Graves' disease and Hashimoto's thyroiditis are autoimmune thyroid disorders with distinct pathological and histopathological features. The conversion from Hashimoto's thyroiditis to Graves' disease has been rarely reported throughout the world with no reports in the African race to our knowledge. We here report an African lady who was initially diagnosed with primary hypothyroidism following Hashimoto's disease but later became thyrotoxic due to Graves' disease.

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Background: Most patients diagnosed with diabetes mellitus < 35 years will have type 1 diabetes (T1D). The increase in youthonset type 2 diabetes (T2D) parallels the obesity epidemic and in African subjects ketosis-prone type 2 diabetes (KPD) may occur in this age group. Objectives, setting and subjects: To evaluate the clinical, biochemical and immunologic characteristics of patients diagnosed with diabetes < 35 years presenting to a tertiary diabetes clinic in Durban, South Africa over 13 years. Design: A retrospective chart review of patients < 35 years diagnosed with diabetes was conducted. Data included clinical and laboratory variables, complications and follow-up status. Results: The study included 517 patients of whom 445 (86.1%) were diagnosed with T1D, 27 (5.2%) with T2D, 27 with KPD (5.2%) and 18 (3.5%) with other forms of diabetes. Mean age of the total group was 28 ± 10 years. Subjects with T1D were younger at diagnosis with a lower BMI than both T2D and KPD. HbA1c was higher in subjects with T1D. Overall mortality was low (3.5%) and follow-up was poor in all groups. Conclusion: The majority of young people with diabetes in KwaZulu-Natal, South Africa, have T1D, with small numbers of other types. Glucose control is poor with a high loss to follow-up.

Metformin is a commonly used treatment modality in type 2 diabetes mellitus with lactic acidosis as a rare but life-threatening side effect. In this case report we highlight the importance of recognizing this uncommon side effect and the treatment options in a resource limited situation. We present a 14-year-old African girl who ingested an unknown amount of metformin intentionally after an argument with her mother. She was referred late to our institution in severe lactic acidosis. Lactic acidosis resolved with appropriate treatment including peritoneal dialysis. We conclude that in resource constrained settings, peritoneal dialysis may be used for metformin associated lactic acidosis with favourable outcome.