Acute Acalculous Cholecystitis as a Rare Manifestation of Thyroid Storm: A Case Report

Acute acalculous cholecystitis (AAC) is an uncommon, but potentially life-threatening inflammation of the gallbladder without gallstones. While typically seen in critically ill patients, its association with thyroid storm is exceedingly rare.

We report a 28-year-old male with a history of Hashimoto's thyroiditis and Graves' disease, nonadherent to methimazole, who presented with dizziness, palpitations, epigastric pain, and nausea. Examination revealed tachycardia, hypertension, and atrial fibrillation with rapid ventricular response. Laboratory evaluation showed severe thyrotoxicosis (Free T4 5.63 ng/dL, Total T3 527 ng/dL, TSH <0.01 μIU/mL) and mildly elevated liver function tests. Abdominal imaging demonstrated gallbladder wall thickening without cholelithiasis, consistent with AAC. The patient was managed conservatively with antithyroid therapy, beta-blocker, IV fluids, and antibiotics. He experienced significant symptomatic improvement, and follow-up confirmed resolution of abdominal symptoms.

This case report highlights AAC as a rare, but clinically relevant complication of thyroid storm. Early recognition, appropriate imaging and management of underlying hyperthyroidism can allow successful non-operative treatment in patients. Clinicians should maintain a high index of suspicion for AAC in patients presenting with abdominal pain and severe thyrotoxicosis.

Further research is needed to clarify the pathophysiological link between thyrotoxicosis and AAC as well as development of nonoperative management guidelines.