Simultaneous occurrence of diabetic ketoacidosis, thyroid storm, and multiple cerebral infarctions due to Moyamoya disease
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Byoungho H. Noh
Abstract
Diabetic ketoacidosis (DKA) is one of the precipitating factors that can evoke a thyroid storm. Thyroid storm may cause cerebral ischemia in Moyamoya disease, which can coexist in patients with Graves’ disease. A 16-year-old girl complaining of dizziness and palpitations visited the emergency department and was diagnosed with DKA combined with hyperthyroidism. A thyroid storm occurred 6 h after the start of DKA management. Her Burch and Wartofsky score was 65 points. Right hemiplegia developed during the thyroid storm, and brain magnetic resonance (MR) diffusion-weighted images revealed multiple acute infarcts in both hemispheres. MR angiography showed stenosis of both distal internal carotid arteries and both M1 portions of the middle cerebral arteries, consistent with Moyamoya disease. After acute management for the thyroid storm with methimazole, Lugol solution and hydrocortisone, the patient’s neurological symptoms completely resolved within 1 month, and free T4 level normalized within 2 months. Thyroid storm may trigger cerebral ischemia in Moyamoya disease and lead to rapid progression of cerebrovascular occlusive disease. As a simultaneous occurrence of DKA, thyroid storm and cerebrovascular accident in Moyamoya disease highly elevates morbidity and mortality, prompt recognition and management are critical to save the patient’s life.
References
1. Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am 2006;35:663–86.10.1016/j.ecl.2006.09.008Suche in Google Scholar
2. Chiha M, Samarasinghe S, Kabaker AS. Thyroid storm: an updated review. J Intensive Care Med 2015;30:131–40.10.1177/0885066613498053Suche in Google Scholar
3. Wartofsky L. Thyrotoxic crisis. In: Braverman LE, Cooper DS, editors. Werner’s and Ingbar’s the thyroid, 10th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2013:481–6.Suche in Google Scholar
4. Petzold S, Kapellen T, Siekmeyer M, Hirsch W, Bartelt H, et al. Acute cerebral infarction and extra pontine myelinolysis in children with new onset type 1 diabetes mellitus. Pediatr Diabetes 2011;12:513–7.10.1111/j.1399-5448.2010.00732.xSuche in Google Scholar
5. Yaroglu Kazanci S, Yesilbas O, Ersoy M, Kihtir HS, Yildirim HM, et al. Cerebral infarction and femoral venous thrombosis detected in a patient with diabetic ketoacidosis and heterozygous factor V Leiden G1691A and PAI-1 4G/5G mutations. J Pediatr Endocrinol Metab 2015;28:1183–6.10.1515/jpem-2015-0056Suche in Google Scholar
6. Shoar Z, Dunne C, Yorns W, De Luca F, Rezvani G. Diabetic ketoacidosis with cerebral hemorrhage and alpha coma in an adolescent female. J Pediatr Endocrinol Metab 2013;26:561–4.10.1515/jpem-2012-0321Suche in Google Scholar
7. Akamizu T, Satoh T, Isozaki O, Suzuki A, Wakino S, et al.; Japan Thyroid Association. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Thyroid 2012;22:661–79.10.1089/thy.2011.0334Suche in Google Scholar
8. Feldt-Rasmussen U, Emerson CH. Further thoughts on the diagnosis and diagnostic criteria for thyroid storm. Thyroid 2012;22:1094–5.10.1089/thy.2012.2211.comSuche in Google Scholar
9. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am 1993;22:263–77.10.1016/S0889-8529(18)30165-8Suche in Google Scholar
10. Cruz AA, Akaishi PM, Vargas MA, de Paula SA. Association between thyroid autoimmune dysfunction and non-thyroid autoimmune diseases. Ophthal Plast Reconstr Surg 2007;23:104–8.10.1097/IOP.0b013e318030b06bSuche in Google Scholar PubMed
