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1.
In. Galvão, Luiz Augusto C; Finkelman, Jacobo; Henao, Samuel. Determinantes ambientais e sociais da saúde. Rio de Janeiro, Opas; Editora Fiocruz, 2011. p.279-300, tab.
Monografia em Português | LILACS | ID: lil-756794
2.
Rev. venez. endocrinol. metab ; 2(2): 10-13, jun. 2004. ilus, tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: lil-631307

RESUMO

Objetivo: Presentación de un caso clínico de coexistencia de tirotoxicosis y cetoacidosis diabética en infancia Métodos: Además de la historia clínica, se realizaron estudios para evaluar su condición endocrino-metabólica: niveles séricos de hormonas tiroideas, hematología, electrolitos y gases arteriales, captación de 131I y gammagrafía tiroidea. Resultados: Escolar femenina de 10 años de edad, ingresó en malas condiciones generales, taquipneica, deshidratada con historia de pérdida de 10 Kg. en el último mes. Antecedente de hipertiroidismo desde los 5 años de edad, razón por la cual recibe metimazol en forma irregular desde hace dos años. En el examen clínico se constató deshidratación y síntomas/ signos sugestivos de tirotoxicosis. El análisis de laboratorio reportó niveles séricos de T3L y T4L anormalmente elevados, hiperglucemia en ayunas (712 mg/dL); cetonuria (++++) e hipokalemia. Con los hallazgos clínicos y bioquímicos se hizo el diagnóstico de enfermedad de Graves, tormenta tiroidea, diabetes mellitus-1 complicada con cetoacidosis diabética. Se corrigió el desequilibrio hidroelectrolítico y se inició insulinoterapia horaria, además de corticoesteroides y antagonistas b-adrenérgicos. Corregida la cetoacidosis y normalizada la función tiroidea, se administraron 11mCi de yodo radioactivo. La paciente evolucionó satisfactoriamente y fue dada de alta para control ambulatorio. Conclusiones: En el presente caso se reporta la rara coexistencia de dos entidades clínicas de etiología autoinmune en la infancia y se hace revisión de la literatura.


Objective: To present a clinical report of the coexistence of tirotoxicosis and diabetic ketoacidosis in childhood. Methods: Besides the clinical history, different studies were performed in order to evaluate her endocrine and metabolic conditions: thyroid hormone serum levels, hemathology, serum electrolites and arterial blood gases. Thyroid gammagraphy and radioiodine uptake of the thyroid gland were performed. Results: A 10-year-old school-girl, admitted in poor general conditions, with a weight loss of 10 kg in the last month. With a previous history of hyperthyroidism since she was 5 years old, receiving irregular treatment with methimazole in the last two years. Dehidration, and thyrotoxicosis were evident on clinical examination. Laboratory measurements reported serum free-T3 and free-T4 levels abnormally high; fasting hyperglucemia (712 mg/dL); excessive urine ketone bodies, and hypokalemia. Based on clinical and biochemical features the admission diagnosis were Graves disease, thyroid storm, and type 1-diabetes mellitus, complicated with diabetic ketoacidosis. Dehydration and electrolyte disorder were corrected, and insulin hourly regimen was initiated, plus corticosteroids and b-adrenergic antagonists. Once the ketoacidosis and the thyroid function were normalized, 11mCi of radioiodine was administered. Hyperthyroidism was controlled, and the patient was discharged in good control, to be followed in the outpatient clinic. Conclusions: We report a patient with the coexistence of two clinical entities of rare presentation in childhood, both of them with a autoimmune substratum; we review the existence of similar cases in the literature.

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