A 29-year-old male of Albanian descent presented after being hospitalized owing to
diabetic ketoacidosis. The diagnosis of
type 1 diabetes mellitus was placed, and intensified
insulin therapy was initiated. Medical history was not of significance except a 5 kg
weight loss within 2 months. The patient presented with recurrent episodes of
hypoglycemia, and the doses of preprandial and basal
insulin were reduced. The differential diagnosis included
type 1 diabetes mellitus "honeymoon" period or another type of
diabetes mellitus. His serological tests only revealed positive
autoantibodies against
glutamic acid decarboxylase 65 and
C-peptide. The diagnosis leaned toward
latent autoimmune diabetes in adults, and the therapeutic approach involved cessation of preprandial
insulin therapy, regulation, and subsequent discontinuation of basal
insulin and introduction of
metformin. Two years later, basal
insulin was reintroduced along with a
glucagon-like peptide-receptor agonist and
metformin. Further physical examination during the initial visit disclosed upper limb
tremor, lid lag, excessive sweating, increased sensitivity to heat, and
tachycardia. Laboratory tests were indicative of hashitoxicosis (suppressed level of
thyroid-stimulating hormone, high levels of total and free
thyroid hormones, positive
anti-thyroglobulin and anti-
thyroid peroxidase, and negative anti-
thyroid-stimulating hormone receptor).
Thyroid-stimulating hormone level was spontaneously restored, but an increase was observed during follow-up.
Levothyroxine was administrated for 2 years until the patient had normal thyroid function.
CONCLUSIONS: