So how would you manage this patient at this time? And how would you counsel her for a future pregnancy, given that it would be potentially risky to have her back on PTU? Yeah,

so I think it depends, but if she's still hyperthyroid and she wants to be pregnant soon, I probably would not reintroduce PT if she had a big rash because the likelihood that that would probably occur again.

And I would not probably want to use methimazole because your risk of congenital malformation is definitely higher with methimazole.

So the two options on the table would be either a surgery or radioactive iodine therapy.

So, you know, if you're trying to, and I think she should be presented with both, um, radioactive iodine therapy, um, you know, again, depending on when she wants to get pregnant, that will make a difference.

So, um, number one, radioactive iodine therapy may take a while for it to work right for her to become euthyroid, but you don't want to become pregnant at least within the first six months post pregnancy.

There may be also a theoretical risk of maybe increased neonatal graves if you have a slightly increased titer of the thyroid receptor antibody.

In

Do you think this is starvation called ketosis or diabetic ketoacidosis? And what features can help us differentiate?

So I think it can be difficult to really differentiate.

And I think the thing that's important to know in this person is she's got type 1 diabetes.

Her insulin doses were decreased.

So you definitely need to think about treating and managing this.

managing as DKA but if you were sort of to kind of compare the two in general starvation ketosis may be a bit milder if it's a person who's not living with diabetes often it's resolved by just giving them carbohydrate and they wouldn't go onto the full-blown DKA.

And this person, it may have been the thing that kind of triggered her problem in the first place.

Dr. Malcolm, can you please summarize for our listeners the key take-home points of this case?

Do you think this is starvation called ketosis or diabetic ketoacidosis? And what features can help us differentiate?

So I think it can be difficult to really differentiate.

And I think the thing that's important to know in this person is she's got type 1 diabetes.

Her insulin doses were decreased.

So you definitely need to think about treating and managing this.

managing as DKA but if you were sort of to kind of compare the two in general starvation ketosis may be a bit milder if it's a person who's not living with diabetes often it's resolved by just giving them carbohydrate and they wouldn't go onto the full-blown DKA.

And this person, it may have been the thing that kind of triggered her problem in the first place.

Dr. Malcolm, can you please summarize for our listeners the key take-home points of this case?