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ARTICLE |

Thyroid Storm With Normal Serum Triiodothyronine Level During Diabetic Ketoacidosis FREE

Naseer Ahmad, MD; Margo P. Cohen, MD
[+] Author Affiliations

Reprint requests to Department of Medicine, Wayne State University School of Medicine, 540 E Canfield, Detroit, MI 48201 (Dr Cohen).


JAMA. 1981;245(24):2516-2517. doi:10.1001/jama.1981.03310490034021
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IT IS now established that nonthyroidal illness can alter thyroid hormone metabolism in such a way that the serum level of triiodothyronine (T3) is decreased and the level of reverse triiodothyronine (rT3) is elevated in otherwise euthyroid persons.1 The list of such nonthyroidal illnesses in which these findings occur has been growing. In patients with hyperthyroidism and intercurrent, nonthyroidal illness, the serum T3 level may be normal or even less than normal and there is a concomitant increase in the rT3 level.2-4 Although one recent report describes a patient with diabetic ketoacidosis, hyperthyroidism, and a normal T3 level,4 and another describes a patient in whom thyroid storm developed postoperatively and who at that time had a normal T3 level,5 the occurrence of thyroid storm in a patient with a normal T3 level and severe intercurrent illness has not been

REFERENCES

Chopra IJ, Chopra U, Smith SR, et al:  Reciprocal changes in serum concentration of rT, and T, in systemic illness . J Clin Endocrinol Metab 1975;;41:1043-1049.
Engler D, Donaldson EB, Stockigt JR, et al:  Hyperthyroidism without triiodothyronine excess: An effect of severe nonthyroidal illness . J Clin Endocrinol Metab 1978;;46:77-82.
Engler D, Donaldson EB, Stockigt JR:  Effect of surgical stress on serum thyroid hormones in hyperthyroidism . Aust NZ J Med 1978;;8:131-135.
Mayfield RK, Sagel J, Colwell JA:  Thyrotoxicosis without elevated serum triiothyronine levels during diabetic ketoacidosis . Arch Intern Med 1980;;140:408-410.
Topliss DJ, Stockigt JR:  Normal serum T, after abdominal operation in severe hyperthyroidism . N Engl J Med 1979;;300:92-93.
Brooks MH, Waldstein SS, Bronsky D, et al:  Serum triiodothyronine concentration in thyroid storm . J Clin Endocrinol Metab 1975;;40:339-341.
Saberi M, Sterling FH, Utiger RD:  Reduction in extrathyroidal triiodothyronine production by propylthiouracil in man . J Clin Invest 1975;;55:218-223.
Sterling K, Brenner MA, Newman ES, et al:  The significance of triiodothyronine (T,) in maintenance of euthyroid status after treatment of hyperthyroidism . J Clin Endocrinol Metab 1971;;33:729-731.
Cooppan R, Kozak GP:  Hyperthyroidism and diabetes mellitus: An analysis of 70 patients . Arch Intern Med 1980;;140:370-373.

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Chopra IJ, Chopra U, Smith SR, et al:  Reciprocal changes in serum concentration of rT, and T, in systemic illness . J Clin Endocrinol Metab 1975;;41:1043-1049.
Engler D, Donaldson EB, Stockigt JR, et al:  Hyperthyroidism without triiodothyronine excess: An effect of severe nonthyroidal illness . J Clin Endocrinol Metab 1978;;46:77-82.
Engler D, Donaldson EB, Stockigt JR:  Effect of surgical stress on serum thyroid hormones in hyperthyroidism . Aust NZ J Med 1978;;8:131-135.
Mayfield RK, Sagel J, Colwell JA:  Thyrotoxicosis without elevated serum triiothyronine levels during diabetic ketoacidosis . Arch Intern Med 1980;;140:408-410.
Topliss DJ, Stockigt JR:  Normal serum T, after abdominal operation in severe hyperthyroidism . N Engl J Med 1979;;300:92-93.
Brooks MH, Waldstein SS, Bronsky D, et al:  Serum triiodothyronine concentration in thyroid storm . J Clin Endocrinol Metab 1975;;40:339-341.
Saberi M, Sterling FH, Utiger RD:  Reduction in extrathyroidal triiodothyronine production by propylthiouracil in man . J Clin Invest 1975;;55:218-223.
Sterling K, Brenner MA, Newman ES, et al:  The significance of triiodothyronine (T,) in maintenance of euthyroid status after treatment of hyperthyroidism . J Clin Endocrinol Metab 1971;;33:729-731.
Cooppan R, Kozak GP:  Hyperthyroidism and diabetes mellitus: An analysis of 70 patients . Arch Intern Med 1980;;140:370-373.
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