11. Lin CH, Chen SC, Lee CC, Ko PC, Chen WJ. Thyroid storm concealing diabetic ketoacidosis leading to cardiac arrest. Resuscitation 2004;63:345–7.10.1016/j.resuscitation.2004.06.017Suche in Google Scholar PubMed
12. Yeo KF, Yang YS, Chen KS, Peng CH, Huang CN. Simultaneous presentation of thyrotoxicosis and diabetic ketoacidosis resulted in sudden cardiac arrest. Endocr J 2007;54:991–3.10.1507/endocrj.K07-067Suche in Google Scholar PubMed
13. Lin HC, Yang LY, Kang JH. Increased risk of pulmonary embolism among patients with hyperthyroidism: a 5-year follow-up study. J Thromb Haemost 2010;8:2176–81.10.1111/j.1538-7836.2010.03993.xSuche in Google Scholar PubMed
14. Franchini M, Montagnana M, Manzato F, Vescovi PP. Thyroid dysfunction and hemostasis: an issue still unresolved. Semin Thromb Hemost 2009;35:288–94.10.1055/s-0029-1222607Suche in Google Scholar PubMed
15. Squizzato A, Romualdi E, Büller HR, Gerdes VE. Clinical review: thyroid dysfunction and effects on coagulation and fibrinolysis: a systematic review. J Clin Endocrinol Metab 2007;92:2415–20.10.1210/jc.2007-0199Suche in Google Scholar PubMed
16. Squizzato A, Gerdes VE, Brandjes DP, Bullar HR, Stam J. Thyroid diseases and cerebrovascular disease. Stroke 2005;36:2302–10.10.1161/01.STR.0000181772.78492.07Suche in Google Scholar PubMed
17. Hsu SW, Chaloupka JC, Fattal D. Rapidly progressive fatal bihemispheric infarction secondary to Moyamoya syndrome in association with Graves’ thyrotoxicosis. Am J Neuroradiol 2006;27:643–7.Suche in Google Scholar
18. Kamasaki H, Takeuchi T, Mikami T, Komeichi K, Tsutsumi H. A case of Graves’ disease diagnosed in the course of bilateral carotid artery stenoses (Moyamoya disease); a case report and review of the literature. Clin Pediatr Endocrinol 2013;22: 39–44.10.1297/cpe.22.39Suche in Google Scholar
19. Malik S, Russman AN, Katramados AM, Silver B, Mitsias PD. Moyamoya syndrome associated with Graves’ disease: a case report and review of the literature. J Stroke Cerebrovasc Dis 2011;20:528–36.10.1016/j.jstrokecerebrovasdis.2010.03.006Suche in Google Scholar PubMed
20. Panegyres PK, Morris JG, O’Neill PJ, Balleine R. Moyamoya-like disease with inflammation. Eur Neurol 1993;33:260–3.10.1159/000116950Suche in Google Scholar PubMed
21. Tendler BE, Shoukri K, Malchoff C, MacGillivray D, Duckrow R, et al. Concurrence of Graves’ disease and dysplastic cerebral blood vessels of the Moyamoya variety. Thyroid 1997;7:625–9.10.1089/thy.1997.7.625Suche in Google Scholar PubMed
22. Sasaki T, Nogawa S, Amano T. Co-morbidity of Moyamoya disease with Graves’ disease. Report of three cases and a review of the literature. Intern Med 2006;45:649–53.10.2169/internalmedicine.45.1543Suche in Google Scholar PubMed
©2016 by De Gruyter
Artikel in diesem Heft
- Frontmatter
- REVIEW
- Obesity-associated sympathetic overactivity in children and adolescents: the role of catecholamine resistance in lipid metabolism
- MINI REVIEW
- Idiopathic infantile hypercalcemia: case report and review of the literature
- ORIGINAL ARTICLES
- Levothyroxine replacement in primary congenital hypothyroidism: the higher the initial dose the higher the rate of overtreatment
- Effect of auditory guided imagery on glucose levels and on glycemic control in children with type 1 diabetes mellitus
- Kidney injury molecule-1 and neutrophil gelatinase associated lipocalin in normoalbuminuric diabetic children
- Use of the triglyceride to HDL cholesterol ratio for assessing insulin sensitivity in overweight and obese children in rural Appalachia
- Carotid intima media thickness in obese children: is there an association with hyperlipidemia?
