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Ronald K. Mayfield, MD; Julius Sagel, MB, ChB; John A. Colwell, MD, PhD

Arch Intern Med. 1980;140(3):408-410.

Abstract
• Thyrotoxicosis with a normal serum triiodothyronine (T₃) concentration has been described with a variety of acute and chronic illnesses occurring in association with thyrotoxicosis. We describe the first case to our knowledge of thyroxine (T₄) toxicosis in a 16-year-old boy with diabetic ketoacidosis. Although the clinical manifestations of hyperthyroidism were mild, thyromegaly and persistent tachycardia suggested thyrotoxicosis. Serum T₄ levels were elevated; however, the serum T₃ level was normal. Measurement of reverse T₃ (rT₃) initially revealed an elevated level that decreased over several days as _T levels increased into the toxic range. Peripheral conversion of T₄ to T₃ was apparently inhibited by diabetic ketoacidosis and there was a concomitant increase in r_T levels, suggesting that conversion of T₄ to rT₃ was increased during acute ketoacidosis. Assessment of thyroid function based on serum T₃ levels in diabetics may be misleading during ketoacidosis or uncontrolled diabetes.

(Arch Intern Med 140:408-410, 1980)

Author Affiliations
From the Veterans Administration Medical Center and the Department of Medicine, Endocrinology-Metabolism-Nutrition Division, Medical University of South Carolina, Charleston.

Footnotes
Accepted for publication July 17, 1979.

Reprint requests to Veterans Administration Medical Center, Charleston, SC 29403 (Dr Mayfield).

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