Diabetic Ketoacidosis in a Patient with Graves' Disease and Vitiligo.
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Accession number;99A0300741
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| Title;Diabetic Ketoacidosis in a Patient with Graves' Disease and Vitiligo. |
| Author;
KAWACHI SHIN'ICHI
(Takayama Red Cross Hosp.)
OGAWA TOORU
(Takayama Red Cross Hosp.)
NATSUME YOSHIYUKI
(Takayama Red Cross Hosp.)
TANABASHI SHINOBU
(Takayama Red Cross Hosp.)
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Journal Title;Journal of the Japan Diabetic Society
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Journal Code:Z0279B
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ISSN:0021-437X
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VOL.42;NO.1;PAGE.49-54(1999)
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| Figure&Table&Reference;FIG.1, TBL.3, REF.27 |
| Pub. Country;Japan |
| Language;Japanese |
| Abstract;A 43-year-old woman was referred to our hospital because of weight loss, palpitations, thirst and polyuria. A subtotal thyroidectomy had been performed because of Graves' disease when she was 18-years-old. She had complained of hypopigmented cutaneous changes in her hands lasting for about one year, which revealed vitiligo vulgaris later. She also had a diffuse goiter and mild bilateral exophthalmos. On admission, her plasma glucose was 371mg/dl, hemoglobin A1c was 13.0%, and arterial gas analysis and urinalysis revealed ketoacidosis. In addition serum levels of FT3, FT4 and TSH were 2.2pg/ml, 3.7ng/dl and 0.01.MU.U/ml, respectively, and urinary excretion of C-peptide was low (28.MU.g/day). Autoantibodies to glutamic acid decarboxylase(GAD) and TSH-binding inhibitor immunoglobulins were Positive. The 30-min thyroidal uptake of 99mTcO4- was 15.8%. On the basis of these results, we diagnosed this case as diabetic ketoacidosis with autoantibodies to GAD complicated with vitiligo vulgaris and a recurrence of Graves' disease. After admission, she was initially treated with propylthiouracil, a beta-blocking agent, fluid supplementation and continuous lowdose intravenous insulin. The hyperglycemia and ketoacidosis gradually disappeared over several days. It is suggested that autoimmune mechanisms played an important role in the development of diabetes, vitiligo vulgaris and recurrence of Graves' disease in this case. (author abst.) |
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