A case of diabetic ketoacidosis in a type 2 diabetic patient accompanied by Plummer's disease

Ai Murao, Masanori Iwase, Tan Tominaga, Hiroshi Ohtani, Hidefumi Tomari, Yasuhiro Idewaki, Masahiro Nakano, Hiroshi Jyouzaki, Udai Nakamura, Takanari Kitazono

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A 51-year-old woman was admitted to our hospital due to nausea and upper abdominal pain. She had a consciousness disorder and tachycardia. Her laboratory data showed hyperglycemia (plasma glucose level: 694 mg/dl), ketosis (total blood ketone body level: 15.4 mmol/l) and acidemia with preserved insulin secretion and negative findings for anti-GAD antibodies. She was diagnosed with diabetic ketoacidosis, and insulin therapy was commenced. She had a nodular goiter in the left lobe of her thyroid (3×4 cm) in addition to hyperthyroidism (TSH <0.01 μ IU/l; Free T3 3.04 pg/ml). Thyroid autoantibodies were negative; however, 123I thyroid scintigraphy revealed a hot nodule corresponding to the tumor. Plummer disease was diagnosed and hemithyroidectomy was performed. After the surgery, the patient's glycemic control was excellent and the insulin therapy was withdrawn. It is well known that the development of diabetic ketoacidosis may be accelerated by hyperthyroidism mostly caused by Basedow's disease. Clinicians should be aware of Plummer disease as a cause of hyperthyroidism during episodes of diabetic ketoacidosis in patients with type 2 diabetes mellitus.

Original languageEnglish
Pages (from-to)681-687
Number of pages7
JournalJournal of the Japan Diabetes Society
Issue number9
Publication statusPublished - 2015

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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