Type 1 Diabetes Melitus With Post Ketoacidosis, Grave’s Disease And Down Syndrome in 7 Years Old Girl
Agung wiwin Indayani, I Made Arimbawa, Wayan Bikin Suryawan
Department of Child Health Medical School Udayana University Sanglah Hospital
Background : The incidence of Type 1 Diabetes Mellitus (T1DM) in children is about 1/600.000 population and sometimes can be present with another autoimmune condition such as hypertiroidism. Thyroid hormone can affected glucose metabolism and causing hyperglycemia in patient with T1DM. Patients with T1DM and hyperthyroid comorbidity is in higher risk of getting serious complication from T1DM such as diabetic ketoacidosis (DKA).
Case Presentation Summary : We reported a case of a child with T1DM and hyperthyroidism due to Grave’s disease (GD) with suspected down syndrome who admitted to the hospital because of DKA. Laboratory examination during admission at emergency department showed high blood sugar with stick examination which is 338 mg/dL. The test of HbA1c showed the result of 10.5%. Urine examination revealed both ketones and glucose qualitative are +4. Blood gas analysis showed acidosis with blood PH of 6.88 with bicarbonate 2.9mmol/. Thyroid profile showed FT4 serum 2.84 ng/dl, TSH 0.09 µIU/mL, the level of thyroid antibody (TRab) showed positive result which is more than 40.00 IU/L. Chromosome analysis for down syndrome confirmed a positive result. Patient having DKA most likely because of high level of circulating thyroid hormone and poor control of blood sugar. Patient has become out clinic patient and having improvement in overall condition after receiving therapy from hospital.
Learning Points/Discussion : In patient with T1DM and Grave’s disease, risk of developing DKA is higher. Close monitoring of blood glucose and thyroid hormone level needed to prevent the event and decrease morbidity and mortality.
Keywords: children hyperthyroidism diabetes melitus
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
Mid City Hospital, 3-A Shadman II
Jail Road, Lahore ,Pakistan