A case of painless thyroiditis complicated with diabetes mellitus.
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The pathogenesis of painless thyroiditis remains unknown, but recent reports have suggested that immunological abnormalities might play some roles in this condition. No case of painless thyroiditis complicated with diabetes mellitus has been reported, although the incidence of autoimmune thyroiditis has been reported to be high among diabetic patients. We describe a patient who developed diabetes mellitus following painless thyroiditis. A 51-year-old woman was admitted to our hospital because of hyperglycemia and signs of hyperthyroidism. Two months before admission she complained of thirst, polydipsia, polyuria and palpitation. She had lost 5 kg in body weight within 20 days. A diffusely enlarged thyroid was palpable without tenderness. Serum levels of T<SUB>4</SUB>, T<SUB>3</SUB>and free T<SUB>4</SUB>were elevated but thyroid <SUP>131</SUP>I uptake was low in thyroid tissue. The titers of microsome hemagglutination (MCHA) and thyroglobulin hemagglutination (TGHA) were elevated. indenolol had been administered for 6 weeks resulting in a decrease in the scrum levels of thyroid hormones. On admission, the fasting plasma glucose level was 181 mg/d<I>l</I>and HbA<SUB>1</SUB>c was 13.5%. Islet cell surface antibody was negative and the circulating immune complex level was high. The fasting plasma glucose value declined to 100 mg/d<I>l</I>and HbA<SUB>1</SUB>c fell to 8% after treatment with glibenclamide. Fasting plasma glucose value and the level of HbA<SUB>1</SUB>c remained normal after discontinuation of glibenclamide. Thyroid function was also kept within the normal range after discontinuation of indenolol, but the level of TSH transiently increased in parallel with the increased titer of MCHA. A 75-g oral glucose tolerance test revealed an impaired glucose tolerance with low responses of immuno-reactive insulin (IRI). However, responses of IRI to oral glucose loading became normal after thyroid functions had normalized. A transient increase in plasma thyroid hormone might have caused or resulted in clinically manifest diabetes mellitus in this case. However, the contribution of immunological abnormalities observed in painless thyroiditis could not be ruled out in the onset of diabetes mellitus.
- 一般社団法人 日本糖尿病学会の論文
一般社団法人 日本糖尿病学会 | 論文
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