propylthiouracil and Abdominal-Pain

Thyroid storm is a rare but life-threatening condition caused by exaggerated thyrotoxic manifestations. Untreated thyroid storm is fatal, and the case fatality rate is 21% to 30%. The most important clinical management in thyroid storm is early recognition and treatment. We present the case of a previously healthy young woman in whom suspected gastrointestinal tract sepsis complicated by multi-organ dysfunction syndrome masked the major symptomatology of thyroid storm. This patient highlights the importance of a high clinical suspicion for potentially life-threatening conditions, such as thyroid storm, even in the absence of clinical clues (exophthalmos, lid lag, and goiter) or a history of thyrotoxicosis.

Topics: Abdominal Pain; Adult; Anti-Arrhythmia Agents; Antithyroid Agents; Drug Therapy, Combination; Female; Humans; Hydrocortisone; Multiple Organ Failure; Propranolol; Propylthiouracil; Thyroid Crisis

Topics: Abdominal Pain; Adolescent; Antithyroid Agents; Diagnosis, Differential; Drug Overdose; Female; Gastrointestinal Hemorrhage; Glomerular Mesangium; Graves Disease; Humans; IgA Vasculitis; Propylthiouracil; Vasculitis, Leukocytoclastic, Cutaneous; Vomiting

A 32-year-old woman presented with persistent vomiting, epigastric pain and weight loss. A sinus tachycardia was the clue to the diagnosis of hyperthyroidism due to Graves' disease. On treatment with propylthiouracil and a beta-blocking agent, her symptoms resolved within one day, even though her free thyroxine level was still high. Hyperthyroidism is an uncommon, but previously reported cause of persistent vomiting.

Topics: Abdominal Pain; Adrenergic beta-Antagonists; Adult; Chronic Disease; Diagnosis, Differential; Female; Humans; Hyperthyroidism; Metoprolol; Propylthiouracil; Thyrotoxicosis; Vomiting; Weight Loss

A 35-year-old, previously healthy woman, known to be thyrotoxic, was transferred from a community hospital for "acute abdomen." Abdominal pain, distention, and hyperemesis resolved with placement of nasogastric tube (NGT) and return of 2,600 mL of bilious fluid. Continued high NGT output made oral or NGT administration of antithyroid drugs impossible. We gave propylthiouracil (PTU) by retention enemas with therapeutic serum levels and sublingual saturated solution of potassium iodide (SSKI) with 70% absorption based on 24-hour free iodine urinary excretion. The patient's thyroxine (T4) and triiodothyronine (T3) radioimmunoassays were normal on hospital days 10 and 12, respectively. However, free T4 and T3 resin uptake did not normalize until hospital day 31. On hospital day 32, she tolerated removal of NGT without nausea and 4 days later was taking a regular diet. We conclude that our patient's gastrointestinal symptoms were a prominent feature of her thyrotoxicosis and that rectal PTU and sublingual SSKI are effective in administration of antithyroid drugs.

Topics: Abdomen, Acute; Abdominal Pain; Administration, Rectal; Administration, Sublingual; Adult; Antithyroid Agents; Bile; Diet; Duodenal Obstruction; Enema; Female; Follow-Up Studies; Hospitalization; Humans; Intubation, Gastrointestinal; Potassium Iodide; Propylthiouracil; Thyroid Crisis; Thyroxine; Triiodothyronine; Vomiting