Remission of insulin autoimmune syndrome in a patient with Graves' diseaseby treatment with methimazole

The patient, a 24-year-old man, had suffered from hunger, sweating, tachyca rdia and palpitation for three years. He was diagnosed as having Graves' di sease (GD) and treated with methimazole (MMI) for 3 months. He noted that p alpitation and perspiration seemed to particularly occur when he was hungry , and thus he was examined to determine whether these symptoms were caused by hypoglycemia, As a markedly elevated immunoreactive insulin level and th e presence of insulin antibody in serum were found, he was diagnosed as hav ing insulin autoimmune syndrome(IAS). HLA typing revealed the patient to be positive for group Bw62/Cw4/DR4, which is reportedly a specific HLA type i n MMI-treated euthyoroid GD patients with IAS, In spite of the continuation of MMI treatment, the % binding of IRI decreased and the hypoglycemic epis ode disappeared. In contrast to the previously reported MMI induced IAS in GD cases, MMI is unlikely to have exacrebated IAS in the present case, alth ough his HLA combination is identical to that of the previous cases.