- Schoolchildren born VLBW or VLGA show height-related changes in body composition and muscle function but no evidence of metabolic syndrome risk factors. Results from the NEOLONG study
- Topical dihydrotestosterone to treat micropenis secondary to partial androgen insensitivity syndrome (PAIS) before, during, and after puberty – a case series
- Urinary myo-inositol levels in Japanese schoolchildren with normal glucose tolerance
- Barriers in communication and available resources to facilitate conversation about infertility with girls diagnosed with Turner syndrome
- Analysis of the PAX8 gene in 32 children with thyroid dysgenesis and functional characterization of a promoter variant
- Decrease of small dense LDL and lipoprotein-associated phospholipase A2 due to human growth hormone treatment in short children with growth hormone deficiency and small for gestational age status
- Rare and curable renin-mediated hypertension: a series of six cases and a literature review
- CASE REPORTS
- Vulvar fetal rhabdomyoma mimicking 46XX sex differentiation disorder
- Simultaneous occurrence of diabetic ketoacidosis, thyroid storm, and multiple cerebral infarctions due to Moyamoya disease
- Brown-Vialetto-Van Laere syndrome: two siblings with a new mutation and dramatic therapeutic effect of high-dose riboflavin
- Lipomatous nevus and urethral caruncle mistaken for ambiguous genitalia in a female infant
- Thyrotropin-secreting pituitary adenoma in an 11-year-old boy with type 1 autoimmune polyglandular syndrome
- Changes in facial appearance from neonate to adult in 3-M syndrome patient with novel CUL7 gene mutations
Artikel in diesem Heft
- Frontmatter
- REVIEW
- Obesity-associated sympathetic overactivity in children and adolescents: the role of catecholamine resistance in lipid metabolism
- MINI REVIEW
- Idiopathic infantile hypercalcemia: case report and review of the literature
- ORIGINAL ARTICLES
- Levothyroxine replacement in primary congenital hypothyroidism: the higher the initial dose the higher the rate of overtreatment
- Effect of auditory guided imagery on glucose levels and on glycemic control in children with type 1 diabetes mellitus
- Kidney injury molecule-1 and neutrophil gelatinase associated lipocalin in normoalbuminuric diabetic children
- Use of the triglyceride to HDL cholesterol ratio for assessing insulin sensitivity in overweight and obese children in rural Appalachia
- Carotid intima media thickness in obese children: is there an association with hyperlipidemia?
- Schoolchildren born VLBW or VLGA show height-related changes in body composition and muscle function but no evidence of metabolic syndrome risk factors. Results from the NEOLONG study
- Topical dihydrotestosterone to treat micropenis secondary to partial androgen insensitivity syndrome (PAIS) before, during, and after puberty – a case series
- Urinary myo-inositol levels in Japanese schoolchildren with normal glucose tolerance
- Barriers in communication and available resources to facilitate conversation about infertility with girls diagnosed with Turner syndrome
- Analysis of the PAX8 gene in 32 children with thyroid dysgenesis and functional characterization of a promoter variant
- Decrease of small dense LDL and lipoprotein-associated phospholipase A2 due to human growth hormone treatment in short children with growth hormone deficiency and small for gestational age status
- Rare and curable renin-mediated hypertension: a series of six cases and a literature review
- CASE REPORTS
- Vulvar fetal rhabdomyoma mimicking 46XX sex differentiation disorder
- Simultaneous occurrence of diabetic ketoacidosis, thyroid storm, and multiple cerebral infarctions due to Moyamoya disease
- Brown-Vialetto-Van Laere syndrome: two siblings with a new mutation and dramatic therapeutic effect of high-dose riboflavin
- Lipomatous nevus and urethral caruncle mistaken for ambiguous genitalia in a female infant
- Thyrotropin-secreting pituitary adenoma in an 11-year-old boy with type 1 autoimmune polyglandular syndrome
- Changes in facial appearance from neonate to adult in 3-M syndrome patient with novel CUL7 gene mutations
