Myocardial injury complicating diabetic ketoacidosis in type 1 diabetes mellitus with concurrent thyroid storm: Case report and literature review.

RATIONALE

Diabetic ketoacidosis (DKA) and thyrotoxic storm are life-threatening endocrine emergencies that sometimes occur together, but myocardial injury in this setting is rare. This case is unique in showing myocardial injury during simultaneous DKA and thyroid storm (TS), highlighting clinical complexity and raising questions about underlying pathophysiological mechanisms. We highlight the rarity of this presentation and explore how DKA and TS may cause myocardial injury through metabolic derangements, electrolyte disturbances, and inflammatory-mediated damage.

PATIENT CONCERNS

The patient is a 23-year-old male who was admitted primarily due to an 8-year history of intermittent dry mouth, polydipsia, and polyuria, followed by the acute onset of palpitations, fever, and vomiting with blood glucose 25 mmol/L, urine glucose +++, urine ketones +++, arterial blood gas analysis shows pH: 7.190, HCO3-: 7.6 mmol/L, free triiodothyronine: 6.95 pg/mL, free thyroxine: 4.83 ng/dL, thyroid-stimulating hormone < 0.008 uIU/mL. He has a documented medical history of type 1 diabetes mellitus and hyperthyroidism.

DIAGNOSES

Admission diagnosis: type 1 DKA; TS; electrolyte imbalance; upper respiratory tract infection. Discharge diagnosis: type 1 DKA; TS; electrolyte imbalance; myocardial damage; upper respiratory tract infection.

INTERVENTIONS

Regarding the treatment strategy, a multidisciplinary collaborative approach was implemented in this case, incorporating the management of endocrine disorders and cardioprotective measures.

OUTCOMES

Following meticulous management, the patient achieved full recovery from DKA and TS, blood sugar levels dropped and urine ketone bodies disappeared. The thyroid function indicators free triiodothyronine and free thyroxine have shown a decrease compared to previous levels. The blood indicators of myocardial injury have decreased, electrocardiogram has returned to normal. The patient was subsequently discharged from the hospital in stable condition.

LESSONS

This case not only illustrates the efficacy of a comprehensive treatment strategy but also reinforces the importance of close patient monitoring, prompt interpretation of clinical data, and early intervention in the context of multiple concurrent endocrine crises. By documenting this rare presentation, the report contributes valuable clinical insights and serves as a reference for the diagnostic and therapeutic management of similar cases, emphasizing the critical role of multidisciplinary collaboration in optimizing outcomes in critical care settings.

Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.