a ease of diabetic ketoaeidosis with thyroid sto m, and discuss the pathophysiology of this case in this report.
A 43-year-old woman was admitted to our hospital because of semicoma, fever and vomiting.She had had untreated Graves' diseasefor 13 years. After exuess food and soft drink consumption, she developed a thyroid storm and diabetic ketoacidosis simultaneously. She was treated with an anti-thyroid drug, a beta-blocking agent, sodium iodide, hydrocortisone and continuous low-dose intravenous insulin, A family history of non-insulin-dependent diabetes (NIDDM), a past history of probable gestational diabetes and thepresense of proliferative retinopathy were observed. Autoantibodies to islet and glutamic auid deuarboxylase were negative, and her HLA typing showed DR8 and DR14. lnsulin secretion after glucagon loading and the urinary C-peptide concentration were low butnot negative. According to the clinical characteristics described above, we diagnosed her condition as NIDDM. During her clinicalcourse, excess thyroid hormone, reduced lnsulin secretion due to chronic hyperglycemia, and excess soft drink consumption were suggested as playing important roles in the development of diabetic ketoacidosis.