A RARE CASE OF CONCURRENT DIABETIC KETOACIDOSIS AND THYROID STORM IN PREGNANCY

Abstract

INTRODUCTION
Diabetes and thyroid disease are two closely associated disorders. Nevertheless, concurrent presence of diabetic ketoacidosis (DKA) and thyroid storm (TS) is rare, but life-threatening. In pregnancy, it may increase the risk of maternal and fetal complications.

CASE
Herein we present a 23-year-old pregnant woman in her 29 weeks of pregnancy who came to the emergency department with abdominal pain, nausea, and fever. Physical examination revealed tachycardia (>150 bpm), tachypnoea, and dehydration. Her initial laboratory work-up revealed high blood glucose, ketonemia, acidosis with high anion gap, and bacteriuria. Despite aggressive management for DKA, no apparent improvement was observed. Further examinations revealed hyperthyroxinemia and supressed TSH, which fulfilled the Burch Wartofsky score of 50 and TS 2 criteria according to Japan Thyroid Association diagnostic criteria for TS. She was then treated as thyroid storm and her clinical condition improved afterward.

CONCLUSION
The presence of persistent tachycardia despite DKA management lead us to the diagnosis of thyroid storm in this rare case of concurrent DKA and thyroid storm in pregnancy.