Postoperative Thyroid Storm Associated with Strangulated Small Bowel Obstruction: A Case Report

Yasuhiro Ohtsuka and Tsuyoshi Matsumoto

Department of Emergency Medicine, Funabashi Central Hospital of Japan Community Health Care Organization, Japan
Department of Surgery, Funabashi Central Hospital of Japan Community Health Care Organization, Japan
Department of Internal Medicine, Funabashi Central Hospital of Japan Community Health Care Organization, Japan

^*Correspondance to: Yasuhiro Ohtsuka 

 PDF  Full Text DOI: 10.25107/2474-1647.2412

Abstract

A 42-year-old woman was transferred to us because of abdominal pain and vomiting. She was suffering from Graves’ disease; however, her thyroid function had been well-controlled with medication. Enhanced computed tomography revealed dilated and fluid-filled small bowel loops with reduced bowel wall enhancement and a beak sign. Under the diagnosis of strangulated small bowel obstruction, emergency surgery was performed under general anesthesia. Upon laparotomy, 45 cm of the ileum was strangulated by a fibrous band and had developed ischemic necrosis. Therefore, necrotic bowel resection was performed followed by reconstruction with end-to-end anastomosis. Two hours after the surgery, she presented with fever, tachycardia, and restlessness. Laboratory results revealed the presence of jaundice and thyrotoxicosis (free triiodothyronine was 6.16 pg/mL; free thyroxine, 3.83 ng/dL; and thyroid-stimulating hormone, 0.02 μIU/mL). We diagnosed her condition as postoperative thyroid storm, and treatment with thiamazole and potassium iodide was immediately initiated. Owing to this treatment, the following clinical course was uneventful, and she was discharged on the 13th hospital day. For postoperative patients presenting with unexplained high fever and serious tachycardia, occurrence of thyroid storm should be considered, and if the presence of thyrotoxicosis is identified, aggressive treatment for thyroid storm should be immediately initiated without hesitation.

Keywords

Thyroid storm; Thyrotoxicosis; Strangulated small bowel obstruction; Emergency surgery

Cite the article

Ohtsuka Y, Matsumoto T. Postoperative Thyroid Storm Associated with Strangulated SmallBowel Obstruction: A Case Report. Clin Surg. 2019; 4: 2412.