2022 Volume 65 Issue 8 Pages 451-457
A 65-year-old woman presented with poorly controlled type 2 diabetes mellitus and inappropriate secretion of TSH. Pituitary MRI showed a microadenoma; thus, TSH-producing pituitary adenoma was suspected. After admission, she was treated with metformin, an SGLT2 inhibitor, and insulin. A T3 suppression test was performed for the differential diagnosis of SITSH. Just after the T3 suppression test, the patient showed sudden and severe vomiting, fever, tachycardia, hyperglycemia, hyperketonemia, hyperlactacidemia, and metabolic acidosis. She was diagnosed with thyroid storm and diabetic ketoacidosis, and was treated with infusion and insulin. Thereafter, she rapidly recovered. In this case, it was considered that the T3 suppression test under metformin and/or SGLT2 inhibitor treatment caused the thyroid storm and diabetic ketoacidosis. The adjustment of antidiabetic drugs and appropriate use of insulin during sickness (including thyrotoxicosis) are important for the prevention of thyroid storm and diabetic ketoacidosis.
