Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
College of Medicine, Qatar University, Doha, Qatar.
Medicine (Baltimore). 2022 Jun 10;101(23):e28253. doi: 10.1097/MD.0000000000028253.
There are variable complications of hyperthyroidism, including atrial fibrillation, heart failure, osteoporosis, and thyroid storm. One infrequent complication of hyperthyroidism is non-diabetic ketoacidosis (NDKA). To the best of our knowledge, our case is the third report of NDKA related to thyrotoxicosis.
We describe a case of a 41-year-old African lady with no past medical history presented to our hospital with severe abdominal pain and vomiting for three weeks. This was associated with decreased appetite and weight loss.
Laboratory findings were significant for high anion gap metabolic acidosis, positive ketones in the urine, and high serum B-hydroxybutyrate. The blood glucose readings and HbA1c were within normal limits. Also, serum lactic acid and salicylate levels were within the normal range. The diagnosis of NDKA was made. Later, the thyroid functions test (TFT) confirmed the diagnosis of primary hyperthyroidism.
The patient was managed initially with intravenous fluid and antiemetics. Then, she was started on propranolol and carbimazole. After which, her symptoms improved dramatically, and the metabolic acidosis (with serum ketones) were corrected within a few days of starting anti-thyroid medications.
Despite its rarity, NDKA can be associated with severe thyrotoxicosis. Vigorous intravenous hydration and anti-thyroid medication are the mainstay treatment. TFT should be requested in a patient with unexplained NDKA.
甲状腺功能亢进症有多种并发症，包括心房颤动、心力衰竭、骨质疏松症和甲状腺危象。甲状腺功能亢进症的一种罕见并发症是非糖尿病性酮症酸中毒（NDKA）。据我们所知，我们的病例是第三例与甲状腺毒症相关的 NDKA。
我们描述了一例 41 岁的非洲女性，无既往病史，因严重腹痛和呕吐三周来我院就诊。伴有食欲减退和体重减轻。
实验室检查结果显示高阴离子间隙代谢性酸中毒、尿中酮体阳性和高血清 B-羟丁酸。血糖读数和 HbA1c 在正常范围内。此外，血清乳酸和水杨酸盐水平在正常范围内。诊断为 NDKA。后来，甲状腺功能测试（TFT）证实了原发性甲状腺功能亢进症的诊断。
患者最初接受静脉补液和止吐药治疗。然后，她开始服用普萘洛尔和甲巯咪唑。之后，她的症状明显改善，在开始抗甲状腺药物治疗的几天内，代谢性酸中毒（血清酮体）得到纠正。
尽管罕见，但 NDKA 可与严重甲状腺毒症有关。强烈的静脉补液和抗甲状腺药物是主要的治疗方法。在出现不明原因 NDKA 的患者中，应要求进行 TFT。
