Pitfalls in Diagnosing the Simultaneous Presentation of Type 1 Diabetes and Thyrotoxicosis in a Pediatric Patient

Abstract

C.C., a 13-year-old Muslim girl, presented to the accident and emergency department with a history of polyuria, polydipsia, and weight loss over several weeks. She was noted to have an increased appetite. There was no family history of autoimmune disorders. On examination, her pulse rate was 146 bpm, and her weight was between the 9th and 25th percentiles, with a height at the 75th percentile. She was dressed with a traditional headscarf, and neck examination was not performed. No documentation of any thyroid symptoms (e.g., tremor or eye signs) was made. However, she was noted to be slightly agitated and had a rapid speech pattern. Initial biochemical tests showed urine 2+ ketones and 2+ glucose, with a random blood glucose of 462.6 mg/dl. Her pH was 7.39, with a bicarbonate of 406.8 mg/dl. She was managed as having newly diagnosed diabetes without acidosis. Her screening blood samples were collected as per protocol. She was started on subcutaneous insulin, and, after initial diabetes education, she was discharged home …