Thyrotoxicosis and Choledocholithiasis Masquerading as Thyroid Storm

Area of Science:

• Endocrinology
• Gastroenterology
• Hepatology

Background:

• Thyroid storm, a rare and severe manifestation of hyperthyroidism, presents with significant morbidity and mortality.
• Clinical presentation and thyroid function tests are key to diagnosing thyroid storm, though test results may not correlate with disease severity.

Observation:

• A 26-year-old female presented with epigastric pain, jaundice, and weight loss postpartum.
• Initial labs revealed suppressed TSH, elevated free T4, bilirubin, alkaline phosphatase, and transaminases.
• Abdominal ultrasound showed gallstones, but magnetic resonance cholangiopancreatography identified a distal common bile duct stone.

Findings:

• The patient's symptoms were attributed to choledocholithiasis, not thyroid storm, as central nervous system alterations were absent.
• Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy successfully relieved the biliary obstruction.
• Symptomatic improvement was prompt following the ERCP procedure.

Implications:

• This case highlights the importance of considering choledocholithiasis in patients with thyrotoxicosis presenting with jaundice and abdominal pain.
• Accurate diagnosis and timely intervention, such as ERCP, are crucial for managing biliary obstruction in hyperthyroid patients.
• Recognizing the diverse clinical manifestations of hyperthyroidism is essential for prompt and effective patient care.