A Case Of Hashitoxicosis With Autoimmune Diabetes Mellitus Andliterature Review

Objective:Through the analysis ofa case of Hashitoxicosis with malignant exophthalmos,and patient with autoimmune diabetes who were significantly benefited from glucocorticoid combined with immunosuppressive therapy,further explore the pathogenesis,clinical manifestations,auxiliary examination and treatment status.Methods:A patient with malignant exophthalmos admitted to our department of endocrinology who was diagnosed with thyroid function and morphological examination was identified as Hashitoxicosis.The treatment with low-dose of glucocorticoid intravenous therapy combined with immunosuppressive agentswere used to observe the recovery of malignant exophthalmos ? thyroid function and blood glucose,the status of clinical treatment of the disease is reviewed in the literature.Results:This patient had typical clinical manifestations of hyperthyroidism with malignant exophthalmia.Laboratory examinations of FT3 and FT4 increased,TSH decreased,TPOAb and TGAb antibodies were significantly increased,and thyroid color Doppler ultrasonography was not typical of hyperthyroidism.The diagnosis was Hashitoxicosis and thyroid-associated ophthalmopathy.At the same time,"Three more and one less" typical symptoms,increased blood glucose and positive islet autoantibodies were diagnosed as autoimmune diabetes.After giveing anti-thyroid drugs and insulin hypoglycemic treatment,low-dose intravenous glucocorticoid shock therapy,oral glucocorticoid combined with immunosuppressive agents was used.The malignant exophthalmia relieved quickly,had fewer adverse reactionsand blood glucose controlled steadily.Conclusion:Combined with review of the literature,Hashitoxicosis patients with or without malignant exophthalmos in the early choice of clinical treatment of low-dose glucocorticoid combined with immunosuppressive therapy can significantly improve the patient's immune disorders,relieve eye symptoms,promote the recovery of thyroid function,and improve the patient's immune disorders,it has a greater impact on the metabolic control of diabetes,thereby improving the quality of life of patients.