CONCOMITANT REVELATION OF GRAVES DISEASE DURING DIABETIC KETOACIDOSIS: REPORT OF TWO CLINICAL CASES

Introduction: Type 1 diabetes mellitus (T1DM) and autoimmune thyroid diseases, particularly Graves disease, are frequently associated within the framework of autoimmune polyglandular syndrome type 3 variant (APS3v). Approximately 15- 30% of patients withT1DM devel op autoimmune thyroid disease; however, the concomitant occurrence of diabetic ketoacidosis (DKA) and Graves disease remains exceptional.This complex association may delay the diagnosis of hyperthyroidism, as its clinical manifestations can be masked by the symptoms of diabetic ketoacidosis. Case Reports: Two female patients aged 26 and 28 years, followed for type 1 diabetes mellitus, were admitted to the intensive care unit for confusion, vomiting, diarrhea, and polyuria. The diagnosis revealed diabetic ketoacidosis associated with Graves disease, consistent with APS3v.In both patients, DKA was characterized by the severity of ketosis, difficulty in management, and the absence of an identifiable precipitating factor. Treatment included fluid resuscitation, insulin therapy, and correction of electrolyte disturbances. A thyroid work-up, prompted by the persistence of atypical clinical signs (tachycardia up to 180 bpm and polyuria of 4 L/day), led to the diagnosis of hyperthyroidism. Both patients were treated with carbimazole and beta-blockers, resulting in clinical improvement.