A 47-Year-Old Woman with Polyglandular Autoimmune Syndrome III Type A: A Case Report

Abstract

Background: Polyglandular Autoimmune Syndrome (PAS) are extreme conditions characterized by the functional insufficiency of several endocrine organs due to immunologically mediated destructive processes. This report is showed a rare case of grave diseases. The one of grave disease diagnose is characterized by enlargement thyroid gland. Polyglandular Autoimmune Syndrome III Type A usually occur in adulthood (particularly middle-aged women). This condition can be related to autoimmune thyroid disease and diabetes mellitus type 1.

Case Presentation: A 47-year-old female patient presented to the emergency room at Dr. Soetomo General Academic Hospital, with a chief complaint of generalized weakness. Through comprehensive evaluation, including anamnesis, physical examination, and supporting assessments such as hematology, chest X-ray, EKG, and urinalysis, the patient was diagnosed with diabetic ketoacidosis (DKA), partially compensated metabolic acidosis, impending thyroid storm (Burch-Wartofsky score of 25), and hypovolemic hypotonic hyponatremia. The diagnosis of hyperthyroidism or thyrotoxicosis was confirmed by laboratory results, which included positive thyroid-stimulating hormone receptor (TSH-R) antibodies.

Management and Outcomes: Conservative management was adopted, prioritizing hemorrhage control over immediate platelet reduction. Serial monitoring demonstrated a gradual decline in platelet counts from 945,000/μL to 535,000/μL over one week without pharmacological intervention. Blood smear analysis confirmed reactive thrombocytosis, effectively ruling out myeloproliferative disorders. The patient remained stable throughout the observation period without developing thrombotic complications.

Conclusions. DKA is an emergency complication resulting from uncontrolled diabetes mellitus and can develop rapidly, often within 24 hours, without the patient being aware. Hyperthyroidism can act as an initial trigger for DKA, which may subsequently progress to a thyroid storm. Although thyroid storm and DKA are acute complications that rarely occur simultaneously, their concurrent presentation can be life-threatening and potentially fatal.