Hypertireosis as provoking factor of ketoacidosis

This work is to show hypertireosis as provoking factor of katoacidosis incentive in diabetes, type 2, verified at an early chilhood and treated by insuline. A 33-year-old female patient who has been suffering from diabetes since being only six months old, has been treated by fixed mixture therapy of intermediate-acting and rapid-acting insulin (70/30). The patient complains about weakness, loss of appetite, vomitting urge and vomitting itself. In the course of general medical examination the patient is somnolent, extremely dehidrated, slight exoftalmus, anisocoric, sight impaired, with dry tongue coated by whitish layers. Thyroid gland is palpatory slightly increased. Heart beat is tachycardiac, tones clear, heart murmur inaudible. Frequency 150/min, TA 90/40 mm Hg. Weakened respiratory murmur is basal followed by audible inspiratory tone, inclined to the left side. Below chest, abdomen is soft, palpatory sensitive to pain in the area of epigastrium, liver and spleen do not palpate. Extremities: Without oedema, weakened pulse of dorsalis pedis artery at both sides. According to the admission results it is as follows: SE 50/80, Fe 3,8: TIBC 38,7: UIBC 34,9: index saturation 0,10: Na 128: K 56: Cl 89: Ca 2,56: urea 10,6: creatinin 127: GUK 40,8: ABS: pH 7,059: pCO2 1,78: HCO3 3,6: total CO2 4: excess base - 27: pO2 10,66: saturation O2 91,7%: HbA ic 10,0 %: thyroid gland hormone: FT4 98,2: FT3 14,0: TSH 0,01. Medical examination control on discharge: Na 137: K 4,2: Cl 99: urea 3,0: creatinine 52: GUK 4,1: ABS: all parameters within referent value limits. Thyroid gland hormones: FT4 56,9: FT3 10,3: TSH 0,007. On admission, the patient was administered with a four dose crystal insuline s.c. crystal solutions of a wide range usage from the group of cephalosporine, parenterally. Due to repeated disturbances of ABS, and the oscillation of glycaemia, gastroscopy was carried out. Even after regular rehydration and suitable therapy, the occurrence of slight disturbances of ABS followed by tachycardia, about 100/min, was registered. After hormonal status analysis of thyroid gland, a high dosage of ureostatics was administered which resulted in stabilizing of glyacemia and ABS. Gland thyroid control results showed a significant improvement in the patient after 7 days of therapy. Siderosis anaemia is to be corrected by paranteal application of Fe elements. The final regulation of glycaemia is achieved by intensive regime of insuline therapy. After improving the general health condition, the standard analyses were carried out with a view to evaluating diabetes complications. On the ground of clinical survey and other relevant researches, we made the conclusion that diabetes mellitus, type 1, in concerned in this case. All complications detected on target organs of a registered hypertireosis which, together with lungs infiltration, resulted in decompensation of basic disease and hence lead the patient to ketoacidosis. Moreover, the very hypertireosis lead to hyperglyacemia, glyacemia oscillation and repeated ketoacidosis after which, the adequate therapy was applied.