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Duodenal obstruction in thyroid storm

C L Cansler1, J A Latham, P M Brown

  • 1Department of Medicine, East Carolina University School of Medicine, Greenville, NC, USA.

Southern Medical Journal
|December 31, 1997
PubMed
Summary
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This case study shows that rectal propylthiouracil (PTU) and sublingual saturated solution of potassium iodide (SSKI) effectively treated thyrotoxicosis with severe gastrointestinal symptoms when oral administration was not possible. These methods achieved therapeutic drug levels and resolved the patient's acute abdomen.

Area of Science:

  • Endocrinology
  • Gastroenterology
  • Internal Medicine

Background:

  • Thyrotoxicosis can present with severe gastrointestinal symptoms mimicking an acute abdomen.
  • Standard oral or nasogastric tube (NGT) administration of antithyroid drugs may be impossible in such cases due to persistent vomiting and high NGT output.

Observation:

  • A 35-year-old thyrotoxic patient presented with acute abdomen, abdominal pain, distention, and hyperemesis.
  • Nasogastric tube placement resolved acute symptoms but resulted in high fluid output, precluding oral or NGT medication.
  • The patient required alternative routes for antithyroid drug administration.

Findings:

  • Rectal administration of propylthiouracil (PTU) achieved therapeutic serum levels.
  • Sublingual saturated solution of potassium iodide (SSKI) showed 70% absorption, confirmed by urinary iodine excretion.

Related Experiment Videos

  • Thyroid hormone levels normalized, and the patient was able to tolerate NGT removal and resume a regular diet.

    • Implications:

    • Rectal PTU and sublingual SSKI represent effective alternative routes for antithyroid drug administration in patients with severe gastrointestinal manifestations of thyrotoxicosis.
    • This approach can help manage thyrotoxicosis when standard routes are compromised.
    • Highlights the importance of considering alternative drug delivery methods in complex endocrine cases.