Occurrence and Characteristics of Overt Diabetes Mellitus in Patients with Graves' Disease

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  • Inada Mitsuo
    2nd Division, Department of Internal Medicine, Kyoto University School of Medicine
  • Nishikawa Mitsushige
    2nd Division, Department of Internal Medicine, Kyoto University School of Medicine
  • Imura Hiroo
    2nd Division, Department of Internal Medicine, Kyoto University School of Medicine
  • Kurata Shunichiro
    Endocrine Section, Department of Internal Medicine, Tenri Hospital
  • Oishi Mariko
    Department of Iuternal Medicine, Kyoto National Hospital

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Other Title
  • 糖尿病とバセドウ病の合併について
  • トウニョウビョウ ト バセドウビョウ ノ ガッペイ ニ ツイテ

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It is well known that the abnormalities of the glucose tolerance test are often found in patien with Graves' disease. Moreover, the coexistence of Graves' disease, which is regarded as a autoimmune disease, with diabetes mellitus has been noted by several workers. Even so, tl characteristics of overt diabetes mellitus in Graves' disease have not yet been reported in detail.<BR>The occurrence of overt diabetes mellitus was therefore studied in 270 patients with Graves' disease, and the characteristics of the patients were investigated. Seven patients (2.6%) with overt diabetes were found among the 270 patients with Graves' disease. They were all women and most were over 45 yr old. They were characterized by having mainly insulin-dependent diabetes and by showing extremely high titers of anti-microsomal antibody. The family history of 4 patients revealed that one or more close relatives had diabetes mellitus. Moreover, histological findings for specimens obtained by thyroid needle biopsy in 3 of the 7 cases revealed the coexistence of histological features of Hashimoto thyroiditis with the proliferative changes of epithelial cells characterizing Graves' disease, indicating hashitoxicosis histologically. Furthermore, none of the patients suffering from Graves' disease with associated overt diabetes, displayed complications of diabetic retinopathy or evidence of albuminuria.<BR>It has previously been reported that prolonged administration of thyroid hormones can cause the overt diabetes mellitus in animals which is known as metathyroid diabetes. In the present study, one patient with a diabetic tendency in her family showed an apparently diabetic pattern in her glucose tolerance curve and a markedly low response of IRI about 10 months after the onset of clinical signs and symptoms of Graves' disease indicating human metathyroid diabetes. On the other hand, the low incidence of overt diabetes in patients with Graves' disease suggests that the diabetogenic action of thyroid hormones may not necessarily be the important factor in causing the diabetes mellitus. Thus, the role of other factors including abnormalities of the immune mechanism must be considered in relation to the coexistence of Graves' disease and diabetes mellitus.

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