A case of autoimmune type 1 diabetes mellitus complicated by myasthenia gravis and graves' disease

A 35-year-old woman with type 1 diabetes was admitted to our hospital after reporting general fatigue, palpitations and diplopia in February 20xy. At 15 years of age, she was started on treatment with insulin therapy for type 1 diabetes. Five years later, she received a diagnosis of myasthenia gravis (MG'. On admission, a blood test showed apparent Graves' disease, and the patient's glycemic control was poor. Therefore, we began treatment with an insulin pump in addition to thymectomy for MG followed by the administration of tacrolimus and prednisolone as immunosuppressive therapy. Thereafter, tight glycemic control was maintained with adjustments to the basal injection rate. The patient was therefore given a diagnosis of type 3 polyglandular autoimmune syndrome complicated by type 1 diabetes mellitus, MG and Graves' disease in which the difficult to control diabetes was successfully managed with an insulin pump.