Chetoacidosi secondaria a tireotossicosi in ragazza con diabete tipo 1 e celiachia

The paper describes the case of a teenager affected by type 1 diabetes mellitus and coeliac disease who presented secondary ketoacidosis (DKA) triggered by thyrotoxicosis. She was successfully treated with beta-blocker and methimazole, in addition to intravenous insulin therapy. The association of thyrotoxicosis and DKA is uncommon but anecdotal cases are reported in literature. Through different mechanisms hyperthyroidism may cause decreased levels of insulin and increased glycogenolysis, ketogenesis, dehydration, and insulin resistance. The possibility of DKA triggered by thyrotoxicosis should be kept in mind in female patient or in the presence of symptoms of hyperthyroidism.